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Sample records for adverse perinatal outcomes

  1. Doppler prediction of adverse perinatal outcome in intrauterine growth restriction

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    Nina Mahale

    2015-02-01

    Full Text Available Background: Objective of current study was to determine and compare the diagnostic performance of Doppler ultrasonography of the fetal Middle Cerebral Artery (MCA and Umbilical Artery (UA for prediction of adverse perinatal outcome in suspected intrauterine growth restriction (IUGR. Methods: Fifty singleton pregnancies in third trimester of pregnancy with suspected intrauterine growth restriction were examined with Doppler ultrasonography of fetal MCA and UA. Results: Twenty patients of the fifty included patients had at least one major or minor adverse outcome. Major adverse outcome included perinatal deaths which included both intrauterine deaths and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage, necrotizing enterocolitis and septicemia. Minor outcomes included cesarean section for fetal distress, Apgar score below 7 at 5 minutes and admission to Neonatal Intensive Care Unit (NICU for treatment. MCA PI is the most sensitive(90% index in predicting any adverse perinatal outcome i.e. including both major and minor outcomes, Positive Predictive Value (PPV and specificity being greatest for MCA/UA PI (96.6%, 93.7%. For the major adverse outcome most sensitive (86.6% most specific (91.4% and with highest PPV (81.2% and NPV (94.1%, is MCA/UA PI. Ratio of MCA/UAPI is more sensitive (90% than PI of both the arteries alone for overall prediction of adverse perinatal outcome. Conclusions: Thus we conclude that the Doppler studies of the multiple vessels in the fetoplacental unit can help in the monitoring of the compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of deliveries in pregnancies complicated by IUGR. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 119-130

  2. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome?

    DEFF Research Database (Denmark)

    Pinborg, A; Wennerholm, U B; Romundstad, L B; Loft, A; Aittomaki, K; Söderström-Anttila, V; Nygren, K G; Hazekamp, J; Bergh, C

    2013-01-01

    Assisted reproduction technology (ART) is used worldwide, at increasing rates, and data show that some adverse outcomes occur more frequently than following spontaneous conception (SC). Possible explanatory factors for the well-known adverse perinatal outcome in ART singletons were evaluated....

  3. Population Attributable Risk Fractions of Maternal Overweight and Obesity for Adverse Perinatal Outcomes.

    Science.gov (United States)

    MacInnis, Natasha; Woolcott, Christy G; McDonald, Sarah; Kuhle, Stefan

    2016-01-01

    The objective of the current study was to determine the proportion of adverse perinatal outcomes that could be potentially prevented if maternal obesity were to be reduced or eliminated (population attributable risk fractions, PARF); and the number needed to treat (NNT) of overweight or obese women to prevent one case of adverse perinatal outcome. Data from the Atlee Perinatal Database on 66,689 singleton infants born in Nova Scotia, Canada, between 2004 and 2014, and their mothers were used. Multivariable-adjusted PARFs and NNTs of maternal pre-pregnancy weight status were determined for various perinatal outcomes under three scenarios: If all overweight and obese women were to i) become normal weight before pregnancy; ii) shift down one weight class; or iii) lose 10% of their body weight, significant relative reductions would be seen for gestational diabetes mellitus (GDM, 57/33/15%), hypertensive disorders of pregnancy (HDP, 26/16/6%), caesarean section (CS, 18/10/3%), and large for gestational age births (LGA, 24/14/3%). The NNT were lowest for the outcomes GDM, induction of labour, CS, and LGA, where they ranged from 13 to 73. The study suggests that a substantial proportion of adverse perinatal outcomes may be preventable through reductions in maternal pre-pregnancy weight. PMID:26961675

  4. Adverse Perinatal Outcome in Subsequent Pregnancy after Stillbirth by Placental Vascular Disorders.

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    Francesca Monari

    Full Text Available To evaluate outcome in the pregnancy following a stillbirth (SB by a placental vascular disorders.A prospective, observational, multicenter study was conducted in woman with a history of stillbirth (> 22 weeks between 2005 and June 2013, in 3 Italian University Hospitals. Causes of SB were previously identified after extensive investigations. Pregnant women were enrolled within the first trimester. The main outcome was "adverse neonatal outcome", including perinatal death, fetal growth restriction, early preterm birth <33+6 weeks, hypoxic-ischemic encephalopathy, intracranial hemorrhage or respiratory distress.Out of 364 index pregnancies, 320 women (87.9% had a subsequent pregnancy during the study period. Forty-seven had an early pregnancy loss. Out of 273 babies, 67 (24.5% had an adverse perinatal outcome, including 1 SB and 1 early neonatal death (3.7/1000. Women who had a SB related to placental vascular disorders (39.6%, were at higher risk of an adverse neonatal outcome compared with women whose SB was unexplained or resulted from other causes (Adj. OR = 2.1, 95%CI: 1.2-3.8. Moreover, also obesity independently predicts an adverse perinatal outcome (Adj OR = 2.1, 95%CI: 1.1-4.3.When previous SB is related to placental vascular disorders there is a high risk for adverse neonatal outcomes in the subsequent pregnancy. Maternal obesity is an additional risk factor.

  5. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes

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    Lawlor, Debbie A; Mortensen, Laust; Andersen, Anne-Marie Nybo

    2011-01-01

    The mechanisms underlying the association between maternal age (both young and older maternal age) and adverse perinatal outcomes are unclear. Methods We examined the association of maternal age at first birth with preterm birth (<37 weeks gestation) and small for gestational age (SGA) in a cohor...

  6. Interpregnancy interval raise odds of adverse perinatal outcome in high fertility region Mewat, Haryana

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    Anam ul Haq

    2014-06-01

    Methods: Retrospective cross sectional study in which 400 meo women (para 2 to para 5 fulfilling inclusion and exclusion criteria having diverse interpregnancy intervals were selected. Statistical analysis was done using SPSS. We used multivariate logistic regression analysis to assess the risk of adverse perinatal outcome. Results: As compared with infants conceived within a time period of 16 to 48 months after a live birth, infants conceived within 16 months after a live birth had odds ratios of 2.1 (95% CI 1.3 to 3.5 for low birth weight, 2.2 (95% CI 1.3 to 3.8 for preterm birth, and 2.3 (95% CI 1.4 to 3.8 for small size for gestational age; infants conceived more than 48 months after a live birth had odds ratios of 1.88 (95% CI 1.1 to 3.1, 1.96 (95% CI 1.1 to 3.4, and 2.08 (95% CI 1.2 to 3.6 for these three adverse outcomes, respectively; P value <0.05. Conclusions: We came to conclusion that interpregnancy interval of 16 - 48 months is the optimal interval carrying least risk of adverse perinatal outcomes and both short as well as long interpregnancy intervals are significantly associated with birth of preterm, low birth weight and small for gestational age babies. Counselling regarding optimal interpregnancy interval and methods of contraception can go a long way in reducing adverse perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 598-603

  7. Defining the residual risk of adverse perinatal outcome in growth restricted fetuses with normal umbilical artery blood flow.

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    O'Dwyer, Vicky

    2014-07-25

    To determine the cause of adverse perinatal outcome in fetal growth restriction(FGR) where umbilical artery Doppler(UA) was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health(PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal.

  8. Integration of umbilical venous and arterial Doppler flow parameters for prediction of adverse perinatal outcome

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    Hebbar Shripad

    2015-01-01

    Full Text Available Background: Quantification of umbilical vein (UV blood flow rate and umbilical artery Doppler indices might be valuable in assessing fetuses at increased risk of perinatal complications as they receive their supply of oxygen and nutrients through this vessel. Previous studies have indicated that UV blood volume flow rate to umbilical artery pulsatility index (UAPI ratio (venous arterial index [VAI] evaluates both venous and arterial arm of fetal umbilical circulation and hence, can be adopted as a screening tool in management of high risk pregnancy. Objectives: To compare umbilical VAI with adverse perinatal outcome and also to evaluate its efficacy with other flow indices in determining perinatal outcome. Materials and Methods: Various Doppler indices such as normalized blood flow rate in UV (nUV, ml/kg estimated fetal weight/min, VAI (nUV/UAPI, umbilical artery resistance index (RI, UAPI, and systolic diastolic ratio were determined in 103 pregnant women within 2 weeks of the delivery. A risk score was devised using APGAR at 5 min, birth weight, preterm delivery, fetal distress, Neonatal Intensive Care Unit (NICU care, and perinatal death and this score was correlated with antenatal Doppler findings. Results: Subjects with low VAI were found to have a greater association with intrauterine growth restricted fetuses (28.5% and low liquor (35.7%, preterm deliveries (46.4%, lower mean birth weight (2.25 kg, higher NICU admission rates (32.1%. The unfavorable score was noticed in 25.2% of the neonates. They had lower VAI (156 vs. 241, UV diameter (6.2 mm vs. 7.8 mm, UV velocity (16.2 vs. 17.8, nUV (163.7 vs. 206.4, and higher PI (1.3 vs. 0.9. A cut-off of VAI of 105 ml/kg/min had sensitivity of 86.7% and a specificity of 93.5% for predicting poor perinatal outcome. Conclusion: VAI with a cut-off of 105 ml/kg/min can be used as an additional tool along with the other conventional Doppler indices in order to predict adverse fetal outcome.

  9. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births

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    Núbia Karla O. Almeida

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVES: To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS: Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS: For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years, and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births, of low Apgar score at 5 min (for term births, of macrosomia (for non-primiparous women, and of asphyxia. CONCLUSION: As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.

  10. Population-based study of smoking behaviour throughout pregnancy and adverse perinatal outcomes.

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    Murphy, Deirdre J

    2013-09-01

    There has been limited research addressing whether behavioural change in relation to smoking is maintained throughout pregnancy and the effect on perinatal outcomes. A cohort study addressed lifestyle behaviours of 907 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010-2011. Adverse perinatal outcomes were compared for "non-smokers", "ex-smokers" and "current smokers". Of the 907 women, 270 (30%) reported smoking in the six months prior to pregnancy, and of those 160 (59%) had stopped smoking and 110 (41%) continued to smoke at the time of the first antenatal visit. There was virtually no change in smoking behaviour between the first antenatal visit and the third trimester of pregnancy. Factors associated with continuing to smoke included unplanned pregnancy (OR 1.9; 95% CI 1.3, 2.9), alcohol use (OR 3.4; 95% CI 2.1, 6.0) and previous illicit drug use (OR 3.6; 95% CI 2.1, 6.0). Ex-smokers had similar perinatal outcomes to non-smokers. Current smoking was associated with an average reduction in birth weight of 191 g (95% CI -294, -88) and an increased incidence of intrauterine growth restriction (24% versus 13%, adjusted OR 1.39 (95% CI 1.06, 1.84). Public Health campaigns emphasise the health benefits of quitting smoking in pregnancy. The greatest success appears to be pre-pregnancy and during the first trimester where women are largely self-motivated to quit.

  11. Role of Doppler Indices in the Prediction of Adverse Perinatal Outcome in Preeclampsia

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    Monika Singh

    2013-08-01

    Full Text Available Objectives : To determine the role of doppler indices in the prediction of perinatal outcome in pre eclampsia. Materials and methods: A prospective study was conducted at Patna Medical College and Hospital between March 2008-March 2009 on 50 pregnant patients with preeclampsia at and #8805;32 weeks gestation .All these patients were subjected to a detailed history ,clinical examination and laboratory investigations. Study of fetal vesels was performed serially using a pulsed Doppler ultrasound ..Resistance index (RI, pulsatility index(PI and systolic / diastolic ratio (S/D were measured in middle cerebral artery (MCA and umbilical artery (UA. FL/AC(femur length/abdominal circumference ratio was also measured. Results:30 patients had IUGR(intrauterine growth restriction. The patients with abnormal indices had higher incidence of caesarean delivery(44%, low apgar score(32%, need for admission to NICU(26%and neonatal complications(24%as compared to those with normal indices. Conclusion :Doppler indices were more accurate than FL/AC ratio in the early detection of IUGR. MCA/UA ratios were more accurate than the individual components of MCA and UA.Abnormal Doppler ratios were significant predictors of IUGR and adverse perinatal outcome [Natl J Med Res 2013; 3(4.000: 315-318

  12. Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

    NARCIS (Netherlands)

    Ravelli, A. C. J.; Jager, K. J.; de Groot, M. H.; Erwich, J. J. H. M.; Rijninks-van Driel, G. C.; Tromp, M.; Eskes, M.; Abu-Hanna, A.; Mol, B. W. J.

    2011-01-01

    Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care. Design Population-based cohort study from 2000 up to and including 2006. Setting The Netherlands Perinatal Reg

  13. Study of correlation between placental morphology and adverse perinatal outcome in different conditions affecting pregnancy

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    Manik Sirpurkar

    2015-08-01

    Conclusions: These conditions also affect the perinatal outcome. Placental parameters are also altered along with foetal parameters like foetal weight. So the diagnosis of such risk factors in pregnancies during antenatal period will improve the outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1165-1168

  14. Circulating angiogenic factors and risk of adverse maternal and perinatal outcomes in twin pregnancies with suspected preeclampsia.

    Science.gov (United States)

    Rana, Sarosh; Hacker, Michele R; Modest, Anna Merport; Salahuddin, Saira; Lim, Kee-Hak; Verlohren, Stefan; Perschel, Frank H; Karumanchi, S Ananth

    2012-08-01

    To evaluate whether angiogenic factor levels correlate with preeclampsia-related adverse maternal and perinatal outcomes in women with twin pregnancy, we studied 79 women with suspected preeclampsia in the 3rd trimester. Antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and proangiogenic placental growth factor (PlGF) were measured at presentation on an automated platform. An adverse outcome was defined as hemolysis, elevated liver enzymes, and low platelets syndrome; disseminated intravascular coagulation; abruption; pulmonary edema; cerebral hemorrhage; maternal, fetal, and neonatal death; eclampsia; acute renal failure; small for gestational age; and indicated delivery. All outcomes were ascertained 2 weeks after initial evaluation. Comparing the 52 women (65.8%) who experienced an adverse outcome with the 27 women (34.2%) without an adverse outcome, the median sFlt-1 was elevated (11461.5 pg/mL [8794.0-14847.5] versus 7495.0 pg/mL [3498.0-10482.0; P=0.0004]), PlGF was reduced (162.5 pg/mL [98.0-226.5] versus 224.0 pg/mL [156.0-449.0]; P=0.005), and sFlt-1/PlGF ratio was elevated (74.2 [43.5-110.5] versus 36.2 [7.1-71.3]; P=0.0005). Among those presenting preeclampsia, the sFlt-1/PlGF ratio at the time of initial evaluation is associated with subsequent adverse maternal and perinatal outcomes. These findings are similar to those in singleton pregnancies and may implicate common pathogenic pathways. PMID:22753210

  15. Adverse obstetric and perinatal outcomes following treatment of adolescent and young adult cancer: a population-based cohort study.

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    Fatima A Haggar

    Full Text Available OBJECTIVE: To investigate obstetric and perinatal outcomes among female survivors of adolescent and young adult (AYA cancers and their offspring. METHODS: Using multivariate analysis of statewide linked data, outcomes of all first completed pregnancies (n = 1894 in female survivors of AYA cancer diagnosed in Western Australia during the period 1982-2007 were compared with those among females with no cancer history. Comparison pregnancies were matched by maternal age-group, parity and year of delivery. RESULTS: Compared with the non-cancer group, female survivors of AYA cancer had an increased risk of threatened abortion (adjusted relative risk 2.09, 95% confidence interval 1.51-2.74, gestational diabetes (2.65, 2.08-3.57, pre-eclampsia (1.32, 1.04-1.87, post-partum hemorrhage (2.83, 1.92-4.67, cesarean delivery (2.62, 2.22-3.04, and maternal postpartum hospitalization>5 days (3.01, 1.72-5.58, but no excess risk of threatened preterm delivery, antepartum hemorrhage, premature rupture of membranes, failure of labor to progress or retained placenta. Their offspring had an increased risk of premature birth (<37 weeks: 1.68, 1.21-2.08, low birth weight (<2500 g: 1.51, 1.23-2.12, fetal growth restriction (3.27, 2.45-4.56, and neonatal distress indicated by low Apgar score (<7 at 1 minute (2.83, 2.28-3.56, need for resuscitation (1.66, 1.27-2.19 or special care nursery admission (1.44, 1.13-1.78. Congenital abnormalities and perinatal deaths (intrauterine or ≤7 days of birth were not increased among offspring of survivors. CONCLUSION: Female survivors of AYA cancer have moderate excess risks of adverse obstetric and perinatal outcomes arising from subsequent pregnancies that may require additional surveillance or intervention.

  16. Methadone and perinatal outcomes: a prospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-08-01

      Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose.

  17. Countrywide analysis of perinatal outcome.

    Science.gov (United States)

    Stembera, Z; Kravka, A; Mandys, F

    1988-01-01

    The computer laboratory of the Research Institute for the Care of Mother and Child in Prague performs annually a countrywide analysis of perinatal outcome in order to obtain a background for the preparation of the optimal strategy for improving perinatal care in CSR in the future. The total as well as weight specific perinatal mortality rate further sub-divided into early neonatal death rate and late fetal death rate and differentiated according to the birthweight, was correlated with the incidence of different factors influencing the perinatal mortality rate both countrywide and for each of the eight provinces of CSR. This way a correlation was found between some of the mentioned perinatal outcomes and e.g. instrumental equipment of obstetrical departments and neonatal intensive care units, frequency of caesarean sections, or transport of LBW newborns in incubators or "in utero" etc. The results of this analysis have proved that there still remain in some provinces opportunity for further decrease in perinatal mortality due to the incomplete observance of the two intervention strategies "Risk approach" and "New technology" which were introduced in the whole country during the last 10 years. PMID:3221298

  18. Antenatal umbilical cord parameters and perinatal outcome

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    Athira Narayanan

    2016-04-01

    Conclusions: No association between antenatal umbilical cord characteristics and perinatal outcome was found in pregnancies at high risk for poor perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1211-1215

  19. Use of antihypertensive medications in pregnancy and the risk of adverse perinatal outcomes: McMaster Outcome Study of Hypertension In Pregnancy 2 (MOS HIP 2

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    Vermeulen Marian J

    2001-11-01

    Full Text Available Abstract Background Uncertainty remains about the potential harmful effects of antihypertensive therapy on the developing fetus, especially for beta-blockers (βb. Methods We prospectively enrolled all singleton women with a blood pressure ≥ 140/90 mm Hg during pregnancy. The main analysis included 1948 women with all forms of hypertension and compared the use of βb drugs, non-βb drugs or a combination of both, to no treatment. The primary study outcome was a composite of the diseases of prematurity, need for assisted ventilation for greater than 1 day, or perinatal death. A sub-group analysis evaluated the four treatment options among 583 singleton women with chronic hypertension before 20 weeks gestation. Results In the main analysis, no association was observed between βb use and the primary composite outcome [adjusted odds ratio (OR 1.4, 95% CI 0.9–2.2], while an association was seen with non-βb therapy (OR 5.0, 95% CI 2.6–9.6 and combination therapy (OR 2.9, 95% CI 1.8–4.7. In the sub-group of 583 women with hypertension before 20 weeks, use of a non-βb drug (OR 4.9, 95% CI 1.7–14.2 or combination therapy (OR 2.9. 95% CI 1.1–7.7 was significantly associated with the primary composite outcome, while βb monotherapy was not (OR 1.4, 95% CI 0.6–3.4. Conclusions Maternal use of antihypertensive medications other than βbs was associated with both major perinatal morbidity and mortality, while βb monotherapy was not. The combined use of βb and non-βb medications demonstrated the strongest association. Before definitive conclusions can be drawn, a large multicentre randomized controlled trial is needed to address the issues of both maternal efficacy and fetal safety with the use of one or more antihypertensive agents in pregnancy.

  20. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    OpenAIRE

    Medhi R; Das B; Das A; Ahmed M; Bawri S; Rai S

    2016-01-01

    Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae com...

  1. FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

    OpenAIRE

    Lakshmi; Menon Nalini; Aravind

    2015-01-01

    OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for ...

  2. Perinatal depression

    OpenAIRE

    Alhusen, Jeanne L.; Alvarez, Carmen

    2016-01-01

    Abstract: Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes.

  3. FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

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    Lakshmi

    2015-03-01

    Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

  4. The prognostic value of multivoxel magnetic resonance spectroscopy determined metabolite levels in white and grey matter brain tissue for adverse outcome in term newborns following perinatal asphyxia

    Energy Technology Data Exchange (ETDEWEB)

    Doormaal, Pieter Jan van [University Medical Center Groningen and University of Groningen, Department of Pediatrics, Division of Neonatology, Groningen (Netherlands); Meander Medical Center Amersfoort, Department of Radiology, PO Box 1502, Amersfoort (Netherlands); Meiners, Linda C.; Sijens, Paul E. [University Medical Center Groningen and University of Groningen, Department of Radiology, Groningen (Netherlands); Horst, Hendrik J. ter; Veere, Christa N. van der [University Medical Center Groningen and University of Groningen, Department of Pediatrics, Division of Neonatology, Groningen (Netherlands)

    2012-04-15

    Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome. A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days. Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P = 0.003 and P = 0.017, respectively). In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy. (orig.)

  5. PERINATAL OUTCOME IN SEVERE ANAEMIA COMPLICATING PREGNANCY

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    Nirmala Devi

    2015-06-01

    Full Text Available BACKGROUND: Anaemia is the commonest global public health problem and especially harmful when the pregnancy is complicated by anaemia. Women in reproductive age group are more vulnerable for iron deficiency anaemia with an estimated prevalence of around 70 to 80% in pregnant women. MATERIAL AND METHODS: The aim of the study was to analyse the foetal outcome in the hospitalised pregnant women with severe anaemia. This is a prospective study carried out at maternity ward of Government G eneral H ospital, Kurnool of Andhra Pradesh, India over a period of one year from October 2007 to September 2008. RESULTS: Total of 9731 deliveries occurred during the study period, 282 (2.89 % were severely anaemic at the time of delivery. Majority of the women w ere of 20 - 24 years age (68.4% with second gravidas 37.5%, term gestation 52.1%, preterm deliveries 47.9%, lower socio - economic status 87.6% and Unbooked cases 67.4% and low birth weight in 53.2% cases, intra uterine growth retardation and intra uterine foetal death contributes to 12.8% and 16.7% cases respectively. A total of 36 (12.8% neonates required admission in neonatal intensive care unit and 16(5.7% of them died. CONCLUSION: Severe anaemia during pregnancy has adverse perinatal outcome in the fo rm of low birth weight, preterm birth, intrauterine growth retardation and intrauterine death. Regular iron supplementation during the antenatal period, management of anaemia and improving the nutritional status of the mother will improve the adverse neona tal outcome and decreases perinatal morbidity and mortality.

  6. Maternal haemoglobin and perinatal outcome

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    Bharathi Anjanappa

    2015-10-01

    Full Text Available Background: Maternal anaemia is common medical disorder in developing countries. WHO defines anaemia as haemoglobin concentration of and #8804;11 g/dl. However, in developing countries like India, the lower limit is accepted as 10 g/dl. Results: Of 218 women, 69 had anaemia. The prevalence of anaemia was 31.65%; of which 84% had mild anaemia, 14.6% had moderate and only 1.4% had severe anaemia. Mean Hb levels were 12.04% among non-anaemic mothers and mean birth weight was 2.89 Kg whereas 9.14%, 2.18 kg in anaemic mothers respectively. In our study, 21% in anaemic group has birth weight <2.5 kg and only 0.06% in non-anaemic mothers (p<0.0012 3.6 times higher. The risk of IUGR was 3.77 times higher, low APGAR score at 1 min was 3.8 times higher (p<0.0001, meconium stained liquor was 2.3 times higher and NICU admissions 2.96 times higher in anaemic mothers than non-anaemic mothers. Conclusions: Anaemia in pregnancy is one of the causes of poor perinatal outcome. Maternal anaemia is associated with the high risk of low birth weight, IUGR babies, low APGAR scores and NICU admissions and overall increase in perinatal morbidity. Hence proper antenatal care and counseling can reduce occurrence of anaemia in pregnancy. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1335-1338

  7. Hemoglobina materna en el Perú: diferencias regionales y su asociación con resultados adversos perinatales Maternal hemoglobin in Perú: regional differences and its asociation with adverse perinatal outcomes

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    Gustavo F. Gonzales

    2011-09-01

    Full Text Available Objetivos. Establecer la frecuencia de anemia y eritrocitosis en gestantes de diferentes regiones del Perú y la asociación con los resultados adversos perinatales utilizando los datos del Sistema de Información Perinatal (SIP del Ministerio de Salud (MINSA. Materiales y métodos. Se obtuvieron datos de 379 816 partos de 43 centros asistenciales del Ministerio de Salud entre los años 2000 y 2010. Se determinó la frecuencia de anemia y eritrocitosis en cada región geográfica así como de los resultados adversos perinatales. Resultados. La frecuencia de anemia leve fue mayor en la costa (25,8 % y en la selva baja (26,2 %. La frecuencia de anemia moderada/severa es más alta en la selva baja (2,6 % seguido de la costa (1,0 %. En la sierra, las frecuencia más alta de anemia moderada/severa se observa en la sierra sur (0,6 %. La mayor frecuencia de eritrocitosis (Hb>14,5 g/dL fue encontrada en la sierra centro (23,7 %, seguido de 11,9 % en la sierra sur y 9,5 % en la sierra norte. La anemia severa y la eritrocitosis estuvieron relacionadas con los resultados adversos perinatales. Conclusiones. Hay diferencias por región geográfica en la frecuencia de anemia. En la sierra central se encontró mayor frecuencia de eritrocitosis con respecto a la sierra sur. Tanto la anemia severa como la eritrocitosis aumentan los resultados adversos perinatales.Objectives. To evaluate hemoglobin (Hb levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS database of Peruvian Ministry of Health. Materials and methods. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA was used

  8. Antenatal umbilical cord parameters and perinatal outcome

    OpenAIRE

    Athira Narayanan; Priya Ballal; Nikil Shetty; Pralhad Kushtagi

    2016-01-01

    Background: The objective of the study was to study the association between antenatally determined umbilical cord thickness and coiling index at/after 34 weeks of gestation and the measures of perinatal outcome. Methods: Umbilical cord thickness and coiling index were determined sonographically at or after 34 weeks of gestation in 100 singleton pregnancies. The influence of the antenatal cord findings was analyzed for their associations with measures of perinatal outcome in high and low ri...

  9. Management of Gestational Diabetes Mellitus: Selfefficacy and Perinatal Outcomes

    OpenAIRE

    Emine Gerçek; Hakan Şen

    2015-01-01

    The purpose of this review is to give knowledge about effects on perinatal outcomes of self-efficacy in management of gestational diabetes. Gestational diabetes mellitus (GDM) is a significant health concern due to the potentially adverse outcomes for the mother and the fetus/infant. Close monitoring and treatment of GDM are important to the long-term health of a pregnant woman and her baby. More over, maternal metabolic control during pregnancy may positively impact women’s...

  10. Perinatal and neonatal outcome in meconium stained amniotic fluid

    Directory of Open Access Journals (Sweden)

    Shazia Qadir

    2016-05-01

    Conclusions: The significance of meconium in amniotic fluid is a widely debated subject. Traditionally meconium has been considered as a sign of fetal distress occurring due to hypoxia. However it is now recognized as a manifestation of a normally maturing gastrointestinal tract. In a global sense it is still considered a marker for adverse perinatal outcomes. The presence of thick meconium is associated with increase in the perinatal morbidity and mortality and hence its presence should not be overlooked. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1400-1405

  11. Maternal drinking water arsenic exposure and perinatal outcomes in Inner Mongolia, China

    Science.gov (United States)

    Exposure to high levels of arsenic has been reported to increase adverse birth outcomes including spontaneous abortion, preterm birth, and low birthweight. This study evaluated the relationship between maternal arsenic exposure and perinatal endpoints (term birthweight, preterm ...

  12. Obstetric and perinatal outcome of multiple pregnancy

    International Nuclear Information System (INIS)

    To determine the obstetric and perinatal outcome in multiple pregnancies at a teaching hospital. The analysis included data on all women between 20 and 35 years of age with 24 completed weeks gestation having multiple pregnancies during the study period after applying the exclusion criteria. The data retrieved from the hospital-based maternal health medical records included demographic details, complications of pregnancy, and maternal and neonatal outcomes. The data was expressed as frequencies, percentages, mean and standard deviation. Normal distribution of continuous variables was determined by Shapiro Wilk test. The differences in the mean birth weight of the first and second twin were compared by student's t-test considering a p-value less than 0.05 as statistically significant. There were a total of 161 multiple pregnancies with the overall incidence of 37.1 per 1,000 births (3.2%) during the study period. One hundred and twenty two cases had the inclusion criteria applicable. There were 9 triplets among these of whom seven were received as intrauterine death and the other two were lost to follow-up. The four leading maternal adverse outcomes were anemia (74.6%), preterm delivery (31%), pregnancy - induced hypertension (30%) and preterm premature rupture of membranes (26.2%). Median gestational age at delivery was 37 weeks. Most common route of delivery was caesarean section (53.3%). Most common neonatal complication was low birth weight. Prematurity was the most common cause of neonatal death. Multiple pregnancy have high maternal and neonatal complications, especially preterm delivery that increases risk of significant neonatal morbidity and mortality. (author)

  13. Perinatal Outcomes after Assisted Reproductive Technology

    Directory of Open Access Journals (Sweden)

    Setenay Arzu Yilmaz

    2014-08-01

    The aim of this review is to summarize perinatal outcomes and the congenital anomaly risk of IVF pregnancies and also examine the risks of different technologies including ICSI, blastocyst culture, and cryopreservation on this topic. [Archives Medical Review Journal 2014; 23(4.000: 575-586

  14. Epidemiological Risk Factors and Perinatal Outcomes of Congenital Anomalies.

    Science.gov (United States)

    Almeida, Lissa Fernandes Garcia; Araujo Júnior, Edward; Crott, Gerson Claudio; Okido, Marcos Masaru; Berezowski, Aderson Tadeu; Duarte, Geraldo; Marcolin, Alessandra Cristina

    2016-07-01

    Objectives To identify the epidemiological risk factors for congenital anomalies (CAs) and the impact of these fetal malformations on the perinatal outcomes. Methods This prospective cohort study comprised 275 women whose fetuses had CAs. Maternal variables to establish potential risk factors for each group of CA and perinatal outcomes were evaluated. The primary outcome was CA. Secondary outcomes included: fetal growth restriction (FGR); fetal distress (FD); premature rupture of membranes (PROM); oligohydramnios or polyhydramnios; preterm delivery (PTD); stillbirth; cesarean section; low birth weight; Apgar score  7, and need for assisted ventilation at birth. On the other hand, the prevalence of the other considered outcomes varied significantly among groups. Preterm delivery was significantly more frequent in gastrointestinal tract/abdominal wall defects. The stillbirth rate was increased in all CAs, mainly in isolated fetal hydrops (odds ratio [OR]: 27.13; 95% confidence interval [95%CI]: 2.90-253.47). Hospitalization time was higher for the urinary tract and congenital heart disease groups (p < 0.01). Neonatal death was significantly less frequent in the central nervous system anomalies group. Conclusion It was possible to identify several risk factors for CAs. Adverse perinatal outcomes were presented in all CA groups, and may differ according to the type of CA considered. PMID:27459392

  15. Perinatal Outcomes of Polyhydramnios without Associated Congenital Fetal Anomalies after a Gestational Age of 20 weeks.

    OpenAIRE

    Kuang-Chao Chen; Jui-Der Liou; Tai-Ho Hung; Dong-Ming Kuo; Jenn-Jeih Hsu; Ching-Chang Hsieh; T'sang-T'ang Hsieh

    2005-01-01

    Background: Polyhydramnios carries a high rate of complications during pregnancy andadverse perinatal outcomes. We could find no studies of this condition in alarge Asian population. The aim of this investigation was to evaluate therisks of adverse perinatal outcomes in a large study population with polyhydramnioswithout associated fetal anomalies after the gestational age of 20weeks in Taiwan.Methods: We retrospectively reviewed the computerized records of women who hadbabies without associa...

  16. Periodontal treatment for preventing adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush;

    2015-01-01

    OBJECTIVES: Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis. METHODS: An existing systematic review was updated...... assess risk of random errors. RESULTS: Thirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.......79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (<20%) of preterm birth or low birth weight, periodontal treatment was not efficacious for any of the outcomes...

  17. Reverse Engineering Adverse Outcome Pathways

    Energy Technology Data Exchange (ETDEWEB)

    Perkins, Edward; Chipman, J.K.; Edwards, Stephen; Habib, Tanwir; Falciani, Francesco; Taylor, Ronald C.; Van Aggelen, Graham; Vulpe, Chris; Antczak, Philipp; Loguinov, Alexandre

    2011-01-30

    The toxicological effects of many stressors are mediated through unknown, or poorly characterized, mechanisms of action. We describe the application of reverse engineering complex interaction networks from high dimensional omics data (gene, protein, metabolic, signaling) to characterize adverse outcome pathways (AOPs) for chemicals that disrupt the hypothalamus-pituitary-gonadal endocrine axis in fathead minnows. Gene expression changes in fathead minnow ovaries in response to 7 different chemicals, over different times, doses, and in vivo versus in vitro conditions were captured in a large data set of 868 arrays. We examined potential AOPs of the antiandrogen flutamide using two mutual information theory methods, ARACNE and CLR to infer gene regulatory networks and potential adverse outcome pathways. Representative networks from these studies were used to predict a network path from stressor to adverse outcome as a candidate AOP. The relationship of individual chemicals to an adverse outcome can be determined by following perturbations through the network in response to chemical treatment leading to the nodes associated with the adverse outcome. Identification of candidate pathways allows for formation of testable hypotheses about key biologic processes, biomarkers or alternative endpoints, which could be used to monitor an adverse outcome pathway. Finally, we identify the unique challenges facing the application of this approach in ecotoxicology, and attempt to provide a road map for the utilization of these tools. Key Words: mechanism of action, toxicology, microarray, network inference

  18. Perinatal outcome in anaemic pregnant women in South-Western Nigeria

    Directory of Open Access Journals (Sweden)

    Kehinde S. Okunade

    2014-04-01

    Conclusion: This study has thus highlighted the importance of considering maternal anaemia as an indicator of adverse perinatal outcomes. There is therefore, a need to counsel intending mothers and their partners about early antenatal booking, compliance with routine antenatal medications and prompt identification and treatment of anaemia in pregnancy, all as means of curtailing the overwhelming perinatal morbidity and mortality associated with the condition. [Int J Res Med Sci 2014; 2(2.000: 607-611

  19. Methadone and perinatal outcomes: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome.

  20. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    Directory of Open Access Journals (Sweden)

    Medhi R

    2016-04-01

    Full Text Available Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy and delivered at our institution were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. Mothers having pregnancy complicated with diabetes mellitus, renal disorder, thyroid disorders, and cardiac diseases were excluded from the study. Demographic data, maternal complications like severe anemia, pre-eclampsia, eclampsia, gestational age at delivery, mode of delivery, and postpartum complications were compared. Among fetal complications, low-birth weight, preterm birth, neonatal intensive care unit admission, still birth, and early neonatal death were compared. All the patients were interviewed regarding contraceptive knowledge and its use preceding the pregnancy. Results: Quality antenatal care was received by 80.6% of adolescent mothers. The adolescent mothers had a higher incidence of pre-eclampsia (odds ratio [OR] 2.017 95% confidence interval [CI]: 1.045–3.894, P=0.03, preterm deliveries (OR: 1.655, 95% CI: 1.039–2.636, P=0.03. Among fetal outcomes, the low- birth weight babies (OR: 1.59, 95% CI: 1.016–2.478, low mean birth weight (2,544.4±622.09 g versus 2,701.6±582.51 g, and higher admission to neonatal intensive care unit (OR: 1.957, 95% CI: 1.120–3.417 were significantly associated with adolescent mothers. There was no significant difference found regarding the mode of delivery, still birth, and early neonatal death. Moreover

  1. A prospective study of effect of amniotic fluid index less than 5 at term on perinatal outcome

    OpenAIRE

    Padmini C. P.; Chaitra R; Indra N; Sriram Adithya M

    2016-01-01

    Background: To study the effect of oligohydramnios in pregnancy and its value in predicting adverse perinatal outcome. Methods: A prospective case control study of pregnancy outcome in 100 cases with ultrasound diagnosis of oligohydramnios at term compared with 100 controls with no oligohydramnios. The study was done over a period of 3 years at SSMC Tumkur, India. Results: Oligohydramnios at term is associated with poor perinatal outcome. Significant increase in abnormal foetal heart ra...

  2. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes.

    OpenAIRE

    Wilson, L. M.; Reid, A. J.; Midmer, D. K.; Biringer, A; Carroll, J C; Stewart, D.E.

    1996-01-01

    OBJECTIVE: To determine the strength of the association between antenatal psychosocial risk factors and adverse postpartum outcomes in the family, such as assault of women by their partner, child abuse, postpartum depression, marital dysfunction and physical illness. DATA SOURCES: MEDLINE, Cinahl, Famli, Psych Abstracts and the Oxford Database of Perinatal Trials were searched from relevant articles published from Jan. 1, 1980, to Dec. 31, 1993, with the use of MeSH terms "depression, involut...

  3. Polyhydramnios as a Predictor of Adverse Pregnancy Outcomes

    OpenAIRE

    Ilham Moosa Hamdi; Kaukab Tashfeen

    2013-01-01

    Objectives: This study aimed to ascertain the frequency of polyhydramnios in singleton pregnancies, to determine the associated risk factors, and assess the adverse maternal and perinatal outcomes. Methods: A retrospective cohort study of all singleton pregnancies complicated with polyhydramnios after 28 weeks of gestation was carried out in Nizwa Hospital’s Obstetrics & Gynecology Department, Oman, from January 2002 to December 2007. Of 25,979 pregnant women reviewed, 477 were found to have ...

  4. Under-reporting of maternal and perinatal adverse events in New Zealand

    OpenAIRE

    Farquhar, Cynthia; Armstrong, Sarah; Kim, Boa; Masson, Vicki; Sadler, Lynn

    2015-01-01

    Objectives To determine the proportion of maternal and perinatal mortality and morbidity cases, identified by the Perinatal and Maternal Mortality Review Committee (PMMRC), that are also reported within the annual serious adverse events (SAEs) reports published by the Health Quality and Safety Commission (HQSC). Setting Nationally collated data from the PMMRC and HQSC, New Zealand. Participants Analysis of maternal and perinatal mortality and morbidity data 2009–2012. Interventions Every SAE ...

  5. Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

    Science.gov (United States)

    Phoa, K Y N; Chedraui, P; Pérez-López, F R; Wendte, J F; Ghiabi, S; Vrijkotte, T; Pinto, P

    2016-07-01

    Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia. PMID:26790539

  6. Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus

    OpenAIRE

    Yee, Lynn M.; Cheng, Yvonne W.; Inturrisi, Maribeth; CAUGHEY, Aaron B.

    2013-01-01

    OBJECTIVE To investigate whether gestational weight loss after the diagnosis of gestational diabetes mellitus (GDM) in overweight and obese women is associated with improved perinatal outcomes. Obesity and GDM are risk factors for adverse perinatal outcomes, but few studies have investigated weight loss during pregnancy in women with these comorbidities. METHODS Retrospective cohort study of 26,205 overweight and obese gestational diabetic women enrolled in the California Diabetes and Pregnan...

  7. Perinatal Outcomes in Advanced Age Pregnancies

    Directory of Open Access Journals (Sweden)

    Ertuğrul Yılmaz

    2016-06-01

    Full Text Available Objective: The aim of this study is to evaluate the impact of advanced maternal age on pregnancy outcomes Methods: A retrospective analysis of 951 birth registry records of Zeynep Kamil Hospital, were analyzed between Janu­ary 2003 and December 2007. Study group was made up of women ≥40 years old and control group was made up of women younger than 40 years. Results: Mean maternal age was 41.48 years in the study group and 26.41 years in the control group. Mean gesta­tional age at the time of delivery is 37.73 weeks in study group and 38.10 weeks in the control group. There was no statistical difference in terms of preterm delivery, multiple pregnancy, fetal anomaly, IUGR, superimpose preeclampsia oligohidramnios, presentation anomaly and placenta previa rates between the study and control groups. Incidence of preeclampsia (p=0.041, Chronic hypertension (p=0.001, GDM (p= 0.003,is found to be higher in study group. Cesar­ean birth rate is higher (p<0.05 and hospitalization time is longer in study group (p=0.001. 1st minute and 5th minute APGAR scores of the study group (6.99±2, 8.27±2 was lower than the 1st minute and 5th Minutes APGAR scores of the control group (7.38±1.6, 8.58±1.7. Neonatal intensive care unit administration rate is seen also higher in study group (p<0.01. Conclusion: Advanced maternal age was related to increased pregnancy complications and poor perinatal outcome. Preeclampsia, GDM, chronic hypertension is seen more common in advanced age pregnancies. Neonatal intensive care administration is higher and APGAR scores are lower; cesarean delivery was performed more common, and hospitaliza­tion time was longer in advanced age pregnancies. J Clin Exp Invest 2016; 7 (2: 157-162

  8. RISK FACTOR PROFILES OF ADVERSE NEUROMOTOR OUTCOME IN INFANTS

    Directory of Open Access Journals (Sweden)

    Farin SOLEIMANI

    2011-02-01

    Full Text Available ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92], low birth weight (OR = 5.86 [95% CI; 3.07, 11.18], pretermdelivery (OR =6.17 [95% CI; 3.04, 12.52], Premature rupture of membranes (PROM>24 hours (OR = 6.18[95% CI; 2.07, 18.51] and hyperbilirubinemialeading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65] were associated with an increased risk for neuromotor delay on developmentalexamination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.Keywords: Neurodevelopmental outcome, perinatal period, infant, risk factor.

  9. Birth and perinatal outcomes and complications for babies conceived following ART

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Pinborg, Anja

    2014-01-01

    Children born after assisted reproductive techniques (ART) have an increased risk of several adverse perinatal outcomes compared with their naturally conceived peers. This has various causes such as higher multiple birth rates, parental characteristics and higher maternal age, with more being...... nulliparous. Furthermore the in-vitro techniques, the controlled ovarian stimulation, culture media, and possibly additional freezing or vitrification procedures seem to play a role. However, when analyzing the perinatal trends over time, the differences between ART and naturally conceived children appear to...

  10. Eclampsia: maternal and perinatal outcomes in a tertiary care centre

    OpenAIRE

    Sunita Mor; Daya Sirohiwal; Reetu Hooda

    2015-01-01

    Background: Eclampsia is a life threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out maternal and perinatal outcomes of eclampsia. Methods: A prospective study was undertaken in a tertiary care teaching institute over a period of one year. Patients of eclampsia were followed up with regard to the management and maternal and fetal morb...

  11. Management of Gestational Diabetes Mellitus: Selfefficacy and Perinatal Outcomes

    Directory of Open Access Journals (Sweden)

    Emine Gerçek

    2015-12-01

    Full Text Available The purpose of this review is to give knowledge about effects on perinatal outcomes of self-efficacy in management of gestational diabetes. Gestational diabetes mellitus (GDM is a significant health concern due to the potentially adverse outcomes for the mother and the fetus/infant. Close monitoring and treatment of GDM are important to the long-term health of a pregnant woman and her baby. More over, maternal metabolic control during pregnancy may positively impact women’s risk of later onset of type II diabetes and the risk of obesity and type II diabetes in their children. There are few studies which focus on selfefficacy and adoption of health behaviors in women with GDM; however, there is strong evidence demonstrating that health promotion behavior such as weight loss, exercise, healthy diet and self-monitoring blood glucose concentrations will decrease the risk of developing diabetes mellitus (DM. In addition, lifestyle modifications (e.g. weight loss, healthy diet, and exercise, compliance with physician appointments, and postpartum glucose screening are essential for early diagnosis and prevention of DM in women with GDM.

  12. Perinatal outcome in oligohydramnios and borderline amniotic fluid index: a comparative study

    OpenAIRE

    Pradip R. Gaikwad; Mona S. Oswal; Manisha R. Gandhewar; Binti R. Bhatiyani

    2016-01-01

    Background: Oligohydramnios is associated with adverse perinatal outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission. Methods: This was a prospective study of 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI and #8804; 5 cm ...

  13. STUDY OF MATERNAL AND PERINATAL OUTCOME IN REFERRED OBSTETRICS CASES

    OpenAIRE

    Umesh; Alka Murlidhar

    2015-01-01

    OBJECTIVE: To review the referred obstetric cases for reason of referral and to study the maternal and perinatal outcome. DESIGN: Prospective Observational study . STUDY POPULATION: 380 cases referred from periphery to tertiary care institute in one year duration. METHODS: INCLUSION C RITERIA : All referred ANC cases to our tertiary care i...

  14. RISK FACTOR PROFILES OF ADVERSE NEUROMOTOR OUTCOME IN INFANTS

    Directory of Open Access Journals (Sweden)

    Farin Soleimani MD

    2010-12-01

    Full Text Available ObjectiveAssessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants.Material & MethodsThis case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association betweenrisk factors and delayed motor development (developmental quotient below 70 indicating a significant delay was analyzed using correlating risk factors;including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and thecontrol group consisted of 140 infants who had a DQ score of more than 70.ResultsNeonatal seizures, Apgar score less than 3 after 5 minutes of birth (OR = 2.87 [95% CI; 1.68, 4.92], low birth weight (OR = 5.86 [95% CI; 3.07, 11.18], pretermdelivery (OR =6.17 [95% CI; 3.04, 12.52], Premature rupture of membranes (PROM>24 hours (OR = 6.18[95% CI; 2.07, 18.51] and hyperbilirubinemialeading to phototherapy or exchange transfusion (OR =3.75 [95% CI; 2.12, 6.65] were associated with an increased risk for neuromotor delay on developmentalexamination at 1 year.ConclusionThis study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important.

  15. The Influence of Perinatal Complications and Environmental Adversity on Boys' Antisocial Behavior

    Science.gov (United States)

    Beck, Joy E.; Shaw, Daniel S.

    2005-01-01

    Background: The purpose of the present study was to test components of Raine's (2002) biosocial model, specifically the interactive effects of perinatal complications, rejecting parenting, and family adversity on the development of early-onset antisocial behavior (ASB). Boys' internalizing problems were also tested to investigate the specificity…

  16. Adverse Reproductive Outcomes Associated With Teenage Pregnancy

    OpenAIRE

    Yadav, Siddhartha; Choudhary, Dilip; Narayan, K.C.; Mandal, Rajesh Kumar; Sharma, Achyut; Chauhan, Siddharth Singh; Agrawal, Pawan

    2008-01-01

    Introduction It is debated whether teenage pregnancy is associated with an adverse reproductive outcome. This study assessed the reproductive outcomes in teenage pregnancy in Nepal, a developing setting. Methods A hospital based retrospective cohort study of 4,101 deliveries to compare the outcomes between teenage and non-teenage pregnancies. Results Pregnancy in teenagers was associated with significantly increased risk (P

  17. Collateral Adverse Outcomes After Lumbar Spine Surgery.

    Science.gov (United States)

    Daniels, Alan H; Gundle, Kenneth; Hart, Robert A

    2016-01-01

    Collateral adverse outcomes are the expected or unavoidable results of a procedure that is performed in a standard manner and typically experienced by the patient. Collateral adverse outcomes do not result from errors, nor are they rare. Collateral adverse outcomes occur as the direct result of a surgical procedure and must be accepted as a trade-off to attain the intended benefits of the surgical procedure. As such, collateral adverse outcomes do not fit into the traditional definition of a complication or adverse event. Examples of collateral adverse outcomes after lumbar spine arthrodesis include lumbar stiffness, postoperative psychological stress, postoperative pain, peri-incisional numbness, paraspinal muscle denervation, and adjacent-level degeneration. Ideally, a comparison of interventions for the treatment of a clinical condition should include information on both the negative consequences (expected and unexpected) and potential benefits of the treatment options. The objective evaluation and reporting of collateral adverse outcomes will provide surgeons with a more complete picture of invasive interventions and, thus, the improved ability to assess alternative treatment options. PMID:27049197

  18. Linkages among reproductive health, maternal health, and perinatal outcomes.

    Science.gov (United States)

    Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France

    2010-12-01

    Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention

  19. RACIAL RESIDENTIAL SEGREGATION AND ADVERSE BIRTH OUTCOMES

    Science.gov (United States)

    INTRODUCTION. The disparity between black and white women's adverse birth outcomes has been subject to much investigation, yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences, including racial residential segr...

  20. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women

    Directory of Open Access Journals (Sweden)

    Sae Kyung Choi

    2014-01-01

    Full Text Available Background: Maternal prenatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of prenatal depressive symptoms are lacking. The aim of this study was to examine the influence of antenatal depressive symptoms on obstetric outcomes and to determine associations between antenatal and postpartum depressions. Materials and Methods: This was a prospective cohort study. The Edinburgh postnatal depression scale (EPDS questionnaire was completed by pregnant women receiving obstetrical care at Seoul St. Mary′s hospital in the third trimester of gestation. The electronic medical records were reviewed after delivery and perinatal outcomes were evaluated. The association between antenatal and postpartum depression was analyzed using the EPDS questionnaire, which was completed by the same women within 2 months of delivery. Results: Of the 467 participants, 26.34% (n = 123 had antenatal depressive symptoms, with EPDS scores of ≥10. There were no significant perinatal outcomes associated with antenatal depressive symptoms. During the postpartum period, 192 of the women in the initial study cohort were given the EPDS again as a follow-up. Of the 192 participants, 56 (29.17% scored >10. Spearman correlation coefficient between the antenatal and postpartum EPDS scores was 0.604, which was statistically significant (P < 0.001. Conclusion: Antenatal depression does not lead to unfavorable perinatal outcomes. However, screening for antenatal depression may be helpful to identify women at risk of postpartum depression.

  1. Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies

    OpenAIRE

    Persson, Martina; Norman, Mikael; Hanson, Ulf

    2009-01-01

    OBJECTIVE To perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003. RESEARCH DESIGN AND METHODS This was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in mat...

  2. Eclampsia: maternal and perinatal outcomes in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Sunita Mor

    2015-06-01

    Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status and lack of education. Early attention and intensive management are essential for improving the maternal and fetal outcomes. Unless the social and educational status of women is uplifted and obstetric care is brought to the doorstep, no miracle can be expected. [Int J Reprod Contracept Obstet Gynecol 2015; 4(3.000: 653-657

  3. Perinatal and neonatal outcome in meconium stained amniotic fluid

    OpenAIRE

    Shazia Qadir; Sami Jan; Javaid A Chachoo; Shameem parveen

    2016-01-01

    Background: Meconium passage in new born is a developmentally programmed event normally occurring within the first 24 to 48 hours after birth. Intrauterine meconium passage in near-term or term fetuses has been associated with fetomaternal stress factor like hypoxia and infection independent of fetal maturity. The incidence of meconium stained amniotic fluid is 1-18%. The objective of this study was to correlate the presence of meconium in amniotic fluid with perinatal outcome. Methods: A...

  4. A longitudinal study of the interactive effects of perinatal complications and early family adversity on cognitive ability.

    Science.gov (United States)

    Stanton, W R; McGee, R O; Silva, P A

    1989-06-01

    The effects of high, medium and low levels of perinatal complications and family adversity on intelligence quotient (IQ) scores were examined in a large sample of Dunedin children tested every second year in the age group 3-13 years. The aim was to test the hypothesis that favourable environmental circumstances attenuate the effects of perinatal complications on later cognitive ability. The results did not support this hypothesis but rather suggested that perinatal complications and family adversity have independent adverse effects on the development of children's cognitive ability. PMID:2764834

  5. Perinatal outcomes of Southeast Asians with pregnancies complicated by gestational diabetes mellitus or preeclampsia.

    Science.gov (United States)

    Cripe, Swee May; O'Brien, William; Gelaye, Bizu; Williams, Michelle A

    2012-10-01

    To examine risks for adverse perinatal outcomes among Southeast Asian women with pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia. Perinatal outcomes of singleton births of Cambodian (3,489), Laotian (2,038), Vietnamese (11,605), Japanese (3,083) and non-Hispanic White women (33,088) were analyzed using Washington state linked birth certificate and hospitalization discharge records (1993-2006). Both Cambodian (aOR = 1.68) and Laotian (aOR = 1.71) women with GDM had increased odds of macrosomia when compared with Japanese women with GDM. Southeast Asian women with GDM had reduced odds of macrosomia when compared with White women. Southeast Asian women with preeclampsia had increased odds for preterm delivery when compared with Japanese and White women with preeclampsia. Research is needed to understand why Southeast Asian women with GDM are more likely to have better perinatal outcomes when compared with White women. Vigilant monitoring and culturally sensitive care for Southeast Asian women with preeclampsia is needed. PMID:22002706

  6. Perinatal outcomes among immigrant mothers over two periods in a region of central Italy

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    Di Lallo Domenico

    2011-05-01

    Full Text Available Abstract Background The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population, as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods. Methods The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs to evaluate the association between mother's region of birth and perinatal outcomes. Results Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively: 1.80 (95%CI:1.44-2.28 and 1.95 (95%CI:1.72-2.21 for very preterm births, and 1.32 (95%CI:1.16-1.50 and 1.32 (95%CI:1.25-1.39 for preterm births; 1.18 (95%CI:0.99-1.40 and 1.17 (95%CI:1.03-1.34 for a low Apgar score; 1.22 (95%CI:1.15-1.31 and 1.24 (95%CI:1.17-1.32 for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66 and 1.45 (95%CI:1.34-1.57 for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15 and 1.07 (95%CI:1.00-1.15 for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations. Conclusion Our findings suggest that migrant status is a risk factor for

  7. Polyhydramnios as a Predictor of Adverse Pregnancy Outcomes

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    Ilham Moosa Hamdi

    2013-02-01

    Full Text Available Objectives: This study aimed to ascertain the frequency of polyhydramnios in singleton pregnancies, to determine the associated risk factors, and assess the adverse maternal and perinatal outcomes. Methods: A retrospective cohort study of all singleton pregnancies complicated with polyhydramnios after 28 weeks of gestation was carried out in Nizwa Hospital’s Obstetrics & Gynecology Department, Oman, from January 2002 to December 2007. Of 25,979 pregnant women reviewed, 477 were found to have polyhydramnios. The control group consisted of 900 pregnant women. Cases of polyhydramnios were diagnosed as mild, moderate, or severe based on their highest amniotic fluid index. Cases were compared with controls in terms of demographic data; prevalence of diabetes, macrosomia, or Caesarean deliveries; frequency of fetal anomalies, and perinatal mortality rate. Results:Polyhydramnios was diagnosed in 1.8% of pregnancies. It was mild in 382 (80%, moderate in 84 (17.6%, and severe in 12 (2.4%. A total of 72 (15.3 % cases of polyhydramnios were complicated by diabetes (gestational or established diabetes mellitus as compared to 10% of the control group and 39 (8.1% neonates had congenital anomalies.Polyhydramnios was associated with advanced maternal age; 58 (12.2% of subjects were over 40 years old. The perinatal mortality rate with polyhydramnios was 42 per 1,000 births compared to 14 per 1000 births in the control group. Conclusion: These data demonstrate that polyhydramnios is associated with an increased risk of adverseperinatal outcomes, and there is a significant positive relation with maternal age, diabetes, fetal anomalies, and fetal macrosomia.

  8. Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

    Science.gov (United States)

    Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

    2016-04-01

    Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs. PMID:27088708

  9. Assessment of perinatal outcome after sustained tocolysis in early labour (APOSTEL-II trial

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    Scherjon Sicco A

    2009-09-01

    Full Text Available Abstract Background Preterm labour is the main cause of perinatal morbidity and mortality in the Western world. At present, there is evidence that tocolysis for 48 hours is useful in women with threatened preterm labour at least before 32 weeks. This allows transfer of the patient to a perinatal centre, and maximizes the effect of corticosteroids for improved neonatal survival. It is questionable whether treatment with tocolytics should be maintained after 48 hours. Methods/Design The APOSTEL II trial is a multicentre placebo-controlled study. Pregnant women admitted for threatened preterm labour who have been treated with 48 hours corticosteroids and tocolysis will be eligible to participate in the trial between 26+0 and 32+2 weeks gestational age. They will be randomly allocated to nifedipine (intervention or placebo (control for twelve days or until delivery, whatever comes first. Primary outcome is a composite of perinatal death, and severe neonatal morbidity up to evaluation at 6 months after birth. Secondary outcomes are gestational age at delivery, number of days in neonatal intensive care and total days of the first 6 months out of hospital. In addition a cost-effectiveness analysis will be performed. Analysis will be by intention to treat. The power calculation is based on an expected 11% difference in adverse neonatal outcome. This implies that 406 women have to be randomised (two sided test, β 0.2 at alpha 0.05. Discussion This trial will provide evidence as to whether maintenance tocolysis reduces severe perinatal morbidity and mortality in women with threatened preterm labour before 32 weeks. Trial Registration Clinical trial registration: http://www.trialregister.nl, NTR 1336, date of registration: June 3rd 2008.

  10. Association Between Isolated Single Umbilical Artery and Perinatal Outcomes: A Meta-Analysis.

    Science.gov (United States)

    Xu, Yajuan; Ren, Lidan; Zhai, Shanshan; Luo, Xiaohua; Hong, Teng; Liu, Rui; Ran, Limin; Zhang, Yingying

    2016-01-01

    BACKGROUND To evaluate the association between the isolated single umbilical artery (iSUA) and perinatal outcomes, including pregnancy outcomes and perinatal complications. MATERIAL AND METHODS We performed a meta-analysis of 15 eligible studies regarding the relationship between the iSUA and perinatal outcomes, including gestational age at delivery, nuchal cord, placental weight, small for gestational age (SGA), oligohydramnios, polyhydramnios, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preeclampsia, and perinatal mortality. The overall odds ratios (OR) or standardized mean difference (SMD) were calculated. RESULTS The occurrence of nuchal cord was not found to be different between an iSUA and a three-vessel cord (TVC) fetus. For perinatal complications, the SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality showed dramatic difference between women with an iSUA and women with a TVC fetus, which implied that the presence of iSUA significantly increased the risk of perinatal complications. For other perinatal complications, such as PIH and preeclampsia, no significant association was detected. CONCLUSIONS Our meta-analysis suggests that the presence of iSUA would increase the risk of perinatal complications such as SGA, oligohydramnios, polyhydramnios, GDM, and perinatal mortality. Therefore, pregnant women with an iSUA fetus have poorer perinatal outcomes and more attention should be given to the management of their pregnancy compared to women with a TVC fetus. PMID:27130891

  11. Umbilical Coiling Index as a Marker of Perinatal Outcome: An Analytical Study

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    T. Chitra

    2012-01-01

    Full Text Available Objectives. To measure umbilical coiling index (UCI postnatally and to study the association of normocoiling, hypocoiling and hypercoiling to maternal and perinatal outcome. Method(s. One thousand antenatal women who went into labour were studied and umbilical coiling index calculated at the time of delivery. UCI was determined by dividing the total number of coils by the total umbilical cord length in centimeters. Its association with various maternal and perinatal risk factors were noted. The statistical tests were the Chi-square test and assessed with SPSS version 13.0 software and statistically analyzed. P value of less than 0.05 was regarded as statistically significant. Results. The mean umbilical coiling index was found to be 0.24 ± 0.09. Hypocoiling (0.36 was found to be associated with diabetes mellitus, polyhydramnios, cesarean delivery, congenital anomalies, and respiratory distress of the newborn. Conclusion. Abnormal umbilical coiling index is associated with several antenatal and perinatal adverse features.

  12. Systematic review on adverse birth outcomes of climate change

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    Parinaz Poursafa

    2015-01-01

    Full Text Available Background: Climate change and global warming have significant effects on human health. This systematic review presents the effects of the climate changes on pregnancy outcomes. Materials and Methods: The search process was conducted in electronic databases including ISI Web of Knowledge, PubMed, Scopus, and Google Scholar using key words of "environmental temperature" "pregnancy" "low birth weight (LBW" "pregnancy outcome," "climate change," "preterm birth (PTB," and a combination of them. We did not consider any time limitation; English-language papers were included. The related papers were selected in three phases. After quality assessment, two reviewers extracted the data while the third reviewer checked their extracted data. Finally, 15 related articles were selected and included in the current study. Results: Approximately all studies have reported a significant relationship between exposure variable and intended outcomes including eclampsia, preeclampsia, cataract, LBW, PTB, hypertension, sex ratio and length of pregnancy. According to conducted studies, decrease in birth weight is more possible in cold months. Increase in temperature was followed by increase in PTB rate. According to most of the studies, eclampsia and preeclampsia were more prevalent in cold and humid seasons. Two spectrums of heat extent, different seasons of the year, sunlight intensity and season of fertilization were associated with higher rates of PTB, hypertension, eclampsia, preeclampsia, and cataract. Conclusion: Climate change has unfavorable effects on eclampsia, preeclampsia, PTB, and cataract. The findings of this review confirm the crucial importance of the adverse health effects of climate change especially in the perinatal period.

  13. Perinatal outcome after in-vitro fertilization-surrogacy.

    Science.gov (United States)

    Parkinson, J; Tran, C; Tan, T; Nelson, J; Batzofin, J; Serafini, P

    1999-03-01

    The perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilization (IVF)-surrogacy was evaluated and compared to the outcome of pregnancies that resulted from standard IVF. Analysis of medical records and a telephone interview with physicians, IVF-surrogates, and commissioning mothers were conducted to assess prenatal follow up and delivery care in several hospitals. 95 IVF-surrogates delivered 128 liveborn (65 singletons, 27 sets of twins and two sets of triplets). The commissioning mothers and the IVF-surrogates average ages were 37.7 +/- 5.0 and 30.4 +/- 4.7 years old respectively. IVF-surrogates carrying twin and triplet gestations delivered substantially earlier than those who gestated singleton pregnancies (36.2 +/- 0.4 versus 35.5 versus 38.7 +/- 0.3 weeks gestation respectively; P surrogacy (2.7 +/- 0.06 versus 3.5 +/- 0.07 kg; P surrogacy. The incidence of prematurity was significantly greater in both twins delivered by IVF-surrogates (20.4%) and infertile IVF patients (58%). The occurrence of pregnancy-induced hypertension and bleeding in the third trimester was four to five times lower in the IVF-surrogates, independently of whether they were carrying multiples. The incidence of Caesarean section was 21.3% for singleton gestations, while two times higher in the IVF-surrogates carrying multiples (56.3%). Postpartum complications occurred in 6.3% of patients and the incidence of malformation was similar to those reported for the general population. The results provide general reassurance regarding perinatal outcome to couples who wish to pursue IVF-surrogacy. PMID:10221693

  14. Risk factors for and perinatal outcomes of major depression during pregnancy

    DEFF Research Database (Denmark)

    Räisänen, Sari; Lehto, Soili M; Nielsen, Henriette Svarre;

    2014-01-01

    history of depression prior to pregnancy. After history of depression, the second strongest associated factor for major depression was fear of childbirth, with a 2.6-fold (adjusted OR (aOR=2.63, 95% CI 2.39 to 2.89) increased prevalence. The risk profile of major depression also included adolescent or......OBJECTIVES: To identify risk factors for and the consequences (several adverse perinatal outcomes) of physician-diagnosed major depression during pregnancy treated in specialised healthcare. DESIGN: A population-based cross-sectional study. SETTING: Data were gathered from Finnish health registers...... for 1996-2010. PARTICIPANTS: All singleton births (n=511,938) for 2002-2010 in Finland. PRIMARY OUTCOME MEASURES: Prevalence, risk factors and consequences of major depression during pregnancy. RESULTS: Among 511,938 women, 0.8% experienced major depression during pregnancy, of which 46.9% had a...

  15. Adverse blood transfusion outcomes: establishing causation.

    Science.gov (United States)

    Isbister, James P; Shander, Aryeh; Spahn, Donat R; Erhard, Jochen; Farmer, Shannon L; Hofmann, Axel

    2011-04-01

    The transfusion of allogeneic red blood cells (RBCs) and other blood components is ingrained in modern medical practice. The rationale for administering transfusions is based on key assumptions that efficacy is established and risks are acceptable and minimized. Despite the cliché that, "the blood supply is safer than ever," data about risks and lack of efficacy of RBC transfusions in several clinical settings have steadily accumulated. Frequentist statisticians and clinicians demand evidence from randomized clinical trials (RCTs); however, causation for the recognized serious hazards of allogeneic transfusion has never been established in this manner. On the other hand, the preponderance of evidence implicating RBC transfusions in adverse clinical outcomes related to immunomodulation and the storage lesion comes from observational studies, and a broad and critical analysis to evaluate causation is overdue. It is suggested in several circumstances that this cannot wait for the design, execution, and conduct of rigorous RCTs. We begin by examining the nature and definition of causation with relevant examples from transfusion medicine. Deductive deterministic methods may be applied to most of the well-accepted and understood serious hazards of transfusion, with modified Koch's postulates being fulfilled in most circumstances. On the other hand, when several possible interacting risk factors exist and RBC transfusions are associated with adverse clinical outcomes, establishing causation requires inferential probabilistic methodology. In the latter circumstances, the case for RBC transfusions being causal for adverse clinical outcomes can be strengthened by applying modified Bradford Hill criteria to the plethora of existing observational studies. This being the case, a greater precautionary approach to RBC transfusion is necessary and equipoise that justifying RCTs may become problematic. PMID:21345639

  16. The influence of thyroid disorders on adverse pregnancy outcomes

    NARCIS (Netherlands)

    R. Vissenberg

    2016-01-01

    This thesis explores the association between thyroid disorders and adverse pregnancy outcomes, the underlying pathophysiology and treatment possibilities. The association between thyroid disorders and adverse pregnancy outcomes is investigated in a systematic review and two retrospective cohort stud

  17. Predicting adverse obstetric outcome after early pregnancy events and complications: a review

    DEFF Research Database (Denmark)

    van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B;

    2009-01-01

    BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases......) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing...... hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small...

  18. Pre-existing diabetes mellitus and adverse pregnancy outcomes

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    Wahabi Hayfaa A

    2012-09-01

    Full Text Available Abstract Background Pregnancies complicated by pre-existing diabetes mellitus (PDM are associated with a high rate of adverse outcomes, including an increased miscarriage rate, preterm delivery, preeclampsia, perinatal mortality and congenital malformations; compared to the background population. The objectives of this study are to determine the prevalence of PDM and to investigate the maternal and the neonatal outcomes of women with PDM. Methods This is a retrospective cohort study for women who delivered in King Khalid University Hospital (KKUH during the period of January 1st to the 31st of December 2008. The pregnancy outcomes of the women with PDM were compared to the outcomes of all non-diabetic women who delivered during the same study period. Results A total of 3157 deliveries met the inclusion criteria. Out of the study population 116 (3.7% women had PDM. There were 66 (57% women with type 1 diabetes mellitus (T1DM and 50 (43% women with type 2 diabetes mellitus (T2DM. Compared to non-diabetic women those with PDM were significantly older, of higher parity, and they had more previous miscarriages. Women with PDM were more likely to be delivered by emergency cesarean section (C/S, OR 2.67, 95% confidence intervals (CI (1.63-4.32, P P P P = 0.002. They more frequently have APGAR scores P 0.057 and more likely to be delivered at P 0.003. The stillbirth rate was 2.6 times more among the women with PDM; however the difference did not reach statistical significance, P 0.084. Conclusion PDM is associated with increased risk for C/S delivery, macrosomia, stillbirth, preterm delivery and low APGAR scores at 5 min.

  19. The success of cardiotocography in predicting perinatal outcome

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    Alpaslan Kaban

    2012-06-01

    Full Text Available Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within 36-41 weeks of gestation.During a 20-min period of fetal monitoring, a change inFHR (fetal heart rate lasting for 15 s or two elevated runsof 15 beats was evaluated as a reactive NST (non-stresstest. The umbilical artery pH was used as the “gold standard”for assessing fetal asphyxia.Results: The mean age of the women included in thestudy was 27.82 ± 5.29 years, the average parity was1.09± 0.96. The pH was normal in 85 neonates, while 13 hadfetal asphyxia. No significant difference in umbilical cordblood pH, pO2, or pCO2 was observed between these twogroups (p = 0.497, p = 0.722, and p = 0.053, respectively.No significant difference in maternal age, parity, or birthweight was found between the group with fetal distressbased on CTG (cardiotocography and the normal group.Conclusion: Cardiotocography is an important test duringlabor for labor management, it is insufficient for predictingthe perinatal outcome. Therefore, labor should beevaluated on an individualized basis. J Clin Exp Invest2012; 3(2: 168-171

  20. PERINATAL AND MATERNAL OUTCOME IN PREMATURE RUPTURE OF MEMBRANES

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    Mercy Rodrigo

    2016-06-01

    Full Text Available BACKGROUND The objectives of this study are 1 To find out the incidence of premature rupture of membranes, 2 To evaluate the aetiology of premature rupture of membranes, 3 To assess foetal and maternal outcome in premature rupture of membranes. MATERIAL AND METHODS This prospective case control study was conducted in Govt. RSRM Lying In Hospital, Chennai, over a period of 6 months and 100 cases of spontaneous rupture of membranes attending the Department of Obstetrics and Gynaecology were studied. Maternal and neonatal outcome were compared with controls. RESULTS Incidence of PROM was 9.06%. Most of them belonged to low socioeconomic class and in the age group 20-29 years, commonly seen primi gravida and in unbooked cases. Aetiological analysis revealed infection in 15% of cases, which is evident by positive amniotic fluid culture, h/o recent coitus in 20%, mal-presentation in 7%. Cause is unknown in most of the cases. The caesarean section rate is 24% when compared to 12% in control group. The PROM group had higher morbidities like postpartum haemorrhage, postpartum fever, wound infection, neonatal sepsis. CONCLUSION This study showed significantly increased morbidity for both mother and baby. PROM causes major increase in the incidence of prematurity, hence careful screening of high risk factors and treatment of infection promptly is needed to decrease the perinatal morbidity and mortality.

  1. Perinatal outcomes of women with a prior history of unexplained recurrent miscarriage.

    LENUS (Irish Health Repository)

    Dempsey, Mark

    2014-05-14

    Abstract Objective: We sought to determine subsequent pregnancy outcomes in a cohort of women with a history of unexplained RM who were not receiving medical treatment. Study Design: This was a prospective cohort study, of women with a history of three unexplained consecutive first trimester losses, who were recruited and followed in their subsequent pregnancy. Control patients were healthy pregnant patients with no previous adverse perinatal outcome. Results: A total of 42 patients with a history of unexplained RM were recruited to the study. 9 (21.4%) experienced a further first trimester miscarriage, 1 case of ectopic and 1 case of partial molar pregnancy. 74% (23\\/31) of the RM cohort had a vaginal delivery. There was one case of severe pre-eclampsia. The RM group delivered at a mean gestational age of 38+2 weeks and with a mean birth-weight of 3.23kg. None of the neonates were under the 10(th) centile for gestational age. Overall, there was no significant difference in pregnancy outcomes between the two cohorts. Conclusion: Our study confirms the reassuring prognosis for achieving a live birth in the unexplained RM population with a very low incidence of adverse events with the majority delivering appropriately grown fetuses at term.

  2. ADVERSE MATERNAL AND PERINATAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS

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    Ambarisha Bhandiwad, Divyasree B, Surakshith L Gowda

    2015-10-01

    Full Text Available Introduction: Women with Gestational Diabetes Mellitus (GDM are at increased risk for many other health concerns with short and long-term implications for both mother and child. They are at higher risk for glucose-mediated macrosomia, hypertension, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia with increased neonatal intensive care unit (NICU admissions. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Objectives: To study the incidence of maternal and fetal co-morbidities associated with GDM. Materials and Methods: This is a retrospective observational study where cases with GDM were analyzed for maternal and fetal complications. Results: 189 cases were detected to be Gestational Diabetes Mellitus, out of which 63.49% cases developed co-morbidities with GDM. 11.11% cases developed preeclampsia, 9.52% had polyhydramnios, 5.8% patients went into preterm labour, 3 cases had Antepartum Haemorrhage and one case had Postpartum Haemorrhage. 19.57% cases developed macrosomia, hypoglycemia was seen in 7.40% babies and hyperbilirubinemia in 3.70% babies. 6 Intra Uterine Deaths and 2 still borns were documented. Conclusion: GDM is a condition which is worth monitoring and treating, since it has been demonstrated that good metabolic control maintained throughout gestation can reduce maternal and fetal complications.

  3. ADVERSE MATERNAL AND PERINATAL OUTCOMES IN GESTATIONAL DIABETES MELLITUS

    OpenAIRE

    Ambarisha Bhandiwad, Divyasree B, Surakshith L Gowda

    2015-01-01

    Introduction: Women with Gestational Diabetes Mellitus (GDM) are at increased risk for many other health concerns with short and long-term implications for both mother and child. They are at higher risk for glucose-mediated macrosomia, hypertension, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia with increased neonatal intensive care unit (NICU) admissions. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovas...

  4. STUDY OF MATERNAL AND PERINATAL OUTCOME IN REFERRED OBSTETRICS CASES

    Directory of Open Access Journals (Sweden)

    Umesh

    2015-03-01

    Full Text Available OBJECTIVE: To review the referred obstetric cases for reason of referral and to study the maternal and perinatal outcome. DESIGN: Prospective Observational study . STUDY POPULATION: 380 cases referred from periphery to tertiary care institute in one year duration. METHODS: INCLUSION C RITERIA : All referred ANC cases to our tertiary care institute >20 weeks gestation. The total number of deliveries during this period were 11106. The total number of referred cases in above study period was 1980. Out of these 1520 met the inclusion criteria & according to the sample size calculated 380 cases were selected for the study. Selection of cases were done by systematic sampling technique. RESULTS: The proportion of referral cases to the tertiary care institute is 17.83%. Majority (42.37% of referred cases were from district level hospitals showing lacunae in the emergency obstetric care given at the district level hospitals. In present study, there was unavailability of ambulance in 65.26% of cases for transport. Most (92.89% of the patients were not accompanied by any medical assistance during transport. Major complication during immediate postpartum period was postpartum hemorrhage (19.99%. In our study, 31.84% of the patients required blood/blood products transfusion. There were 3(0.79% maternal mortalities in present study & behind these there were total 70(18.42% near miss cases which provide valuable information on the quality of antenatal care at the periphery. 54.87% of all neonates had low birth weight in this study. In present study, 45.90% babies were p reterm. Total NICU admission rate was 14.36%. Neonatal mortality documented in present study was 5.38%. CONCLUSION: The present study has shown that improper antenatal & intranatal care at the periphery level is responsible for poor maternal & perinatal outcome. Rural women have very poor access to MCH services. There is lack of Transportation facilities for referral patients & they have to

  5. The Breathing for Life Trial: a randomised controlled trial of fractional exhaled nitric oxide (FENO)-based management of asthma during pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health

    OpenAIRE

    Vanessa E. Murphy; Jensen, Megan E.; Mattes, Joerg; Hensley, Michael J.; Giles, Warwick B; Peek, Michael J.; Bisits, Andrew; Callaway, Leonie K.; McCaffery, Kirsten; Barrett, Helen L.; Colditz, Paul B.; Seeho, Sean K.; Attia, John; Searles, Andrew; Doran, Christopher

    2016-01-01

    Background Asthma exacerbations are common during pregnancy and associated with an increased risk of adverse perinatal outcomes. Adjusting asthma treatment based on airway inflammation rather than symptoms reduces the exacerbation rate by 50 %. The Breathing for Life Trial (BLT) will test whether this approach also improves perinatal outcomes. Methods/design BLT is a multicentre, parallel group, randomised controlled trial of asthma management guided by fractional exhaled nitric oxide (FENO, ...

  6. Perinatal outcomes and unconventional natural gas operations in Southwest Pennsylvania.

    Directory of Open Access Journals (Sweden)

    Shaina L Stacy

    Full Text Available Unconventional gas drilling (UGD has enabled extraordinarily rapid growth in the extraction of natural gas. Despite frequently expressed public concern, human health studies have not kept pace. We investigated the association of proximity to UGD in the Marcellus Shale formation and perinatal outcomes in a retrospective cohort study of 15,451 live births in Southwest Pennsylvania from 2007-2010. Mothers were categorized into exposure quartiles based on inverse distance weighted (IDW well count; least exposed mothers (first quartile had an IDW well count less than 0.87 wells per mile, while the most exposed (fourth quartile had 6.00 wells or greater per mile. Multivariate linear (birth weight or logistical (small for gestational age (SGA and prematurity regression analyses, accounting for differences in maternal and child risk factors, were performed. There was no significant association of proximity and density of UGD with prematurity. Comparison of the most to least exposed, however, revealed lower birth weight (3323 ± 558 vs 3344 ± 544 g and a higher incidence of SGA (6.5 vs 4.8%, respectively; odds ratio: 1.34; 95% confidence interval: 1.10-1.63. While the clinical significance of the differences in birth weight among the exposure groups is unclear, the present findings further emphasize the need for larger studies, in regio-specific fashion, with more precise characterization of exposure over an extended period of time to evaluate the potential public health significance of UGD.

  7. Do We Pay Enough Attention to Culture Conditions in Context of Perinatal Outcome after In Vitro Fertilization? Up-to-Date Literature Review.

    Science.gov (United States)

    Marianowski, Piotr; Dąbrowski, Filip A; Zyguła, Aleksandra; Wielgoś, Mirosław; Szymusik, Iwona

    2016-01-01

    Adverse perinatal outcomes in singleton IVF pregnancies have been most often explained by parental underlying diseases and so far laboratory conditions during embryo culture are still not explored well. The following review discusses the current state of knowledge on the influence of IVF laboratory procedures on the possible perinatal outcome. The role of improved media for human embryo culture is unquestionable. Addition of certain components to culture media and their effect on embryo survival and implantation rates have been taken into consideration recently and studied on animal model. Impact of media on perinatal outcome in IVF offspring has also been studied. It has been discovered that epigenetic changes and neonatal birth weight are probably associated with the use of specific culture media, as is the relation between placental size and its influence on perinatal outcome. There are still questions in the discussion about duration of embryo culture (cleavage stage versus blastocyst transfer). Some of the IVF methods, such as in vitro maturation of oocytes and freezing/thawing procedures, also require well-powered randomized controlled trials in order to define their exact impact on perinatal outcome. Constant further research is needed to assess the impact of laboratory environment on fetal and postnatal development. PMID:26942190

  8. Do We Pay Enough Attention to Culture Conditions in Context of Perinatal Outcome after In Vitro Fertilization? Up-to-Date Literature Review

    Directory of Open Access Journals (Sweden)

    Piotr Marianowski

    2016-01-01

    Full Text Available Adverse perinatal outcomes in singleton IVF pregnancies have been most often explained by parental underlying diseases and so far laboratory conditions during embryo culture are still not explored well. The following review discusses the current state of knowledge on the influence of IVF laboratory procedures on the possible perinatal outcome. The role of improved media for human embryo culture is unquestionable. Addition of certain components to culture media and their effect on embryo survival and implantation rates have been taken into consideration recently and studied on animal model. Impact of media on perinatal outcome in IVF offspring has also been studied. It has been discovered that epigenetic changes and neonatal birth weight are probably associated with the use of specific culture media, as is the relation between placental size and its influence on perinatal outcome. There are still questions in the discussion about duration of embryo culture (cleavage stage versus blastocyst transfer. Some of the IVF methods, such as in vitro maturation of oocytes and freezing/thawing procedures, also require well-powered randomized controlled trials in order to define their exact impact on perinatal outcome. Constant further research is needed to assess the impact of laboratory environment on fetal and postnatal development.

  9. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002–2010 in Finland

    OpenAIRE

    Räisänen, Sari; Lehto, Soili M; Nielsen, Henriette Svarre; Gissler, Mika; Kramer, Michael R.; Heinonen, Seppo

    2014-01-01

    Objectives To identify risk factors for and the consequences (several adverse perinatal outcomes) of physician-diagnosed major depression during pregnancy treated in specialised healthcare. Design A population-based cross-sectional study. Setting Data were gathered from Finnish health registers for 1996–2010. Participants All singleton births (n=511 938) for 2002–2010 in Finland. Primary outcome measures Prevalence, risk factors and consequences of major depression during pregnancy. Results A...

  10. Neonatal encephalopathic cerebral injury in South India assessed by perinatal magnetic resonance biomarkers and early childhood neurodevelopmental outcome.

    Directory of Open Access Journals (Sweden)

    Peter J Lally

    Full Text Available Although brain injury after neonatal encephalopathy has been characterised well in high-income countries, little is known about such injury in low- and middle-income countries. Such injury accounts for an estimated 1 million neonatal deaths per year. We used magnetic resonance (MR biomarkers to characterise perinatal brain injury, and examined early childhood outcomes in South India.We recruited consecutive term or near term infants with evidence of perinatal asphyxia and a Thompson encephalopathy score ≥6 within 6 h of birth, over 6 months. We performed conventional MR imaging, diffusion tensor MR imaging and thalamic proton MR spectroscopy within 3 weeks of birth. We computed group-wise differences in white matter fractional anisotropy (FA using tract based spatial statistics. We allocated Sarnat encephalopathy stage aged 3 days, and evaluated neurodevelopmental outcomes aged 3½ years using Bayley III.Of the 54 neonates recruited, Sarnat staging was mild in 30 (56%; moderate in 15 (28% and severe in 6 (11%, with no encephalopathy in 3 (6%. Six infants died. Of the 48 survivors, 44 had images available for analysis. In these infants, imaging indicated perinatal rather than established antenatal origins to injury. Abnormalities were frequently observed in white matter (n = 40, 91% and cortex (n = 31, 70% while only 12 (27% had abnormal basal ganglia/thalami. Reduced white matter FA was associated with Sarnat stage, deep grey nuclear injury, and MR spectroscopy N-acetylaspartate/choline, but not early Thompson scores. Outcome data were obtained in 44 infants (81% with 38 (79% survivors examined aged 3½ years; of these, 16 (42% had adverse neurodevelopmental outcomes.No infants had evidence for established brain lesions, suggesting potentially treatable perinatal origins. White matter injury was more common than deep brain nuclei injury. Our results support the need for rigorous evaluation of the efficacy of rescue hypothermic

  11. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Science.gov (United States)

    van der Ven, A. J.; Schaaf, J. M.; van Os, M. A.; de Groot, C. J. M.; Haak, M. C.; Pajkrt, E.; Mol, B. W. J.

    2014-01-01

    Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1) labor onset and delivery in primary care; (2) labor onset in primary care and delivery in secondary care; (3) labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79)). Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27) and low Apgar score (aOR 1.95; 95% CI 1.53–2.48) were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care. PMID:25610468

  12. Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

    Directory of Open Access Journals (Sweden)

    A. J. van der Ven

    2014-01-01

    Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

  13. Maternal Periodontitis, Preeclampsia and Adverse Pregnancy Outcomes

    Directory of Open Access Journals (Sweden)

    Pourandokht Afshari

    2013-07-01

    Full Text Available Background and Aim: Preeclampsia is a considerable problem of pregnancy. Endothelial dysfunction and placental hypoxia are the current hypothesis of preeclampsia. Chronic inflammation, including periodontitis may provoke systemic maternal and placental pro-inflammatory endothelial dysfunction, which represent a significant risk factor for diseases of vascular origin. So this study was carried out to evaluate the possible relationship between periodontitis and preeclampsia. Methods: A total of 360 pregnant women were included, corresponding to 180 pregnant women with mild or sever periodotitis in one group and 180 pregnant women with periodontal health in the other group. Periodontitis was determined by the sum of all pockets with pocket probing depth (PPD ≥4mm and bleeding on probing. periodontal health was defined as the absence of PPD≥ 4mm. Then two groups evaluated to determine the presence of preeclampsia. After delivery, Child weight at birth and gestational age was also evaluated. Chi square and t test analysis were used to analyze the data. Results: There was statistically significant difference between two groups in presence of preeclampsia (p=0.003. Women who had a worse periodontal condition were at higher risk for preeclampsia. In addition, birth weight and gestational age was statistically lower in the case group than the control group (p < 0.001. Conclusion: The results indicate that the presence and severity of peridontitis increase the risk for occurrence of preeclampsia and adverse pregnancy outcomes.

  14. First-Trimester Fasting Hyperglycemia and Adverse Pregnancy Outcomes

    OpenAIRE

    Riskin-Mashiah, Shlomit; Younes, Grace; Damti, Amit; Auslender, Ron

    2009-01-01

    OBJECTIVE The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study found strong associations between higher levels of maternal glucose at 24–32 weeks, within what is currently considered normoglycemia and adverse pregnancy outcomes. Our aim was to evaluate the associations between first-trimester fasting plasma glucose level and adverse pregnancy outcomes. RESEARCH DESIGN AND METHODS Charts of all patients who delivered at our hospital between June 2001 and June 2006 were reviewed. Only s...

  15. Perinatal Outcomes in HIV Positive Pregnant Women with Concomitant Sexually Transmitted Infections

    Directory of Open Access Journals (Sweden)

    Erin Burnett

    2015-01-01

    Full Text Available Objective. To evaluate whether HIV infected pregnant women with concomitant sexually transmitted infection (STIs are at increased risk of adverse perinatal and neonatal outcomes. Methods. We conducted a cohort study of HIV positive women who delivered at an inner-city hospital in Atlanta, Georgia, from 2003 to 2013. Demographics, presence of concomitant STIs, prenatal care information, and maternal and neonatal outcomes were collected. The outcomes examined were the association of the presence of concomitant STIs on the risk of preterm birth (PTB, postpartum hemorrhage, chorioamnionitis, preeclampsia, intrauterine growth restriction, small for gestational age, low Apgar scores, and neonatal intensive care admission. Multiple logistic regression was performed to adjust for potential confounders. Results. HIV positive pregnant women with concomitant STIs had an increased risk of spontaneous PTB (odds ratio (OR 2.11, 95% confidence interval [CI] 1.12–3.97. After adjusting for a history of preterm birth, maternal age, and low CD4+ count at prenatal care entry the association between concomitant STIs and spontaneous PTB persisted (adjusted OR 1.96, 95% CI 1.01–3.78. Conclusions. HIV infected pregnant women with concomitant STIs relative to HIV positive pregnant women without a concomitant STI are at increased risk of spontaneous PTB.

  16. Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care?

    Science.gov (United States)

    Puthussery, Shuby

    2016-04-01

    This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers. PMID:26527304

  17. Maternal and perinatal outcome in severe preeclampsia and eclampsia

    Directory of Open Access Journals (Sweden)

    Neha Saxena

    2016-07-01

    Conclusions: Maternal and perinatal complications are more in patients with eclampsia. The incidence of eclampsia can be reduced by better antenatal care, early recognition and prompt treatment of severe pre-eclampsia. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2171-2176

  18. Serum cortisol concentrations during induced hypothermia for perinatal asphyxia are associated with neurological outcome in human infants.

    Science.gov (United States)

    Scaramuzzo, Rosa T; Giampietri, Matteo; Fiorentini, Erika; Bartalena, Laura; Fiori, Simona; Guzzetta, Andrea; Ciampi, Mariella; Boldrini, Antonio; Ghirri, Paolo

    2015-01-01

    Birth asphyxia is a cause of neonatal death or adverse neurological sequelae. Biomarkers can be useful to clinicians in order to optimize intensive care management and communication of prognosis to parents. During perinatal adverse events, increased cortisol secretion is due to hypothalamo-pituitary-adrenal axis activation. We aimed to investigate if cortisol variations during therapeutic hypothermia are associated with neurodevelopmental outcome. We compared 18 cases (neonates with birth asphyxia) with 18 controls (healthy term newborns) and confirmed increased serum cortisol concentrations following the peri-partum adverse event. Among cases, we stratified patients according to neurological outcome at 18 months (group A - good; group B - adverse) and found that after 24 h of therapeutic hypothermia serum cortisol concentration was significantly lower in group A vs group B (28.7 ng/mL vs 344 ng/mL, *p = 0.01). In group B serum, cortisol concentration decreased more gradually during therapeutic hypothermia. We conclude that monitoring serum cortisol concentration during neonatal therapeutic hypothermia can add information to clinical evaluation of neonates with birth asphyxia; cortisol values after the first 24 h of hypothermia can be a biomarker associated with neurodevelopmental outcome at 18 months of age. PMID:25394684

  19. Evaluation of perinatal outcomes in pregnant women with preterm premature rupture of membranes

    Directory of Open Access Journals (Sweden)

    Alex Sandro Rolland Souza

    2016-06-01

    Full Text Available SUMMARY Objective: To determine the association between amniotic fluid index (AFI and perinatal outcomes in preterm premature rupture of membranes (PPROM. Method: A retrospective cohort study was conducted between 2008 and 2012. 86 pregnant women were included, with a diagnosis of PPROM and gestational age from 24 to 35 weeks. Women who presented hypertensive disorders, diabetes, fetuses with birth defects and infection at admission were excluded. To determine the association between AFI and perinatal outcomes, chi-square and Fisher’s exact test were used if necessary, as well as risk ratio (RR and 95% confidence intervals (95CI. Correlation between AFI and perinatal outcomes was determined by using simple linear regression, and AFI progression during pregnancy was analyzed by Z-test. Results: When comparing newborns presenting ultrasound with AFI5cm, there was a higher frequency of perinatal mortality when the AFI was lower than 5 cm. However, when the oligohydramnios was diagnosed as severe (AFI3cm. There was a positive correlation between AFI and gestational age at delivery, birth weight and Apgar scores at minutes 1 and 5. There was also a decrease in amniotic fluid volume with increased gestational age. Conclusion: The presence of severe oligohydramnios after PPROM contributed to a higher frequency of perinatal complications and death.

  20. The Success of Cardiotocography in predicting Perinatal Outcome

    OpenAIRE

    Kaban, Alpaslan; Cengiz, Hüseyin; Kaban, Işık; Özcan, Alim; Karakaş, Sema

    2012-01-01

    Objectives: The determination of the fetal condition during labor is important to minimize fetal death due to asphyxia and the neurological sequelae of fetal hypoxia. This study evaluated the success of fetal cardiotocography in predicting perinatal consequences. Materials and methods: This study enrolled 101 full-term pregnant women admitted for delivery to Vakif Gureba Training and Research Hospital between October 2009 and February 2010. Women were included if they were aged 18-45 year...

  1. The success of cardiotocography in predicting perinatal outcome

    OpenAIRE

    Alpaslan Kaban; Hüseyin Cengiz; Işık Kaban; Alim Özcan; Sema KarakaşBakirköy Dr. Sadi Konuk Teaching and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey

    2012-01-01

    Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within ...

  2. Somatosensory evoked potentials and outcome in perinatal asphyxia.

    OpenAIRE

    Gibson, N A; Graham, M.; Levene, M I

    1992-01-01

    Somatosensory evoked potentials (SEP) can be measured in the term newborn infant and given an index of function in the areas of the brain most likely to be damaged in perinatal asphyxia. We studied the median nerve SEP in 30 asphyxiated term infants over the course of their encephalopathy and until discharge from the neonatal unit. Three types of response were noted: normal waveform, abnormal waveform, or absence of cortical response. Follow up of the survivors was undertaken at a mean age of...

  3. Maternal and perinatal outcomes in critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Arati Appinabhavi

    2014-02-01

    Conclusions: Pregnancy-induced hypertensive disorders and hemorrhage were the major risk factors apart from pneumonia and hepatitis that continue to take toll in obstetric patients. Adequate antenatal care, increased vigilance of women during pregnancy for subtle signs and symptoms, early transfer to tertiary centre and aggressive management to prevent complications can bring about the desired reduction in maternal-perinatal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 189-194

  4. STUDY OF AMNIOTIC FLUID INDEX AT THE ONSET OF LABOUR ON PERINATAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Supriya

    2015-01-01

    Full Text Available Aim of the present study is to determine amniotic fluid index in labour and to assess the course of labour, mode of delivery and perinatal outcome in relation to AFI. Objective of the study is the early detection of fetal distress and prevention of neonatal morbidity and mortality. This study was conducted in Department of Obstetrics and Gynecology, Rangaraya Medical College, Kakinada from October, 2011 to October 2013, to evaluate perinatal outcome in relation to AFI with a gestational age between 37 - 42 weeks. AFI was measured and the perinatal o utcome compared between three groups. The cesarean section rate for fetal distress and low birth weight babies, <2.5 kgs was higher in patients with oligohydroamnios. There was a significant difference in meconium staining, APGAR at 1 & 5 mins <7 at the time of birth between three groups. Oligohydroamnios has a significant correlation with cesarean section for fetal distress and low birth weight babies.

  5. Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and Trial Sequential Analysis

    Science.gov (United States)

    Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush; Gluud, Christian

    2015-01-01

    Objectives Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis. Methods An existing systematic review was updated and meta-analyses performed. Risk of bias, heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial sequential analysis was used to assess risk of random errors. Results Thirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (<20%) of preterm birth or low birth weight, periodontal treatment was not efficacious for any of the outcomes, and trial sequential analyses indicated that further trials might be futile. For populations with high occurrence (≥20%) of preterm birth and low birth weight, periodontal treatment seemed to reduce the risk of preterm birth (0.42 [0.24-0.73]) and low birth weight (0.32 [0.15-0.67]), but trial sequential analyses showed that firm evidence was not reached. Periodontal treatment did not significantly affect perinatal mortality, and firm evidence was not reached. Risk of bias, but not publication bias or patients’ age modified the effect estimates. Conclusions Providing periodontal treatment to pregnant women could potentially reduce the risks of perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to risks of bias, risks of random

  6. The role of brain sparing in the prediction of adverse outcomes in intrauterine growth restriction: results of the multicenter PORTO Study.

    LENUS (Irish Health Repository)

    Flood, Karen

    2014-05-06

    The aim of the Prospective Observational Trial to Optimize Pediatric Health in IUGR (PORTO) Study was to evaluate the optimal management of fetuses with estimated fetal weight (EFW) <10(th) centile. The objective of this secondary analysis was to describe the role of the cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome.

  7. Does the minor trauma during pregnancy have any effect on perinatal outcome?

    Directory of Open Access Journals (Sweden)

    Neslihan Yerebasmaz

    2015-12-01

    Full Text Available Objective: Women having major trauma during pregnancy are at increased risk for both maternal and fetal morbidity. However, the association between minor trauma and adverse perinatal outcomes is still unknown. Therefore, we aimed to analyze the incidence of minor trauma in pregnancy and effect on the outcomes of pregnancy. Methods: The data of patients, who were admitted to the emergency service of Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between January 2013 and December 2014, were evaluated. A total of 283 patients (0.3%, who had minor trauma during pregnancy, were included in the study. Demographic and obstetric data were analyzed with descriptive statistics. Additionally, antenatal complications and pregnancy outcomes were evaluated in 188 patients, who were followed during pregnancy and delivered their babies at our hospital Results: During the study period, of 105,727 women who were admitted to the emergency service of our hospital, 283 (0.3% had minor trauma during pregnancy. The causes of minor trauma, in order of frequency, included home accidents (81.3%, domestic violence (9.9% and traffic accidents (8.8%. Preterm delivery has been the most frequently antenatal complication observed in these patients (15.4%. Conclusion: Home accidents and domestic violence are the most common causes of minor trauma during pregnancy, and the patients are particularly at risk during the second trimester. The patients must be cautioned regarding the risk of preterm delivery and advised to attend regular pregnancy follow-up visits due to the fact that these patients have a higher risk of preterm delivery.

  8. Circulating angiogenic factors and urinary prolactin as predictors of adverse outcomes in women with preeclampsia.

    Science.gov (United States)

    Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Ramírez-Valenzuela, Karla Leticia; Chinolla-Arellano, Zarela Lizbeth; Isordia-Salas, Irma

    2013-05-01

    Preeclampsia is characterized by an imbalance in angiogenic factors. Urinary prolactin (PRL) levels and its antiangiogenic PRL fragments have been associated with disease severity. In this study, we assessed whether these biomarkers are associated with an increased risk of adverse maternal and perinatal outcomes in preeclamptic women. We studied 501 women with preeclampsia attended at a tertiary care hospital. Serum concentrations of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), as well as urinary PRL levels, were measured by enzymed-linked immunosorbent assay. Antiangiogenic PRL fragments were determined by immunoblotting. The risk for any adverse maternal outcome and for having a small-for-gestational-age infant was higher among women with sFlt-1/PlGF ratios, sEng, and urinary PRL level values in the highest quartile (odds ratios ≥ 2.7), compared with the lowest quartile. Both urinary PRL levels and the presence of antiangiogenic PRL fragments were more closely associated with the risk of specific adverse maternal outcomes (placental abruption, hepatic hematoma or rupture, acute renal failure, pulmonary edema, maternal death, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis; odds ratios ≥ 5.7 and ≥ 4.7, respectively) than either sFlt-1/PlGF ratio or sEng alone. We concluded that in preeclamptic women at the time of initial evaluation, sFlt-1/PlGF ratio and sEng are associated with increased risk of combined adverse maternal outcomes. However, urinary PRL concentrations and its antiangiogenic fragments appear to be better predictors of an adverse maternal outcome and may be useful for risk stratification in preeclampsia. PMID:23460287

  9. To study the effect of maternal basal metabolic index on the pregnancy and perinatal outcome

    Directory of Open Access Journals (Sweden)

    Rekha Wadhwani

    2016-06-01

    Conclusions: From this tudy, we concluded that the health of women throughout their child bearing years should be addressed, to improve the pregnancy and the perinatal outcomes. Therefore, education programs, health services and nutrition consultation are recommended for women in reproductive age. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1953-1958

  10. Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting

    NARCIS (Netherlands)

    Browne, J. L.; Vissers, K. M.; Antwi, E.; Srofenyoh, E. K.; Van der Linden, E. L.; Agyepong, I. A.; Grobbee, D. E.; Klipstein-Grobusch, K.

    2015-01-01

    Objective: The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting. Methods: A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal cli

  11. PREGNANCY AND PERINATAL OUTCOMES IN RELATION TO DRINKING WATER ARSENIC EXPOSURE IN BAMEN, INNER MONGOLIA, CHINA

    Science.gov (United States)

    Pregnancy and Perinatal Outcomes in Relation to Drinking Water Arsenic Exposure in BaMen, Inner Mongolia, ChinaDanelle T. Lobdell, Zhixiong Ning, Richard K. Kwok, Judy Mumford, Zhi Yi Liu, Pauline MendolaIntroduction: Close to 40 million people worldwide are exposed t...

  12. MORTALITY AS AN ADVERSE OUTCOME OF SARCOPENIA

    OpenAIRE

    ARANGO-LOPERA, V.E.; Arroyo, P.; GUTIERREZ-ROBLEDO, L.M.; PEREZ-ZEPEDA, M.U.; Cesari, M.

    2013-01-01

    Sarcopenia has an important impact in elderly. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the loss of muscle mass plus low muscle strength or low physical performance. Lack of clinical sounding outcomes (ie external validity), is one of the flaws of this algorithm. The aim of our study was to determine the association of sarcopenia and mortality in a group of Mexican elderly. A total of 345 elderly were recruited in Mexico City, and follow...

  13. The epidemiology of disasters and adverse reproductive outcomes: lessons learned.

    Science.gov (United States)

    Cordero, J F

    1993-07-01

    A disaster has been defined as a disruption of human ecology that exceeds the capacity of the community to function normally. Little is known about the adverse effects of natural disasters on reproductive outcomes. Important lessons can be derived from several disasters caused by human factors, such as the Minamata Bay disaster. Adverse reproductive outcomes include infertility, early pregnancy loss, stillbirths, congenital malformations, and serious developmental disabilities such as cerebral palsy and mental retardation. Recent disasters like the Chernobyl and Bhopal explosions have provided important lessons on the need for accurate and sound information about the risk of prenatal exposures for adverse reproductive outcomes. To study questions of adverse reproductive outcomes and disasters requires a well-planned approach. It should include early development of surveillance for adverse reproductive outcomes, analytic studies on the risk of disasters from direct and indirect effects, sensitive methods to measure early pregnancy loss, and long-term follow-up programs to assess outcomes such as developmental disabilities. PMID:8243383

  14. Use of brain lactate levels to predict outcome after perinatal asphyxia

    DEFF Research Database (Denmark)

    Leth, H; Toft, P.B.; Peitersen, Birgit;

    1996-01-01

    Perinatal asphyxia is an important cause of neurological disability, but early prediction of outcome can be difficult. We performed proton magnetic resonance spectroscopy (MRS) and global cerebral blood flow measurements by xenon-133 clearance in 16 infants with evidence of perinatal asphyxia....... Cerebral blood flow was determined daily in the first 3 days after birth in seven cases. Proton MRS was performed in 11 infants within the first week (mean 3.7 days), the rest within the first month (mean 22.2 days), and all had a scan around 3 months of age. Four infants died neonatally, three showed...... min-1), (p = 0.02) and outcome. The diagnostic and prognostic implications of early MRS and CBF are predictive of poor outcome in severely asphyxiated infants...

  15. Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan

    Directory of Open Access Journals (Sweden)

    Elbashir Hagir M

    2010-07-01

    Full Text Available Abstract Aim To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. Method This was a retrospective Cohort study where medical files of women with dengue were reviewed. Results There were 10820 deliveries and 78 (0.7% pregnant women with confirmed dengue IgM serology at the mean (SD gestational age of 29.4(8.2 weeks. While the majority of these women had dengue fever (46, 58.9%, hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0% and 12, (15.3% of these women, respectively. There were 17(21.7% maternal deaths. Fourteen (17.9% of these 78 women had preterm deliveries and 19 (24.3% neonates were admitted to neonatal intensive care unit. Nineteen (24.3% women gave birth to low birth weight babies. There were seven (8.9% perinatal deaths. Eight (10.2% patients delivered by caesarean section due to various obstetrical indications. Conclusion Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.

  16. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort.

    Directory of Open Access Journals (Sweden)

    Louise C Kenny

    Full Text Available BACKGROUND: Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited. METHODS: We performed a population-based cohort study using data on all singleton births in 2004-2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30-34, 35-39 and ≥40 years with women aged 20-29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index. RESULTS: The final study cohort consisted of 215,344 births; 122,307 mothers (54.19% were aged 20-29 years, 62,371(27.63% were aged 30-34 years, 33,966(15.05% were aged 35-39 years and 7,066(3.13% were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37-2.43], pre-term (RR = 1.25, [95% CI: 1.14-1.36] and very pre-term birth (RR = 1.29, [95% CI:1.08-1.55], Macrosomia (RR = 1.31, [95% CI: 1.12-1.54], extremely large for gestational age (RR = 1.40, [95% CI: 1.25-1.58] and Caesarean delivery (RR = 1.83, [95% CI: 1.77-1.90]. CONCLUSIONS: Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers.

  17. Perinatal outcome in sickle cell anemia: a prospective study from India.

    Science.gov (United States)

    Daigavane, Mayoor M; Jena, Rabindra K; Kar, Tushar J

    2013-01-01

    Sickle cell anemia, the homozygous genotype of sickle cell disease is one of the most common heritable diseases in the world. The Arab-Asian haplotype present in India is one of the least severe of all haplotypes. Many sickle cell anemia patients are now leading a symptom-free productive life due to hydroxyurea (HU) and better supportive care. Although pregnancy in sickle cell anemia patients is considered a high-risk category, it perinatal outcome is least studied, particularly among carriers of the Arab-Asian haplotype. Thus, the present prospective, randomized study was performed to assess the perinatal outcome in sickle cell anemia. Neonatal outcome such as low birth weight, perinatal mortality rate, special care newborn unit (SCNU) admission, intrauterine growth retardation (IUGR) and pre term births were significantly higher in sickle cell anemia mothers. Maternal outcome such as severe anemia, preeclampsia, vasoocclusive crisis (VOC), pulmonary complications, jaundice and blood transfusion requirements were significantly higher in sickle cell anemia mothers, which were successfully managed. Cesarian section rate was not significantly different from normal controls. Successful pregnancies were achieved in 84.44% of cases. However, we strongly recommend that pregnancies in these patients should be managed in an institutional setup. PMID:23952263

  18. Hospital-based Perinatal Outcomes and Complications in Teenage Pregnancy in India

    OpenAIRE

    Mukhopadhyay, Prianka; Chaudhuri, R. N.; Paul, Bhaskar

    2010-01-01

    Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. A cross-sectional observational study was undertaken to compare the different sociodemographic characteristics and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers in a tertiary-care hospital in eastern India. A sample of 350 each in cases and comparison group comprised the study subjects. Data were collected through intervi...

  19. Effects of nutritional management intervention on gestational weight gain and perinatal outcome

    OpenAIRE

    Luo, Xiao-Dong; Dong, Xiaojing; Zhou, Jin

    2014-01-01

    ABSTRACT Objectives: To evaluate whether nutritional management intervention can prevent excessive weight gain during pregnancy and improve perinatal outcomes. Methods: This cross-sectional study included 276 pregnant women undergoing prenatal care between June 2010 and December 2011 at the Obstetrics and Gynecology Department of the Second Affiliate Hospital of the ChongQing University of Medical Sciences, Chongqing, China. Of them, 131 women received individualized nutritional management in...

  20. Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes

    OpenAIRE

    Gláucia Rosana Guerra Benute; Roseli Mieko Yamamoto Nomura; Juliana Siracuza Reis; Renério Fraguas Junior; Mara Cristina Souza de Lucia; Marcelo Zugaib

    2010-01-01

    BACKGROUND: Approximately one‐fifth of women present depression during pregnancy and puerperium, and almost 13% of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty‐six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted fo...

  1. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

    OpenAIRE

    Indu Sharma; Alpana Bansal

    2016-01-01

    Background: Eclampsia is one of the major causes of maternal and perinatal morbidity and mortality in India and other developing countries. This problem is continued in spite of challenging efforts to reviev each and every pregnant woman with eclampsia and to analyse the factors affecting the outcome. The aim of the research is to study the demographic profile, maternal as well as perinatal outcome of patients with eclampsia and factor affecting it in tertiary care centre of tribal population...

  2. Prenatal Depression and Adverse Birth Outcomes: An Updated Systematic Review

    OpenAIRE

    Accortt, EE; Cheadle, ACD; Dunkel Schetter, C

    2015-01-01

    © 2014 Springer Science+Business Media New York Complications related to preterm birth (PTB) and low birth weight (LBW) are leading causes of infant morbidity and mortality. Prenatal depression is a hypothesized psychosocial risk factor for both birth outcomes. The purpose of this systematic review was to examine evidence published between 1977 and 2013 on prenatal depression and risks of these primary adverse birth outcomes. A systematic search of the PUBMED and PsycINFO databases was conduc...

  3. Proteomics for Adverse Outcome Pathway Discovery using Human Kidney Cells?

    Science.gov (United States)

    An Adverse Outcome Pathway (AOP) is a conceptual framework that applies molecular-based data for use in risk assessment and regulatory decision support. AOP development is based on effects data of chemicals on biological processes (i.e., molecular initiating events, key intermedi...

  4. Role of maternal weight gain on perinatal outcome

    Directory of Open Access Journals (Sweden)

    Madhuri Alwani

    2015-03-01

    Conclusion: Maternal weight gain may be a determinant of pregnancy outcomes. Therefore antenatal care are to be offered to all women to help them reach a healthy weight before conceiving and normal weight gain during pregnancy [Natl J Med Res 2015; 5(1.000: 30-32

  5. Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial.

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    Neena Shah More

    Full Text Available INTRODUCTION: Improving maternal and newborn health in low-income settings requires both health service and community action. Previous community initiatives have been predominantly rural, but India is urbanizing. While working to improve health service quality, we tested an intervention in which urban slum-dweller women's groups worked to improve local perinatal health. METHODS AND FINDINGS: A cluster randomized controlled trial in 24 intervention and 24 control settlements covered a population of 283,000. In each intervention cluster, a facilitator supported women's groups through an action learning cycle in which they discussed perinatal experiences, improved their knowledge, and took local action. We monitored births, stillbirths, and neonatal deaths, and interviewed mothers at 6 weeks postpartum. The primary outcomes described perinatal care, maternal morbidity, and extended perinatal mortality. The analysis included 18,197 births over 3 years from 2006 to 2009. We found no differences between trial arms in uptake of antenatal care, reported work, rest, and diet in later pregnancy, institutional delivery, early and exclusive breastfeeding, or care-seeking. The stillbirth rate was non-significantly lower in the intervention arm (odds ratio 0.86, 95% CI 0.60-1.22, and the neonatal mortality rate higher (1.48, 1.06-2.08. The extended perinatal mortality rate did not differ between arms (1.19, 0.90-1.57. We have no evidence that these differences could be explained by the intervention. CONCLUSIONS: Facilitating urban community groups was feasible, and there was evidence of behaviour change, but we did not see population-level effects on health care or mortality. In cities with multiple sources of health care, but inequitable access to services, community mobilization should be integrated with attempts to deliver services for the poorest and most vulnerable, and with initiatives to improve quality of care in both public and private sectors. TRIAL

  6. Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort.

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    Jennifer L Marino

    Full Text Available BACKGROUND: Fertility treatment is associated with increased risk of major birth defects, which varies between in vitro fertilisation (IVF and intracytoplasmic sperm injection (ICSI, and is significantly reduced by embryo freezing. We therefore examined a range of additional perinatal outcomes for these exposures. METHODS: All patients in South Australia receiving assisted conception between Jan 1986-Dec 2002 were linked to the state-wide perinatal collection (all births/stillbirths ≥20 weeks gestation or 400 g birth weight, n = 306 995. We examined stillbirth, mean birth weight, low birth weight (90th percentile, preterm birth (32-<37 weeks, <32 weeks gestation, postterm birth (≥41 weeks gestation, Apgar <7 at 5 minutes and neonatal death. RESULTS: Relative to spontaneous conceptions, singletons from assisted conception were more likely to be stillborn (OR = 1.82, 95% Confidence Interval (CI 1.34-2.48, while survivors as a group were comprehensively disadvantaged at birth, including lower birth weight (-109 g, CI -129--89, very low birth weight (OR = 2.74, CI 2.19-3.43, very preterm birth (OR = 2.30, CI 1.82-2.90 and neonatal death (OR = 2.04, CI 1.27-3.26. Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were markedly more common in singleton births from IVF and to a lesser degree, in births from ICSI. Using frozen-embryos eliminated all significant adverse outcomes associated with ICSI but not with IVF. However, frozen-embryo cycles were also associated with increased risk of macrosomia for IVF and ICSI singletons (OR = 1.36, CI 1.02-1.82; OR = 1.55, CI 1.05-2.28. Infertility status without treatment was also associated with adverse outcomes. CONCLUSIONS: Births after assisted conception show an extensive range of compromised outcomes that vary by treatment modality, that are substantially reduced after embryo freezing, but which

  7. Perinatal outcomes in 6,338 singletons born after intrauterine insemination in Denmark, 2007 to 2012

    DEFF Research Database (Denmark)

    Malchau, Sara Sofia; Loft, Anne; Henningsen, Anna-Karina Aaris;

    2014-01-01

    OBJECTIVE: To study perinatal outcomes in singletons born after intrauterine insemination (IUI) compared with children born after in vitro fertilization (IVF), intracytoplasmic sperm injection, and spontaneous conception (SC), and to assess predictors of poor outcome in singletons born after IUI......, exploring the effect of ovarian stimulation. DESIGN: National cohort study, 2007-2012. SETTING: Danish national registries. PATIENT(S): Four thousand two hundred twenty-eight singletons born after insemination with partner semen (IUI-H) and 1,881 singletons born after insemination with donor semen...

  8. Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae

    International Nuclear Information System (INIS)

    To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage (APH). Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of regnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing greater or equal to 500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level < 0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 (p < 0.01). Near-miss cases were also significantly higher in abruptio placentae, 22.27%. Verus 11.18% (p < 0.01). Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae (p < 0.05). (author)

  9. MANAGEMENT OF ECLAMPSIA IN A TERTIARY CARE CENTRE-MATERNAL AND PERINATAL OUTCOME

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    Usha Rani

    2015-11-01

    Full Text Available AIM: Management of 240 cases of eclampsia during a period of 1yr 6 months. MATERIALS AND METHODS : A study of 240 cases of eclampsia over a period of 1yr 6months at a tertiary level referral centre.They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, No.of convulsions, condition at the time of admission.Management of eclampsia ,maternal and perinatal outcome analyzed. RESULTS: Out of 240 cases of eclampsia most of them were primigravida belonging to low socio economic stata 73% had antenatal care but not regularly. 215 cases were given Mg So4 and the remaining patients Lorazepam and Phenytoin were added. The total perinatal mortality in our study was 28.3%.The perinatal mortality decreases with increasing gestational age and birth weight.Maternal Complications we encountered were Encephalopathy, Pyrexia, RTI, Retained Placenta. 6/240 Maternal deaths, in this two undelivered,CVA was the major cause of death. CONCLUSIONS: Eclampsia is a life endangering obstetric emergency still prevails in developing countries due to inadequate antenatal care, low socio economic stata and lack of transport facility, more common in primis. Good antenatal care helps in preventing ecampsia. Attentive nursing and individualized treatment algorithms, include prompt fluid replacement, anticonvulsant therapy (Mg So4 aggressive antihypertensive therapy and prompt delivery, availability of CT scan with good neonatal unit will improve the maternal and fetal outcome

  10. Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes in 220 Saudi Women 

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    Turki Gasim

    2012-03-01

    Full Text Available  Objectives: To assess the maternal and fetal complications of pregnancy in mothers with gestational diabetes mellitus (GDM compared with non-diabetic patients who delivered in the hospital during the study period.Methods: The outcome of pregnancy in 220 Saudi patients with GDM identified from the delivery register/hospital database and matched for age, parity and body mass index with 220 non-diabetic controls were studied retrospectively from their case files. Patients with multiple pregnancies and abnormal presentation of the fetus were excluded from the study.Results: The GDM patients were treated with either diet alone or with additional insulin in some patients who required better control of their blood sugar levels. Patients with GDM had a significantly higher incidence of pre-eclampsia (p<0.0001; preterm delivery (p=0.0226; induction of labor (p<0.0001; cesarean section (p=0.0019; higher mean birth weight (p<0.0001 of babies; large for gestational age infants (p=0.0011; macrosomia (p=0.0186; and admission to the neonatal intensive care unit (p=0.0003, compared with the control group. However, the rates of Apgarscore <7 at 5 minutes, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia and the need for phototherapy were similar in both groups of patients. Congenital anomalies and perinatal mortality rates were not significantly different in the two groups.Conclusion: GDM is recognized to be associated with increased rates of adverse maternal and neonatal outcomes, which are supported by the findings of this study. Even the mild form of GDM seems to have significant consequences for women and their offspring and is recommended to be aggressively treated. Evidence suggests that early diagnosis and strict control of blood sugar levels throughout the pregnancy can significantly reduce maternal and fetal complications. A multicenter, randomized controlled trial, based on universally accepted criteria for GDM screening test

  11. Perinatal outcome after ultrasound diagnosis of anhydramnios at term.

    LENUS (Irish Health Repository)

    Visvalingam, G

    2012-01-01

    The aim was to assess the maternal and fetal outcome in women who had labour induced for anhydramnios after 37 completed weeks of gestation. A retrospective study was conducted at the Rotunda Hospital from 1 January 2003 to 31 December 2007. All women with anhydramnios at term were identified from a review of ViewPoint® (computer software for antenatal scans performed), hospital data and the labour ward register. All women with a history of previous lower segment caesarean section (LSCS), current significant medical illness such as diabetes, hypertension, pre-eclampsia or ruptured membranes were excluded because the aim of the study was to focus specifically on low risk pregnancies with an incidental diagnosis of anhydramnios after 37 weeks\\' gestation. The maternal and fetal outcome parameters reviewed included: maternal age, parity, gestation, method of induction, mode of delivery, Apgar score and the requirement for obstetric or neonatal intervention. This study showed that anhydramnios is associated with a 56.6% LSCS rate in primigravida and a 19.0% LSCS rate in multigravida. Our study did not show any significant neonatal morbidity and there were no cases of mortality.

  12. Behavioural change in relation to alcohol exposure in early pregnancy and impact on perinatal outcomes - a prospective cohort study

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    Murphy Deirdre J

    2013-01-01

    Full Text Available Abstract Background There has been limited research addressing whether behavioural change in relation to alcohol exposure in pregnancy results in better perinatal outcomes. Methods A cohort study of 6725 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. A detailed history of alcohol consumption pre-pregnancy and during early pregnancy was recorded at the first antenatal visit with follow-up of the mother and infant until discharge following birth. Adverse perinatal outcomes were compared for ‘non-drinkers’, ‘ex-drinkers’ and ‘current drinkers’. Results Of the 6017 (90% women who reported alcohol consumption prior to pregnancy 3325 (55% engaged in binge drinking and 266 (4.4% consumed more than 14 units on average per week. At the time of booking 5649 (94% women were ex-drinkers and of the 368 women who continued to drink 338 (92% had a low intake (0–5 units per week, 30 (8% an excess intake (6-20+ units per week and 93 (25% reported at least one episode of binge drinking. Factors associated with continuing to drink in early pregnancy included older maternal age (30–39 years, (OR 1.6; 95% CI 1.3 to 1.8, Irish nationality (OR 3.1; 95% CI 2.2 to 4.3 and smoking (OR 2.6; 95% CI 1.9 to 3.5. Ex-drinkers had similar perinatal outcomes to non-drinkers. Compared to non-drinkers current drinking was associated with an increased risk of intrauterine growth restriction (IUGR (13% versus 19%, crude OR 1.6; 95% CI 1.1 to 2.2, adjusted OR 1.2; 95% CI 0.8 to 1.8. The greatest risk of IUGR was among women who continued to both drink and smoke, (9% versus 32%, crude OR 4.8; 95% CI 3.3 to 7.0, adjusted OR 4.5; 95% CI 3.1 to 6.7. Conclusions Public Health campaigns need to emphasise the potential health gains of abstaining from both alcohol and smoking in pregnancy.

  13. Gestational and Pregestational Diabetes Mellitus in Omani Women; Comparison of obstetric and perinatal outcomes

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    Adel T. Abu-Heija

    2015-11-01

    Full Text Available Objectives: The aim of this study was to assess the prevalence of gestational diabetes mellitus (GDM and pregestational diabetes mellitus (PGDM among pregnant women in Oman and compare their obstetric and perinatal outcomes. Methods: This retrospective study assessed the obstetric and perinatal outcomes of pregnant Omani women with GDM or PGDM who delivered at the Sultan Qaboos University Hospital in Muscat, Oman, between January 2009 and December 2010. Results: There were a total of 5,811 deliveries during the study period. Of the 5,811 women who gave birth, 639 women were found to have diabetes mellitus (11.0%. A total of 581 of the diabetic women had GDM (90.9% and only 58 (9.1% had PGDM. Women with PGDM had a significantly higher incidence of pre-eclampsia (P = 0.022, preterm deliveries (P <0.001 and Caesarean sections (P <0.001. Neonatal complications, such as respiratory distress syndrome (RDS, neonatal hypoglycaemia, neonatal jaundice and subsequent admission to a neonatal intensive care unit (NICU were significantly higher for neonates born to mothers with PGDM compared to those born to mothers with GDM (P <0.001. The corrected perinatal mortality rates for women with PGDM and GDM were 34.5 and 13.7 per 1,000 live births, respectively. Conclusion: In this Omani cohort, women with PGDM were at higher risk of developing obstetric and perinatal complications such as pre-eclampsia, preterm delivery and Caesarean delivery compared to women with GDM. In addition, neonates who had mothers with PGDM had higher rates of RDS, neonatal hypoglycaemia, neonatal jaundice and admission to the NICU.

  14. Differential Susceptibility to Early Literacy Intervention in Children with Mild Perinatal Adversities: Short- and Long-Term Effects of a Randomized Control Trial

    Science.gov (United States)

    Van der Kooy-Hofland, Verna A. C.; Van der Kooy, Jacoba; Bus, Adriana G.; van IJzendoorn, Marinus H.; Bonsel, Gouke J.

    2012-01-01

    In a randomized control trial, the authors tested whether short- and long-term effects of an early literacy intervention are moderated by mild perinatal adversities in accordance with differential susceptibility theory. One-hundred 5-year-old children (58% male) who scored at or below the 30th percentile on early literacy measures were randomized…

  15. Role of Perinatal Adversities on Tic Severity and Symptoms of Attention Deficit/Hyperactivity Disorder in Children and Adolescents With a Tic Disorder

    NARCIS (Netherlands)

    Bos-Veneman, Netty G. P.; Kuin, Anne; Minderaa, Ruud B.; Hoekstra, Pieter J.

    2010-01-01

    Objective: To investigate the role of perinatal adversities with regard to tic severity and comorbid attention deficit/hyperactivity disorder (ADHD) symptoms in children with a tic disorder. Methods: In 75 children and adolescents with a tic disorder, we retrospectively assessed presence of pregnanc

  16. MATERNAL AND PERINATAL OUTCOMES IN GDM: A STUDY

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    Vijaya Sheela

    2015-03-01

    Full Text Available BACKGROUND: India today is the diabetic capital of the world. A venous blood sugar level more than 140 mg/dl is suggestive of Gestational Diabetes mellitus (GDM and more than 90% of these people are managed by mea l plan alone. GDM tends to occur in older women with higher body mass index, higher parity, and other associated risk factor. AIMS AND OBJECTIVES: To assess the hospital prevalence of GDM, maternal and fetal outcomes in pregnancies complicated by GDM compared with non - diabetic pregnancies managed at a tertia ry care unit during the study period. MATERIALS AND METHODS: A Study was conducted at KING GEORGE HOSPITAL, Visakhapatnam, over a period of 2 years from October 2011 to October 2013. A total of 64 subjects of GDM were recruited and compared with 100 contro ls selected randomly that matched that matched for age, parity, BMI, who delivered in the hospital during the study period. RESULTS: Prevalence of GDM increases as the parity of the woman increases. Incidence of GDM increases as the age of the pregnant wom an increases. Obesity and pre pregnancy weight act as high risk factors for the development of GDM. Patients with known risk factors are more likely to have GDM than those with risk factors. There is increased incidence of operative delivery among GDM case s compare to controls. There is increased prevalence of macrosomia, hyperbilirubinemia and hypoglycemia in GDM cases compared to controls. CONCLUSIONS: Outcomes of pregnancy in women with GDM in this study showed significantly raised incidence of hypertens ive disorders, LGA Neonates, macrosomia and NICU admissions for more than 24hrs compared to non - diabetic mothers who delivered in the hospital.

  17. First trimester screening using ultrasound and serum markers in Panamanians : f0 actors associated with adverse pregnancy outcomes

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    Tania T Herrera

    2014-01-01

    Full Text Available Background: There is no published data on the association between serum biochemical and ultrasonographic markers and adverse pregnancy outcomes. Therefore, the aim of this study was to determine the factors associated with perinatal outcomes in singleton pregnancies using ultrasound and maternal serum markers during the first trimester in Panamanians. Materials and Methods: This was a prospective observational study of 468 first trimester singleton pregnancies conducted over a 7-year period. All women attending a prenatal screening clinic during the study period were informed of the study and the option to participate. Two maternal serum markers, free β-human chorionic gonadotropin (β-hCG and pregnancy associated plasma protein-A (PAPP-A, and four fetal ultrasound markers, nuchal translucency thickness, nasal bone, flow across the tricuspid valve, and flow in the ductus venosus (DV, were measured by certified maternal fetal medicine specialists. Adverse outcomes included miscarriage, major structural defects, genetic disorders, and major fetal cardiac defects. Results: A total of 454 (97% pregnancies were unaffected. Median maternal age was 31.5 years (range: 18-50. Maternal age was significantly greater in cases of adverse outcome (P = 0.007. The number of adverse outcomes associated with an absent or hypoplastic nasal bone, tricuspid valve regurgitation, and abnormal flow in the DV were significantly greater relative to unaffected pregnancies (Ps < 0.001. No differences were found in fetal crown-rump length or maternal serum levels of β-hCG or PAPP-A. Conclusion: Abnormal ultrasound markers are associated with adverse outcomes. Women with normal ultrasound and serum markers should be reassured of low risk of adverse pregnancy outcomes.

  18. Accelerating Adverse Outcome Pathway (AOP) development via computationally predicted AOP networks

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. Ho...

  19. ELEPHANTIASIS WITH PREGNANCY - GOOD MATERNAL AND PERINATAL OUTCOME

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    Jagrati Kiran

    2014-11-01

    Full Text Available : Elephantiasis had been described in India by Sushruta (600 BC and in Persia by Rhazes and Anicenna. So this disease is as ancient as our history.Microfilaria was first demonstrated in human blood in Calcutta by Lewis who called it filarial sangunis hominis wuchheria bancrofti is distributive widely in the tropics and sub-tropics of Asia, Africa and south America.so the largest number of cases of Filariasis occur in India where over 300 million people live in endemic zones. It is estimated that at least 6 million attacks of acute filarial disease occur every year in India and that over 15 million peoples have chronic filarial disease. The endemic areas are mainly along the sea coast and along the banks of large rivers through infections occur virtually in all states except the north-west. Aprimigravida 25 year old patient was admitted in tili hospital labour room with history of Amenorrohea 9 month with history of elephantiasis of right leg since birth and complain of pain abdomen since morning at 7:40 am on 13/9/2012. By menstrual history her LMP was? December 2009 and by this LMP patient EDD was? September 2010.because of huge swelling of right leg normal delievery could not be possible so she was taken for LSCS, patient delivered a full term alive female baby of 2.8 kg weight on 13/9/2010 at 1:45 pm patient stood procedure well post-operative period was uneventfull. Stitches were removed on 8th and 9th day and patient and baby were well at the time of discharge. Filariasis can lead to sub-fertility but this is very rare case of huge elephantiasis with good maternal and faetal outcome.

  20. Perinatal outcomes and anomalies associated with fetal right aortic arch

    Directory of Open Access Journals (Sweden)

    Ahmet Gül

    2012-09-01

    Full Text Available Objective: To evaluate the prenatal findings, associated anomalies, and prognosis of right aortic arch (RAA anomalies. Material and Methods: All cases referred for detailed ultrasonography and fetal echocardiography between October 2006 and July 2009 were systematically examined for aortic arch anomalies and associated cardiac and extracardiac anomalies. Prenatal findings of all cases with aortic arch anomalies and intracardiac and extracardiac findings were prospectively registered in an electronic database that included fetal echocardiography. Outcomes of the cases were collected postnatally from the patients’ obstetricians, neonatal unit archieves, and pediatric cardiologists. Results: We detected 12 cases of RAA (0.37%; n=12/3200. Mean gestational age at diagnosis was 24 weeks (range, 21–33 weeks. Of the 12 cases of RAA, five (41.7% had a major cardiac defect, including tetralogy of Fallot (n= 3, atrioventricular septal defect (n=1, and ventricular septal defect (n=1. An extracardiac anomaly was observed in three cases (25%. The fetal karyotype was trisomy 21 in one case with increased nuchal translucency (6.6 mm. Microdeletion 22q11 analyses performed in three cases were normal. The postnatal courses of the cases with isolated RAA were uneventful. Two cases associated with major cardiac and extracardiac anomalies were lost in the early neonatal period. The case of trisomy 21 was terminated. The other four cases of RAA with an associated cardiac anomaly are currently in follow up. Conclusion: Aortic arch anomalies, particularly RAA, can be diagnosed by fetal echocardiography. The prognosis for isolated RAA is relatively good compared with that for RAA with associated anomalies.

  1. Adverse Pregnancy Outcomes and Cardiovascular Risk Factor Management

    OpenAIRE

    Mehta, Puja K.; Minissian, Margo; Merz, C. Noel Bairey

    2015-01-01

    Cardiovascular disease (CVD) is the leading health threat to American women. In addition to established risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman’s risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger wome...

  2. Maternal Serum Screening Markers and Adverse Outcome: A New Perspective

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    David Krantz

    2014-07-01

    Full Text Available There have been a number of studies evaluating the association of aneuploidy serum markers with adverse pregnancy outcome. More recently, the development of potential treatments for these adverse outcomes as well as the introduction of cell-free fetal DNA (cffDNA screening for aneuploidy necessitates a re-evaluation of the benefit of serum markers in the identification of adverse outcomes. Analysis of the literature indicates that the serum markers tend to perform better in identifying pregnancies at risk for the more severe but less frequent form of individual pregnancy complications rather than the more frequent but milder forms of the condition. As a result, studies which evaluate the association of biomarkers with a broad definition of a given condition may underestimate the ability of such markers to identify pregnancies that are destined to develop the more severe form of the condition. Consideration of general population screening using cffDNA solely must be weighed against the fact that traditional screening using serum markers enables detection of severe pregnancy complications, not detectable with cffDNA, of which many may be amenable to treatment options.

  3. EVALUATION OF AMNIOT IC FLUID VOLUME AND ITS RELATION TO PERINATAL OUTCOME

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    Urmila

    2015-05-01

    Full Text Available BACKGROUND: Amniotic fluid is an indicator of placental function on the fetal development. The AFI is the most commonly used method of measuring amniotic fluid. AIMS: We aimed to study the amniotic fluid volume in pregnancies beyond 34 weeks of gestation and to evalu ate the predictive value of amniotic fluid index (AFI 5 cm during one year from August 2013 to July 2014. The women's history, clinical examination recorded and AFI were measured using the Phelan's technique and the perinatal outcome compared between the two groups i.e. AFI 5cm. STATISTICAL ANALYSIS USED: Chi - square test was carried out at 5% (  =0.05 level of significance to analyze the collected data for final outcome. RESULTS: Labour was induced in 30% in group A as compared to 18% in group B. Induction of labour was significantly less in cases with AFI>5 cm of same gestational age group. The non - reassuring fetal heart rate were recorded more often in group A i.e. AFI < 5 cm. The incidence of meconium sta ining in caesarean section and low 5 min Apgar score was higher in patients with oligohydramnios i.e. AFI < 5 cm (p=0.015, 0.012, 0.027 respectively. There was no significant difference in NICU admissions and perinatal death between the two groups. CONCLUSIO N: Amniotic fluid index is a helpful tool in determining the high risk patients during labour and AFI < 5 cm is one of the indicators of comparatively poor perinatal outcome.

  4. MANAGEMENT OF ECLAMPSIA IN A TERTIARY CARE CENTRE-MATERNAL AND PERINATAL OUTCOME

    OpenAIRE

    Usha Rani; Vijaya

    2015-01-01

    AIM: Management of 240 cases of eclampsia during a period of 1yr 6 months. MATERIALS AND METHODS : A study of 240 cases of eclampsia over a period of 1yr 6months at a tertiary level referral centre.They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, No.of convulsions, condition at the time of admission.Management of eclampsia ,maternal and perinatal outcome analyzed. RESULTS: Out of 240 cases of eclampsia most of them were prim...

  5. Psychopathology and treatment outcome of drug dependent women in a perinatal program

    OpenAIRE

    Ingersoll, Karen S.; Knisely, Janet S.; Dawson, Kathryn S.; Schnoll, Sidney H.

    2004-01-01

    One hundred and five drug-dependent women in outpatient perinatal addiction treatment were classified by cluster analysis of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles into high and low psychopathology (HP and LP) groups that differed on three validation measures. The HP group (n = 29, 27.6%) had elevations on MMPI-2 Scales F, 2, 4, 6, 7, and 8, while the LP group (n = 76, 72.4%) generated a normal range profile with elevations on Scales F and 4. Psychological outcome...

  6. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population.

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    Liang-Miao Chen

    Full Text Available OBJECTIVE: Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH during pregnancy remains controversial. The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. METHODS: A prospective study of data from 8012 pregnant women (371 women with SCH, 7641 euthyroid women was performed. Maternal serum samples were collected in different trimesters to examine thyroid hormone concentrations. SCH was defined as a thyroid stimulating hormone concentration exceeding the trimester-specific reference value with a normal free thyroxine concentration. The occurrence of maternal outcomes, including gestational hypertension (GH, gestational diabetes mellitus, placenta previa, placental abruption, prelabor rupture of membranes (PROM, and premature delivery; and perinatal outcomes, including intrauterine growth restriction (IUGR, fetal distress, low birth weight (LBW; live birth weight ≤ 2500 g, stillbirth, and malformation, was recorded. Logistic regression with adjustment for confounding demographic and medical factors was used to determine the risks of adverse outcomes in patients with SCH. RESULTS: Compared with euthyroid status, SCH was associated with higher rates of GH (1.819% vs. 3.504%, P = 0.020; χ2 = 7.345; odds ratio (OR, 2.243; 95% confidence interval (CI, 1.251-4.024, PROM (4.973% vs. 8.625%, P = 0.002; χ2 = 72.102; adjusted OR, 6.014; 95% CI, 3.975-9.099, IUGR (1.008% vs. 2.965%, <0.001; χ2 = 13.272; adjusted OR, 3.336; 95% CI, 1.745-6.377, and LBW (1.885% vs. 4.582%, P<0.001; χ2 = 13.558; adjusted OR, 2.919; 95% CI, 1.650-5.163. CONCLUSIONS: The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their fetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function

  7. Perinatal Safety: From Concept to Nursing Practice

    OpenAIRE

    Lyndon, Audrey; Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support n...

  8. MATERNAL AND PERINATAL OUTCOME IN ECLAMPSIA IN A TE RTIARY CARE CENTRE

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    Bharti

    2013-04-01

    Full Text Available ABSTRACT: BACKGROUND : Eclampsia is a life threatening emergency that con tinues to be a major cause of serious maternal morbidity and is st ill the leading cause of maternal mortality worldwide. OBJECTIVE: Analysis of all cases of Eclampsia patients to find out the incidence, to evaluate the clinical course, medical & obstetric m anagement, and complications and to study the maternal &perinatal outcome. METHODS : This study was a hospital based prospective observational study. We obtained the data for this study from the case records of all Eclampsia patients who admitted in the Department of Obstetrics & Gynaecology, Gandhi Medical College, Bhopal from 01.01.2011 to 31.12.2011 and data were r ecorded on a predesigned proforma. All the obstetrical women with convulsions after 20 wee ks pregnancy or in postpartum period were evaluated. Each case was documented with respec t to age, socioeconomic status, education, occupation, gestational age, time of onse t of Eclampsia, duration and frequency of seizures, mode of delivery, use of drugs (anticonvu lsant and antihypertensive, maternal and perinatal outcome RESULTS: Out of total 203 Eclampsia patients, 144 cases(70.93% were Antepartum Eclampsia, 22 patients (10.84% were intrapa rtum Eclampsia, 35 cases (17.24% were postpartum Eclampsia & 2 cases (0.9% were status Eclampticus.30% Patients did not have oedema,14% had BP<140/90 mm of Hg and 11.4% di d not have proteinuria at the time of admission. There were 21 maternal deaths and morbid ity consisted of pulmonary oedema in 31(33.6% cases, CVA in 17(18.4% cases, renal fail ure in 7(7.6% cases, HELLP syndrome in 6(6.5% cases and aspiration pneumonia in 2(2.2% cas es. Perinatal mortality was 44.3% with majority being related to extreme prematurity. CONCLUSIONS: There is a need of proper antenatal care to prevent Eclampsia and the need for intensive monitoring of women with Eclampsia throughout the hospitalization to improve bo th the maternal

  9. Obstetric and perinatal outcome of elderly mothers aged 35 years and above: a comparative study

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    Nirmala Ramachandran

    2015-01-01

    Full Text Available Background: Across the world, there is a rising trend among women towards delaying pregnancy and child birth. The wide educational and career choices available currently encourage women to pursue their professional goals relentlessly and many opt to delay pregnancy. Easy access to the wide range of modern contraceptive methods has enabled them to achieve better control of fertility. Methods: The study conducted in Chennai Medical College and Research Centre, Trichy over a period of 18 months compared pregnancy related complications, maternal and perinatal outcomes in elderly women, with non-elderly women as controls. Forty two elderly gravidae were compared with 50 non-elderly gravidae. Results: The mean age of women in study group was 37.1 and 27.6 in the control group. 14.3% in the study group of patients had assisted conception whereas all of patients in the control group conceived spontaneously. There were 4 (9.5% miscarriages in the study group and none in the control group. The incidence of pre-gestational diabetes, gestational diabetes and preeclampsia was found to be higher in the study group and this was statistically significant (P Value <0.0001. Conclusion: This study analyzing the effect of advanced maternal age on pregnancy has shown favourable maternal and perinatal outcomes. The study showed a significant difference in the incidence of pre-gestational diabetes, gestational diabetes, preeclampsia, miscarriage, antepartum hemorrhage, induction of labour, instrumental deliveries and caesarean section rates in elderly gravidae. But the risk of aneuploidy, malpresentations, placenta previa and prolonged labour were not found to be high. The incidence of low APGAR score was high in the study group, but it was attributable to specific causes like placental abruption. There were no perinatal deaths in both groups. [Int J Res Med Sci 2015; 3(1.000: 214-219

  10. Chemical respiratory allergy: Reverse engineering an adverse outcome pathway

    International Nuclear Information System (INIS)

    Allergic sensitisation of the respiratory tract by chemicals is associated with rhinitis and asthma and remains an important occupational health issue. Although less than 80 chemicals have been confirmed as respiratory allergens the adverse health effects can be serious, and in rare instances can be fatal, and there are, in addition, related socioeconomic issues. The challenges that chemical respiratory allergy pose for toxicologists are substantial. No validated methods are available for hazard identification and characterisation, and this is due in large part to the fact that there remains considerable uncertainty and debate about the mechanisms through which sensitisation of the respiratory tract is acquired. Despite that uncertainty, there is a need to establish some common understanding of the key events and processes that are involved in respiratory sensitisation to chemicals and that might in turn provide the foundations for novel approaches to safety assessment. In recent years the concept of adverse outcome pathways (AOP) has gained some considerable interest among the toxicology community as a basis for outlining the key steps leading to an adverse health outcome, while also providing a framework for focusing future research, and for developing alternative paradigms for hazard characterisation. Here we explore application of the same general principles to an examination of the induction by chemicals of respiratory sensitisation. In this instance, however, we have chosen to adopt a reverse engineering approach and to model a possible AOP for chemical respiratory allergy working backwards from the elicitation of adverse health effects to the cellular and molecular mechanisms that are implicated in the acquisition of sensitisation

  11. Perfluorinated compounds in umbilical cord blood and adverse birth outcomes.

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    Mei-Huei Chen

    Full Text Available BACKGROUND: Previous animal studies have shown that perfluorinated compounds (PFCs have adverse impacts on birth outcomes, but the results have been inconclusive in humans. We investigated associations between prenatal exposure to perfluorooctanoic acid (PFOA, perfluorooctyl sulfonate (PFOS, perfluorononanoic acid (PFNA, and perfluoroundecanoic acid (PFUA and birth outcomes. METHODS: In total, 429 mother-infant pairs were recruited from the Taiwan Birth Panel Study (TBPS. Demographic data were obtained by interviewing mothers using a structured questionnaire and birth outcomes were extracted from medical records. Cord blood was collected for PFOA, PFOS, PFNA, and PFUA analysis by ultra-high-performance liquid chromatography/tandem mass spectrometry. RESULTS: The geometric mean (standard deviation levels of PFOA, PFOS, PFNA, and PFUA in cord blood plasma were 1.84 (2.23, 5.94 (1.95, 2.36(4.74, and 10.26 (3.07 ng/mL, respectively. Only PFOS levels were found to be inversely associated with gestational age, birth weight, and head circumference [per ln unit: adjusted β (95% confidence interval, CI = -0.37 (-0.60, -0.13 wks, -110.2 (-176.0, -44.5 gm and -0.25 (-0.46, -0.05 cm]. Additionally, the odds ratio of preterm birth, low birth weight, and small for gestational age increased with PFOS exposure [per ln unit: adjusted odds ratio (OR (95%CI = 2.45 (1.47, 4.08, 2.61(0.85, 8.03 and 2.27 (1.25, 4.15]. When PFOS levels were divided into quartiles, a dose-response relation was observed. However, PFOA, PFNA, and PFUA were not observed to have any convincing impact on birth outcomes. CONCLUSIONS: An adverse dose-dependent association was observed between prenatal PFOS exposure and birth outcomes. However, no associations were found for the other examined PFCs.

  12. β-Blocker treatment during pregnancy and adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Petersen, Kasper Meidahl; Jimenez-Solem, Espen; Andersen, Jon Traerup; Petersen, Morten; Brødbæk, Kasper; Køber, Lars; Torp-Pedersen, Christian; Poulsen, Henrik Enghusen

    2012-01-01

    To investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort.......To investigate the association between exposure to β-blockers during pregnancy and the risk of being born small for gestational age (SGA), preterm birth and perinatal mortality in a nationwide cohort....

  13. Spousal Military Deployment During Pregnancy and Adverse Birth Outcomes.

    Science.gov (United States)

    Spieker, Amy; Schiff, Melissa A; Davis, Beth E

    2016-03-01

    Pregnant women with a military-deployed spouse have increased risk of depression and self-reported stress. In nonmilitary populations, depression and stress during pregnancy are associated with adverse birth outcomes. This study assesses the association between a spouse's military deployment and adverse birth outcomes. We conducted a retrospective cohort study at a large military medicine center in the Northwest and evaluated records of singleton deliveries to dependent Army spouses from September 2001 to September 2011. We used logistic regression to estimate relative risks and 95% confidence intervals (CI) of the associations between deployment and low birth weight (<2,500 g), preterm delivery (<37 weeks), small for gestational age (SGA, <10 percentile for gestational age), and cesarean delivery. We identified 10,536 births; 1,364 (12.9%) spouses were deployed at delivery. No associations were observed in the overall population. Among women with two or more children, we observed an 81% increased risk of SGA (95% CI 1.18-2.79). Women 30 to 34 years old had an 82% (95% CI 1.06-3.14) increased risk of low birth weight and an 84% increased risk of SGA (95% CI 1.13-2.98). Deployment's effects vary by maternal age and the number of children in the household. These findings may inform programs and practitioners to best serve women with military-deployed spouses. PMID:26926749

  14. Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes

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    Gláucia Rosana Guerra Benute

    2010-01-01

    Full Text Available BACKGROUND: Approximately one-fifth of women present depression during pregnancy and puerperium, and almost 13% of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty-six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted for each participant using a questionnaire that had been developed previously. Major depression was diagnosed using the Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME-MD. The medical records of the participants were thoroughly reviewed to evaluate the perinatal results. RESULTS: Major depressive disorder was diagnosed in 29 cases (9.0%. The prevalence of major depression was as follows: 7.1% for preeclampsia or chronic hypertension, 12.1% for cardiac disorder, 7.1% for diabetes mellitus, 6.3% for maternal anemia, 8.3% for collagenosis and 12.5% for a high risk of premature delivery. An univariate analysis showed a significant positive correlation between an average household income below minimum wage and a PRIME-MD diagnosis of major depression. A multiple regression analysis identified unplanned pregnancy as an independent predictor of major depression (86.2% in the group with a diagnosis of major depression by PRIME-MD vs. 68.4% in the group without major depression. A comparison between women who presented major depression and those who did not revealed no significant differences in the perinatal results (i.e., preterm delivery, birth weight and low Apgar scores. CONCLUSION: In the present study, unplanned pregnancy in women with a medical disorder was identified as a risk factor for major depression during gestation. Major depression during pregnancy in women with a medical disorder should be routinely investigated using

  15. STUDY OF MATERNAL AND PERINATAL OUTCOME IN WOMEN PRESENTING WITH FEBRILE ILLNESS DURING PREGNANCY

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    Surabhi

    2014-08-01

    Full Text Available OBJECTIVE: To find out the prevalence of various pathogens responsible for febrile illness during pregnancy and their impact on maternal and perinatal outcome. METHODS: After approval by institutional ethical committee the prospective case control study was conducted in the department of obstetrics and gynecology, NSCB Medical College, Jabalpur (M.P. from 1st June 2012 to 31st October 2013. A total 100 febrile antenatal women as cases and 50 antenatal women without fever as control were included and analyzed in this study. In women fulfilling inclusion criteria detailed history was taken and documented in proforma. Required investigations were sent to the department of pathology and virology laboratory of Indian Council of Medical Research, Jabalpur. Results were analyzed statistically by using t test and chi square test. RESULT: Prevalence of viral pathogen responsible for febrile illness during pregnancy was highest 19.33%, followed by bacteria (16% and protozoa (16% each. Duration of stay in the hospital, preterm delivery, coexisting maternal morbidity were more in cases as compared to control and were statistically significant. 9% cases died due to Malaria and Hepatitis B. Incidence of prematurity (55%, low birth weight (72%, perinatal mortality (41% (Intrauterine death & Still birth, neonatal admission in nursery (34% and congenital malformation (6% were more in cases as compared to control and were statistically significant. CONCLUSION: Fever during pregnancy is major public health problem and a high risk situation. Early identification of high risk cases should be done, so that prompt treatment will be instituted early, thereby reducing maternal and perinatal morbidity & mortality associated with fever

  16. Maternal obesity and its adverse impact on labor outcome

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    Inas Mahmoud Hamdy

    2011-10-01

    Full Text Available Objective: to study the impact of maternal obesity on the outcome of labour. Setting: Al zahraa University hospital.Design: prospective randomized control study.Patients: a total of (80 pregnant women were included in this study from April 2009 to March 2010. Patients and Methods:According to the BMI the patients were classified into two groups. Group (I: (Control Group:Included (30 patients with (body mass index (BMI ranging from 20 to 25 kg/m2.Group (II: (Obese Group: Included (50 patients with (BMI ranging from 25 to 30kg/m2. Each patient were subjected to full clinical examination (General Abdominal and pelvic U/S pelviabdominal examination that is to confirm the inclusion and exclusion criteria of the study. Results : A significant differences was noticed between 2 groups as regard the BMI. The current study showed significant difference in cases subjected to induction of labour with p-value 0.05.No significant diff. were noticed between the 2 groups as regard the cases with Apgar score < 7 at 5 minutes with p-value 0.06. A positive correlation coefficient between the BMI (25-29, (29-33 kg/m2 with the case of induction of labour, failure to progress 1st stage, shoulder dystoca, cesarean section and fetal low Apgar score. While a negative correlation was recorded between the BMI of the control group and all the adverse outcomes. Conclusion:Obesity of the gravid women is a sensitive predictor of the adverse outcome during pregnancy, labour, and post partum. Researches are needed into effective, applicable and acceptable community -based program for obese women planning a pregnancy.

  17. Perinatal Outcome of Discordant Anomalous Twins: A Single-Center Experience in a Developing Country.

    Science.gov (United States)

    Fernandes, Tatiana R M M; Carvalho, Paulo R N; Flosi, Fernanda B; Baião, Ana Elisa R; Junior, Sant Claire G

    2016-08-01

    A dramatic increase in twin pregnancies has been observed in the past few decades, primarily related to assisted reproductive techniques (ART) and increased average maternal age during pregnancy. Multiple pregnancies, compared to singleton pregnancies, are associated with greater perinatal morbidity and mortality. The present study evaluated the perinatal outcomes of pregnancies with discordant anomalous twins in a tertiary maternity ward in a developing country. Data were retrospectively collected from the Instituto Fernandes Figueira/FIOCRUZ, Brazil between January 2002 and December 2014. We identified 74 twin pregnancies with discordant anomalous twins. Final data analysis was based on 40 pregnancies. Congenital defects were classified according to the International Classification of Diseases: ICD-10: the digestive system was responsible in 27 (34%) cases; the central nervous system was responsible in 18 (22%) cases; the urinary tract was responsible in 14 (17%) cases; and the circulatory system was responsible in 14 (17%) cases. A total of 19 deaths occurred during the study period, and delivery before 30.4 weeks was a significant prediction of fetal death (p = .01). The presence of hydrops in the affected fetus was related to a higher number of deaths in healthy fetuses and contributed to a worse prognosis. The presence of this condition was the cause of 12 (55.6%) deaths in healthy fetuses. A 10 times higher risk of death of a normal co-twin was observed in cases of death of the anomalous twin (p = .002, OR 10.55, 95% CI: 1.9-58.52). PMID:27321141

  18. Perinatal outcome of growth restricted fetus with absent end diastolic umbilical blood flow: Case report

    Directory of Open Access Journals (Sweden)

    Tasić Marija

    2010-01-01

    Full Text Available Introduction. Absent or reversed end-diastolic blood flow in the umbilical artery is usually associated with poor perinatal outcome and high perinatal mortality rate. Case report. We present the case of a pregnant woman with absent end-diastolic blood flow in the umbilical artery in the 27th week of pregnancy with initial restriction of fetal growth. All though it was more and more obvious that the fetal growth was hindered, the Doppler, cardiotocographic and biophysical parameters did not get any worse as the pregnancy developed. The full fetal maturation was reached after the intense monitoring of the fetal condition and the pregnancy was terminated in the 37lh week by elective Cesarean section. Conclusion. The basic purpose of prenatal fetal monitoring in the situation of hindered fetal growth with chronic hypoxia is to predict the phase of decompensation and to terminate pregnancy before it is developed. The major problem is in great individual variations at the moment of development of decompensation phase, so the major obstetric aim in the monitoring of the fetus hindered in growth is to determine the optimal time and way of delivery.

  19. The relationship between salivary bacterial flora and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Sadeghi R

    2011-04-01

    Full Text Available "n 800x600 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Background: Many studies have shown that periodontal pathogens are emerging as a risk factor for preterm delivery and low birth weight, but there are few studies about the relationship between other oral bacteria and pregnancy outcomes. The aim of the present study was to determine the relationship between salivary bacteria and pregnancy outcomes."n"nMethods: This cohort study was performed on 300 pregnant women who were recruited from the prenatal clinic of Zeynab Hospital in Tehran during 2009-2010. The patients' demographic and pregnancy data were recorded. Using samplers, saliva samples were collected about one hour after breakfast. Microbial evaluation was performed by counting the bacteria based on their shape and the Gram reaction. The studied bacteria were composed of gram-positive and negative cocci, gram-positive and negative bacilli, spirilla, spirochetes, yeasts, fusiform bacteria and actinomycetes."n"nResults: The data on the bacteriological profile and pregnancy outcome of 243 out of the 300 eligible participants of the study were completed. Five cases (2% had intra uterine fetal death (IUFD while 238 (98% delivered live infants. There was a significant statistical relationship between the mean of gram-negative cocci and IUFD (P=0.04. 10 cases (4.1% of 243, experienced adverse delivery outcomes and 233 cases (95% had normal delivery. The adverse pregnancy outcomes had a significant relationship with the presence of spirochetes in saliva (P<0.05 but this relationship was not

  20. Adverse obstetric outcome for the vanishing twin syndrome.

    Science.gov (United States)

    Almog, Benny; Levin, Ishai; Wagman, Israel; Kapustiansky, Rita; Lessing, Joseph B; Amit, Ami; Azem, Foad

    2010-02-01

    The aim was to compare obstetric outcomes of IVF singleton pregnancies diagnosed with vanishing twin (VT) syndrome with those pregnancies originating as singleton pregnancies and with twin pregnancies. In this case control study, 57 patients diagnosed with VT syndrome were matched and compared with 171 singleton controls and 171 twin controls. Mean gestational age was 35.1+/-3.7 versus 38.2+/-2.6 weeks (P=0.001) for patients and singleton controls respectively. Birth weights were 2834.4+/-821.2 versus 3036+/-489.3g (P=0.02), proportion of low birth weight (< 2500 g) was 33.3 versus 11.7% (P=0.0001) and very low birth weight (< 1500 g) 3.5 versus 0.6% for patients and singleton controls respectively. The proportion of deliveries before 28 weeks of gestation was 7.0 versus 1.2% (P=0.01) for patients and singleton controls respectively. When comparing the study group to twin control pregnancies, a similar gestational age at delivery (35 weeks) and rate of preterm birth (23%) were found. In conclusion, pregnancies diagnosed with the VT syndrome after IVF carry a higher rate of adverse obstetric outcomes in terms of preterm deliveries and lower birth weight, compared with IVF pregnancies that were originally singleton. Additionally, significant similarities were observed in the obstetrics outcome of vanishing twin pregnancies and twin pregnancies. PMID:20113963

  1. The relationship between the neighbourhood environment and adverse birth outcomes.

    Science.gov (United States)

    Farley, Thomas A; Mason, Karen; Rice, Janet; Habel, Joanna D; Scribner, Richard; Cohen, Deborah A

    2006-05-01

    Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birthweight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birthweight-for-gestational-age was associated with the neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influences on birth outcomes. PMID:16629693

  2. Excessive folic acid intake and relation to adverse health outcome.

    Science.gov (United States)

    Selhub, Jacob; Rosenberg, Irwin H

    2016-07-01

    The recent increase in the intake of folic acid by the general public through fortified foods and supplements, has raised safety concern based on early reports of adverse health outcome in elderly with low B12 status who took high doses of folic acid. These safety concerns are contrary to the 2015 WHO statement that "high folic acid intake has not reliably been shown to be associated with negative healeffects". In the folic acid post-fortification era, we have shown that in elderly participants in NHANES 1999-2002, high plasma folate level is associated with exacerbation of both clinical (anemia and cognitive impairment) and biochemical (high MMA and high Hcy plasma levels) signs of vitamin B12 deficiency. Adverse clinical outcomes in association with high folate intake were also seen among elderly with low plasma B12 levels from the Framingham Original Cohort and in a study from Australia which combined three elderly cohorts. Relation between high folate and adverse biochemical outcomes were also seen in the Sacramento Area Latino Study on Aging (High Hcy, high MMA and lower TC2) and at an outpatient clinic at Yale University where high folate is associated with higher MMA in the elderly but not in the young. Potential detrimental effects of high folic acid intake may not be limited to the elderly nor to those with B12 deficiency. A study from India linked maternal high RBC folate to increased insulin resistance in offspring. Our study suggested that excessive folic acid intake is associated with lower natural killer cells activity in elderly women. In a recent study we found that the risk for unilateral retinoblastoma in offspring is 4 fold higher in women that are homozygotes for the 19 bp deletion in the DHFR gene and took folic acid supplement during pregnancy. In the elderly this polymorphism is associated with lower memory and executive scores, both being significantly worse in those with high plasma folate. These and other data strongly imply that

  3. A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine Hagedorn in type 1 diabetes

    DEFF Research Database (Denmark)

    Hod, Moshe; Mathiesen, Elisabeth R; Jovanovič, Lois;

    2014-01-01

    OBJECTIVE: This randomized controlled trial aimed to compare the efficacy and safety of insulin detemir (IDet) with neutral protamine Hagedorn (NPH), both with insulin aspart, in pregnant women with type 1 diabetes. The perinatal and obstetric pregnancy outcomes are presented. METHODS: Subjects...

  4. Poverty in childhood and adverse health outcomes in adulthood.

    Science.gov (United States)

    Raphael, Dennis

    2011-05-01

    The experience of poverty during childhood is a potent predictor of a variety of adverse health outcomes during middle and late adulthood. Children who live in poverty are more likely as adults than their peers to develop and die earlier from a range of diseases. These effects are especially strong for cardiovascular disease and type II diabetes. Most disturbingly, these effects appear in large part to be biologically embedded such that later improved life circumstances have only a modest ameliorative effect. Considering these findings and the relatively high rates of child poverty in nations such as Canada, UK, and USA, those concerned with improving the health of citizens should focus their attention on advocating for public policy that will reduce the incidence of child poverty. PMID:21398059

  5. Perinatal outcomes following an earlier post-term labour induction policy

    DEFF Research Database (Denmark)

    Lidegaard, Ø; Skovlund, C W; Mørch, L.S.;

    2015-01-01

    OBJECTIVE: To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009. DESIGN: Register-based cohort study. SETTING: Denmark, 2000-12. POPULATION: Newborns from 37 weeks of gestation. METHODS...... from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23%; odds ratio (OR) 0.77 (95% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units...

  6. Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

    Directory of Open Access Journals (Sweden)

    Semra Eroglu

    2015-11-01

    Full Text Available Aim: The purpose of this study was to investigate the association between maternal-fetal outcomes and the severity of preeclampsia. Material and Method: A total of 528 singleton pregnancies diagnosed with preeclampsia, severe preeclampsia or HELLP syndrome with pregnancies >24 weeks of gestation were retrospectively evaluated. For each patient, maternal age, gravidity, previous obstetric history, family history, gestational age at the time of hospitalization, systolic and diastolic blood pressures, presence of severe preeclampsia symptoms, laboratory values, dexamethasone use for the treatment of thrombocytopenia, route of delivery, maternal and perinatal outcomes were recorded. Results: Within the study period, the occurences of preeclampsia, HELLP syndrome and severe preeclampsia were 1.4%, 0.12% and 0.57%, respectively. In patients with HELLP syndrome, cesarean delivery rate, blood product transfusion, acute renal failure, liver function tests, D-dimer levels, neonatal respiratory distress syndrome (RDS, necrotizing enterocolitis (NEC, preterm retinopathy, pulmonary hemorrhage and sepsis occurrences, were significantly higher than in patients with mild and severe preeclampsia. On the contrary, platelet counts were significantly lower . In patients with mild preeclampsia, gestational age at the time of delivery, vaginal delivery rate, 1 and 5 minute APGAR score and newborn birthweight were significantly higher when compared to patients with severe preeclampsia or HELLP syndrome. In contrast, systolic and diastolic blood pressures, neonatal intensive care unit admission rate, hospital stay, protein levels in 24 hr urine, and maternal hemoglobin levels were significantly lower in this group. Discussion: In the present study, it was found that HELLP syndrome was more frequently associated with maternal complications and neonatal morbidities. For the prevention of morbidities due to these unpredictable syndromes with unclear etiologies

  7. Maternal and perinatal outcome in women with threatened abortion in first trimester

    Directory of Open Access Journals (Sweden)

    Meenal S. Sarmalkar

    2016-05-01

    Conclusions: Pregnant women with first trimester threatened abortion are at increased risk for spontaneous loss and adverse pregnancy outcomes. Knowledge of these risks may help the obstetricians to manage these cases vigorously in the antepartum period and do timely interventions as needed for a healthy mother and baby. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1438-1445

  8. Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women

    OpenAIRE

    Bernardo Ana L; Baciuk Erica P; Pereira Rosa I; Cecatti Jose G; Cavalcante Sergio R; Silveira Carla

    2009-01-01

    Abstract Background To evaluate the effectiveness and safety of water aerobics during pregnancy. Methods A randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fisher's or Student's t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across ...

  9. UTERINE ARTERY DOPPLER STUDY FOR PREDICTION OF ADVERSE OUTCOME IN HIGH RISK PREGNANCY

    Directory of Open Access Journals (Sweden)

    Gunjan

    2015-07-01

    Full Text Available AIM : To detect abnormal waveforms in uterine artery in pregnancies at risk between 20 to 24 weeks of gestation and to measure Resistance index (RI and systolic/diastolic ratio(S/D of these waveforms in study population and to study correlation of Doppler dat a with adverse pregnancy outcome. METHODS : This is a prospective study included Doppler analysis of uterine artery waveforms in 107 normotensive women with singleton pregnancy between 20 to24 weeks of period of gestation who were considered to be at increa sed risk of developing pregnancy complications. Women with Multiple gestation, with congenital anomaly of fetus, chronic hypertension, renal disease, cardiac disease, Diabetes Mellitus were excluded from the study. Bilateral uterine artery Doppler was done and Parameters studied were S/D ratio and RI in uterine artery. Early diastolic notch in uterine artery was watched for. The flow velocity waveforms considered abnormal if there was an early diastolic notch in uterine artery in either right or left uterin e artery was watched for abnormal pregnancy outcomes considered are Gestational hypertension, Pre - eclampsia IUGR, Abruptio placentae, IUD and preterm deliveries. RESULTS : minimum women were aged 21 – 25 year with minimum of 18 years and maximum of 36 years, 28% were primigravidae while 72% were multigravidae mean gestational age of which scan was done was 22 wks 1 day (20 - 24 minimum gestational age at time of delivery was 28 wks of gestation 70% women were delivered vaginally and 30% LSCS. 7% women developed Gestational Hypertension, 5% developed Preeclampsia, 8% neonates with IUGR, 3% developed Placental Abruption while 4% had IUD and 8% had Preterm deliveries. CONCLUSION : Abnormal uterine artery Doppler studies in second trimester have been associated with subsequent adverse pregnancy out comes including Preeclampsia IUGR and perinatal mortality. Doppler velocimetry is a primary tool for fetomaternal surveillance in high

  10. 皮肤瘙痒对ICP围产儿结局的影响%Influence of skin pruritus on perinatal outcomes of intrahepatic cholestasis of pregnancy

    Institute of Scientific and Technical Information of China (English)

    刘翠; 王勇; 楼方

    2013-01-01

    Objective To study the influence of skin pruritus on the perinatal outcomes of intrahepatic cholestasis of pregnancy ( ICP ). Methods A retrospective analysis was conducted on 455 cases of ICP, who were divided into group with skin pruritus and group without skin pruritus. The group with skin pruritus was further divided into group with long-term pruritus and group with short-term pruritus. The incidence of adverse perinatal outcomes was compared among different groups. Results The differences between group with skin pruritus and group without skin pruritus were not statistically significant in the incidence of fetus distress, birth asphyxia, premature rupture of membranes, pollution of amniotic fluid, premature, small for gestational age and respiratory system disease (χ2 value was 2.010, 0.791, 2.687, 2.004, 0.770, 1.082 and 0.705, respectively, all P >0.05 ). The differences in incidence of adverse perinatal outcomes were not significantly between group with long-term pruritus and group with short-term pruritus (χ2 value was 0. 651, 2. 622, 1. 518, 0. 218, 0.034, 1. 353 and 1. 105, respectively, all P > 0.05 ). Conclusion The perinatal outcomes of ICP are not impacted by skin pruritus or the duration of pruritus. Skin pruritus neither can be used as the index to determine the severity of ICP, nor can it be used to predict perinatal outcomes.%目的 探讨皮肤瘙痒对妊娠期肝内胆汁淤积症(ICP)围产儿结局的影响.方法 采用回顾性分析的方法,将455例ICP患者分为皮肤瘙痒组、无皮肤瘙痒组,再将皮肤瘙痒组分为长时间瘙痒组、短时间瘙痒组,比较各组围产儿不良结局发生率的差异.结果 皮肤瘙痒组与无皮肤瘙痒组在胎儿窘迫、出生窒息、胎膜早破、羊水污染、早产儿、小于胎龄儿、呼吸系统疾病发生率的差异均无统计学意义(χ2值分别为2.010、0.791、2.687、2.004、0.770、1.082、0.705,均P>0.05);长时间瘙痒组与短时间瘙痒组围产儿

  11. Efficacy of e-technologies in improving breastfeeding outcomes among perinatal women: a meta-analysis.

    Science.gov (United States)

    Lau, Ying; Htun, Tha P; Tam, Wai S W; Klainin-Yobas, Piyanee

    2016-07-01

    A growing line of research has highlighted that e-technologies may play a promising role in improving breastfeeding outcomes. The objective of this review was to synthesise the best of available evidence by conducting a meta-analysis to evaluate whether e-technologies have had any effect in improving breastfeeding outcomes among perinatal women. The review was conducted using nine electronic databases to search for English-language research studies from 2007 to 2014. A 'risk of bias' table was used to assess methodological quality. Meta-analysis was performed with the RevMan software. The Q test and I(2) test was used to assess the heterogeneity. The test of overall effect was assessed using z-statistics at P attitude (z = 3.01, P = 0.003) and breastfeeding knowledge (z = 4.54, P = < 0.00001) in subgroup analyses. This review provides support for the development of web-based, texting messaging, compact disc read-only memory, electronic prompts and interactive computer agent interventions for promoting and supporting breastfeeding. PMID:26194599

  12. Maternal Obesity: Lifelong Metabolic Outcomes for Offspring from Poor Developmental Trajectories During the Perinatal Period.

    Science.gov (United States)

    Zambrano, Elena; Ibáñez, Carlos; Martínez-Samayoa, Paola M; Lomas-Soria, Consuelo; Durand-Carbajal, Marta; Rodríguez-González, Guadalupe L

    2016-01-01

    The prevalence of obesity in women of reproductive age is increasing in developed and developing countries around the world. Human and animal studies indicate that maternal obesity adversely impacts both maternal health and offspring phenotype, predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Several mechanisms act together to produce these adverse health effects including programming of hypothalamic appetite-regulating centers, increasing maternal, fetal and offspring glucocorticoid production, changes in maternal metabolism and increasing maternal oxidative stress. Effective interventions during human pregnancy are needed to prevent both maternal and offspring metabolic dysfunction due to maternal obesity. This review addresses the relationship between maternal obesity and its negative impact on offspring development and presents some maternal intervention studies that propose strategies to prevent adverse offspring metabolic outcomes. PMID:26827819

  13. Adverse pregnancy outcomes and subsequent risk of cardiovascular disease in women with systemic lupus erythematosus

    OpenAIRE

    Lin, Pin; Rhew, Elisa; Ness, Roberta B.; PEACEMAN, Alan; Dyer, Alan; McPherson, David; Kondos, George T.; Edmundowicz, Daniel; Sutton-Tyrrell, Kim; Thompson, Trina; Ramsey-Goldman, Rosalind

    2014-01-01

    Background/objective Patients with systemic lupus erythematosus (SLE) are at increased risk for adverse pregnancy outcomes and cardiovascular disease (CVD). The objective of this exploratory study was to investigate the association between a history of adverse pregnancy outcomes and subsequent risk of subclinical CVD assessed by imaging studies and verified clinical CVD events in 129 women with SLE. Methods The occurrence of adverse pregnancy outcomes, specifically pre-eclampsia, preterm birt...

  14. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford;

    2007-01-01

    Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauterine...... study focuses on pro-thrombotic and cardiovascular genetic polymorphisms in a nested-case control study comparing pregnancies with and without an adverse pregnancy outcome in the index pregnancy. This study will be adequately powered to determine the relationship between adverse pregnancy outcome and...

  15. Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries: A Systematic Literature Review.

    Science.gov (United States)

    Aguiar, Carolina; Jennings, Larissa

    2015-09-01

    Encouraging male partners to accompany women to antenatal care (ANC) is an important first step in engaging men on maternal and newborn health. However, little is known regarding the impact of male partner antenatal accompaniment beyond HIV-related perinatal outcomes. A systematic review was conducted to synthesize the evidence on the influence of male accompaniment on non-HIV outcomes during pregnancy and into the postpartum period. Eligible studies were published in English from 2003 to 2013 and evaluated the effect of male antenatal accompaniment on perinatal health in a developing country. Four electronic databases and selected reference lists were searched. Out of 84 potential citations retrieved, seven publications were retained for the assessment of male antenatal accompaniment's influence using iterative thematic analysis. During pregnancy, male antenatal accompaniment positively impacted women's knowledge of danger signs, but did not affect birth preparedness, ANC utilization, or miscarriages. During labor and delivery, men's ANC presence was associated with increases in institutional delivery and skilled birth attendance, but with no effect for birth-related outcomes. During the early postnatal period, male antenatal accompaniment was associated with higher uptake of postnatal services, but with mixed effects on breastfeeding and newborn survival. Couples' increased communication on pregnancy care and men's subsequent motivation to ensure safe delivery may explain these observed benefits. Inadequate communication, late accompaniment, or partner type may explain the lack of influence on some outcomes. More efforts are needed to expand the implementation and evaluation of male involvement strategies to improve perinatal health. PMID:25656727

  16. Maternal and perinatal outcome in eclampsia and factors affecting the outcome: a study in North Indian population

    Directory of Open Access Journals (Sweden)

    Deepika Pannu

    2014-04-01

    Results: During the defined period incidence of Eclampsia was 3.2 per 1000 deliveries. Maternal death occurred in 8.4% of patients and still birth in 18.8%. Inadequate and delayed initiation of treatment and preterm deliveries was found to be associated with poor maternal and fetal outcome. As the time interval between and lsquo;onset of fit and delivery' increased, chances of adverse outcome also increased. However, age, parity, onset of seizures before, during or after delivery was not found to have any effect on maternal and fetal outcome. Conclusions: It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities and multidisciplinary units are available. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 347-351

  17. Mental and Behavioral Disorders Due to Substance Abuse and Perinatal Outcomes: A Study Based on Linked Population Data in New South Wales, Australia

    Directory of Open Access Journals (Sweden)

    Michelle R. Bonello

    2014-05-01

    Full Text Available Background: The effects of mental and behavioral disorders (MBD due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA, 306 for MBD due to opioids use (MBDO and 497 for MBD due to cannabinoids (MBDC between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97–8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76–22.57 both periods; preterm birth (AOR = 3.26, 95% CI: 1.52–6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50–11.01 both periods and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31–4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72–9.44 both periods. Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62–8.57. Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes.

  18. CLINICAL STUDY TO EVALUATE THE MATERNAL AND PERINATAL OUTCOME OF PREGNANCIES WITH POLYHYDRAMNIOS

    Directory of Open Access Journals (Sweden)

    Sudha

    2013-10-01

    Full Text Available ABSTRACT: BACKGROUND : Due to active involvement of fetal system in regulation of amn iotic fluid volume, AFI has been identified as indicator of intrauterine fetal status. USG has revolutionized the process of assessment of amniotic fluid thus becoming an integral part of fetal surveillance . Polyhydramnios is an obstetrical condition assoc iated with significant perinatal and maternal morbidity and mortality. In a low resource health facility as India with poor coverage of antenatal care and malnutrition it still becomes more important to screen pregnancies for such high risk factors. AIMS: 1. To study incidence of polyhydramnios. 2. To identify major etiological factors of polyhydramnios. 3. To study perinatal outcome. SETTINGS AND DESIGN: A hospital based cross section study for duration from 1 st May 2009 to 31 st October 2010. MATERIAL & ME THOD: All the cases identified as polyhydramnios according to AFI in four pocket were included in the study. The cases identified as having polyhydramnios but not delivered at the facility were excluded. OBSERVATION: Incidence of polyhydramnios is 0.72% of the total antenatal cases, multiparous ie, 52% more than primiparous cases. Majority were unbooked (77.3% 63% were from rural set up. 76% belonged to low socio economic status. Majority 66% of the cases had their 1 st antenatal visit at term. Increased in cidence of operative delivery was seen in the study. Associated maternal factors found with polyhydramnios were gestation hypertension (8.4%, preeclampsia (2.9%, eclampsia (2.9%, anaemia (11%, twins (8.4%, malpresentation (5%, RH negative factor (3.7 %, and diabetes (1.9%. Fetal complication include prematurity 21.6%, IUFT 20.7%, congenital malformation 21.6%, cord prolapse 3.7%, birth asphyxia 1.9%. Most common congenital anomaly was anencephaly i.e., 11%. CONCLUSION : The study gives us the underst anding of the impact of polyhydramnios on the maternal and fetal outcome. Our study demonstrate s

  19. Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure--retrospective cohort study in an urban obstetric population in Ireland.

    LENUS (Irish Health Repository)

    Mullally, Aoife

    2011-04-01

    Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption.

  20. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

    LENUS (Irish Health Repository)

    McKenny, M

    2011-05-01

    This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery.

  1. Physical Activity and Excess Weight in Pregnancy Have Independent and Unique Effects on Delivery and Perinatal Outcomes

    OpenAIRE

    Morgan, Kelly L.; Rahman, Muhammad A.; Hill, Rebecca A; Zhou, Shang-Ming; Bijlsma, Gunnar; Khanom, Ashrafunnesa; Lyons, Ronan A.; Brophy, Sinead T.

    2014-01-01

    Background This study examines the effect of low daily physical activity levels and overweight/obesity in pregnancy on delivery and perinatal outcomes. Methods A prospective cohort study combining manually collected postnatal notes with anonymised data linkage. A total of 466 women sampled from the Growing Up in Wales: Environments for Healthy Living study. Women completed a questionnaire and were included in the study if they had an available Body mass index (BMI) (collected at 12 weeks gest...

  2. Study of Maternal and Perinatal outcome in moderate to severe degree iron deficiency anaemia in rural community

    OpenAIRE

    Bangal, Vidyadhar B; Aher, Kunal; Bhosale, Ketki; Tuse, Harshad

    2016-01-01

    Background: Anaemia is the commonest medical disorder associated with pregnancy. It contributes to one fifth of the maternal deaths and large number of preterm deliveries and low birth weight babies in India.Objectives: To study maternal and perinatal outcome in pregnancies complicated by anaemia.Setting- Tertiary care teaching hospital in central India.Study Design: Prospective observational study.Material and Methods: Study was conducted for a period of two years from September 2012 to Augu...

  3. Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review

    OpenAIRE

    Perales, María; Santos-Lozano, Alejandro; Ruiz, Jonatan R.; Lucía Mulas, Alejandro; Barakat, Rubén

    2016-01-01

    To understand what evidence exists with regard to maternal and offspring benefits of aerobic and/or resistance training during pregnancy. Systematic review of RCTs (published until May 2015) with healthy pregnant women and focusing on the benefits of exercise interventions on maternal health or perinatal outcomes. Studies were ranked as high/low quality, and a level of evidence was established according to the number of high-quality studies and consistency of the results. 61 RCTs were analyze...

  4. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects

    DEFF Research Database (Denmark)

    Hod, Moshe; Damm, Peter; Kaaja, Risto;

    2008-01-01

    The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy.......The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy....

  5. Perinatal outcome in terms of apgar score at 5 minutes after induction of term and post-date pregnancies

    International Nuclear Information System (INIS)

    Objective: To determine perinatal outcome in terms of Apgar score at 5 minutes after delivery and admission in neonatal intensive care unit (NICU) in induction of term and post-dates pregnancies. Study Design: Descriptive case series. Place and Duration: Gynaecology/Obstetrics Department, Military Hospital, Rawalpindi from 16-02-2009 to 15-08-2009. Subjects and Methods: One hundred and sixty three patients were included in this study. Patients were closely monitored during labour. Perinatal outcome was noted by assessing Apgar score at 5 minutes after delivery and by number of babies admitted to NICU within 1st 24 hours after delivery. Results: Apgar score at 5 minutes was more than > 7 in 67 (94.4%) of term pregnancy and in 85 (92.4%) in post date pregnancy and this difference was insignificant (p=0.618). Only one baby (1.4%) among term group required admission in NICU within first 24 hours of delivery while 3 babies (3.3%) in post date pregnancy had admission in NICU with insignificant difference (p=0.448). Conclusion: Post-term pregnancy, in most cases, probably represents a variant of normal and is associated with good outcome, regardless of form of care givers. In minority of cases there is an increased risk of perinatal death and early neonatal convulsions. (author)

  6. Maternal and perinatal outcome of eclampsia in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Sasmita Swain

    2016-02-01

    Results: In this study 218 eclampsia cases were studied. The incidence of eclampsia in S.C.B.MCH during study period was 1.39%. Most of the patients were primigravida accounting 83.48% out of which 74.31% were antepartum, 14.22% were intrapartum and 11.47% were postpartum. 44.04% of cases had no ANC and 40.36 irregular ANC. Occurrence of onset of eclampsia at 38 weeks 29.35%. Most of patients were from rural area (97.50% and having low socioeconomic status (83.94% and illiterate. Out of 218 cases 46.33% patients had vaginal delivery, 3.21% patients had vaginal delivery with instrumentation. Conclusions: There is a need of proper antenatal care to prevent eclampsia and the need for intensive monitoring of women with eclampsia throughout hospitalization to improve both the maternal and perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 384-390

  7. Management of resistant prolactinoma in infertile lady with successful maternal and perinatal outcome

    Directory of Open Access Journals (Sweden)

    Niroopama Pushpagiri

    2015-10-01

    Full Text Available Mrs. X of 28 years presented to the gynaecology department with primary infertility for 4 years, secondary amenorrhea for 6 months and galactorrhea for 3 months. She was investigated and diagnosed to have macroprolactinoma. Medical treatment with cabergoline was started. Patient became symptomatically free in 6 months with gradual reduction in serum prolactin levels as well as tumour size. After 2 years of therapy, failure of normalisation of prolactin levels and failure of significant tumour reduction observed and diagnosed it as resistant prolactinoma. Considering her infertility and future complications associated with resistant macroadenoma, she was treated with stereotactic radiosurgery using cyber knife radiation. Tumour regression in MRI with significant decrease in serum prolactin levels were observed in the post radiation period and monthly follow up done. She conceived spontaneously after 2 months of radiotherapy. She has been followed up with visual field testing during antenatal period. Her antenatal, intranatal period was uneventful with successful maternal and perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1659-1662

  8. Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes.

    Science.gov (United States)

    Tedeschi, Sara K; Guan, Hongshu; Fine, Alexander; Costenbader, Karen H; Bermas, Bonnie

    2016-07-01

    Systemic lupus erythematosus (SLE) is a disease of reproductive-age women, and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the 6 months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women's Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, pre-term delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12-20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. Most pregnancies resulted in a live term delivery (76.5 %). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use 6 months before conception, nephritis during pregnancy (odds ratio (OR) 3.6, 95 % confidence interval (CI) 1.0-12.8), cytopenias during pregnancy (OR 3.9, 95 % CI 1.3-11.4), and serositis during pregnancy (OR 5.9, 95 % CI 1.0-34.0) were significantly associated with adverse pregnancy outcome. Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias, and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy. PMID:27166627

  9. Maternal obesity in early pregnancy and risk of adverse outcomes.

    Directory of Open Access Journals (Sweden)

    Inmaculada Bautista-Castaño

    Full Text Available OBJECTIVES: To assess the role of the health consequences of maternal overweight and obesity at the start of pregnancy on gestational pathologies, delivery and newborn characteristics. METHODS: A cohort of pregnant women (n = 6.558 having delivered at the Maternal & Child University Hospital of Gran Canaria (HUMIGC in 2008 has been studied. Outcomes were compared using multivariate analyses controlling for confounding variables. RESULTS: Compared to normoweight, overweight and obese women have greater risks of gestational diabetes mellitus (RR = 2.13 (95% CI: 1.52-2.98 and (RR = 2.85 (95% CI: 2.01-4.04, gestational hypertension (RR = 2.01 (95% CI: 1.27-3.19 and (RR = 4.79 (95% CI: 3.13-7.32 and preeclampsia (RR = 3.16 (95% CI: 1.12-8.91 and (RR = 8.80 (95% CI: 3.46-22.40. Obese women have also more frequently oligodramnios (RR = 2.02 (95% CI: 1.25-3.27, polyhydramnios. (RR = 1.76 (95% CI: 1.03-2.99, tearing (RR = 1.24 (95% CI: 1.05-1.46 and a lower risk of induced deliveries (RR = 0.83 (95% CI: 0.72-0.95. Both groups have more frequently caesarean section (RR = 1.36 (95% CI: 1.14-1.63 and (RR = 1.84 (95% CI: 1.53-2.22 and manual placenta extraction (RR = 1.65 (95% CI: 1.28-2.11 and (RR = 1.77 (95% CI: 1.35-2.33. Newborns from overweight and obese women have higher weight (p<0.001 and a greater risk of being macrosomic (RR = 2.00 (95% CI: 1.56-2.56 and (RR = 2.74 (95% CI: 2.12-3.54. Finally, neonates from obese mother have a higher risk of being admitted to special care units (RR = 1.34 (95% CI: 1.01-1.77. Apgar 1 min was significantly higher in newborns from normoweight mothers: 8.65 (95% CI: 8.62-8.69 than from overweight: 8.56 (95% CI: 8.50-8.61 or obese mothers: 8.48 (95% CI: 8.41-8.54. CONCLUSION: Obesity and overweight status at the beginning of pregnancy increase the adverse outcomes of the pregnancy. It is important to promote the normalization of bodyweight in those

  10. Reduced Perinatal Leptin Availability May Contribute to Adverse Metabolic Programming in a Rat Model of Uteroplacental Insufficiency.

    Science.gov (United States)

    Nüsken, Eva; Wohlfarth, Maria; Lippach, Gregor; Rauh, Manfred; Schneider, Holm; Dötsch, Jörg; Nüsken, Kai-Dietrich

    2016-05-01

    Leptin availability in perinatal life critically affects metabolic programming. We tested the hypothesis that uteroplacental insufficiency and intrauterine stress affect perinatal leptin availability in rat offspring. Pregnant rats underwent bilateral uterine vessel ligation (LIG; n = 14), sham operation (SOP; n = 12), or no operation (controls, n = 14). Fetal livers (n = 180), placentas (n = 180), and maternal blood were obtained 4 hours (gestational day [E] 19), 24 hours (E20), and 72 hours (E22) after surgery. In the offspring, we took blood samples on E22 (n = 44), postnatal day (P) 1 (n = 29), P2 (n = 16), P7 (n = 30), and P12 (n = 30). Circulating leptin (ELISA) was significantly reduced in LIG (E22, P1, P2) and SOP offspring (E22). Postnatal leptin surge was delayed in LIG but was accelerated in SOP offspring. Placental leptin gene expression (quantitative RT-PCR) was reduced in LIG (E19, E20, E22) and SOP (E20, E22). Hepatic leptin receptor (Lepr-a, mediating leptin degradation) gene expression was increased in LIG fetuses (E20, E22) only. Surprisingly, hypoxia-inducible factors (Hif; Western blot) were unaltered in placentas and were reduced in the livers of LIG (Hif1a, E20; Hif2a, E19, E22) and SOP (Hif2a, E19) fetuses. Gene expression of prolyl hydroxylase 3, a factor expressed under hypoxic conditions contributing to Hif degradation, was increased in livers of LIG (E19, E20, E22) and SOP (E19) fetuses and in placentas of LIG and SOP (E19). In summary, reduced placental leptin production, increased fetal leptin degradation, and persistent perinatal hypoleptinemia are present in intrauterine growth restriction offspring, especially after uteroplacental insufficiency, and may contribute to perinatal programming of leptin resistance and adiposity in later life. PMID:27007072

  11. Perinatal Outcomes of Newborn Infants Conceived by Assisted Reproductive Techniques in Royan Institute

    Directory of Open Access Journals (Sweden)

    Sharareh Dadashloo

    2009-01-01

    Full Text Available Background: The outcomes of such pregnancies have been rarely evaluated in our country. Adescriptive study was planned to assess the health and condition of neonates conceived with assistedtechniques in a one year period.Materials and Methods: At Royan Institute, Tehran, 443 women who became pregnant by oneof the assisted techniques in vitro fertilization (IVF, intrauterine insemination (IUI andintracytoplasmic sperm injection (ICSI enrolled in a descriptive study during 16 month periodbeginning on September, 2007. The sampling method used was non-incidental, consecutive.Questionnaires regarding the contents of the baby birth card were completed after interviews withthe mothers. The time from fertilization of the ovum until delivery was considered as the gestational(conception age. Pregnant mothers were under periodic evaluation until delivery. Women withstillborn babies were followed via phone contact.Results: From a total of 443 conceptions, there were 13 (2.9% pregnancies demised in utero(stillbirths and 10 (2.6% who died during the neonatal period. Additionally, 133 (43% infantswere born after multifetal pregnancies and 96 (31% infants were prematurely born. There were 106(34.3% infants with low birth weight (LBW; less than 2500 g, of which 83 (78.3% LBW infantswere multiplets. After completion of the study, 71 women were still passing their pregnancy periodand no assessed.Conclusion: The most important factor for untoward perinatal events was multifetal pregnancy. Suchpregnancies were more frequently complicated and higher risk. Low birth weight and prematuritywere more frequent in singletons conceived by assisted techniques in respect to control singletons.

  12. BIRTH MALFORMATIONS AND OTHER ADVERSE PERINATAL OUTCOMES IN FOUR U.S. WHEAT PRODUCING STATES: RESPONSE

    Science.gov (United States)

    Chlorophenoxy herbicides are widely used in the U.S. and Western Europe for broadleaf weed control in grain farming and park maintenance. Most of the spring and durum wheat produced in the U.S. is grown in Minnesota, Montana, North Dakota, and South Dakota, with over 85% of the a...

  13. Risk of adverse pregnancy outcome in women exposed to livestock

    DEFF Research Database (Denmark)

    Nielsen, Stine Yde; Henriksen, T B; Hjøllund, Niels Henrik Ingvar; Mølbak, Kare; Andersen, Annett Dalbøge

    2013-01-01

    outcome in women with self-reported occupational or domestic contact with livestock compared to pregnant women without such contact. The Danish National Birth Cohort collected information on pregnancy outcome from 100 418 pregnant women (1996-2002) from which three study populations with occupational and...

  14. Population-based investigations to study the association of cardiovascular polymorphisms and adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Lykke, Jacob Alexander; Langhoff-Roos, Jens; Young, Bradford;

    2007-01-01

    Adverse pregnancy outcome refers to placenta-mediated complications that may share a common etiopathogenesis in some cases. Unraveling associations between prothrombotic genetic predispositions and these pregnancy disorders, namely recurrent fetal loss, stillbirth, severe preeclampsia, intrauteri...... pro-thrombotic and cardiovascular genetic polymorphisms. These studies are urgently needed to accurately assess the linkage between family history, presence of adverse pregnancy outcome, and long-term cardiovascular risk....... growth restriction, and placental abruption, requires rigorous epidemiological studies involving large cohorts of patients with sufficient numbers of the adverse pregnancy outcomes in question. Such is the case with the Denmark National Birth Cohort, which was initiated in 1996 and followed pregnant...

  15. Residential exposure to traffic emissions and adverse pregnancy outcomes

    OpenAIRE

    Pereira, Gavin; Nassar, Natasha; Bower, Carol; Weinstein, Philip; Cook, Angus

    2010-01-01

    Motor vehicle traffic emissions are the single largest contributor to ambient air pollution in many developed countries and it has been suggested that these emissions can affect outcomes of pregnancy. An individual’s exposure experience is greatly influenced by where they live as emission concentrations are much higher closer to roads. A systematic review was conducted using the MOOSE guidelines in order to synthesise studies published 1989-2009 which investigated pregnancy outcomes in relat...

  16. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China

    OpenAIRE

    Jin, Wen-Yuan; Lin, Sheng-Liang; Hou, Ruo-Lin; Chen, Xiao-Yang; Han, Ting; Jin, Yan; Tang, Li; Zhu, Zhi-wei; Zhao, Zheng-yan

    2016-01-01

    Background Dyslipidemia in pregnancy are associated with gestational diabetes mellitus (GDM), preeclampsia, preterm birth and other adverse outcomes, which has been extensively studied in western countries. However, similar studies have rarely been conducted in Asian countries. Our study was aimed at investigating the associations between maternal dyslipidemia and adverse pregnancy outcomes among Chinese population. Methods Data were derived from 934 pairs of non-diabetic mothers and neonates...

  17. Perinatal and neurodevelopmental outcome of late-onset growth restricted fetuses

    OpenAIRE

    Orós López, Daniel

    2010-01-01

    [spa] DE LA TESIS: "Resultado perinatal y del neurodesarrollo en fetos con retraso de crecimiento intrauterino de instauración tardía" TEXTO: El retraso de crecimiento intrauterino es una de las patologías más graves del desarrollo fetal, asociándose con un incremento la mortalidad intrauterina, mortalidad perinatal y prematuridad, siendo un conocido factor de riesgo para el desarrollo de déficits neurológicos durante la infancia y la adolescencia. Se considera "pequeños" a todos los fetos co...

  18. Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Thomas Angela N

    2009-09-01

    Full Text Available Abstract Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR. Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133 with birth weight 1500 g or more at Muhimbili National Hospital (MNH. The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care. The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

  19. Long-Term Cognitive Outcomes of Birth Asphyxia and the Contribution of Identified Perinatal Asphyxia to Cerebral Palsy.

    Science.gov (United States)

    Pappas, Athina; Korzeniewski, Steven J

    2016-09-01

    Neonatal encephalopathy among survivors of presumed perinatal asphyxia is recognized as an important cause of cerebral palsy (CP) and neuromotor impairment. Recent studies suggest that moderate to severe neonatal encephalopathy contributes to a wide range of neurodevelopmental and cognitive impairments among survivors with and without CP. Nearly 1 of every 4 to 5 neonates treated with hypothermia has or develops CP. Neonatal encephalopathy is diagnosed in only approximately 10% of all cases. This article reviews the long-term cognitive outcomes of children with presumed birth asphyxia and describes what is known about its contribution to CP. PMID:27524454

  20. Impact of Changes in Perinatal Care on Neonatal Respiratory Outcome and Survival of Preterm Newborns: An Overview of 15 Years

    Directory of Open Access Journals (Sweden)

    Filipa Flor-de-Lima

    2012-01-01

    Full Text Available Survival and outcomes for preterm infants with respiratory distress syndrome (RDS have improved over the past 30 years. We conducted a study to assess the changes in perinatal care and delivery room management and their impact on respiratory outcome of very low birth weight newborns, over the last 15 years. A comparison between two epochs was performed, the periods before and after 2005, when early nasal continuous positive airway pressure (NCPAP and Intubation-SURfactant-Extubation (INSURE were introduced in our center. Three hundred ninety-five clinical records were assessed, 198 (50.1% females, gestational age 29.1 weeks (22–36, and birth weight 1130 g (360–1498. RDS was diagnosed in 247 (62.5% newborns and exogenous surfactant was administered to 217 (54.9%. Thirty-three (8.4% developed bronchopulmonary dysplasia (BPD, and 92 (23% were deceased. With the introduction of early NCPAP and INSURE, there was a decrease on the endotracheal intubation need and invasive ventilation (P<0.0001, oxygen therapy (P=0.002, and mortality (P<0.0001. The multivariate model revealed a nonsignificant reduction in BPD between the two epochs (OR=0.86; 95% CI 0.074–9.95; P=0.9. The changes in perinatal care over the last 15 years were associated to an improvement of respiratory outcome and survival, despite a nonsignificant decrease in BPD rate.

  1. VIOLENT CRIME EXPOSURE CLASSIFICATION AND ADVERSE BIRTH OUTCOMES: A GEOGRAPHICALLY-DEFINED COHORT STUDY

    Science.gov (United States)

    BackgroundArea-level socioeconomic disparities have long been associated with adverse pregnancy outcomes. Crime is an important element of the neighborhood environment inadequately investigated in the public health literature. Using geocoded linked birth, crime and cens...

  2. Motor Testing at 1 Year Improves the Prediction of Motor and Mental Outcome at 2 Years after Perinatal Hypoxic-Ischaemic Encephalopathy

    Science.gov (United States)

    van Schie, Petra Em; Becher, Jules G.; Dallmeijer, Annet J.; Barkhof, Frederik; van Weissenbruch, Mirjam M.; Vermeulen, R. Jeroen

    2010-01-01

    Aim: To investigate the predictive value of motor testing at 1 year for motor and mental outcome at 2 years after perinatal hypoxic-ischaemic encephalopathy (HIE) in term neonates. Method: Motor and mental outcome at 2 years was assessed with the Bayley Scales of Infant Development, 2nd edition (BSID-II) in 32 surviving children (20 males, 12…

  3. Long-term health-related and economic consequences of short-term outcomes in evaluation of perinatal interventions

    Directory of Open Access Journals (Sweden)

    Teune Margreet J

    2010-08-01

    Full Text Available Abstract Background Many perinatal interventions are performed to improve long-term neonatal outcome. To evaluate the long-term effect of a perinatal intervention follow-up of the child after discharge from the hospital is necessary because serious sequelae from perinatal complications frequently manifest themselves only after several years. However, long-term follow-up is time-consuming, is not in the awareness of obstetricians, is expensive and falls outside the funding-period of most obstetric studies. Consequently, short-term outcomes are often reported instead of the primary long-term end-point. With this project, we will assess the current state of affairs concerning follow-up after obstetric RCTs and we will develop multivariable prediction models for different long-term health outcomes. Furthermore, we would like to encourage other researchers participating in follow-up studies after large obstetric trials (> 350 women to inform us about their studies so that we can include their follow-up study in our systematic review. We would invite these researchers also to join our effort and to collaborate with us on the external validation of our prediction models. Methods/Design A systematic review of neonatal follow-up after obstetric studies will be performed. All reviews of the Cochrane Pregnancy and Childbirth group will be assessed for reviews on interventions that aimed to improve neonatal outcome. Reviews on interventions primary looking at other aspects than neonatal outcome such as labour progress will also be included when these interventions can change the outcome of the neonate on the short or long-term. Our review will be limited to RCTs with more than 350 women. Information that will be extracted from these RCTs will address whether, how and for how long follow-up has been performed. However, in many cases long-term follow-up of the infants will not be feasible. An alternative solution to limited follow-up could be to develop

  4. Therapeutic Hypothermia Modifies Perinatal Asphyxia-Induced Changes of the Corpus Callosum and Outcome in Neonates

    NARCIS (Netherlands)

    Alderliesten, Thomas; de Vries, Linda S.; Khalil, Yara; van Haastert, Ingrid C.; Benders, Manon J. N. L.; Koopman-Esseboom, Corine; Groenendaal, Floris

    2015-01-01

    What Is Known about this Subject? Diffusion-weighted MRI has demonstrated changes in the corpus callosum of term neonates with perinatal asphyxia. The severity of cerebral changes demonstrated using diffusion-weighted MRI is difficult to assess without measuring values of the Apparent Diffusion Coef

  5. Abnormal umbilical artery Doppler in third trimester and perinatal outcome: a retrospective study

    Directory of Open Access Journals (Sweden)

    Shiny Varghese

    2016-07-01

    Conclusions: Umbilical artery Doppler helps in the prediction of possible maternal and foetal complications in cases of compromised placental flow. Monitoring of antenatal parameters, availability of emergency facility for early surgical intervention and neonatal care pave a long way in curtailing perinatal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2196-2199

  6. Femoral and Inguinal Hernia : How to Minimize Adverse Outcomes Following Repair

    OpenAIRE

    Dahlstrand, Ursula

    2011-01-01

    Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures ...

  7. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-01-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far.......Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far....

  8. Development of a Screening Tool for Predicting Adverse Outcomes of Gestational Diabetes Mellitus

    Science.gov (United States)

    Park, Jee Soo; Kim, Deok Won; Kwon, Ja-Young; Park, Yong Won; Kim, Young Han; Cho, Hee Young

    2016-01-01

    Abstract Gestational diabetes mellitus (GDM) is a common disease in pregnancy causing maternal and fetal complications. To prevent these adverse outcomes, optimal screening and diagnostic criteria must be adequate, timely, and efficient. This study suggests a novel approach that is practical, efficient, and patient- and clinician-friendly in predicting adverse outcomes of GDM. The authors conducted a retrospective cohort study via medical record review of patients admitted between March 2001 and April 2013 at the Severance Hospital, Seoul, South Korea. Patients diagnosed by a conventional 2-step method were evaluated according to the presence of adverse outcomes (neonatal hypoglycemia, hyperbilirubinemia, and hyperinsulinemia; admission to the neonatal intensive care unit; large for gestational age; gestational insulin therapy; and gestational hypertension). Of 802 women who had an abnormal 50-g, 1-hour glucose challenge test, 306 were diagnosed with GDM and 496 did not have GDM (false-positive group). In the GDM group, 218 women (71.2%) had adverse outcomes. In contrast, 240 women (48.4%) in the false-positive group had adverse outcomes. Women with adverse outcomes had a significantly higher body mass index (BMI) at entry (P = 0.03) and fasting blood glucose (FBG) (P = 0.03). Our logistic regression model derived from 2 variables, BMI at entry and FBG, predicted GDM adverse outcome with an area under the curve of 0.642, accuracy of 61.3%, sensitivity of 57.2%, and specificity of 66.9% compared with the conventional 2-step method with an area under the curve of 0.610, accuracy of 59.1%, sensitivity of 47.6%, and specificity of 74.4%. Our model performed better in predicting GDM adverse outcomes than the conventional 2-step method using only BMI at entry and FBG. Moreover, our model represents a practical, inexpensive, efficient, reproducible, easy, and patient- and clinician-friendly approach. PMID:26735528

  9. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

    OpenAIRE

    Hjortdal Vibeke E; Christensen Thomas D; Andersen Niels H; Gjedsted Jakob; Hansen Troels K; Mikkelsen Martin M; Johnsen Søren P

    2010-01-01

    Abstract Background Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery. Methods In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients unde...

  10. Psychosocial job strain and risk of adverse birth outcomes

    DEFF Research Database (Denmark)

    Larsen, Ann Dyreborg; Hannerz, Harald; Juhl, Mette;

    2013-01-01

    A number of studies examined the effects of prenatal stress on birth outcomes with diverging and inconclusive results. We aimed to examine if working with high job strain during pregnancy measured in week 16 was associated with risk of giving birth to a child born preterm or small/large for...

  11. Adverse reproduction outcomes among employees working in biomedical research laboratories

    DEFF Research Database (Denmark)

    Wennborg, H.; Bonde, Jens Peter; Stenbeck, M.;

    2002-01-01

    Objectives The aim of the study was to investigate reproductive outcomes such as birthweight, preterm births, and postterm births among women working in research laboratories while pregnant. Methods Female university personnel were identified from a source cohort of Swedish laboratory employees...

  12. A CLINICAL STUDY OF EFFECTS OF POLY AND OLIGOHY DROMNIOS ON OBSTETRIC OUTCOME WITH A SP E C I AL REF ERENCE TO PERINATAL MORTALITY AND MORBI D ITY

    Directory of Open Access Journals (Sweden)

    Sunanda Bai

    2015-08-01

    oligohydramn ios group (54%. IUGR cases were common in oligohydramnios group. NICU admission was highest in oligohydramnios group (50.66% than polyhydramnios (28% group. CONCLUSION: Development of abnormal liquor volume during pregnancy signals danger to the foetus. It is associated with an increased incidence of caesarean section, labour complications and adverse perinatal outcome. Etiological factors are important in all cases of abnormal liquor volume, to get better foetal outcome as well as to avoid the maternal complications

  13. Theoretical Framework to Extend Adverse Outcome Pathways to Include Pharmacokinetic Considerations

    Science.gov (United States)

    Adverse Outcome Pathways (AOPs) have generated intense interest for their utility in linking known population outcomes to a molecular initiating event (MIE) that can be quantified using in vitro methods. While there are tens of thousands of chemicals in commercial use, biology h...

  14. Early MRI in term infants with perinatal hypoxic–ischaemic brain injury: Interobserver agreement and MRI predictors of outcome at 2 years

    International Nuclear Information System (INIS)

    Aim: To compare diffusion-weighted imaging (DWI) and non-DWI magnetic resonance imaging (MRI), proton MR spectroscopy (1H-MRS), and clinical biomarkers for prediction of 2 year developmental outcome in term infants with perinatal hypoxic–ischaemic encephalopathy (HIE). Materials and methods: Nineteen infants ≥36 weeks gestation with HIE were recruited and MRI performed day 3–7 (mean = 5). MRI was scored independently by three radiologists using a standardized scoring system. Lactate-to-N-acetylaspartate ratio (Lac:NAA) in the lentiform nucleus was calculated. Developmental assessment was performed at 2 years using the Bayley Scales of Infant and Toddler Development (BSID-III). Interobserver agreement about abnormality in 10 brain regions was measured. Univariate analysis was performed to determine variables associated with adverse outcome (i.e., death or Bayley score for any domain <70). Results: Good interobserver agreement (kappa = 0.61–0.69) on scores for DWI was obtained for the cortex, putamen, and brainstem, but not for any region on non-DWI. A significant association was found between outcome and Lac:NAA (p < 0.003) and DWI scores for lentiform nucleus, thalamus, cortex, posterior limb of the internal capsule (PLIC), and paracentral white matter (p = 0.001–0.013), but for non-DWI score only in the vermis or brainstem. A combination of Lac:NAA ≥0.25 or DWI/apparent diffusion coefficient (ADC) signal abnormality in the PLIC had 100% specificity and sensitivity for poor outcome. Conclusion: Interobserver agreement for non-DWI performed during the first week is poor. Agreement by three radiologists about the presence of abnormal signal within the PLIC on ADC/DWI images or elevation of Lac:NAA above 0.25 improved sensitivity without reducing the prognostic specificity of MRS in the 19 patients, but this requires validation in a larger group of infants with HIE who have been treated with hypothermia

  15. Psychiatric disorders and cognitive outcomes in children and adolescent with perinatally acquired HIV – a review

    Directory of Open Access Journals (Sweden)

    Zielińska, Anna

    2013-06-01

    Full Text Available The main focus of research on consequences of HIV infection is on adult population and not much attention is given to children, especially to children with perinatally acquired HIV. Researches have shown higher frequency of mental disorders in this group. HIV infection also has a negative impact on cognitive functions, especially attention concentration. Among the possible causes of mental disorders and cognitive impairment, attention is not only paid to the neurotoxic effects of HIV on the CNS, but also on other factors, such as awareness of chronic disease, the impact of opportunistic infections and side effects of antiviral therapy. Comorbid psychiatric disorders correlate with worse compliance and higher prevalence of risk behaviors among infected adolescents. This article reviews what is known about psychiatric disorders and cognitive disorders among perinatal HIV-infected children.

  16. Psychiatric disorders and cognitive outcomes in children and adolescent with perinatally acquired HIV – a review

    OpenAIRE

    Zielińska, Anna; Kaźmierczak-Mytkowska, Anna; Bryńska Anita

    2013-01-01

    The main focus of research on consequences of HIV infection is on adult population and not much attention is given to children, especially to children with perinatally acquired HIV. Researches have shown higher frequency of mental disorders in this group. HIV infection also has a negative impact on cognitive functions, especially attention concentration. Among the possible causes of mental disorders and cognitive impairment, attention is not only paid to the neurotoxic effects of HIV on the...

  17. An unusual prenatal manifestation of a huge congenital cystic adenomatoid malformation with favorable perinatal outcome

    OpenAIRE

    Suk, Hye-Jin; Won, Hye-Sung; Lee, Eun Jung; Lee, Mi-Young

    2014-01-01

    Congenital cystic adenomatoid malformation (CCAM) is a rare condition which is easily detectable by prenatal ultrasonography. Fetuses with large CCAMs associating with hydrops are predisposed to perinatal mortality, therefore prenatal intervention is required. While macrocystic CCAM is treated prenatally by thoracentesis or thoraco-amniotic shunt, microcystic or mixed CCAM is difficult to manage in the fetus. In these latter lesions, fetal lobectomy, sclerotherapy, or laser ablation was used ...

  18. CLINICAL STUDY TO EVALUATE THE MATERNAL AND PERINATAL OUTCOME OF PREGNANCIES WITH POLYHYDRAMNIOS

    OpenAIRE

    Sudha; Juhi; Mahendra

    2013-01-01

    ABSTRACT: BACKGROUND : Due to active involvement of fetal system in regulation of amn iotic fluid volume, AFI has been identified as indicator of intrauterine fetal status. USG has revolutionized the process of assessment of amniotic fluid thus becoming an integral part of fetal surveillance . Polyhydramnios is an obstetrical condition assoc iated with significant perinatal and maternal morbidity and mortality. In a low resource health facility as Ind...

  19. Proteinúria nas síndromes hipertensivas da gestação: prognóstico materno e perinatal Proteinuria in hypertensive syndrome of pregnancy: maternal and perinatal outcome

    Directory of Open Access Journals (Sweden)

    Tarcísio Mota Coelho

    2004-04-01

    /EPM from January 1, 1999 to December 31, 2002. RESULTS: The patients were divided into four groups: (I without proteinuria (n-203; (II with proteinuria of 0.3 to 1.0g (n-39; (III 1.0 to 2.0g (n-45; and (IV 2.0g or more. Without proteinuria there was one case of placental abruption. The presence of proteinuria predicted adverse maternal outcome with increase of complications proportional to his elevation; among them, HELLP syndrome was the most frequent with 30.5% (40/131 followed by eclampsia with 3.8% (5/131, DPP 3.1% (4/131 and renal insufficiency with 0.7% (1/131. It was confirmed one maternal death in that group, when Maternal Mortality of 763/100.000nv was added up. As to the perinatal effects there was not increase of adverse effects without proteinuria. In the presence of proteinuria and its levels was observed the worst perinatal outcome with the elevation of the following indicatives: increase prematurety (62.2% vs 11.5%, newborn with weight < 2500g (6.5% vs 1.5%, newborn with Apgar < 7 in the 5th minute (30.4% vs 3.5%, concepts with growing restriction of intrauterine (41.9% vs 6.5%, newborn interned in the neonatal undid, (59.8% vs 15.5% stillborn (14.4% vs 1.4%, neonatal deaths (6.1% vs 0.98%. The Perinatal Mortality was greater with proteinúria (175 vs 19,7 and, when = 2.0g (297.8 vs 19.6. CONCLUSIONS: The presence of proteinuria in the hipertensives syndromes during gestation and the elevation of their levels increase the risks of maternal complications, especially HELLP syndromes and eclampsia. Besides, it was observed a significative incidence of premature birth, newborn with Apgar < 7, weight < 2500g, IUGR, stillborn and neonatal deaths.

  20. Maternal and fetal outcome in subclinical hypothyroidism in Jammu region, North India

    Directory of Open Access Journals (Sweden)

    Gagan Singh

    2016-07-01

    Conclusions: In view of adverse maternal and fetal outcome, detecting and treating the women with subclinical hypothyroidism in early pregnancy will improve the perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2362-2366

  1. Adverse pregnancy outcome in a petrochemical polluted area in Taiwan.

    Science.gov (United States)

    Lin, M C; Yu, H S; Tsai, S S; Cheng, B H; Hsu, T Y; Wu, T N; Yang, C Y

    2001-08-24

    The petrochemical industry is the main source of industrial air pollution in Taiwan. Reported here are the results from an ongoing study of outdoor air pollution and the health of individuals living in a community in close proximity to petrochemical industrial complexes. The prevalences of term low birth weight (LBW) in the petrochemical municipality and control municipality were 3.22%, and 1.84%, respectively. After controlling for several possible confounders (including maternal age, season, marital status, maternal education, and infant sex), the adjusted odds ratio was 1.767 (1.002-3.116) for term LBW in the petrochemical municipality. Data provide further support for the hypothesis that air pollution can affect the outcome of pregnancy. PMID:11549116

  2. The three-hit concept of vulnerability and resilience: towards understanding adaptation to early-life adversity outcome

    Science.gov (United States)

    Daskalakis, Nikolaos P.; Bagot, Rosemary C.; Parker, Karen J.; Vinkers, Christiaan H.; de Kloet, E. R.

    2013-01-01

    Stressful experiences during early-life can modulate the genetic programming of specific brain circuits underlying emotional and cognitive aspects of behavioral adaptation to stressful experiences later in life. Although this programming effect exerted by experience-related factors is an important determinant of mental health, its outcome depends on cognitive inputs and hence the valence an individual assigns to a given environmental context. From this perspective we will highlight, with studies in rodents, non-human primates and humans, the three-hit concept of vulnerability and resilience to stress-related mental disorders, which is based on gene-environment interactions during critical phases of perinatal and juvenile brain development. The three-hit (i.e., hit-1: genetic predisposition, hit-2: early-life environment, and hit-3: later-life environment) concept accommodates the cumulative stress hypothesis stating that in a given context vulnerability is enhanced when failure to cope with adversity accumulates. Alternatively, the concept also points to the individual’s predictive adaptive capacity, which underlies the stress inoculation and match/mismatch hypotheses. The latter hypotheses propose that the experience of relatively mild early-life adversity prepares for the future and promotes resilience to similar challenges in later-life; when a mismatch occurs between early and later-life experience, coping is compromised and vulnerability is enhanced. The three-hit concept is fundamental for understanding how individuals can either be prepared for coping with life to come and remain resilient or are unable to do so and succumb to a stress-related mental disorder, under seemingly identical circumstances. PMID:23838101

  3. Late childbearing and changing risks of adverse birth outcomes in Korea.

    Science.gov (United States)

    Cho, Youngtae; Hummer, Robert A; Choi, Yoon-Jung; Jung, Sung Won

    2011-05-01

    This study aimed to examine whether the relative importance of maternal age as a correlate of adverse birth outcomes has changed and to investigate if social inequalities in birth outcomes have widened during the past decade when the marriage and fertility related social environment has undergone tremendous change in Korea. Probabilities of adverse birth outcomes (prematurity and intrauterine growth retardation [IUGR]) were estimated with multinomial logistic regression models, utilizing the Korean birth registration data of 1995 and 2005. The main effects of maternal age and parental socioeconomic characteristics were compared between two study years, net of infant sex, birth order, and plurality. The association between maternal age and adverse birth outcomes, relative to the maternal and parental social characteristics, has clearly diminished between 1995 and 2005. During this period, differences in prematurity and IUGR by maternal age have also diminished, while those by parental social characteristics, particularly maternal education, have substantially widened. The intensified overall socioeconomic polarization since the economic crisis of the late 1990s is most likely responsible for the increased social inequality in adverse birth outcomes in Korea. A massive structural change in macro-economic conditions and culture during the study period may have modified the relationship between maternal age and birth outcomes. PMID:20432060

  4. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada.

    OpenAIRE

    Liu, Shiliang; Krewski, Daniel; Shi, Yuanli; Chen, Yue; Richard T. Burnett

    2003-01-01

    The association between ambient air pollution and adverse health effects, such as emergency room visits, hospitalizations, and mortality from respiratory and cardiovascular diseases, has been studied extensively in many countries, including Canada. Recently, studies conducted in China, the Czech Republic, and the United States have related ambient air pollution to adverse pregnancy outcomes. In this study, we examined association between preterm birth, low birth weight, and intrauterine growt...

  5. Ethno-Specific Risk Factors for Adverse Pregnancy Outcomes: Findings from the Born in Bradford Cohort Study.

    Science.gov (United States)

    Stacey, Tomasina; Prady, Stephanie; Haith-Cooper, Melanie; Downe, Soo; Simpson, Nigel; Pickett, Kate

    2016-07-01

    Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK's Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26-28 weeks' gestation at the Bradford Royal Infirmary (2007-2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required. PMID:26983444

  6. Fetal and perinatal outcomes in type 1 diabetes pregnancy : a randomized study comparing insulin aspart with human insulin in 322 subjects

    NARCIS (Netherlands)

    Hod, Moshe; Damm, Peter; Kaaja, Risto; Visser, Gerard H. A.; Dunne, Fidelma; Demidova, Irina; Hansen, Anne-Sofie Pade; Mersebach, Henriette

    2008-01-01

    OBJECTIVE: The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy. STUDY DESIGN: This was a randomized, parallel, open-label, controlled, mult

  7. Early Gestational Weight Gain Rate and Adverse Pregnancy Outcomes in Korean Women.

    Directory of Open Access Journals (Sweden)

    Eun-Hee Cho

    Full Text Available During pregnancy, many women gain excessive weight, which is related to adverse maternal and neonatal outcomes. In this study, we evaluated whether rate of gestational weight gain (RGWG in early, mid, and late pregnancy is strongly associated with adverse pregnancy outcomes. A retrospective chart review of 2,789 pregnant Korean women was performed. Weights were recorded at the first clinic visit, during the screening test for fetal anomaly, and during the 50g oral glucose challenge test and delivery, to represent early, mid, and late pregnancy, respectively. A multivariate logistic regression analysis was performed to examine the relationship between RGWG and adverse pregnancy outcomes. At early pregnancy, the RGWG was significantly associated with high risk of developing gestational diabetes mellitus (GDM, pregnancy-induced hypertension (PIH, large for gestational age (LGA infants, macrosomia, and primary cesarean section (P-CS. The RGWG of mid pregnancy was not significantly associated with any adverse pregnancy outcomes. The RGWG at late pregnancy was significantly associated with a lower risk of developing GDM, preterm birth and P-CS, but with a higher risk of developing LGA infants and macrosomia. When the subjects were divided into three groups (Underweight, Normal, and Obese, based on pre-pregnancy body mass index (BMI, the relationship between early RGWG and adverse pregnancy outcomes was significantly different across the three BMI groups. At early pregnancy, RGWG was not significantly associated to adverse pregnancy outcomes for subjects in the Underweight group. In the Normal group, however, early RGWG was significantly associated with GDM, PIH, LGA infants, macrosomia, P-CS, and small for gestational weight (SGA infants, whereas early RGWG was significantly associated with only a high risk of PIH in the Obese group. The results of our study suggest that early RGWG is significantly associated with various adverse pregnancy outcomes

  8. Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

    Directory of Open Access Journals (Sweden)

    García-Díaz Lutgardo

    2012-07-01

    Full Text Available Abstract Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops.

  9. Perinatal outcome of twin pregnancies delivered in a teaching hospital Resultado perinatal de gestações gemelares com parto em hospital universitário

    Directory of Open Access Journals (Sweden)

    Renata Almeida de Assunção

    2010-01-01

    Full Text Available OBJECTIVE: This study aimed to evaluate the perinatal outcome of twin pregnancies delivered in a tertiary teaching hospital according to chorionicity. METHODS: A retrospective study involving 289 twin pregnancies delivered from January 2003 to December 2006 was carried out. Maternal and perinatal data were obtained from hospital charts and delivery logs. Chorionicity was determined by ultrasonography or histopathological study. RESULTS: Incidence of twin gestations was 3.4% and 96.4% were spontaneously conceived. 60.5% were dichorionic (DC, 30.8% of monochorionic diamniotic (MCDA, 6.6% monochorionic monoamniotic (MCMA and for 2.1% chorionicity was unknown. The mean gestation age at delivery was respectively 35.4, 33.6, 32.9 for DC, MCDA and MCMA. The mean birth weight was 2.171, 1.832 and 1.760 g respectively for DC, MC and MCMA. The proportion of fetuses delivered with less than 34 weeks in DC was of 21.7%, while in MCDA it was of 39.3% and in MCMA of 42.1%. Birth weight below the 10th centile occurred in 15.7% for DC, 22.5% for MCDA and 26.3% in MCMA. Congenital anomalies were observed in 21.3% in monochorionic and in 7.4% in the dichorionic. Lenght of hospital stay was shorter for DC when compared to MCDA and MCMA twins (13.1, 17.3 and 23.3 days, respectively. The proportion of twin pregnancies with both babies discharged alive were 85.7% in DC and 61.1% in MC. CONCLUSION: The rate of preterm deliveries and low birth weight is higher in monochorionic pregnancies when compared to dichorionic twins. However, when adjusted for complications such as fetal abnormalities and twin-twin transfusion syndrome, double survival rates were similar in the two groups.OBJETIVO: Avaliar o resultado perinatal nas gestações gemelares com partos em hospital universitário segundo a corionicidade. MÉTODOS: Estudo retrospectivo de 289 gestações gemelares com partos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no per

  10. Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age.

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    Yi-Hao Weng

    Full Text Available Although a number of studies have investigated correlations of maternal age with birth outcomes, an extensive assessment using age as a continuous variable is lacking. In the current study, we estimated age-specific risks of adverse birth outcomes in childbearing women.National population-based data containing maternal and neonatal information were derived from the Health Promotion Administration, Taiwan. A composite adverse birth outcome was defined as at least anyone of stillbirth, preterm birth, low birth weight, macrosomia, neonatal death, congenital anomaly, and small for gestational age (SGA. Singletons were further analyzed for outcomes of live birth in relation to each year of maternal age. A log-binomial model was used to adjust for possible confounders of maternal and neonatal factors.In total, 2,123,751 births between 2001 and 2010 were utilized in the analysis. The risk of a composite adverse birth outcome was significantly higher at extreme maternal ages. In specific, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight were higher at the extremes of maternal age. Furthermore, risk of macrosomia rose proportionally with an increasing maternal age. In contrast, risk of SGA declined proportionally with an increasing maternal age. The log-binomial model showed greater risks at the maternal ages of 30 years for a composite adverse birth outcome.Infants born to teenagers and women at advanced age possess greater risks for stillbirth, preterm birth, neonatal death, congenital anomaly, and low birth weight. Pregnancies at advanced age carry an additional risk for macrosomia, while teenage pregnancies carry an additional risk for SGA. The data suggest that the optimal maternal ages to minimize adverse birth outcomes are 26∼30 years.

  11. Explaining racial disparities in adverse birth outcomes: unique sources of stress for Black American women.

    Science.gov (United States)

    Rosenthal, Lisa; Lobel, Marci

    2011-03-01

    The infant mortality rate for Black Americans in the US is more than twice the rate for White Americans, with similar racial disparities existing in rates of low birthweight and preterm delivery. Survivors of these adverse birth outcomes have poorer development and health in infancy, childhood, and adulthood. Increasingly, evidence suggests that maternal stress is an important risk factor for adverse birth outcomes. We offer a novel perspective on racial disparities in birth outcomes suggesting that Black American women are subject to unique sources of stress throughout their lives and particularly during pregnancy based on their multiple identities as women, Black, and pregnant. We draw on interdisciplinary work to examine three unique sources of stress for Black American women that elevate their risk for adverse birth outcomes: 1) abuses of Black American women by the medical system and issues of power in obstetrics that disadvantage Black American women; 2) contradictory societal pressures exerted on Black American women about whether they should have children; and 3) historical and contemporary stereotypes about Black American women related to sexuality and motherhood. We discuss implications of this analysis, including applications to research and intervention. Developing a better understanding of the experience of Black American women during pregnancy and throughout their lives offers insight into ways to reduce racial disparities in adverse birth outcomes and their lifelong consequences. PMID:21345565

  12. Reported estimates of adverse pregnancy outcomes among women with and without syphilis: a systematic review and meta-analysis.

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    Jiabi Qin

    Full Text Available To estimate probability of adverse pregnancy outcomes (APOs among women with and without syphilis through a systematic review of published literatures.Chinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks, pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8, pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10. Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I2 = 93.9%; P<0.0001 and women without syphilis (I2 = 94.8%; P<0.0001.Syphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority.

  13. Pathways of neighbourhood-level socio-economic determinants of adverse birth outcomes

    OpenAIRE

    Meng, Gang; Thompson, Mary E.; Hall, G Brent

    2013-01-01

    Background Although socio-economic factors have been identified as one of the most important groups of neighbourhood-level risks affecting birth outcomes, uncertainties still exist concerning the pathways through which they are transferred to individual risk factors. This poses a challenge for setting priorities and developing appropriate community-oriented public health interventions and planning guidelines to reduce the level of adverse birth outcomes. Method This study examines potential d...

  14. Risk for Gestational Diabetes Mellitus and Adverse Birth Outcomes in Chinese Women with Polycystic Ovary Syndrome

    OpenAIRE

    Qing Xiao; Yong-Yi Cui; Jine Lu; Guo-Zheng Zhang; Fang-Ling Zeng

    2016-01-01

    Objective. To examine the association of polycystic ovary syndrome (PCOS) in early pregnancy with gestational diabetes mellitus (GDM) and adverse birth outcomes. Methods. In this retrospective cohort study including 2389 pregnant women, the medical records of 352 women diagnosed with PCOS were evaluated. Outcomes included GDM, preterm birth, low birth weight, macrosomia, and being small and large for gestational age. Multivariable logistic regression models were used to examine the associatio...

  15. Studying Biology to Understand Risk: Dosimetry Models and Quantitative Adverse Outcome Pathways

    Science.gov (United States)

    Confidence in the quantitative prediction of risk is increased when the prediction is based to as great an extent as possible on the relevant biological factors that constitute the pathway from exposure to adverse outcome. With the first examples now over 40 years old, physiologi...

  16. Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction

    NARCIS (Netherlands)

    Roze, Elise; Kerstjens, Jorien M.; Maathuis, Carel G. B.; ter Horst, Hendrik J.; Bos, Arend F.

    2008-01-01

    OBJECTIVE. Our objective was to identify risk factors that were associated with mortality and adverse neurologic outcome at 18 months of age in preterm infants with periventricular hemorrhagic infarction. METHODS. This was a retrospective cohort study of all preterm infants who were <37 weeks' gesta

  17. Adverse Outcomes to Early Middle Age Linked With Childhood Residential Mobility

    DEFF Research Database (Denmark)

    Webb, Roger T; Pedersen, Carsten B; Mok, Pearl L H

    2016-01-01

    vigilance is indicated for relocated adolescents and their families, with a view to preventing longer-term adverse outcomes in this population among all socioeconomic groups. Risk management will require close cooperation among multiple public agencies, particularly child, adolescent, and adult mental...

  18. Comparação entre dois testes de rastreamento do diabetes gestacional e o resultado perinatal Comparison between two gestational diabetes screening tests and the perinatal outcome

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    Wilson Ayach

    2010-05-01

    Full Text Available OBJETIVO: comparar dois testes de rastreamento para diabetes e seus resultados com o resultado da gestação. MÉTODOS: no total, 279 pacientes foram submetidas a dois testes de rastreamento do diabetes gestacional - associação glicemia de jejum e fatores de risco (GJ + FR e o teste de tolerância à glicose simplificado (TTG50g. O rastreamento pela associação GJ + FR caracterizou-se pela dosagem da glicemia de jejum e anamnese para identificação dos fatores de risco na primeira consulta de pré-natal. O TTG50g foi realizado entre a 24ª e a 28ª semana de gestação e caracterizou-se pela dosagem das glicemias plasmáticas em jejum e uma hora após a sobrecarga oral com 50 g de glicose. Os resultados, positivo e negativo, foram relacionados ao resultado da gestação. Foram consideradas variáveis dependentes: via de parto, idade gestacional, peso e índice ponderal ao nascimento, índices de Apgar PURPOSE: to compare two screening tests for diabetes and their results to pregnancy outcomes. METHODS: in total, 279 pregnant women were submitted to two screening tests for gestational diabetes - fasting glycemia plus risk factors (FG + RF and to the simplified glucose tolerance test (GTT50g. Screening by FG + RF consisted of the determination of fasting glycemia and anamnesis for the identification of risk factors on the occasion of the first prenatal visit. The GTT50g was performed between the 24th and the 28th week of pregnancy and consisted of the determination of plasma glycemia under fasting conditions and one hour after an oral overload with 50 g glucose. Positive and negative results were compared to pregnancy outcome. The dependent variables were: type of delivery, gestational age, weight and ponderal index at birth, Apgar indexes <7 in the 1st and 5th minutes, need for admission to the Intensive Care Unit (ICU, duration of hospitalization, and neonatal death. Data were analyzed statistically through the Students t-test, and the level

  19. Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycem)a

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. Methodology: This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences (SPSS Ver. 15.0). Results: A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +- 9.748 (95% CI 57.39 - 55.31). Male were 58.1% (n=198). The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation (AF) 15.8%, ventricular tachycardia (VT) 11.7%, ventricular fibrillation (VF) 10.9% and complete heart block (CHB) 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema (CPE) 7.9% and cardiogenic shock (CS) 11.7%. Conclusion: Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively. (author)

  20. Perinatal acquisition of drug-resistant HIV-1 infection: mechanisms and long-term outcome

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    Dollfus Catherine

    2009-09-01

    Full Text Available Abstract Background Primary-HIV-1-infection in newborns that occurs under antiretroviral prophylaxis that is a high risk of drug-resistance acquisition. We examine the frequency and the mechanisms of resistance acquisition at the time of infection in newborns. Patients and Methods We studied HIV-1-infected infants born between 01 January 1997 and 31 December 2004 and enrolled in the ANRS-EPF cohort. HIV-1-RNA and HIV-1-DNA samples obtained perinatally from the newborn and mother were subjected to population-based and clonal analyses of drug resistance. If positive, serial samples were obtained from the child for resistance testing. Results Ninety-two HIV-1-infected infants were born during the study period. Samples were obtained from 32 mother-child pairs and from another 28 newborns. Drug resistance was detected in 12 newborns (20%: drug resistance to nucleoside reverse transcriptase inhibitors was seen in 10 cases, non-nucleoside reverse transcriptase inhibitors in two cases, and protease inhibitors in one case. For 9 children, the detection of the same resistance mutations in mothers' samples (6 among 10 available and in newborn lymphocytes (6/8 suggests that the newborn was initially infected by a drug-resistant strain. Resistance variants were either transmitted from mother-to-child or selected during subsequent temporal exposure under suboptimal perinatal prophylaxis. Follow-up studies of the infants showed that the resistance pattern remained stable over time, regardless of antiretroviral therapy, suggesting the early cellular archiving of resistant viruses. The absence of resistance in the mother of the other three children (3/10 and neonatal lymphocytes (2/8 suggests that the newborns were infected by a wild-type strain without long-term persistence of resistance when suboptimal prophylaxis was stopped. Conclusion This study confirms the importance of early resistance genotyping of HIV-1-infected newborns. In most cases (75%, drug

  1. Adverse Outcome Pathway for Embryonic Vascular Disruption and Alternative Methods to Identify Chemical Vascular Disruptors During Development

    Science.gov (United States)

    Chemically induced vascular toxicity during embryonic development can result in a wide range of adverse prenatal outcomes. We used information from genetic mouse models linked to phenotypic outcomes and a vascular toxicity knowledge base to construct an embryonic vascular disrupt...

  2. The effectiveness of Technology-assisted Cascade Training and Supervision of community health workers in delivering the Thinking Healthy Program for perinatal depression in a post-conflict area of Pakistan – study protocol for a randomized controlled trial

    OpenAIRE

    Zafar, Shamsa; Sikander, Siham; Hamdani, Syed Usman; Atif, Najia; Akhtar, Parveen; Nazir, Huma; Maselko, Joanna; Rahman, Atif

    2016-01-01

    Background Rates of perinatal depression in low and middle income countries are reported to be very high. Perinatal depression not only has profound impact on women’s health, disability and functioning, it is associated with poor child health outcomes such as pre-term birth, under-nutrition and stunting, which ultimately have an adverse trans-generational impact. There is strong evidence in the medical literature that perinatal depression can be effectively managed with psychological treatmen...

  3. Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women

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    Bernardo Ana L

    2009-01-01

    Full Text Available Abstract Background To evaluate the effectiveness and safety of water aerobics during pregnancy. Methods A randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fisher's or Student's t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across time using MANOVA or Friedman multiple analysis. Results There were no significant differences between the groups regarding maternal weight gain, BMI or percentage of body fat during pregnancy. Incidence of preterm births (RR = 0.84; 95%CI:0.28–2.53, vaginal births (RR = 1.24; 95%CI:0.73–2.09, low birthweight (RR = 1.30; 95%CI:0.61–2.79 and adequate weight for gestational age (RR = 1.50; 95%CI:0.65–3.48 were also not significantly different between groups. There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session. Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition, type of delivery, preterm birth rate, neonatal well-being or weight.

  4. Perinatal outcomes in a South Asian setting with high rates of low birth weight

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    Joseph K S

    2009-02-01

    Full Text Available Abstract Background It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference. Methods Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA live births were identified using both a recent Canadian and an older Indian fetal growth standard. Results The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and Conclusion High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories.

  5. Risk for Gestational Diabetes Mellitus and Adverse Birth Outcomes in Chinese Women with Polycystic Ovary Syndrome

    Science.gov (United States)

    Xiao, Qing; Cui, Yong-Yi; Lu, Jine; Zhang, Guo-Zheng

    2016-01-01

    Objective. To examine the association of polycystic ovary syndrome (PCOS) in early pregnancy with gestational diabetes mellitus (GDM) and adverse birth outcomes. Methods. In this retrospective cohort study including 2389 pregnant women, the medical records of 352 women diagnosed with PCOS were evaluated. Outcomes included GDM, preterm birth, low birth weight, macrosomia, and being small and large for gestational age. Multivariable logistic regression models were used to examine the association of the risk for GDM and adverse birth outcomes with PCOS after adjusting for confounders. Results. Women previously diagnosed with PCOS had a higher risk of GDM (adjusted odds ratio [OR] 1.55, 95% confidence interval [CI]: 1.14–2.09). A strong association was seen between PCOS and preterm birth (adjusted OR 1.69, 95% CI: 1.08–2.67). On stratified analysis, the adjusted OR for GDM among women with PCOS undergoing assisted reproductive technology was 1.44 (95% CI: 1.03–1.92) and among women with PCOS who conceived spontaneously was 1.60 (1.18–2.15). No increased risk for other adverse birth outcomes was observed. Conclusions. Women with PCOS were more likely to experience GDM and preterm birth. PMID:27066074

  6. Risk for Gestational Diabetes Mellitus and Adverse Birth Outcomes in Chinese Women with Polycystic Ovary Syndrome

    Directory of Open Access Journals (Sweden)

    Qing Xiao

    2016-01-01

    Full Text Available Objective. To examine the association of polycystic ovary syndrome (PCOS in early pregnancy with gestational diabetes mellitus (GDM and adverse birth outcomes. Methods. In this retrospective cohort study including 2389 pregnant women, the medical records of 352 women diagnosed with PCOS were evaluated. Outcomes included GDM, preterm birth, low birth weight, macrosomia, and being small and large for gestational age. Multivariable logistic regression models were used to examine the association of the risk for GDM and adverse birth outcomes with PCOS after adjusting for confounders. Results. Women previously diagnosed with PCOS had a higher risk of GDM (adjusted odds ratio [OR] 1.55, 95% confidence interval [CI]: 1.14–2.09. A strong association was seen between PCOS and preterm birth (adjusted OR 1.69, 95% CI: 1.08–2.67. On stratified analysis, the adjusted OR for GDM among women with PCOS undergoing assisted reproductive technology was 1.44 (95% CI: 1.03–1.92 and among women with PCOS who conceived spontaneously was 1.60 (1.18–2.15. No increased risk for other adverse birth outcomes was observed. Conclusions. Women with PCOS were more likely to experience GDM and preterm birth.

  7. Paternal occupational exposure to radiofrequency electromagnetic fields and risk of adverse pregnancy outcome

    International Nuclear Information System (INIS)

    Background:During the last decades, public concern that radiofrequency radiation (RFR) may be related to adverse reproductive outcomes has been emerging. Our objective was to assess associations between paternal occupational exposure to RFR and adverse pregnancy outcomes including birth defects using population-based data from Norway.Methods:Data on reproductive outcomes derived from the Medical Birth Registry of Norway were linked with data on paternal occupation derived from the general population censuses. An expert panel categorized occupations according to exposure. Using logistic regression, we analyzed 24 categories of birth defects as well as other adverse outcomes.Results:In the offspring of fathers most likely to have been exposed, increased risk was observed for preterm birth (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.03, 1.15). In this group we also observed a decreased risk of cleft lip (OR: 0.63, 95% CI: 0.41, 0.97). In the medium exposed group, we observed increased risk for a category of ,other defects' (OR: 2.40, 95% CI: 1.22, 4.70), and a decreased risk for a category of ,other syndromes' (OR: 0.75, 95% CI: 0.56, 0.99) and upper gastrointestinal defects (OR: 0.61, 95% CI: 0.40, 0.93).Conclusion:The study is partly reassuring for occupationally exposed fathers

  8. Adverse pregnancy outcomes in rural Maharashtra, India (2008–09: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Doke Prakash

    2012-07-01

    Full Text Available Abstract Background The study was carried out to record adverse pregnancy outcomes and to obtain information about sex ratio at birth in rural especially tribal areas in the State of Maharashtra, India. Although the tribal population is considered vulnerable to innumerable adversities, regretfully information about pregnancy wastage among them is not available. About 10% population of the state is tribal. The study of sex ratio at birth was planned as the overall sex ratio and child sex ratio had declined in the state. Methods The cohort of antenatal cases registered in rural areas of Maharashtra in the calendar year 2008 was followed up to study the pregnancy outcomes. A retrospective study was carried out from October 2009 to August 2010. The outcomes of all the registered antenatal cases were recorded by the Auxiliary Nurse Midwives. The summary sheets were obtained by Block Medical Officers. The data was entered at the block level by trained data entry operators in specially designed web-based software. Adverse pregnancy outcome was categorized in two groups abortions and stillbirths. Results About 1.1 million registered pregnancies were followed up. In the state 5.34% registered pregnancies ended in abortions. In tribal PHCs the relative risk of spontaneous abortion and induced abortion was 0.91and 0.38 respectively. It was also revealed that about 1.55% pregnancies culminated in stillbirth. The relative risk of stillbirths in tribal PHCs was 1.33. The sex ratio at birth in the state was 850. The ratio was 883 in the tribal PHCs. Correlation was observed between sex ratio at birth and induced abortion rate. Conclusions The study indicates that women from tribal PHCs are exposed to higher risk of adverse pregnancy outcome in the form of stillbirths. In non-tribal areas high induced abortion rate and poor sex ratio at birth is observed. These two indicators are correlated. The correlation may be explained by the unscrupulous practice of sex

  9. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

    Directory of Open Access Journals (Sweden)

    Hjortdal Vibeke E

    2010-12-01

    Full Text Available Abstract Background Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery. Methods In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics. Results Neither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4] comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85] was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83] and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality. Conclusions Elevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery. Trial Registration The Danish Data Protection Agency; reference no

  10. Changes in androgens and insulin sensitivity indexes throughout pregnancy in women with polycystic ovary syndrome (PCOS): relationships with adverse outcomes

    OpenAIRE

    Falbo Angela; Rocca Morena; Russo Tiziana; D'Ettore Antonietta; Tolino Achille; Zullo Fulvio; Orio Francesco; Palomba Stefano

    2010-01-01

    Abstract Background Given the high rate of pregnancy and perinatal complications recently observed in patients with polycystic ovary syndrome (PCOS) and the lack of data on the serum variations in androgens and insulin sensitivity indexes in pregnant women with PCOS, the current study was aimed to assess these changes and their potential effect on pregnancy outcomes in a population of women with PCOS. Methods Forty-five pregnant patients with ovulatory PCOS (PCOS group) and other 42 healthy p...

  11. Development of computationally predicted Adverse Outcome Pathway (AOP) networks through data mining and integration of publicly available in vivo, in vitro, phenotype, and biological pathway data

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. Ho...

  12. Adverse Pregnancy Outcomes: Opportunity for Analysis of Biospecimens and Co-development of Prognostics | NCI Technology Transfer Center | TTC

    Science.gov (United States)

    The Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Pregnancy and Perinatology Branch seeks partners interested in collaborative research to: (i) evaluate data and samples taken from women for potential biomarkers indicative for adverse pregnancy outcomes and (ii) co-develop diagnostic kits useful as predictors of adverse pregnancy outcomes.

  13. The Perinatal Adverse events and Special Trends in Cognitive Trajectory (PLASTICITY - pre-protocol for a prospective longitudinal follow-up cohort study [v1; ref status: indexed, http://f1000r.es/qe

    Directory of Open Access Journals (Sweden)

    Laura Hokkanen

    2013-02-01

    Full Text Available Prospective follow-up studies on long term effects of pre- and perinatal adverse conditions in adulthood are rare. We will continue to follow the prospective cohort of initially 1196 subjects with predefined at-delivery risk factors out of 22,359 consecutive deliveries during 1971-74 at a single maternity hospital. The risk cohort and 93 controls have been followed up with a comprehensive clinical program at 5, 9, and 16 years of age and by questionnaire at the age of 30 years. Major medical events known to affect the development and growth of the brain, or cognitive functions and personality have been documented. Here we present a pre-protocol for the project, which we will call PLASTICITY, whose aim is to follow consenting subjects and controls into mid-adulthood and beyond, and to explore how the neonatal risk factors modulate neurodevelopmental and neurodegenerative processes such as learning disabilities, ADHD, aging, early onset mild cognitive impairment and even dementia. Our first focus is on the neurological and cognitive outcomes at age 40 years, using detailed neurological, neuropsychological, neuroimaging, genetic, blood chemistry and registry based methods. Results will be expected to offer information on the risk of neurological, psychiatric, metabolic and other medical consequences as well as the need for health and social services at the brink of middle age, when new degenerative phenomena are known to emerge. The evaluation at age 40 years will serve as a baseline for later aging studies. We welcome all comments and suggestions, which we will apply in finalizing details and inviting collaboration.

  14. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, David; Truong, Pauline T. [Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia (Canada); Parpia, Sameer [Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario (Canada); Olivotto, Ivo A. [Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Berrang, Tanya [Vancouver Island Centre, British Columbia Cancer Agency, Victoria, British Columbia (Canada); Kim, Do-Hoon; Kong, Iwa [Juravinski Cancer Centre at Hamilton Health Sciences, McMaster University, Hamilton, Ontario (Canada); Germain, Isabelle [Centre Hospitalier Universitaire de Québec, Pavillon Hôtel-Dieu de Quebec, Quebec City, Québec (Canada); Nichol, Alan [Vancouver Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Akra, Mohamed [CancerCare Manitoba, Winnipeg, Manitoba (Canada); Roy, Isabelle [Centre intégré de cancérologie de Laval, Laval, Québec (Canada); Reed, Melanie [Center for the Southern Interior, British Columbia Cancer Agency, Kelowna, British Columbia (Canada); Fyles, Anthony [University Health Network, Princess Margaret Hospital, Toronto, Ontario (Canada); Trotter, Theresa [Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Perera, Francisco [London Regional Cancer Centre, London, Ontario (Canada); Balkwill, Susan [Fraser Valley Centre, British Columbia Cancer Agency, Surrey, British Columbia (Canada); Lavertu, Sophie [Centre Hospitalier de l' Université de Montréal, Hôpital Notre-Dame, Montreal, Québec (Canada); Elliott, Elizabeth [Juravinski Cancer Centre at Hamilton Health Sciences, McMaster University, Hamilton, Ontario (Canada); and others

    2015-04-01

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  15. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    International Nuclear Information System (INIS)

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  16. Blood carbon dioxide levels and adverse outcome in neonatal hypoxic-ischemic encephalopathy.

    LENUS (Irish Health Repository)

    Nadeem, Montasser

    2012-01-31

    We investigated pCO(2) patterns and the relationship between pCO(2) levels and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy. Blood gases during the first 72 hours of life were collected from 52 infants with hypoxic-ischemic encephalopathy. Moderate hypocapnia (pCO(2) <3.3 kPa), severe hypocapnia (pCO(2) <2.6 kPa), and hypercapnia (pCO(2) >6.6 kPa) were correlated to neurodevelopmental outcome at 24 months. Normocapnia was documented in 416\\/551 (75.5%) of samples and was present during the entire 72 hours in only 6 out of 52 infants. Mean (standard deviation) pCO(2) values did not differ between infants with normal and abnormal outcomes: 5.43 (2.4) and 5.41 (2.03), respectively. There was no significant association between moderate hypocapnia, severe hypocapnia, or hypercapnia and adverse outcome (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 0.49 to 6.89; OR = 3.16, CI = 0.14 to 28.45; and OR = 1.07, CI = 0.24 to 5.45, respectively). In conclusion, only one in nine newborns had normocapnia throughout the first 72 hours. Severe hypocapnia was rare and occurred only in ventilated babies. Hypercapnia and hypocapnia in infants with hypoxic-ischemic encephalopathy during the first 72 hours of life were not associated with adverse outcome.

  17. Violent crime exposure classification and adverse birth outcomes: a geographically-defined cohort study

    Directory of Open Access Journals (Sweden)

    Herring Amy

    2006-05-01

    Full Text Available Abstract Background Area-level socioeconomic disparities have long been associated with adverse pregnancy outcomes. Crime is an important element of the neighborhood environment inadequately investigated in the reproductive and public health literature. When crime has been used in research, it has been variably defined, resulting in non-comparable associations across studies. Methods Using geocoded linked birth record, crime and census data in multilevel models, this paper explored the relevance of four spatial violent crime exposures: two proximal violent crime categorizations (count of violent crime within a one-half mile radius of maternal residence and distance from maternal residence to nearest violent crime and two area-level crime categorizations (count of violent crimes within a block group and block group rate of violent crimes for adverse birth events among women in living in the city of Raleigh NC crime report area in 1999–2001. Models were adjusted for maternal age and education and area-level deprivation. Results In black and white non-Hispanic race-stratified models, crime characterized as a proximal exposure was not able to distinguish between women experiencing adverse and women experiencing normal birth outcomes. Violent crime characterized as a neighborhood attribute was positively associated with preterm birth and low birth weight among non-Hispanic white and black women. No statistically significant interaction between area-deprivation and violent crime category was observed. Conclusion Crime is variably categorized in the literature, with little rationale provided for crime type or categorization employed. This research represents the first time multiple crime categorizations have been directly compared in association with health outcomes. Finding an effect of area-level violent crime suggests crime may best be characterized as a neighborhood attribute with important implication for adverse birth outcomes.

  18. Ambient air pollution and adverse birth outcomes: a natural experiment study

    OpenAIRE

    Huang, Cheng; Nichols, Catherine; Liu, Yang; Zhang, Yunping; Liu, Xiaohong; Gao, Suhong; Li, Zhiwen; Ren, Aiguo

    2015-01-01

    Background Radical regulations to improve air quality, including traffic control, were implemented prior to and during the 2008 Beijing Olympic Games. Consequently, ambient concentrations of nitrogen dioxide (NO2) and particular matter 10 micrometers or less (PM10), were reduced in a distinct and short window of time, which presented a natural experiment for testing the relationships between maternal exposure to PM10 and NO2 during pregnancy and adverse birth outcomes. Methods We estimated th...

  19. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

    OpenAIRE

    Le Nhu D; Teschke Kay; Chow Yat; Lorenzi Maria; Beking Kris; Spinelli John J; Ratner Pamela A; Gallagher Richard P; Dimich-Ward Helen

    2010-01-01

    Abstract Background To determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs) from British Columbia, Canada (BC). Methods Female RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213). The identifier file was linked to Canadian cancer registries. An RN offspring coh...

  20. Excess risk of adverse pregnancy outcomes in women with porphyria: a population-based cohort study

    OpenAIRE

    Tollånes, Mette Christophersen; Aarsand, Aasne Karine; Sandberg, Sverre

    2010-01-01

    The porphyrias comprise a heterogeneous group of rare, primarily hereditary, metabolic diseases caused by a partial deficiency in one of the eight enzymes involved in the heme biosynthesis. Our aim was to assess whether acute or cutaneous porphyria has been associated with excess risks of adverse pregnancy outcomes. A population-based cohort study was designed by record linkage between the Norwegian Porphyria Register, covering 70% of all known porphyria patients in Norway, and the Medical Bi...

  1. TLR-9 Activation Coupled To IL-10 Deficiency Induces Adverse Pregnancy Outcomes

    OpenAIRE

    Thaxton, Jessica E.; Romero, Roberto; Sharma, Surendra

    2009-01-01

    Pregnancy outcome is severely compromised by intrauterine infections and inflammation. Although the pregnant uterine microenvironment is replete with innate immune cells and Toll-like receptor (TLR) expression, the mechanisms that facilitate adverse effects of their activation are largely unknown. Here we mimic the activation of TLR-9 with its pathogenic ligand hypomethylated CpG, and demonstrate that IL-10 proficiency protects against CpG-induced pregnancy complications. We show that fetal r...

  2. Fetal outcome of trisomy 18 diagnosed after 22 weeks of gestation: Experience of 123 cases at a single perinatal center.

    Science.gov (United States)

    Nagase, Hiromi; Ishikawa, Hiroshi; Toyoshima, Katsuaki; Itani, Yasufumi; Furuya, Noritaka; Kurosawa, Kenji; Hirahara, Fumiki; Yamanaka, Michiko

    2016-01-01

    To investigate the pregnancy outcome of the fetuses with trisomy 18, we studied 123 cases of trisomy 18 who were born at our hospital from 1993 to 2009. Among them, 95.9% were diagnosed with trisomy 18 prenatally. Prenatal ultrasound findings showed fetal growth restriction in 77.2%, polyhydramnios in 63.4% and congenital heart defects in 95.1%. For 18 cases, cesarean section (C-section) was chosen, and for 75 cases, transvaginal delivery was chosen. Premature delivery occurred in 35.5%. Stillbirths occurred in 50 cases (40.7%). Fetal demise before onset of labor occurred in 30 cases and fetal demise during labor occurred in 20 cases which was 26.7% of vaginal deliveries. Among the 73 live-born infants, the survival rate for 24 h, 1 week, 1 month and 1 year were 63%, 43%, 33% and 3%. The median survival time was 3.5 days. There was no significant difference between the survival time of C-section and that of vaginal delivery. However, for the births involving breech presentation, the survival time of C-section was significantly longer than that of vaginal delivery. When the fetus is diagnosed with trisomy 18, the parents have to make many choices. These findings constitute critical information in prenatal counseling to the couples whose fetuses have been found to have trisomy 18, especially when they choose palliative approaches in the perinatal management. PMID:26104883

  3. Resultados maternos e perinatais em gestantes portadoras de leucemia Maternal and perinatal outcomes in pregnant women with leukemia

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2011-08-01

    grupo de gestantes com LMC, verificou-se a ocorrência de anemia em quatro casos (44,4% e plaquetopenia em um (11,1%. Quanto aos resultados perinatais, nas gestações complicadas pela leucemia aguda, a média da idade gestacional no parto foi de 32 semanas (desvio padrão - DP=4,4 e a média do peso do recém-nascido foi 1476 g (DP=657 g. Houve 2 (40,0% óbitos perinatais (um fetal e um neonatal. Nas gestações complicadas pela LMC, a média da idade gestacional no parto foi de 37,6 semanas (DP=1,1 e a média do peso do recém-nascido foi 2870 g (DP=516 g; não houve morte perinatal e nenhuma anomalia fetal foi detectada. CONCLUSÕES: É elevada a morbidade materna e fetal nas gestações complicadas pela leucemia aguda; enquanto que, nas complicadas pela LMC, o prognóstico materno e fetal parece ser mais favorável, com maior facilidade no manejo das complicações.PURPOSE: To describe the maternal and perinatal outcomes of pregnant women diagnosed with leukemia who were followed up for prenatal care and delivery at a university hospital. METHODS: A retrospective study of the period from 2001 to 2011, which included 16 pregnant women with a diagnosis of leukemia followed by antenatal care specialists in hematological diseases and pregnancy. For acute leukemia diagnosed after the first trimester, the recommendation was to perform chemotherapy despite the current pregnancy. For chronic leukemia, patients who were controlled in hematological terms were maintained without medication during pregnancy, or chemotherapy was introduced after the first trimester. We analyzed the maternal and perinatal outcome. RESULTS: Acute lymphoblastic leukemia (ALL was diagnosed in five cases (31.3%, acute myeloid leukemia (AML in two cases (12.5% and chronic myeloid leukemia (CML in nine cases (56.3%. Of the cases of acute leukemia, two (28.6% were diagnosed in the first trimester, two (28.6% in the second and three (42.9% in the third. Two patients with ALL diagnosed in the first

  4. Influence of chorionicity on perinatal outcome in a large cohort of Danish twin pregnancies

    DEFF Research Database (Denmark)

    Oldenburg, Anna; Rode, Line; Bødker, Birgit;

    2012-01-01

    Objective To assess outcome in twin pregnancies according to chorionicity. Methods A cohort was retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between weeks 11 to 14 in the period 1 January 2004 to 31...

  5. Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

    OpenAIRE

    Kwok, Chun Shing; Muhammad RASHID; Beynon, Rhys; Barker, Diane; Patwala, Ashish; Morley-Davies, Adrian; Satchithananda, Duwarakan; Nolan, James; Myint, Phyo K; Buchan, Iain; Loke, Yoon K.; Mamas, Mamas A.

    2016-01-01

    Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR interval...

  6. Prediction of adverse outcomes of acute coronary syndrome using intelligent fusion of triage information with HUMINT

    Science.gov (United States)

    McCullough, Claire L.; Novobilski, Andrew J.; Fesmire, Francis M.

    2006-04-01

    Faculty from the University of Tennessee at Chattanooga and the University of Tennessee College of Medicine, Chattanooga Unit, have used data mining techniques and neural networks to examine a set of fourteen features, data items, and HUMINT assessments for 2,148 emergency room patients with symptoms possibly indicative of Acute Coronary Syndrome. Specifically, the authors have generated Bayesian networks describing linkages and causality in the data, and have compared them with neural networks. The data includes objective information routinely collected during triage and the physician's initial case assessment, a HUMINT appraisal. Both the neural network and the Bayesian network were used to fuse the disparate types of information with the goal of forecasting thirty-day adverse patient outcome. This paper presents details of the methods of data fusion including both the data mining techniques and the neural network. Results are compared using Receiver Operating Characteristic curves describing the outcomes of both methods, both using only objective features and including the subjective physician's assessment. While preliminary, the results of this continuing study are significant both from the perspective of potential use of the intelligent fusion of biomedical informatics to aid the physician in prescribing treatment necessary to prevent serious adverse outcome from ACS and as a model of fusion of objective data with subjective HUMINT assessment. Possible future work includes extension of successfully demonstrated intelligent fusion methods to other medical applications, and use of decision level fusion to combine results from data mining and neural net approaches for even more accurate outcome prediction.

  7. Perinatal Programming of Childhood Asthma: Early Fetal Size, Growth Trajectory during Infancy, and Childhood Asthma Outcomes

    Directory of Open Access Journals (Sweden)

    Steve Turner

    2012-01-01

    Full Text Available The “fetal origins hypothesis” or concept of “developmental programming” suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding the interpretation of antenatal fetal ultrasound measurements are discussed. Finally, recent reports linking antenatal measurement and growth trajectory to early childhood asthma outcomes are discussed. Understanding the nature and timing of factors which influence antenatal growth may give important insight into the antecedents of early-onset asthma with implications for interventions.

  8. The Violence Proneness Scale of the DUSI-R predicts adverse outcomes associated with substance abuse.

    Science.gov (United States)

    Kirisci, Levent; Tarter, Ralph; Reynolds, Maureen

    2009-01-01

    Accuracy of the Violence Proneness Scale (VPS) of the Drug Use Screening Inventory (DUSI-R) was evaluated in 328 boys for predicting use of illegal drugs, DUI, selling drugs, sexually transmitted disease, car accident while under acute effects of drugs/alcohol, trading drugs for sex, injuries from a fight, and traumatic head injury. Boys were prospectively tracked from age 16 to 19 at which time these outcomes were documented in the interim period. The results demonstrated that the VPS score is a significant predictor of all outcomes. Prediction accuracy ranged between 62%-83%. These findings suggest that the VPS may be useful for identifying youths who are at high risk for using illicit drugs and commonly associated adverse outcomes. PMID:19283571

  9. Association between maternal HBsAg carrier status and neonatal adverse outcomes: meta-analysis.

    Science.gov (United States)

    Luo, Lili; Wu, Jinlin; Qu, Yi; Li, Jiao; Pan, Lingli; Li, Deyuan; Wang, Huiqing; Mu, Dezhi

    2014-09-18

    Abstract Objective: We conducted a meta-analysis to evaluate whether maternal hepatitis B virus (HBV) carrier status increases the risk of neonatal complications. Methods: Publications addressing the association between maternal HBV carrier status and neonatal outcomes were selected from the PubMed, EMBASE, Web of Science, Cochrane Library and China National Knowledge Infrastructure. Publication bias and heterogeneity across studies were evaluated and summary odds ratios, weighted mean difference or standardized mean difference and 95% confidence intervals were calculated and compared between groups. Results: Eighteen studies and 7600 pregnant HBV carriers were selected for analyses. A statistically association with maternal HBV carrier status was demonstrated for premature birth and asphyxia, with no difference found among perinatal mortality, gestational age, small for gestational age, large for gestational age, birth weight, low birth weight, macrosomia, Apgar sore at 1 min, jaundice and congenital anomaly. Heterogeneity across studies was found, and no publication bias was detected. Conclusion: Our analysis suggests that maternal hepatitis B carrier status is significantly associated with premature birth and asphyxia. Large-scale prospective studies are still warranted. PMID:25231370

  10. Risk factors and perinatal outcome of uterine rupture in a low-resource setting

    OpenAIRE

    Anthony Osita Igwegbe; George Uchenna Eleje; Onyebuchi Izuchukwu Udegbunam

    2013-01-01

    Background: Uterine rupture has continued to be a catastrophic feature of obstetric practice especially in the low-resource settings. This study determined the incidence, predisposing factors, treatment options and feto-maternal outcome of ruptured uterus. Materials and Methods: A 10-year retrolective study of all cases of uterine ruptures that were managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria between 1st January, 2001 and 31st December, 2010 was undertaken. The prof...

  11. Perinatal Outcome of Monochorionic in Comparison to Dichorionic
Twin Pregnancies

    OpenAIRE

    Nihal Al Riyami; Asmaa Al-Rusheidi; Murtadha Al-Khabori

    2013-01-01

    Objective: The aim of this study is to compare the neonatal outcomes of monochorionic and dichorionic twin pregnancies.Methods: A retrospective cohort study involving 51 twin pregnancies followed and delivered at Sultan Qaboos University Hospital was conducted between January 2006 and December 2011.Result: Thirty six (71%) pregnancies were dichorionic diamniotic (DCDA), 14 (27%) were monochorionic diamniotic (MCDA), and one (2%) was monochorionic monoamniotic (MCMA). The antepartum complicati...

  12. Perinatal Programming of Childhood Asthma: Early Fetal Size, Growth Trajectory during Infancy, and Childhood Asthma Outcomes

    OpenAIRE

    Steve Turner

    2012-01-01

    The “fetal origins hypothesis” or concept of “developmental programming” suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding t...

  13. Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome.

    Science.gov (United States)

    Tollenaar, Lisanne S A; Slaghekke, Femke; Middeldorp, Johanna M; Klumper, Frans J; Haak, Monique C; Oepkes, Dick; Lopriore, Enrico

    2016-06-01

    Monochorionic twins share a single placenta and are connected with each other through vascular anastomoses. Unbalanced inter-twin blood transfusion may lead to various complications, including twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). TAPS was first described less than a decade ago, and the pathogenesis of TAPS results from slow blood transfusion from donor to recipient through a few minuscule vascular anastomoses. This gradually leads to anemia in the donor and polycythemia in the recipient, in the absence of twin oligo-polyhydramnios sequence (TOPS). TAPS may occur spontaneously in 3-5% of monochorionic twins or after laser surgery for TTTS. The prevalence of post-laser TAPS varies from 2% to 16% of TTTS cases, depending on the rate of residual anastomoses. Pre-natal diagnosis of TAPS is currently based on discordant measurements of the middle cerebral artery peak systolic velocity (MCA-PSV; >1.5 multiples of the median [MoM] in donors and 8 g/dL), and at least one of the following: reticulocyte count ratio >1.7 or minuscule placental anastomoses. Management includes expectant management, and intra-uterine blood transfusion (IUT) with or without partial exchange transfusion (PET) or fetoscopic laser surgery. Post-laser TAPS can be prevented by using the Solomon laser surgery technique. Short-term neonatal outcome ranges from isolated inter-twin Hb differences to severe neonatal morbidity and neonatal death. Long-term neonatal outcome in post-laser TAPS is comparable with long-term outcome after treated TTTS. This review summarizes the current knowledge after 10 years of research on the pathogenesis, diagnosis, management, and outcome in TAPS. PMID:27068715

  14. Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease.

    Directory of Open Access Journals (Sweden)

    James A G Crispo

    Full Text Available Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD. The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS. Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits.Many individuals (57.8% were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥ 4 were more likely to be diagnosed with fractures (adjusted odds ratio (AOR: 1.56, 95% CI: 1.29-1.88 and delirium (AOR: 1.61, 95% CI: 1.08-2.40 relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR: 1.32, 95% CI: 1.10-1.58 and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33 within 30-days of discharge.We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.

  15. Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75-g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Damm, P; Sørensen, B;

    2003-01-01

    AIMS: To study if established diagnostic threshold values for gestational diabetes based on a 75-g, 2-h oral glucose tolerance test can be supported by maternal and perinatal outcomes. METHODS: Historical cohort study of 3260 pregnant women examined for gestational diabetes on the basis of risk....../l than in women with 2-h glucose of 9.0-11.0 mmol/l. CONCLUSIONS: The risk for several maternal and perinatal complications increased with the diagnostic threshold for 2-h glucose. Large-scale blinded studies are needed to clarify the question of a clinically meaningful diagnosis of gestational diabetes...... mellitus. Until these results are available, a 2-h threshold level of 9.0 mmol/l after a 75-g oral glucose tolerance test seems acceptable....

  16. Adverse Geriatric Outcomes Secondary to Polypharmacy in a Mouse Model: The Influence of Aging.

    Science.gov (United States)

    Huizer-Pajkos, Aniko; Kane, Alice E; Howlett, Susan E; Mach, John; Mitchell, Sarah J; de Cabo, Rafael; Le Couteur, David G; Hilmer, Sarah N

    2016-05-01

    We aimed to develop a mouse model of polypharmacy, primarily to establish whether short-term exposure to polypharmacy causes adverse geriatric outcomes. We also investigated whether old age increased susceptibility to any adverse geriatric outcomes of polypharmacy. Young (n= 10) and old (n= 21) male C57BL/6 mice were administered control diet or polypharmacy diet containing therapeutic doses of five commonly used medicines (simvastatin, metoprolol, omeprazole, acetaminophen, and citalopram). Mice were assessed before and after the 2- to 4-week intervention. Over the intervention period, we observed no mortality and no change in food intake, body weight, or serum biochemistry in any age or treatment group. In old mice, polypharmacy caused significant declines in locomotor activity (pre minus postintervention values in control 2 ± 13 counts, polypharmacy 32 ± 7 counts,p< .05) and front paw wire holding impulse (control -2.45 ± 1.02 N s, polypharmacy +1.99 ± 1.19 N s,p< .05), loss of improvement in rotarod latency (control -59 ± 11 s, polypharmacy -1.7 ± 17 s,p< .05), and lowered blood pressure (control -0.2 ± 3 mmHg, polypharmacy 11 ± 4 mmHg,p< .05). In young mice, changes in outcomes over the intervention period did not differ between control and polypharmacy groups. This novel model of polypharmacy is feasible. Even short-term polypharmacy impairs mobility, balance, and strength in old male mice. PMID:25940962

  17. Below knee angioplasty in elderly patients: predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2012-02-01

    AIM: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). MATERIALS AND METHODS: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. RESULTS: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). CONCLUSION: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  18. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, Aoife N.; Khalidi, Karim; Leong, Sum [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Wang, Tim T. [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Ayyoub, Alaa S.; McGrath, Frank P. [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland); Athanasiou, Thanos [Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary' s Hospital, London W2 1NY (United Kingdom); Lee, Michael J., E-mail: mlee@rcsi.ie [Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9 (Ireland)

    2011-03-15

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  19. Pivmecillinam and adverse birth and neonatal outcomes: a population-based cohort study.

    Science.gov (United States)

    Vinther Skriver, Mette; Nørgaard, Mette; Pedersen, Lars; Carl Schønheyder, Henrik; Sørensen, Henrik Toft

    2004-01-01

    A previous study unexpectedly showed an increased, statistically imprecise, risk of low Apgar score in children of women redeeming prescriptions for pivmecillinam in late pregnancy. To improve statistical precision we extended the previous dataset with data for 5 more y, and in addition added more neonatal outcomes. We thus examined the risk of adverse birth and neonatal outcomes among pregnant users of pivmecillinam based on population-based registries in North Jutland County, Denmark. We included 63,659 women with a live birth, or stillbirth after the 28th week of gestation. 2031 had redeemed prescriptions for pivmecillinam any time during pregnancy, 559 in the first trimester and 371 within 28 d before delivery. Adjusted odds ratios were: birth defects 0.83 (95% confidence interval (95% CI) 0.53-1.32) for exposure during first trimester, preterm delivery 0.96 (95% CI 0.79-1.18) and low birth weight 0.79 (95% CI 0.52-1.20) for exposure any time during pregnancy, and stillbirth 1.19 (95% CI 0.30-4.80), low Apgar score 1.17 (95% CI 0.37-3.66), hypoglycaemia 1.03 (95% CI 0.53-2.00), and respiratory distress syndrome 0.79 (95% CI 0.38-1.68) for exposure within 28 d before delivery. Use of pivmecillinam during pregnancy did not appear to increase the risk of adverse birth and neonatal outcomes; however, statistical precision is still low. PMID:15513399

  20. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes

    International Nuclear Information System (INIS)

    Aim: To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI). Materials and methods: Over 7.5 years, 76 patients (CLI 72%, n = 55) underwent below knee PTA. The composite end-point of interest was major adverse clinical outcome (MACO) of the treated limb at follow-up which was defined as clinical failure, need for subsequent endovascular or surgical revascularization or amputation. Actuarial freedom from MACO was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards regression. Results: IC was improved in 95% at mean 3.4 years (range 0.5-108 months). Successful limb salvage and ulcer healing were seen in 73% with CLI. Most failures were in the CLI group (27% CLI vs. 5% IC), with an amputation rate of 16% for CLI vs. 5% for IC and persistent ulceration in 24% of CLI. Significant independent predictors of MACO were ulceration (hazard ratio 4.02, 95% CI = 1.55-10.38) and family history of atherosclerosis (hazard ratio 2.53, 95% CI = 1.1-5.92). Conclusion: Primary below knee PTA is a feasible therapeutic option in this elderly population. Limb ulceration and family history of atherosclerosis may be independent predictors of adverse outcome.

  1. Under-attending free antenatal care is associated with adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Heinonen Seppo

    2007-09-01

    Full Text Available Abstract Background Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. Methods This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 – 2001. Pregnancy outcomes of women having low numbers (1–5 of antenatal care visits (n = 207 and no antenatal care visits (n = 270 were compared with women having 6–18 antenatal visits (n = 23137. Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s in multiple logistic regression models. Results Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1–5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio-amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65–12.68 and 5.46 (3.90–7.65, respectively more fetal deaths (OR:s 12.05 (5.95–24.40 and 5.19 (2.04–13.22, respectively and more neonatal deaths (OR:s 10.03 (3.85–26.13 and 8.66 (3.59–20.86, respectively. Conclusion Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the

  2. Obstetric and perinatal outcomes of teenage pregnant women: a retrospective study

    Directory of Open Access Journals (Sweden)

    Martina Derme

    2013-09-01

    Full Text Available Background: teenage pregnancy is a worldwide social problem. The aim of this study is to provide more data for a better understanding of the possible maternal and foetal risks associated with teenage pregnancies.Methods: the hospital records of all pregnant women, aged between 14 and 19, from the obstetric registers of the Policlinico Umberto I Hospital in Rome, between 2000 and 2010, have been completely reviewed (n=184. For each pregnant woman socio-demographic characteristics, obstetric history, pregnancy and birth outcomes were also determined. Our results were compared with a control group composed of 150 primigravida adult women aged 20-29 years who delivered at the Policlinico Umberto I Hospital in Rome in the same period.Results: the mean age ± SD of the study group was 17.9 ± 1.2, while that of the control group was 25.4 ± 2.4. The control group had a significantly lower risk of preterm delivery (p=0.000. The rate of low birth weight babies born to the young mothers was significantly higher than that of babies born to the adult mothers (p=0.036. The study group had a lower risk of instrumental delivery and a higher proportion of spontaneous delivery (p=0.000. Finally, we observed a statistically significant difference of the APGAR score at the fifth minute between the two groups (p=0.004.Conclusions: our results seemed to confirm the outcomes of previous studies for adolescent pregnant women, mainly regarding the increased risks of preterm deliveries and low birth weight babies, the higher incidence of spontaneous vaginal delivery and the lower incidence of instrumental delivery.

  3. Effect of RAAS blockers on adverse clinical outcomes in high CVD risk subjects with atrial fibrillation

    Science.gov (United States)

    Chaugai, Sandip; Sherpa, Lhamo Yanchang; Sepehry, Amir A.; Arima, Hisatomi; Wang, Dao Wen

    2016-01-01

    Abstract Recent studies have demonstrated that atrial fibrillation significantly increases the risk of adverse clinical outcomes in high cardiovascular disease risk subjects. Application of renin–angiotensin–aldosterone system blockers for prevention of recurrence of atrial fibrillation and adverse clinical outcomes in subjects with atrial fibrillation is a theoretically appealing concept. However, results of clinical trials evaluating the effect of renin–angiotensin–aldosterone blockers on adverse clinical outcomes in high cardiovascular disease risk subjects with atrial fibrillation remain inconclusive. A pooled study of 6 randomized controlled trials assessing the efficacy of renin–angiotensin–aldosterone blockers on subjects with atrial fibrillation was performed. A total of 6 randomized controlled trials enrolled a total of 53,510 patients followed for 1 to 5 years. RAAS blockade therapy was associated with 14% reduction in the incidence of heart failure (OR: 0.86, [95%CI: 0.76– 0.97], P=0.018) and 17% reduction in the incidence of CVE (OR: 0.83, [95%CI: 0.70–0.99], P = 0.038). The corresponding decline in absolute risk against heart failure (ARR: 1.4%, [95%CI: 0.2–2.6%], P = 0.018) and CVE (ARR: 3.5%, [95%CI: 0.0–6.9%], P = 0.045) in the AF group was much higher than the non-AF group for heart failure (ARR: 0.4%, [95%CI: 0.0–0.7%], P = 0.057) and CVE (ARR: 1.6%, [95%CI: –0.1% to 3.3%], P = 0.071). No significant effect was noted on all-cause or cardiovascular mortality, stroke, or myocardial infarction. This study suggests that RAAS blockade offers protection against heart failure and cardiovascular events in high cardiovascular disease risk subjects with atrial fibrillation. PMID:27368043

  4. Blood rheology at term in normal pregnancy and in patients with adverse outcome events.

    Science.gov (United States)

    von Tempelhoff, Georg-Friedrich; Velten, Eva; Yilmaz, Asli; Hommel, Gerhard; Heilmann, Lothar; Koscielny, Jürgen

    2009-01-01

    Plasma volume expansion of more than 1.5 l and sustainable activation of the hemostatic system that results in a steady rise of the fibrinogen/fibrin turnover are contemporary physiological events during normal pregnancy. In contrast, adverse outcome of pregnancy i.e. pre-eclampsia commonly coincide with hemo concentration and over activation of blood coagulation both of which alter blood rheology. On the basis of 4,985 consecutively recorded singleton pregnancies values range of blood rheological parameters in women with normal and complicated outcome of pregnancy at the time of their delivery were compared. Plasma viscosity (pv) was determined using KSPV 1 Fresenius and RBC aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne. Seventy-nine point four percent (n=3,959) had normal pregnancy outcome and 1,026 with adverse outcome of pregnancy had pre-eclampsia (8.4%; n=423), had newborn with a birth-weight < 2,500 g (9.5%; n=473), had early-birth before week 37 (9.3%; n=464), and/or were diagnosed with intra uterine growth retardation (IUGR) (5.0%; n=250). In women with normal pregnancy outcome mean (+/-SD) of pv was 1.31+/-0.09 mPa s, of E0 was 21.6+/-5.3, and of E1 was 38.4+/-7.9 while in women with adverse outcome means for rheological parameters were statistically significantly different i.e. pv: 1.32+/-0.08 mPa s; p=0.006, E0: 22.1+/-5.5; p=0.002 and E1: 39.5+/-8.5; p=0.0006. Subgroup analysis revealed statistical significant lower pv in women who either had pre term delivery or a low birth-weight child (p<0.005) as compared to women who had normal pregnancy outcome while patients with pre-eclampsia had markedly higher low shear and stasis RBC aggregation (p<0.0001). None of the rheological results at term were correlated with either maternal age (r<0.04), BMI (r<0.09), maternal weight gain until delivery (r<0.04), or fetal outcome such as APGAR-score (r<0.09) art. pH in the umbilical cord (-0.05

  5. Adverse pregnancy outcomes in offspring of fathers working in biomedical research laboratories

    DEFF Research Database (Denmark)

    Magnusson, Linda L; Bodin, Lennart; Wennborg, Helena

    2006-01-01

    BACKGROUND: Laboratory work may constitute a possible health hazard for workers as well as for their offspring, and involves a wide range of exposures, such as organic solvents, carcinogenic agents, ionizing radiation, and/or microbiological agents. Adverse pregnancy outcomes in the offspring of...... significant increased ORs concerning birth weight and/or gestational age, but work specifically with radioactive isotopes gave OR 1.8 (CI 1.0-3.2) for high birth weight and a relative risk of 1.2 (CI 1.0-1.4) for sex ratio (male/female). CONCLUSIONS: There was no clear association between periconceptional...

  6. Generation of computationally predicted Adverse Outcome Pathway networks through integration of publicly available in vivo, in vitro, phenotype, and biological pathway data.

    Science.gov (United States)

    The Adverse Outcome Pathway (AOP) framework is becoming a widely used tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse ecological and human health outcomes. However, the conventional process...

  7. Conceptual Model for Assessing Criteria Air Pollutants in a Multipollutant Context: A Modified Adverse Outcome Pathway Approach

    Science.gov (United States)

    Background: Air pollution consists of a complex mixture of particulate and gaseous components. Individual criteria and other hazardous air pollutants have been linked to adverse respiratory and cardiovascular health outcomes. However, assessing risk of air pollutant mixtures is d...

  8. Perinatal use of aripiprazole: plasma levels, placental transfer, and child outcome in 3 new cases.

    Science.gov (United States)

    Windhager, Elmar; Kim, Sung-Wan; Saria, Alois; Zauner, Katharina; Amminger, Paul G; Klier, Claudia M

    2014-10-01

    The use of new agents of second-generation antipsychotics in childbearing women is increasing and poses an unknown risk to the fetus; thus, information of pregnancy and child outcome are urgently needed. We reviewed the literature of 12 patients, 3 of them were exposed during the first trimester, and added 3 new cases of peripartum use of aripiprazole. No teratogenesis was observed despite all 3 women having received the substance during part or full first trimester. All 3 pregnancies were uncomplicated with spontaneous birth. Dosage had to be changed during the course of gestation from 2.5 to 15 mg and plasma levels (PL) were below recommended levels, although all 3 women remained in stable remission throughout pregnancy and postpartum period.The extent of placental transfer of aripiprazole (mean ratio of 56.2%) is comparable with that of other second-generation antipsychotics.Our observations have clinical implications: antipsychotic PLs show large-scale decreases, which may require dose adjustments during pregnancy. Pregnant women may require lower PLs. In our cases, a PL of one third of the previous effective PL was effective and safe. Repeated therapeutic drug monitoring during late gestation based on individual, previous effective PLs seems to be a feasible way for safe and effective antipsychotic therapy in unplanned pregnancy. PMID:24949701

  9. Should we continue using amphotericin B deoxycholate for the treatment of fungal infections? Adverse events and clinical outcomes.

    Science.gov (United States)

    Garbino, Jorge; Markham, Lydia; Matulionyte, Raimonda; Rives, Vincent; Lew, Daniel

    2006-01-01

    Amphotericin B deoxycholate (AmBd) has been a standard therapy for IFI but is associated with high adverse event and mortality rates. A retrospective review was undertaken to describe adverse events and clinical outcomes in adult patients with IFI treated with only AmBd as initial therapy. PMID:16449001

  10. Maternal Snoring May Predict Adverse Pregnancy Outcomes: A Cohort Study in China.

    Directory of Open Access Journals (Sweden)

    Xing Ge

    Full Text Available To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes.Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes.Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM (RR 1.66, 95%CI 1.09-2.53. Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17-3.27, and RR 2.33, 95%CI 1.22-4.46, respectively. Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09-1.73 and having macrosomia (RR 1.54, 95%CI 1.05-2.27 and large for gestational age (LGA (RR 1.71, 95%CI 1.31-2.24 infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes.Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results.

  11. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    OpenAIRE

    Padhi, Bijaya K.; Baker, Kelly K.; Ambarish Dutta; Oliver Cumming; Freeman, Matthew C.; Radhanatha Satpathy; Das, Bhabani S.; Pinaki Panigrahi

    2015-01-01

    Editors' Summary Background Pregnancy is usually a happy time for women and their families. But, for some women, pregnancy ends unhappily. Some women lose their baby during early pregnancy (spontaneous abortion or miscarriage) or during late pregnancy (stillbirth). Others have their baby earlier than expected (preterm birth) or have a baby with low birth weight, two outcomes that adversely affect the baby’s survival and long-term health. The burden of adverse pregnancy outcomes (low birth wei...

  12. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study

    OpenAIRE

    Padhi, BK; Baker, KK; Dutta, A; Cumming, O.; Freeman, MC; Satpathy, R; Das, BS; Panigrahi, P

    2015-01-01

    Editors' Summary Background Pregnancy is usually a happy time for women and their families. But, for some women, pregnancy ends unhappily. Some women lose their baby during early pregnancy (spontaneous abortion or miscarriage) or during late pregnancy (stillbirth). Others have their baby earlier than expected (preterm birth) or have a baby with low birth weight, two outcomes that adversely affect the baby’s survival and long-term health. The burden of adverse pregnancy outcomes (low birth wei...

  13. The adverse effect of spasticity on 3-month poststroke outcome using a population-based model.

    Science.gov (United States)

    Belagaje, S R; Lindsell, C; Moomaw, C J; Alwell, K; Flaherty, M L; Woo, D; Dunning, K; Khatri, P; Adeoye, O; Kleindorfer, D; Broderick, J; Kissela, B

    2014-01-01

    Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS) as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question "Did you have spasticity following your stroke?" on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n = 30) or did not have spasticity data available (n = 102) were excluded. Spasticity affected the 3-month functional status (β = 0.420, 95 CI = 0.194 to 0.645) after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model's R (2) changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors. PMID:25147752

  14. The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

    Directory of Open Access Journals (Sweden)

    S. R. Belagaje

    2014-01-01

    Full Text Available Several devices and medications have been used to address poststroke spasticity. Yet, spasticity’s impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was defined by a positive response to the question “Did you have spasticity following your stroke?” on direct interview at 3 months from stroke onset. Patients who had expired by 90 days (n=30 or did not have spasticity data available (n=102 were excluded. Spasticity affected the 3-month functional status (β=0.420, 95 CI=0.194 to 0.645 after accounting for age, diabetes, leukoaraiosis, and retrospective NIHSS. Using spasticity as a covariable, the model’s R2 changed from 0.599 to 0.622. In our model, the presence of spasticity in the cohort was associated with a worsened 3-month mRS by an average of 0.4 after adjusting for known covariables. This significant adverse effect on functional outcomes adds predictive value beyond previously established factors.

  15. Serotonin Reuptake Inhibitors in Pregnancy: Can Genes Help Us in Predicting Neonatal Adverse Outcome?

    Directory of Open Access Journals (Sweden)

    Valentina Giudici

    2014-01-01

    Full Text Available Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome. So far, still little is known about the possible etiologic mechanism that could not only explain the adverse neonatal effects but also the degree of clinical involvement and presentation in the early period after birth. Pharmacogenetics and moreover pharmacogenomics, the study of specific genetic variations and their effect on drug response, are not widespread. This review describes possible relationship between SSRIs pharmacogenetics and different neonatal outcomes and summarizes the current pharmacogenetic inquiries in relation to maternal-foetal environment.

  16. Applying Adverse Outcome Pathways (AOPs) to support Integrated Approaches to Testing and Assessment (IATA).

    Science.gov (United States)

    Tollefsen, Knut Erik; Scholz, Stefan; Cronin, Mark T; Edwards, Stephen W; de Knecht, Joop; Crofton, Kevin; Garcia-Reyero, Natalia; Hartung, Thomas; Worth, Andrew; Patlewicz, Grace

    2014-12-01

    Chemical regulation is challenged by the large number of chemicals requiring assessment for potential human health and environmental impacts. Current approaches are too resource intensive in terms of time, money and animal use to evaluate all chemicals under development or already on the market. The need for timely and robust decision making demands that regulatory toxicity testing becomes more cost-effective and efficient. One way to realize this goal is by being more strategic in directing testing resources; focusing on chemicals of highest concern, limiting testing to the most probable hazards, or targeting the most vulnerable species. Hypothesis driven Integrated Approaches to Testing and Assessment (IATA) have been proposed as practical solutions to such strategic testing. In parallel, the development of the Adverse Outcome Pathway (AOP) framework, which provides information on the causal links between a molecular initiating event (MIE), intermediate key events (KEs) and an adverse outcome (AO) of regulatory concern, offers the biological context to facilitate development of IATA for regulatory decision making. This manuscript summarizes discussions at the Workshop entitled "Advancing AOPs for Integrated Toxicology and Regulatory Applications" with particular focus on the role AOPs play in informing the development of IATA for different regulatory purposes. PMID:25261300

  17. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    International Nuclear Information System (INIS)

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V22 (volume of lung exposed to a radiation dose ≥22 Gy) and V30 (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and Vdose (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used

  18. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Venkatramani, Rajkumar, E-mail: rvenkatramani@chla.usc.edu [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Kamath, Sunil [Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Wong, Kenneth [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Olch, Arthur J. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Radiation Oncology, University of Southern California, Los Angeles, California (United States); Malvar, Jemily [Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Sposto, Richard [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Goodarzian, Fariba [Department of Radiology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Freyer, David R. [Division of Hematology/Oncology, Children' s Hospital Los Angeles, Los Angeles, California (United States); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Keens, Thomas G. [Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (United States); Department of Pulmonology, Children' s Hospital Los Angeles, Los Angeles, California (United States); and others

    2013-08-01

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed

  19. Integrating Publicly Available Data to Generate Computationally Predicted Adverse Outcome Pathways for Fatty Liver.

    Science.gov (United States)

    Bell, Shannon M; Angrish, Michelle M; Wood, Charles E; Edwards, Stephen W

    2016-04-01

    Newin vitrotesting strategies make it possible to design testing batteries for large numbers of environmental chemicals. Full utilization of the results requires knowledge of the underlying biological networks and the adverse outcome pathways (AOPs) that describe the route from early molecular perturbations to an adverse outcome. Curation of a formal AOP is a time-intensive process and a rate-limiting step to designing these test batteries. Here, we describe a method for integrating publicly available data in order to generate computationally predicted AOP (cpAOP) scaffolds, which can be leveraged by domain experts to shorten the time for formal AOP development. A network-based workflow was used to facilitate the integration of multiple data types to generate cpAOPs. Edges between graph entities were identified through direct experimental or literature information, or computationally inferred using frequent itemset mining. Data from the TG-GATEs and ToxCast programs were used to channel large-scale toxicogenomics information into a cpAOP network (cpAOPnet) of over 20 000 relationships describing connections between chemical treatments, phenotypes, and perturbed pathways as measured by differential gene expression and high-throughput screening targets. The resulting fatty liver cpAOPnet is available as a resource to the community. Subnetworks of cpAOPs for a reference chemical (carbon tetrachloride, CCl4) and outcome (fatty liver) were compared with published mechanistic descriptions. In both cases, the computational approaches approximated the manually curated AOPs. The cpAOPnet can be used for accelerating expert-curated AOP development and to identify pathway targets that lack genomic markers or high-throughput screening tests. It can also facilitate identification of key events for designing test batteries and for classification and grouping of chemicals for follow up testing. PMID:26895641

  20. Clinical Features and Correlates of Outcomes for High-Risk, Marginalized Mothers and Newborn Infants Engaged with a Specialist Perinatal and Family Drug Health Service

    Science.gov (United States)

    Taylor, Lee; Hutchinson, Delyse; Rapee, Ron; Burns, Lucy; Stephens, Christine; Haber, Paul S.

    2012-01-01

    Background. There is a paucity of research in Australia on the characteristics of women in treatment for illicit substance use in pregnancy and the health outcomes of their neonates. Aims. To determine the clinical features and outcomes of high-risk, marginalized women seeking treatment for illicit substance use in pregnancy and their neonates. Methods. 139 women with a history of substance abuse/dependence engaged with a perinatal drug health service in Sydney, Australia. Maternal (demographic, drug use, psychological, physical, obstetric, and antenatal care) and neonatal characteristics (delivery, early health outcomes) were examined. Results. Compared to national figures, pregnant women attending a specialist perinatal and family drug health service were more likely to report being Australian born, Aboriginal or Torres Strait Islander, younger, unemployed, and multiparous. Opiates were the primary drug of concern (81.3%). Pregnancy complications were common (61.9%). Neonates were more likely to be preterm, have low birth weight, and be admitted to special care nursery. NAS was the most prevalent birth complication (69.8%) and almost half required pharmacotherapy. Conclusion. Mother-infant dyads affected by substance use in pregnancy are at significant risk. There is a need to review clinical models of care and examine the longer-term impacts on infant development. PMID:23227054

  1. A CLINICAL STUDY OF EFFECTS OF POLY AND OLIGOHY DROMNIOS ON OBSTETRIC OUTCOME WITH A SP E C I AL REF ERENCE TO PERINATAL MORTALITY AND MORBI D ITY

    OpenAIRE

    Sunanda Bai

    2015-01-01

    OBJECTIVES: To study the obstetric outcome in pregnancies with oligohydramnios and polyhydramnios. To determine the perinatal outcome in pregnancies complicated with oligohydramnios and polyhydramnios. METHODS: This study is conducted on pregnant woman with abnormal liquor volume who attended the antenatal clinic at Institute of obstetrics and gynecology , Bowring and Lady curzon Hospital attached to BMCRI Bengaluru Ja...

  2. Missing paternal demographics: A novel indicator for identifying high risk population of adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Wen Shi

    2004-11-01

    Full Text Available Abstract Background One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. Methods We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995–1997, which was a matched multiple birth file (only twins were included in the current analysis. We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. Results There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score Conclusions Mothers whose partner's information was partly and (especially totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor.

  3. Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Mojgan Barati

    2014-01-01

    Full Text Available Background : Increased impedance to flow in the uterine arteries assessed by value of the Doppler is associated with adverse pregnancy outcomes, especially pre-eclampsia. We investigated the predictive value of a uterine artery Doppler in the identification of adverse pregnancy outcomes such as ′pre-eclampsia′ and ′small fetus for gestational age′ (SGA. Materials and Methods: Three hundred and seventy-nine women, with singleton pregnancy, between 18 and 40 years of age, without risk factors, randomly underwent Doppler interrogation of the uterine arteries, between 16-22 weeks of gestation. Those who had a mean pulsatility index (PI of >1.45 were considered to have an abnormal result, and were evaluated and compared with those who had normal results for adverse pregnancy outcomes, including pre-eclampsia and small for gestational age. The relationship between the variables was assessed with the use of the chi-square test. Results : There were 17 cases (4.5% of abnormal uterine artery Doppler results and 15 of them (88.2% developed pre-eclampsia and four cases (23.5% had neonates small for gestational age. For predicting pre-eclampsia, the mean uterine artery PI had to be >1.45, had to have a specificity of 95.5% (95% CI, 70-92%, a sensitivity of 79% (95% CI, 43-82%, a negative predictive value (NPV of 98.9% (95% CI, 72-96%, and a positive predictive value (PPV of 88.2% (95% CI, 68-98%. In the case of ′small for gestational age′ it had to have a specificity of 96.5% (95% CI, 42-68%, a sensitivity of 57% (95% CI, 53-76%, an NPV of 99.2% (95% CI, 70-92%, and a PPV of 23.5% (95% CI, 30-72%. Conclusion : Uterine artery Doppler evaluation at 16-22 weeks of gestation might be an appropriate tool for identifying pregnancies that may be at an increased risk for development of pre-eclampsia and small fetus for gestational age.

  4. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Indu Sharma

    2016-06-01

    Conclusions: The incidence of eclampsia in our institute was very high with corresponding very high maternal and perinatal morbidity and mortality which emphasizes the need of education, improvement in health care services and universal antenatal checkup and enhancement in timely referral with improvement in transport facilities. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1887-1891

  5. Urinary Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) • Insulin-Like Growth Factor-Binding Protein 7 (IGFBP7) Predicts Adverse Outcome in Pediatric Acute Kidney Injury

    Science.gov (United States)

    Westhoff, Jens H.; Tönshoff, Burkhard; Waldherr, Sina; Pöschl, Johannes; Teufel, Ulrike; Westhoff, Timm H.; Fichtner, Alexander

    2015-01-01

    Background The G1 cell cycle inhibitors tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been identified as promising biomarkers for the prediction of adverse outcomes including renal replacement therapy (RRT) and mortality in critically ill adult patients who develop acute kidney injury (AKI). However, the prognostic value of urinary TIMP-2 and IGFBP7 in neonatal and pediatric AKI for adverse outcome has not been investigated yet. Methods The product of the urinary concentration of TIMP-2 and IGFBP7 ([TIMP-2]•[IGFBP7]) was assessed by a commercially available immunoassay (NephroCheck™) in a prospective cohort study in 133 subjects aged 0–18 years including 46 patients with established AKI according to pRIFLE criteria, 27 patients without AKI (non-AKI group I) and 60 apparently healthy neonates and children (non-AKI group II). AKI etiologies were: dehydration/hypovolemia (n = 7), hemodynamic instability (n = 7), perinatal asphyxia (n = 9), septic shock (n = 7), typical hemolytic-uremic syndrome (HUS; n = 5), interstitial nephritis (n = 5), vasculitis (n = 4), nephrotoxic injury (n = 1) and renal vein thrombosis (n = 1). Results When AKI patients were classified into pRIFLE criteria, 6/46 (13%) patients fulfilled the criteria for the category “Risk”, 13/46 (28%) for “Injury”, 26/46 (57%) for “Failure” and 1/46 (2%) for “Loss”. Patients in the “Failure” stage had a median 3.7-fold higher urinary [TIMP-2]•[IGFBP7] compared to non-AKI subjects (P<0.001). When analyzed for AKI etiology, highest [TIMP-2]•[IGFBP7] values were found in patients with septic shock (P<0.001 vs. non-AKI I+II). Receiver operating characteristic (ROC) curve analyses in the AKI group revealed good performance of [TIMP-2]•[IGFBP7] in predicting 30-day (area under the curve (AUC) 0.79; 95% CI, 0.61–0.97) and 3-month mortality (AUC 0.84; 95% CI, 0.67–0.99) and moderate performance in predicting RRT

  6. Similar adverse pregnancy outcome in native and nonnative dutch women with pregestational type 2 diabetes: a multicentre retrospective study

    OpenAIRE

    Rutgert Bianchi; Bartelink, Anton K M; Geelhoed-Duijvestijn, Petronella H. L. M.; Willy Visser; Manon C. J. Schreuder; Faas, Marijke M; Sluiter, Wim J.; Visser, Gerard H. A.; Sharon Moerman; Marieke Hellinga; van den Berg, Paul P.; Links, Thera P.; Bart Groen; de Valk, Harold W.

    2013-01-01

    Objective. To assess the incidence of adverse pregnancy outcome in native and nonnative Dutch women with pregestational type 2 diabetes (T2D) in a multicenter study in The Netherlands. Methods. Maternal characteristics and pregnancy outcome were retrospectively reviewed and the influence of ethnicity on outcome was evaluated using independent t-test, Mann-Whitney U-test, and chi-square test. Results. 272 pregnant women (80 native and 192 non-native Dutch) with pregestational T2D were included...

  7. Optimal screening for increased risk for adverse outcomes in hospitalised older adults

    DEFF Research Database (Denmark)

    Heim, Noor; van Fenema, Ester M; Weverling-Rijnsburger, Annelies W E; Tuijl, Jolien P; Jue, Peter; Oleksik, Anna M; Verschuur, Margot J; Haverkamp, Jasper S; Blauw, Gerard Jan; van der Mast, Roos C; Westendorp, Rudi G J

    2015-01-01

    . SUBJECTS: Patients aged ≥70 years, electively or acutely hospitalised for ≥2 days. METHODS: Screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of...... Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities...... strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70-80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the...

  8. Severe Adverse Maternal Outcomes among Women in Midwife-Led versus Obstetrician-Led Care at the Onset of Labour in the Netherlands: A Nationwide Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ank de Jonge

    Full Text Available To test the hypothesis that it is possible to select a group of low risk women who can start labour in midwife-led care without having increased rates of severe adverse maternal outcomes compared to women who start labour in secondary care.We conducted a nationwide cohort study in the Netherlands, using data from 223 739 women with a singleton pregnancy between 37 and 42 weeks gestation without a previous caesarean section, with spontaneous onset of labour and a child in cephalic presentation. Information on all cases of severe acute maternal morbidity collected by the national study into ethnic determinants of maternal morbidity in the Netherlands (LEMMoN study, 1 August 2004 to 1 August 2006, was merged with data from the Netherlands Perinatal Registry of all births occurring during the same period. Our primary outcome was severe acute maternal morbidity (SAMM, i.e. admission to an intensive care unit, uterine rupture, eclampsia or severe HELLP, major obstetric haemorrhage, and other serious events. Secondary outcomes were postpartum haemorrhage and manual removal of placenta.Nulliparous and parous women who started labour in midwife-led care had lower rates of SAMM, postpartum haemorrhage and manual removal of placenta compared to women who started labour in secondary care. For SAMM the adjusted odds ratio's and 95% confidence intervals were for nulliparous women: 0.57 (0.45 to 0.71 and for parous women 0.47 (0.36 to 0.62.Our results suggest that it is possible to identify a group of women at low risk of obstetric complications who may benefit from midwife-led care. Women can be reassured that we found no evidence that midwife-led care at the onset of labour is unsafe for women in a maternity care system with a well developed risk selection and referral system.

  9. Adverse events and outcomes of procedural sedation and analgesia in major trauma patients

    Directory of Open Access Journals (Sweden)

    Robert S Green

    2015-01-01

    Full Text Available Context: Trauma patients requiring procedural sedation and analgesia (PSA may have increased risk of adverse events (AEs and poor outcomes. Aims: To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes. Settings and Design: Retrospective analysis of adult patients (age >16 who received PSA between 2006 and 2014 at a Canadian academic tertiary care center. Materials and Methods: We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures. The majority (77% of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1, and most (85% of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23% and hypotension (20%. After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89. Conclusion: Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.

  10. Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

    Science.gov (United States)

    Daskalou, Efstratia; Galli-Tsinopoulou, Assimina; Karagiozoglou-Lampoudi, Thomais; Augoustides-Savvopoulou, Persefone

    2016-01-01

    Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients. PMID:26709552

  11. Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis.

    Science.gov (United States)

    Gillick, K; Elbeltagi, H; Bhattacharya, S

    2016-01-01

    Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients' general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann-Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of disease

  12. An integrative data mining approach to identifying adverse outcome pathway signatures.

    Science.gov (United States)

    Oki, Noffisat O; Edwards, Stephen W

    2016-03-28

    The Adverse Outcome Pathway (AOP) framework is a tool for making biological connections and summarizing key information across different levels of biological organization to connect biological perturbations at the molecular level to adverse outcomes for an individual or population. Computational approaches to explore and determine these connections can accelerate the assembly of AOPs. By leveraging the wealth of publicly available data covering chemical effects on biological systems, computationally-predicted AOPs (cpAOPs) were assembled via data mining of high-throughput screening (HTS) in vitro data, in vivo data and other disease phenotype information. Frequent Itemset Mining (FIM) was used to find associations between the gene targets of ToxCast HTS assays and disease data from Comparative Toxicogenomics Database (CTD) by using the chemicals as the common aggregators between datasets. The method was also used to map gene expression data to disease data from CTD. A cpAOP network was defined by considering genes and diseases as nodes and FIM associations as edges. This network contained 18,283 gene to disease associations for the ToxCast data and 110,253 for CTD gene expression. Two case studies show the value of the cpAOP network by extracting subnetworks focused either on fatty liver disease or the Aryl Hydrocarbon Receptor (AHR). The subnetwork surrounding fatty liver disease included many genes known to play a role in this disease. When querying the cpAOP network with the AHR gene, an interesting subnetwork including glaucoma was identified. While substantial literature exists to support the potential for AHR ligands to elicit glaucoma, it was not explicitly captured in the public annotation information in CTD. The subnetwork from this analysis suggests a cpAOP that includes changes in CYP1B1 expression, which has been previously established in the literature as a primary cause of glaucoma. These case studies highlight the value in integrating multiple data

  13. Mechanistic study of chlordecone-induced endocrine disruption: Based on an adverse outcome pathway network.

    Science.gov (United States)

    Yang, Lihua; Zhou, Bingsheng; Zha, Jinmiao; Wang, Zijian

    2016-10-01

    The adverse outcome pathway (AOP) framework could be helpful for chemical risk assessment and mechanistic research. The aim of the present study was to unravel the mechanism of chlordecone-induced endocrine disruption by illustrating the main molecular initiating event (MIE)/perturbations responsible for the observed effects. In silico simulations were performed to predict the MIE(s), and the results pointed to agonistic interaction with estrogen receptors (ERα, ERβ), androgen receptor (AR), cytochrome P450 (CYP19A) by chlordecone. In vivo endocrine disruptions were evaluated in rare minnow (Gobiocypris rarus) exposed to 0.01, 0.1, 1 and 10 μg L(-1) chlordecone from 2 h post-fertilization until sexually mature. In the females, increases of vitellogenin (vtg) mRNA levels in liver and gonad, plasma estradiol (E2), testosterone (T) and E2/T, and renalsomatic index confirmed the role of agonism of ER and CYP19A as MIEs, but the decreased gonadosomatic index, degenerated ovaries as well as the feed-forward response pointed to other potential but important MIEs and corresponding AOPs. In the males, increased E2/T ratio, increased testis vtg mRNA levels and occurrence of intersex confirmed the roles of agonism of ERα and CYP19A as main MIEs in chlordecone-induced endocrine disruptions. Our results also fetches out the limit of AOPs in predicting the adverse outcomes and explaining the mechanism of chemicals at present, thus reflected a critical need for expanding AOPs and AOP network before using it in chemical risk assessment. PMID:27448318

  14. Patient-reported outcomes and the evolution of adverse event reporting in oncology.

    Science.gov (United States)

    Trotti, Andy; Colevas, A Dimitrios; Setser, Ann; Basch, Ethan

    2007-11-10

    Adverse event (AE) reporting in oncology has evolved from informal descriptions to a highly systematized process. The Common Terminology Criteria for Adverse Events (CTCAE) is the predominant system for describing the severity of AEs commonly encountered in oncology clinical trials. CTCAE clinical descriptors have been developed empirically during more than 30 years of use. The method of data collection is clinician based. Limitations of the CTC system include potential for incomplete reporting and limited guidance on data analysis and presentation methods. The Medical Dictionary for Regulatory Activities (MedDRA) is a comprehensive medical terminology system used for regulatory reporting and drug labeling. MedDRA does not provide for severity ranking of AEs. CTC-based data presentations are the primary method of AE data reporting used in scientific journals and oncology meetings. Patient-reported outcome instruments (PROs) cover the subjective domain of AEs. Exploratory work suggests PROs can be used with a high degree of patient engagement and compliance. Additional studies are needed to determine how PROs can be used to complement current AE reporting systems. Potential models for integrating PROs into AE reporting are described in this review. AE reporting methods will continue to evolve in response to changing therapies and growing interest in measuring the impact of cancer treatment on health status. Although integration of PROs into AE reporting may ultimately improve the comprehensiveness and quality of collected data, it may also increase the administrative burden and cost of conducting trials. Therefore, care must be used when developing health outcomes and safety data collection plans. PMID:17991931

  15. The adverse outcome pathway (AOP) for chemical binding to tubulin in oocytes leading to aneuploid offspring.

    Science.gov (United States)

    Marchetti, Francesco; Massarotti, Alberto; Yauk, Carole L; Pacchierotti, Francesca; Russo, Antonella

    2016-03-01

    The Organisation for Economic Co-operation and Development (OECD) has launched the Adverse Outcome Pathway (AOP) Programme to advance knowledge of pathways of toxicity and improve the use of mechanistic information in risk assessment. An AOP links a molecular initiating event (MIE) to an adverse outcome (AO) through intermediate key events (KE). Here, we present the scientific evidence in support of an AOP whereby chemicals that bind to tubulin cause microtubule depolymerization resulting in spindle disorganization followed by altered chromosome alignment and segregation and the generation of aneuploidy in female germ cells, ultimately leading to aneuploidy in the offspring. Aneuploidy, an abnormal number of chromosomes that is not an exact multiple of the haploid number, is a well-known cause of human disease and represents a major cause of infertility, pregnancy failure, and serious genetic disorders in the offspring. Among chemicals that induce aneuploidy in female germ cells, a large majority impairs microtubule dynamics and spindle function. Colchicine, a prototypical chemical that binds to tubulin and causes microtubule depolymerization, is used here to illustrate the AOP. This AOP is specific to female germ cells exposed during the periovulation period. Although the majority of the data come from rodent studies, the available evidence suggests that the MIE and KEs are conserved across species and would occur in human oocytes. The development of AOPs related to mutagenicity in germ cells is expected to aid the identification of potential hazards to germ cell genomic integrity and support regulatory efforts to protect population health. Environ. Mol. Mutagen. 57:87-113, 2016. © 2015 Her Majesty the Queen in Right of Canada. PMID:26581746

  16. Subvalvular apparatus and adverse outcome of balloon valvotomy in rheumatic mitral stenosis☆

    Science.gov (United States)

    Bhalgat, Parag; Karlekar, Shrivallabh; Modani, Santosh; Agrawal, Ashish; Lanjewar, Charan; Nabar, Ashish; Kerkar, Prafulla; Agrawal, Nandu; Vaideeswar, Pradeep

    2015-01-01

    Background Balloon mitral valvotomy (BMV) is a well-established therapeutic modality for rheumatic mitral stenosis (RMS). However, there are chances of procedural failure and the more ominous post-procedural severe mitral regurgitation. There are only a few prospective studies, which have evaluated the pathogenic mechanisms for these major complications of BMV, especially in relation to the subvalvular apparatus (SVA) pathology. Methods All symptomatic patients of RMS suitable for BMV by echocardiographic criteria in a span of 1 year were selected. In addition to the standard echocardiographic assessment of RMS (Wilkins score and score by Padial et al.), a separate grading and scoring system was assigned to evaluate the severity of the SVA pathology. The SVA score was ‘I’, when none of the two SVAs had severe disease, ‘II’ when one of the two SVAs has severe disease, and ‘III’ when both SVAs had severe disease. With these scoring systems, the outcomes of BMV (successful procedure, failure, and post-procedural mitral regurgitation) were analyzed. Emergency valve replacement was performed depending on clinical situation, and in cases of replacement, the pathology of the excised mitral valves were compared with echocardiographic findings. Results Of the 356 BMVs performed in a year, 43 patients had adverse outcomes in the form of failed procedure (14 patients) and mitral regurgitation (29 patients). Forty-one among these had a SVA score of III. The sensitivity and specificity of the MR score was lesser than the SVA score (sensitivity 0.34 vs. 1.00, specificity 0.92 vs. 0.99, respectively). The mitral valvular morphology in 39 patients who underwent post-procedural valve replacements correlated well with echocardiography findings. Conclusion It is important to assess the degree of SVA pathology in the conventional echocardiographic assessment for RMS, as BMV would have adverse events when both SVAs were severely diseased. PMID:26432729

  17. Association of Maternal Body Mass Index with Adverse Maternal and Prenatal Outcomes

    Directory of Open Access Journals (Sweden)

    Rahele Alijahan

    2013-09-01

    Full Text Available Background: The present study aimed to determine association between abnormal maternal body mass index and adverse maternal/prenatal outcomesMaterials and Methods: In this descriptive-correlation study 8270 pregnant women referred to rural and urban health centers of Ardabil district (from Mar 2009 to Dec 2010 were studied. Data were collected from prenatal healthcare records using a self designed questionnaire. Women with twin pregnancy, less than 18 and above 35 of age, and women with systemic or chronic disease were excluded from the study. The variables examined in this study include, demographic information (e.g. age, social and economy status, and literacy, present pregnancy information (e.g. parity, hemoglobin level, gestational diabetes, preeclampsia and prenatal information (e.g. preterm delivery, low birth weight, and congenital malformation. Data were analyzed through Kruscal wallis, chi-square, and logistic regression tests using SPSS-16.Results: Eight point two, 25 and 15.4% pregnant of women were underweight, overweight, and obese, respectively. Obese women were at increased risk for macrosomia (OR=1.820, CI: 1.345-2.447, p=0.001, unwanted pregnancy (OR= 1.436, CI: 1.198-1.720, p=0.001, pregnancy induced hypertension (OR= 1.633, CI: 1.072-2.486, p=0.022, preeclampsia (OR= 4.666, CI: 2.353-9.2550, p=0.001, and still birth (OR= 2.602, CI: 1.306-5.184, p=0.007. However, the risk of low birth weight delivery in underweight women were 1.6 times higher than the normal cases (OR= 1.674, CI: 0962-2.912, p=0.068.Conclusion: Considering high prevalence of abnormal maternal body mass index and its associated adverse maternal and prenatal outcomes; consultation before pregnancy is recommended in order to achieve normal body mass index and reduce the relevant complications.

  18. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

    Energy Technology Data Exchange (ETDEWEB)

    Showalter, Timothy N., E-mail: tns3b@virginia.edu [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States); Hegarty, Sarah E. [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Rabinowitz, Carol [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Maio, Vittorio [Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Hyslop, Terry [Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina (United States); Dicker, Adam P. [Department of Radiation Oncology, Kimmel Cancer Center & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Louis, Daniel Z. [Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (United States)

    2015-03-15

    Purpose: Although the likelihood of radiation-related adverse events influences treatment decisions regarding radiation therapy after prostatectomy for eligible patients, the data available to inform decisions are limited. This study was designed to evaluate the genitourinary, gastrointestinal, and sexual adverse events associated with postprostatectomy radiation therapy and to assess the influence of radiation timing on the risk of adverse events. Methods: The Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database was queried to identify a cohort of men who received radical prostatectomy for prostate cancer during 2003 to 2009, including patients who received postprostatectomy radiation therapy. Patients with prior radiation therapy were excluded. Outcome measures were genitourinary, gastrointestinal, and sexual adverse events after prostatectomy. Rates of adverse events were compared between the cohorts who did and did not receive postoperative radiation therapy. Multivariable Cox proportional hazards models were developed for each class of adverse events, including models with radiation therapy as a time-varying covariate. Results: A total of 9876 men were included in the analyses: 2176 (22%) who received radiation therapy and 7700 (78%) treated with prostatectomy alone. In multivariable Cox proportional hazards models, the additional exposure to radiation therapy after prostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81; 95% confidence interval [CI] 1.44-2.27; P<.001) and urinary nonincontinence events (RR 1.83; 95% CI 1.83-2.80; P<.001) but not urinary incontinence events or erectile dysfunction. The addition of the time from prostatectomy to radiation therapy interaction term was not significant for any of the adverse event outcomes (P>.1 for all outcomes). Conclusion: Radiation therapy after prostatectomy is associated with an increase in gastrointestinal and genitourinary adverse events. However

  19. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy

    International Nuclear Information System (INIS)

    Purpose: Although the likelihood of radiation-related adverse events influences treatment decisions regarding radiation therapy after prostatectomy for eligible patients, the data available to inform decisions are limited. This study was designed to evaluate the genitourinary, gastrointestinal, and sexual adverse events associated with postprostatectomy radiation therapy and to assess the influence of radiation timing on the risk of adverse events. Methods: The Regione Emilia-Romagna Italian Longitudinal Health Care Utilization Database was queried to identify a cohort of men who received radical prostatectomy for prostate cancer during 2003 to 2009, including patients who received postprostatectomy radiation therapy. Patients with prior radiation therapy were excluded. Outcome measures were genitourinary, gastrointestinal, and sexual adverse events after prostatectomy. Rates of adverse events were compared between the cohorts who did and did not receive postoperative radiation therapy. Multivariable Cox proportional hazards models were developed for each class of adverse events, including models with radiation therapy as a time-varying covariate. Results: A total of 9876 men were included in the analyses: 2176 (22%) who received radiation therapy and 7700 (78%) treated with prostatectomy alone. In multivariable Cox proportional hazards models, the additional exposure to radiation therapy after prostatectomy was associated with increased rates of gastrointestinal (rate ratio [RR] 1.81; 95% confidence interval [CI] 1.44-2.27; P<.001) and urinary nonincontinence events (RR 1.83; 95% CI 1.83-2.80; P<.001) but not urinary incontinence events or erectile dysfunction. The addition of the time from prostatectomy to radiation therapy interaction term was not significant for any of the adverse event outcomes (P>.1 for all outcomes). Conclusion: Radiation therapy after prostatectomy is associated with an increase in gastrointestinal and genitourinary adverse events. However

  20. Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

    Science.gov (United States)

    Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

    2014-10-01

    In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. PMID:25288430

  1. Serum 25-hydroxyvitamin D levels are not associated with adverse outcomes in Clostridium difficile infection

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    Dejan Micic

    2015-09-01

    Full Text Available Clostridium difficile infection (CDI is a significant source of healthcare-associated morbidity and mortality. This study investigated whether serum 25-hydroxyvitamin D is associated with adverse outcomes from CDI. Patients with CDI were prospectively enrolled. Charts were reviewed and serum 25-hydroxyvitamin D was measured. The primary outcome was a composite definition of severe disease: fever (temperature >38°C, acute organ dysfunction, or serum white blood cell count >15,000 cells/μL within 24-48 hours of diagnosis; lack of response to therapy by day 5; and intensive care unit admission; colectomy; or death within 30 days. Sixty-seven patients were included in the final analysis. Mean (±SD serum 25- hydroxyvitamin D was 26.1 (±18.54 ng/mL. Severe disease, which occurred in 26 (39% participants, was not associated with serum 25-hydroxyvitamin D [odds ratio (OR 1.00; 95% confidence interval (CI 0.96-1.04]. In the adjusted model for severe disease only serum albumin (OR 0.12; 95%CI 0.02-0.64 and diagnosis by detection of stool toxin (OR 5.87; 95%CI 1.09-31.7 remained independent predictors. We conclude that serum 25-hydroxyvitamin D is not associated with the development of severe disease in patients with CDI.

  2. Application of in silico and in vitro methods in the development of adverse outcome pathway constructs in wildlife

    OpenAIRE

    Madden, Judith C.; Rogiers, Vera; Vinken, Mathieu

    2014-01-01

    There is a long history of using both in silico and in vitro methods to predict adverse effects in humans and environmental species where toxicity data are lacking. Currently, there is a great deal of interest in applying these methods to the development of so-called ‘adverse outcome pathway’ (AOP) constructs. The AOP approach provides a framework for organizing information at the chemical and biological level, allowing evidence from both in silico and in vitro studies to be rationally combin...

  3. The effect of body mass index change on perinatal outcome of pregnant woman with gestational diabetes mellitus%妊娠期糖尿病孕妇BMI的变化对围生结局的影响

    Institute of Scientific and Technical Information of China (English)

    金莉娅; 张玉芳; 吕玲

    2014-01-01

    [ ABSTRACT] Objective To explore the effect of pregestational and gestational body mass index ( BMI) increase on perinatal out-come of pregnant women with gestational diabetes mellitus ( GDM ) .Methods 264 pregnant woman with GDM were divided into nor-mal group (18.525) in light of pregestational BMI or group A (6) based on BMI increase from early pregnancy to termination of pregnancy.The details of perinatal complication occurrence and adverse pregnancy outcomes were recorded respectively.Results The incidence of pre-eclampsia and premature delivery and cesarean section rate in the obesity group were significantly higher than in the normal group( P<0.05).The incidence of preeclampsia, polyhydramnios, premature rupture of fetal membranes, fetal distress, premature delivery and neonatal hypoglycaemia in group B were significantly lower than in group C (P<0.05).The incidence of premature rupture of fetal membranes and fetal macrosomia in group C were significantly higher than in group A (P<0.05).Conclusion Pregestational obesity or too much gestational weight increase of pregnant women with GDM can lead to higher risk of adverse pregnancy outcome.The total gestational BMI increase of pregnant women with GDM should be controlled at a suitable lever so as to reduce incidence of adverse preg-nancy outcome and improve mother and neonate outcome.%目的:探讨妊娠期糖尿病( GDM)孕妇妊娠前体质量指数( BMI)及妊娠期BMI增幅对围生结局的影响。方法264例GDM患者,根据妊娠前体质量指数,分为正常组(18.5<BMI<23)、超重组(23<BMI<25)、肥胖组( BMI>25),又按早孕至终止妊娠前体质量BMI增幅,分为<4组、4~6组、>6组。详细记录围生并发症的发生及不良妊娠结局。结果肥胖组子痫前期、早产发生率、剖宫产率显著高于正常组,差异有统计学意义(P<0.05)。 BMI增幅4~6组子痫前期、羊水过多、胎膜早破、胎儿窘

  4. The effect of body mass index change on perinatal outcome of pregnant woman with gestational diabetes mellitus%妊娠期糖尿病孕妇BMI的变化对围生结局的影响

    Institute of Scientific and Technical Information of China (English)

    金莉娅; 张玉芳; 吕玲

    2014-01-01

    目的:探讨妊娠期糖尿病( GDM)孕妇妊娠前体质量指数( BMI)及妊娠期BMI增幅对围生结局的影响。方法264例GDM患者,根据妊娠前体质量指数,分为正常组(18.5<BMI<23)、超重组(23<BMI<25)、肥胖组( BMI>25),又按早孕至终止妊娠前体质量BMI增幅,分为<4组、4~6组、>6组。详细记录围生并发症的发生及不良妊娠结局。结果肥胖组子痫前期、早产发生率、剖宫产率显著高于正常组,差异有统计学意义(P<0.05)。 BMI增幅4~6组子痫前期、羊水过多、胎膜早破、胎儿窘迫、早产和新生儿低血糖的发生率均明显低于BMI增幅>6组,差异均有统计学意义( P<0.05)。BMI增幅>6组胎膜早破及巨大儿的发生率明显高于<4组,差异均有统计学意义(P<0.05)。结论妊娠前肥胖及妊娠期体质量增加过多可增加GDM孕妇发生不良妊娠结局危险性,GDM孕妇妊娠期体质量指数总增幅应控制在合适范围内以减少不良妊娠结局的发生和改善母儿结局。%[ ABSTRACT] Objective To explore the effect of pregestational and gestational body mass index ( BMI) increase on perinatal out-come of pregnant women with gestational diabetes mellitus ( GDM ) .Methods 264 pregnant woman with GDM were divided into nor-mal group (18.525) in light of pregestational BMI or group A (6) based on BMI increase from early pregnancy to termination of pregnancy.The details of perinatal complication occurrence and adverse pregnancy outcomes were recorded respectively.Results The incidence of pre-eclampsia and premature delivery and cesarean section rate in the obesity group were significantly higher than in the normal group( P<0.05).The incidence of preeclampsia, polyhydramnios, premature rupture of fetal membranes, fetal distress, premature delivery and neonatal hypoglycaemia in group B were significantly lower than in group C (P<0.05).The

  5. Changes in maternal and child health outcomes after introduction of a helicopter into perinatal transportation in Japan.

    Science.gov (United States)

    Kumagai, Takeshi; Higuchi, Ryuzo; Okutani, Takahiro; Yagi, Shigetaka; Ikejima, Miwa; Minami, Sawako

    2011-02-01

    To examine the effect of perinatal helicopter transportation on maternal and child health. Helicopter transportation for the sparsely populated southern areas of Wakayama and Mie prefectures was introduced in June 2003. Maternal and child health statistics for 2000-2002 and 2004-2006 were compared between the south and north regions of the prefectures. There were 9 maternal transports from south Wakayama, 2 from north Wakayama, and 5 from south Mie in 2004-2006; and 13 neonatal transports from south Wakayama and 7 from north Wakayama during the same period. Decreases in neonatal and perinatal mortalities in 2004-2006 compared to 2000-2002 were greater in south Wakayama than in north Wakayama (-0.31 vs. -0.28, and -0.57 vs. -0.18, respectively); and greater in south Mie than in north Mie (-0.90 vs. -0.49, and -2.49 vs. -1.48, respectively). The changes in the number of maternal deaths between 2000-2002 and 2004-2006 were 0 in south Wakayama, 1 in north Wakayama, -2 in south Mie, and -1 in north Mie, with the greatest change occurring in south Mie. Use of a helicopter for perinatal transportation can possibly improve maternal and child health in sparsely populated areas far away from urban areas. PMID:20101449

  6. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis

    OpenAIRE

    Oteng-Ntim Eugene; Varma Rajesh; Croker Helen; Poston Lucilla; Doyle Pat

    2012-01-01

    Abstract Background Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes. Methods A systematic review and meta-analyses ...

  7. Influence of Malnutrition on Adverse Outcome in Children with Confirmed or Probable Viral Encephalitis: A Prospective Observational Study

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    Priyanka Singh

    2015-01-01

    Full Text Available A prospective observational study was conducted in a tertiary care teaching hospital from August 2008 to August 2009 to explore the independent predictors of adverse outcome in the patients with confirmed/probable viral encephalitis. The primary outcome variable was the incidence of adverse outcomes defined as death or severe neurological deficit such as loss of speech, motor deficits, behavioural problems, blindness, and cognitive impairment. Patients with confirmed or probable viral encephalitis were classified into two groups based on their Z-score of weight-for-age as per WHO growth charts. Group I. Patients with confirmed or probable viral encephalitis with weight-for-age (W/A Z-scores below −2SD were classified as undernourished. Group II. Patients with confirmed or probable viral encephalitis were classified as having normal nutritional status (weight-for-age Z-score >−2SD. A total of 114 patients were classified as confirmed or probable viral encephalitis based on detailed investigations. On multivariate logistic regression, undernutrition (adjusted OR: 5.05; 95% CI: 1.92 to 13.44 and requirement of ventilation (adjusted OR: 6.75; 95% CI: 3.63 to 77.34 were independent predictors of adverse outcomes in these patients. Thus, the results from our study highlight that the association between undernutrition and adverse outcome could be extended to the patients with confirmed/probable viral encephalitis.

  8. Human cytomegalovirus-induces cytokine changes in the placenta with implications for adverse pregnancy outcomes.

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    Stuart T Hamilton

    Full Text Available Human cytomegalovirus (CMV infection of the developing fetus can result in adverse pregnancy outcomes including death in utero. Fetal injury results from direct viral cytopathic damage to the CMV-infected fetus, although evidence suggests CMV placental infection may indirectly cause injury to the fetus, possibly via immune dysregulation with placental dysfunction. This study investigated the effects of CMV infection on expression of the chemokine MCP-1 (CCL2 and cytokine TNF-α in placentae from naturally infected stillborn babies, and compared these changes with those found in placental villous explant histocultures acutely infected with CMV ex vivo. Tissue cytokine protein levels were assessed using quantitative immunohistochemistry. CMV-infected placentae from stillborn babies had significantly elevated MCP-1 and TNF-α levels compared with uninfected placentae (p = 0.001 and p = 0.007, which was not observed in placentae infected with other microorganisms (p = 0.62 and p = 0.71 (n = 7 per group. Modelling acute clinical infection using ex vivo placental explant histocultures showed infection with CMV laboratory strain AD169 (0.2 pfu/ml caused significantly elevated expression of MCP-1 and TNF-α compared with uninfected explants (p = 0.0003 and p<0.0001 (n = 25 per group. Explant infection with wild-type Merlin at a tenfold lower multiplicity of infection (0.02 pfu/ml, caused a significant positive correlation between increased explant infection and upregulation of MCP-1 and TNF-α expression (p = 0.0001 and p = 0.017. Cytokine dysregulation has been associated with adverse outcomes of pregnancy, and can negatively affect placental development and function. These novel findings demonstrate CMV infection modulates the placental immune environment in vivo and in a multicellular ex vivo model, suggesting CMV-induced cytokine modulation as a potential initiator and/or exacerbator of placental and fetal injury.

  9. A Workflow to Investigate Exposure and Pharmacokinetic Influences on High-Throughput in Vitro Chemical Screening Based on Adverse Outcome Pathways

    Science.gov (United States)

    Background: Adverse outcome pathways (AOPs) link adverse effects in individuals or populations to a molecular initiating event (MIE) that can be quantified using in vitro methods. Practical application of AOPs in chemical-specific risk assessment requires incorporation of knowled...

  10. Impact of Coastal Pollution on Childhood Disabilities and Adverse Pregnancy Outcomes: The Case of Bangladesh

    Directory of Open Access Journals (Sweden)

    Juma Rahman

    2012-07-01

    Full Text Available Objective: The objective of this review was to explore the situation of coastal water pollution and its impact on child health and pregnancy outcomes in Bangladesh. Background: Globally coastal pollution is of greater significance than inland’s for its huge resources and contribution to livelihood. As a result it has been a source of increased Global Burden of Disease by means of consumption of seafood, involvement in risky jobs, and exposure to water related disastrous events. Almost sixty percent of the world’s population is at risk of costal contamination and developing countries like Bangladesh, geographically located at the tip of the Bay of Bengal, are facing significant challenges by this form of pollution. Method: This study was based on a critical review of published literature and unpublished documents from 1972 to 2011 retrieved from databases of scientific publications, from public-access search engines, reports from government, international organizations, and non-government agencies, and personal communications. Discussion: Huge noxious pollutants including heavy metals, oil spill and redionucleotides were found in the Bay of Bengal, those have enormous adverse impacts on child health and pregnancy outcomes. This review focuses on children and pregnant women because of their vulnerable physiological conditions to the impacts of environmental factors. The physiological systems of children and fetuses are developing fast and usually are sensitive to disruptions induced by environmental pollutants and exposures in utero increase the risk of future toxic insults. Conclusion: The coastal zone of Bangladesh is one of the vulnerable zones in the world which is predicted to disappear due to climate change impacts. This areas face huge weather-related disasters due to continuous changing coastal-configuration and man-made pollutions. However, these observations are indecisive due to limitations of supportive evidence. Therefore, further

  11. International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO).

    OpenAIRE

    Woodruff, Tracey J.; Parker, Jennifer D.; Kate Adams; Bell, Michelle L.; Ulrike Gehring; Svetlana Glinianaia; Eun-Hee Ha; Bin Jalaludin; Rémy Slama

    2010-01-01

    Reviews find a likely adverse effect of air pollution on perinatal outcomes, but variation of findings hinders the ability to incorporate the research into policy. The International Collaboration on Air Pollution and Pregnancy Outcomes (ICAPPO) was formed to better understand relationships between air pollution and adverse birth outcomes through standardized parallel analyses in datasets from different countries. A planning group with 10 members from 6 countries was formed to coordinate the p...

  12. Socioeconomic disparities in ectopic pregnancy: predictors of adverse outcomes from Illinois hospital-based care, 2000-2006.

    Science.gov (United States)

    Stulberg, Debra B; Zhang, James X; Lindau, Stacy Tessler

    2011-02-01

    This study aimed to identify the incidence of adverse outcomes from ectopic pregnancy hospital care in Illinois (2000-2006), and assess patient, neighborhood, hospital and time factors associated with these outcomes. Discharge data from Illinois hospitals were retrospectively analyzed and ectopic pregnancies were identified using DRG and ICD-9 diagnosis codes. The primary outcome was any complication identified by ICD-9 procedure codes. Secondary outcomes were length of stay and discharge status. Residential zip codes were linked to 2000 U.S. Census data to identify patients' neighborhood demographics. Logistic regression was used to identify risk factors for adverse outcomes. Independent variables were insurance status, age, co-morbidities, neighborhood demographics, hospital type, hospital ectopic pregnancy service volume, and year of discharge. Of 13,007 ectopic pregnancy hospitalizations, 7.4% involved at least one complication identified by procedure codes. Hospitalizations covered by Medicare (for women with chronic disabilities) were more likely than those with other source or without insurance to result in surgical sterilization (OR 4.7, P = 0.012). Hospitalization longer than 2 days was more likely with Medicaid (OR 1.46, P hospitals (OR 1.21, P hospitals, private hospitals had lower rates of complications (OR 0.39, P hospitalization longer than 2 days (OR 0.57, P hospitalizations became shorter (OR 0.53, P hospitals, were more likely to experience adverse outcomes. PMID:20177756

  13. Internal exposure dynamics drive the Adverse Outcome Pathways of synthetic glucocorticoids in fish

    Science.gov (United States)

    Margiotta-Casaluci, Luigi; Owen, Stewart F.; Huerta, Belinda; Rodríguez-Mozaz, Sara; Kugathas, Subramanian; Barceló, Damià; Rand-Weaver, Mariann; Sumpter, John P.

    2016-02-01

    The Adverse Outcome Pathway (AOP) framework represents a valuable conceptual tool to systematically integrate existing toxicological knowledge from a mechanistic perspective to facilitate predictions of chemical-induced effects across species. However, its application for decision-making requires the transition from qualitative to quantitative AOP (qAOP). Here we used a fish model and the synthetic glucocorticoid beclomethasone dipropionate (BDP) to investigate the role of chemical-specific properties, pharmacokinetics, and internal exposure dynamics in the development of qAOPs. We generated a qAOP network based on drug plasma concentrations and focused on immunodepression, skin androgenisation, disruption of gluconeogenesis and reproductive performance. We showed that internal exposure dynamics and chemical-specific properties influence the development of qAOPs and their predictive power. Comparing the effects of two different glucocorticoids, we highlight how relatively similar in vitro hazard-based indicators can lead to different in vivo risk. This discrepancy can be predicted by their different uptake potential, pharmacokinetic (PK) and pharmacodynamic (PD) profiles. We recommend that the development phase of qAOPs should include the application of species-species uptake and physiologically-based PK/PD models. This integration will significantly enhance the predictive power, enabling a more accurate assessment of the risk and the reliable transferability of qAOPs across chemicals.

  14. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy

    Directory of Open Access Journals (Sweden)

    Bro SP

    2015-01-01

    Full Text Available Søren Pauli Bro,1 Maiken Ina Siegismund Kjaersgaard,2 Erik Thorlund Parner,2 Merete Juul Sørensen,3 Jørn Olsen,4 Bodil Hammer Bech,4 Lars Henning Pedersen,4,5 Jakob Christensen,6,7 Mogens Vestergaard11Research Unit and Section for General Practice, Department of Public Health, 2Section for Biostatistics, Department of Public Health, Aarhus University, 3Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, 4Section for Epidemiology, Department of Public Health, 5Department of Clinical Medicine – Obstetrics and Gynecology, Aarhus University, 6Department of Clinical Pharmacology, 7Department of Neurology, Aarhus University Hospital, Aarhus, DenmarkObjective: To determine if prenatal exposure to methylphenidate (MPH or atomoxetine (ATX increases the risk of adverse pregnancy outcomes in women with attention deficit/hyperactivity disorder (ADHD.Materials and methods: This was a population-based cohort study of all pregnancies in Denmark from 1997 to 2008. Information on use of ADHD medication, ADHD diagnosis, and pregnancy outcomes was obtained from nationwide registers.Results: We identified 989,932 pregnancies, in which 186 (0.02% women used MPH/ATX and 275 (0.03% women had been diagnosed with ADHD but who did not take MPH/ATX. Our reference pregnancies had no exposure to MPH/ATX and no ADHD diagnosis. Exposure to MPH/ATX was associated with an increased risk of spontaneous abortion (SA; ie, death of an embryo or fetus in the first 22 weeks of gestation (adjusted relative risk [aRR] 1.55, 95% confidence interval [CI] 1.03–2.36. The risk of SA was also increased in pregnancies where the mother had ADHD but did not use MPH/ATX (aRR 1.56, 95% CI 1.11–2.20. The aRR of Apgar scores <10 was increased among exposed women (aRR 2.06, 95% CI 1.11–3.82 but not among unexposed women with ADHD (aRR 0.99, 95% CI 0.48–2.05.Conclusion: MPH/ATX was associated with a higher risk of SA, but our study indicated that it may at

  15. Brain-derived neurotrophic factor expression predicts adverse pathological & clinical outcomes in human breast cancer

    Directory of Open Access Journals (Sweden)

    Mokbel Kefah

    2011-07-01

    emerged as an independent prognostic variable in multivariate analysis for disease free survival (DFS (p = 0.026 and approached significance for OS (p = 0.055. Conclusion BDNF expression was found to be significantly higher in BC specimens compared to normal tissue. Higher transcript levels were significantly associated with unfavourable pathological parameters including nodal positivity and increasing NPI; and adverse clinical outcomes including LR, death from BC, poor prognosis, reduced DFS and OS. BDNF offers utility as a prognostic marker and potential for targeted therapeutic strategies.

  16. Resultado perinatal em mulheres portadoras de hipertensão arterial crônica: revisão integrativa da literatura Resultado perinatal en mujeres que sufren de hipertensión crónica: revisión integradora de la literatura Perinatal outcome in women suffering from chronic hypertension: literature integrative review

    Directory of Open Access Journals (Sweden)

    Angelita José Henrique

    2012-12-01

    la hipertensión, sin mostrar tendencia a evolución, durante las dos décadas estudiadas, en el resultado perinatal.The study aimed to identify patterns in the evolution of risk of perinatal outcomes of pregnant women with chronic hypertension in order to compare the results of the pregnancy outcome. It was held an integrative literature with time span between the years 1990 and 2010, in the databases LILACS, SciELO and MEDLINE. As results, it was observed that pregnant women had chronic hypertensive superimposed preeclampsia (20% to 78%, fetal growth restriction (8.5% to 30.7%, prematurity (32.4% to 86.4%, cesarean section (69 2%, placental abruption (3.75% to 8.4%, fetal death (9.5% to 27.2%, cardiovascular complications, maternal kidney and lung. We conclude that the association of chronic hypertension and pregnancy shows strong risk for maternal and perinatal complications, especially when associated with the severity and etiology of hypertension, showing no trend during the two decades studied on perinatal outcome.

  17. Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose?

    DEFF Research Database (Denmark)

    Jensen, Dorte; Lauridsen, Lars Korsholm; Ovesen, Per Glud; Beck-Nielsen, Henning; Mølsted-Pedersen, Lars; Damm, Peter

    2008-01-01

    The diagnostic criteria of gestational diabetes mellitus (GDM) have been based on the risk of future maternal diabetes rather than the short-term risk of mother and infant. Our aim was to illustrate the relation between various adverse pregnancy outcomes and maternal glucose levels in women with...

  18. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies?

    DEFF Research Database (Denmark)

    Johansen, Mathias; Oldenburg, A.; Rosthøj, Susanne;

    2014-01-01

    OBJECTIVES: To evaluate the usefulness of first-trimester crown-rump length (CRL) discordance in predicting adverse outcome in twin pregnancies. METHODS: This retrospective study included a large cohort retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising a...

  19. Via de Parto e Resultados Perinatais em Gestantes Diabéticas Route of Delivery and Perinatal Outcomes of Diabetic Pregnant Women

    Directory of Open Access Journals (Sweden)

    Belmiro Gonçalves Pereira

    1999-10-01

    Full Text Available Objetivo: apresentar os resultados perinatais obtidos a partir da aplicação de um protocolo de assistência às gestantes diabéticas no Centro de Atenção Integral à Saúde da Mulher (CAISM da UNICAMP. Métodos: foram estudadas 90 gestantes diabéticas que iniciaram controle pré-natal na instituição e foram submetidas a este protocolo. Foram comparadas com dois grupos controles de 180 gestantes cada: um constituído por gestantes pareadas por idade e número de gestações (controle A e outro por gestantes aleatoriamente selecionadas (controle B. Nos três grupos foram avaliadas as seguintes variáveis: tipo de parto, indicações de cesárea, idade gestacional, índice de Apgar ao primeiro e quinto minuto de vida, peso e adequação de peso para idade gestacional, morbidade e mortalidade perinatal. Para a análise estatística utilizaram-se médias, desvio-padrão, os testes t de Student e do chi². Resultados: entre as gestantes diabéticas ocorreu maior incidência de cesáreas, recém-nascidos prematuros e grandes para a idade gestacional (GIG, assim como uma maior freqüência de patologias neonatais (hipoglicemia, hipocalcemia, hiperbilirrubinemia, desconforto respiratório e depressão neonatal. A incidência de Apgar Purpose: to present the perinatal outcomes resulting from the use of a protocol for assistance to diabetic pregnant women used at the Center for Integral Assistance to Women's Health (CAISM, of the University of Campinas. Methods: ninety diabetic pregnant women, who were assisted at the institution with this protocol, were compared with two control grups: the first consisted of 180 pregnant women with equal number of gestations and same age (control A and the second consisted of 180 randomly selected pregnant women (control B. The study variables were route of delivery, indication for cesarean section, gestational age, Apgar score at first and fifth minute, weight, adequacy of weight for gestational age and perinatal

  20. Impact of Different Childhood Adversities on 1-Year Outcomes of Psychotic Disorder in the Genetics and Psychosis Study.

    Science.gov (United States)

    Trotta, Antonella; Murray, Robin M; David, Anthony S; Kolliakou, Anna; O'Connor, Jennifer; Di Forti, Marta; Dazzan, Paola; Mondelli, Valeria; Morgan, Craig; Fisher, Helen L

    2016-03-01

    While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services. PMID:26373540

  1. Retinal artery and vein thrombotic occlusion during pregnancy: markers for familial thrombophilia and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Kurtz WS

    2016-05-01

    pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent thrombophilia evaluation and institution of thromboprophylaxis to prevent adverse maternal and fetal–placental thrombotic events. Keywords: thrombophilia, ocular thrombosis, retinal vascular occlusion, CRVO, BRAO, pregnancy, miscarriage, fetal loss, ocular vascular occlusion, pre-eclampsia, eclampsia

  2. Vital Sign Prediction of Adverse Maternal Outcomes in Women with Hypovolemic Shock: The Role of Shock Index.

    Directory of Open Access Journals (Sweden)

    Alison M El Ayadi

    Full Text Available To determine the optimal vital sign predictor of adverse maternal outcomes in women with hypovolemic shock secondary to obstetric hemorrhage and to develop thresholds for referral/intensive monitoring and need for urgent intervention to inform a vital sign alert device for low-resource settings.We conducted secondary analyses of a dataset of pregnant/postpartum women with hypovolemic shock in low-resource settings (n = 958. Using receiver-operating curve analysis, we evaluated the predictive ability of pulse, systolic blood pressure, diastolic blood pressure, shock index, mean arterial pressure, and pulse pressure for three adverse maternal outcomes: (1 death, (2 severe maternal outcome (death or severe end organ dysfunction morbidity; and (3 a combined severe maternal and critical interventions outcome comprising death, severe end organ dysfunction morbidity, intensive care admission, blood transfusion ≥ 5 units, or emergency hysterectomy. Two threshold parameters with optimal rule-in and rule-out characteristics were selected based on sensitivities, specificities, and positive and negative predictive values.Shock index was consistently among the top two predictors across adverse maternal outcomes. Its discriminatory ability was significantly better than pulse and pulse pressure for maternal death (p<0.05 and p<0.01, respectively, diastolic blood pressure and pulse pressure for severe maternal outcome (p<0.01, and systolic and diastolic blood pressure, mean arterial pressure and pulse pressure for severe maternal outcome and critical interventions (p<0.01. A shock index threshold of ≥ 0.9 maintained high sensitivity (100.0 with clinical practicality, ≥ 1.4 balanced specificity (range 70.0-74.8 with negative predictive value (range 93.2-99.2, and ≥ 1.7 further improved specificity (range 80.7-90.8 without compromising negative predictive value (range 88.8-98.5.For women with hypovolemic shock from obstetric hemorrhage, shock index was

  3. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Sera Young

    Full Text Available Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART. We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG, and hemoglobin concentration (Hb among 166 women initiating cART in rural Uganda.Prospective cohort.HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis.Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW (19.6%, preterm delivery (17.7%, fetal death (3.9%, stunting (21.1%, small-for-gestational age (15.1%, and head-sparing growth restriction (26%. No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%.In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women.Clinicaltrials.gov NCT00993031.

  4. Peri-Implantation Hormonal Milieu: Elucidating Mechanisms of Adverse Neurodevelopmental Outcomes.

    Science.gov (United States)

    Mainigi, Monica; Rosenzweig, Jason M; Lei, Jun; Mensah, Virginia; Thomaier, Lauren; Talbot, C Conover; Olalere, Devvora; Ord, Teri; Rozzah, Rayyan; Johnston, Michael V; Burd, Irina

    2016-06-01

    While live births resulting from assisted reproductive technology (ART) exceed 1% of total births annually, the effect of ART on fetal development is not well understood. Data have demonstrated that IVF leads to alterations in DNA methylation and gene expression in the placenta that may have long-term effects on health and disease. Studies have linked adverse neurodevelopmental outcomes to ART, although human studies are inconclusive. In order to isolate the peri-implantation environment and its effects on brain development, we utilized a mouse model with and without superovulation and examined the effect of adult behavior as well as adult cortical neuronal density. Adult offspring of superovulated dams showed increased anxiety-like behavior compared to offspring of naturally mated dams (P < .05). There was no difference in memory and learning tests between the 2 groups. The adult brains from offspring of superovulated recipients had fewer neurons per field compared to naturally mated control offspring (P < .05). In order to examine potential pathways leading to these changes, we measured messenger RNA and microRNA (miRNA) expression in fetal brains at E18.5. Microarray analysis found that miRNAs miR-122, miR-144, and miR-211, involved in regulation of neuronal migration and differentiation, were downregulated in brains of offspring exposed to a superovulated environment(P < .05). There was also altered expression of genes involved in neuronal development. These results suggest that the peri-implantation environment can affect neurodevelopment and can lead to behavioral changes in adulthood. Human studies with long-term follow-up of children from ART are necessary to further investigate the influence of ART on the offspring. PMID:26614264

  5. Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome

    International Nuclear Information System (INIS)

    Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population. Study Design: Analytical study. Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007. Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth, large for gestational age (LGA), and caesarean section. Logistic regression analysis was weight (LBW), preterm delivery performed to control for confounders like age, parity, working status and ethnicity. Results: The prevalence of LBW decreased with increasing BMI. GWG of the population was noted as 8.5 kg. LBW was omen below the age of 19 were twice more likely to have LBW than observed to have an inverse relationship with GWG. W above 35 years of age. Weight gain above the recommended range were twice more likely to have large for dates. Overweight women were 1.5 times more likely to deliver preterm whereas obese women were 1.4 times more likely to undergo caesarean section than women with normal BMI. Conclusion: The optimal weight gain was estimated to be 8.5 kg to prevent low birth weight in our population. Obese women are more likely to have LGA, caesarean sections and pre-term deliveries. (author)

  6. Limitations of toxicity characterization in life cycle assessment: Can adverse outcome pathways provide a new foundation?

    Science.gov (United States)

    Gust, Kurt A; Collier, Zachary A; Mayo, Michael L; Stanley, Jacob K; Gong, Ping; Chappell, Mark A

    2016-07-01

    Life cycle assessment (LCA) has considerable merit for holistic evaluation of product planning, development, production, and disposal, with the inherent benefit of providing a forecast of potential health and environmental impacts. However, a technical review of current life cycle impact assessment (LCIA) methods revealed limitations within the biological effects assessment protocols, including: simplistic assessment approaches and models; an inability to integrate emerging types of toxicity data; a reliance on linear impact assessment models; a lack of methods to mitigate uncertainty; and no explicit consideration of effects in species of concern. The purpose of the current study is to demonstrate that a new concept in toxicological and regulatory assessment, the adverse outcome pathway (AOP), has many useful attributes of potential use to ameliorate many of these problems, to expand data utility and model robustness, and to enable more accurate and defensible biological effects assessments within LCIA. Background, context, and examples have been provided to demonstrate these potential benefits. We additionally propose that these benefits can be most effectively realized through development of quantitative AOPs (qAOPs) crafted to meet the needs of the LCIA framework. As a means to stimulate qAOP research and development in support of LCIA, we propose 3 conceptual classes of qAOP, each with unique inherent attributes for supporting LCIA: 1) mechanistic, including computational toxicology models; 2) probabilistic, including Bayesian networks and supervised machine learning models; and 3) weight of evidence, including models built using decision-analytic methods. Overall, we have highlighted a number of potential applications of qAOPs that can refine and add value to LCIA. As the AOP concept and support framework matures, we see the potential for qAOPs to serve a foundational role for next-generation effects characterization within LCIA. Integr Environ Assess Manag

  7. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    Science.gov (United States)

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care. PMID:27159762

  8. Tratamento do diabetes mellitus gestacional com glibenclamida: fatores de sucesso e resultados perinatais Gestational diabetes mellitus management with glyburide: factors of success and perinatal outcomes

    Directory of Open Access Journals (Sweden)

    Jean Carl Silva

    2007-11-01

    Full Text Available OBJETIVO: identificar os fatores relacionados ao sucesso no tratamento do diabetes mellitus gestacional (DMG com a glibenclamida e avaliar os resultados perinatais. MÉTODOS: estudo longitudinal, prospectivo, no qual foram incluídas, no período de agosto de 2005 até julho de 2006, 50 gestantes portadoras de DMG, que necessitaram de terapêutica complementar à dietoterapia e à atividade física, com feto apresentando circunferência abdominal (CA normal à ultra-sonografia (abaixo do percentil 75. Foi mantida a glibenclamida até o parto, enquanto o controle glicêmico estivesse adequado e a CA fetal normal, sendo considerado um sucesso terapêutico. Na falta de controle glicêmico ou a CA fetal alterada, a terapêutica foi substituída por insulinoterapia, sendo considerada falha terapêutica. As gestantes foram divididas em dois grupos: um que obteve sucesso com a terapêutica (n=29 e outro, falha (n=21. Os resultados avaliados foram: sucesso terapêutico, características maternas e resultado perinatal. RESULTADOS: dos casos analisados, 58% obtiveram sucesso com a glibenclamida. Não foi encontrada diferença (p>0,05 nos dois grupos quanto à idade materna, valores das glicemias no teste de tolerância oral à glicose com 75 g, índice de massa corpórea (IMC materno, número de consultas no pré-natal e número de gestações anteriores. Ajustando-se a um modelo de regressão logística, encontramos que as gestantes com sucesso terapêutico tiveram o diagnóstico mais tardio (p=0,02 e menor ganho de peso durante a gestação (pPURPOSE: to identify the factors related to successful gestational diabetes mellitus (GDM management with glyburide and to evaluate perinatal outcomes. METHODS: prospective longitudinal study including 50 pregnant women with GDM who required complementary treatment to diet and physical activity, whose fetus presented normal abdominal circumference (AC to ultrasound (pct0.05 in either group, with regards to maternal

  9. Attention-deficit/hyperactivity disorder and adverse health outcomes in adults.

    Science.gov (United States)

    Spencer, Thomas J; Faraone, Stephen V; Tarko, Laura; McDermott, Katie; Biederman, Joseph

    2014-10-01

    Whereas the adverse impact of attention-deficit/hyperactivity disorder (ADHD) on emotional and psychosocial well-being has been well investigated, its impact on physical health has not. The main aim of this study was to assess the impact of ADHD on lifestyle behaviors and measures of adverse health risk indicators. Subjects were 100 untreated adults with ADHD and 100 adults without ADHD of similar age and sex. Unhealthy lifestyle indicators included assessments of bad health habits, frequency of visits to healthcare providers, and follow through with recommended prophylactic tests. Assessments of adverse health risk indicators included measurements of cardiovascular and metabolic parameters, weight, body mass index, and waist circumference. No differences were identified in health habits between subjects with and without ADHD, but robust differences were found in a wide range of adverse health risk indicators. ADHD is associated with an adverse impact in health risk indicators well known to be associated with high morbidity and mortality. PMID:25211634

  10. Maternal pre-pregnancy BMI and adverse pregnancy outcomes among Chinese women: Results from the C-ABCS.

    Science.gov (United States)

    Ding, X-X; Xu, S-J; Hao, J-H; Huang, K; Su, P-Y; Tao, F-B

    2016-04-01

    The aim of this study was to investigate associations between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among Chinese pregnant women. A prospective population-based cohort study was performed using data collected as part of the China-Anhui Birth Cohort Study or C-ABCS. A total of 13,121 pregnant women who received the first prenatal visit were enrolled from November 2008 to October 2010. Logistic regression analysis was used to calculate associations between pre-pregnancy BMI and pregnancy outcomes. Results indicated that the increased pre-pregnancy BMI was associated with a number of adverse pregnancy outcomes such as hypertensive disorder (adjusted relative risk (ARR) 2.3, 95% confidence interval [CI] 1.5-3.6), gestational diabetes (ARR 3.5, 95% CI 2.3-5.2), caesarean delivery (ARR 2.0, 95% CI 1.6-2.4), and medically indicated preterm delivery (ARR 1.8, 95% CI 1.1-2.9). Women with pre-pregnancy BMI above the normal range pose an increased risk of adverse pregnancy outcomes. PMID:26492517

  11. Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Sørensen, B; Feilberg-Jørgensen, N;

    2000-01-01

    To assess maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) compared to non-diabetic pregnancies with an otherwise similar risk profile and to study the association between different anti-diabetic treatments and fetal outcomes....

  12. APCR, factor V gene known and novel SNPs and adverse pregnancy outcomes in an Irish cohort of pregnant women

    LENUS (Irish Health Repository)

    Sedano-Balbas, Sara

    2010-03-10

    Abstract Background Activated Protein C Resistance (APCR), a poor anticoagulant response of APC in haemostasis, is the commonest heritable thrombophilia. Adverse outcomes during pregnancy have been linked to APCR. This study determined the frequency of APCR, factor V gene known and novel SNPs and adverse outcomes in a group of pregnant women. Methods Blood samples collected from 907 pregnant women were tested using the Coatest® Classic and Modified functional haematological tests to establish the frequency of APCR. PCR-Restriction Enzyme Analysis (PCR-REA), PCR-DNA probe hybridisation analysis and DNA sequencing were used for molecular screening of known mutations in the factor V gene in subjects determined to have APCR based on the Coatest® Classic and\\/or Modified functional haematological tests. Glycosylase Mediated Polymorphism Detection (GMPD), a SNP screening technique and DNA sequencing, were used to identify SNPs in the factor V gene of 5 APCR subjects. Results Sixteen percent of the study group had an APCR phenotype. Factor V Leiden (FVL), FV Cambridge, and haplotype (H) R2 alleles were identified in this group. Thirty-three SNPs; 9 silent SNPs and 24 missense SNPs, of which 20 SNPs were novel, were identified in the 5 APCR subjects. Adverse pregnancy outcomes were found at a frequency of 35% in the group with APCR based on Classic Coatest® test only and at 45% in the group with APCR based on the Modified Coatest® test. Forty-eight percent of subjects with FVL had adverse outcomes while in the group of subjects with no FVL, adverse outcomes occurred at a frequency of 37%. Conclusions Known mutations and novel SNPs in the factor V gene were identified in the study cohort determined to have APCR in pregnancy. Further studies are required to investigate the contribution of these novel SNPs to the APCR phenotype. Adverse outcomes including early pregnancy loss (EPL), preeclampsia (PET) and intrauterine growth restriction (IGUR) were not significantly more

  13. Relationship between Advanced Glycation End Products and Perinatal Outcome of Gestational Diabetes Patients%晚期糖基化终产物水平及其受体的表达与妊娠期糖尿病围生儿结局关系的研究

    Institute of Scientific and Technical Information of China (English)

    汤栩文; 林斯; 谢晓斌

    2012-01-01

    Objective:To explore the relationship between serum advanced glycation end products (AGEs) level in gestation diabetic(GDM) patients and their perinatal outcomes, and to observe the RAGE protein expression in placenta. Methods: Recruit 100 cases pregnant women diagnosed with GDM between 24-28 weeks gestational age as the observation group, and another 50 cases of normal pregnant women of corresponding age as the study control. The blood samples of GDM patients was extracted ,blood glucose, HbAic. AGE was determined. The placentas were cryopreservated immediately after delivery for the analysis of tissue expression of RAGE protein. And the maternal and infant clinical information were collected, The patients were also divided into normal perinatal group and abnormal perinatal group according to their perinatal outcomes. Results:①GDM groups had higher serum AGEs levels and fasting blood glucose compared to the control group (P0. 05), but the level of serum AGEs remained higher. ③Abnormal perinatal outcome in GDM had significantly higher maternal serum AGEs level than that in controls with normal perinatal outcome( P<0.05) . ④Logistic regression analysis showed that AGEs was a predictor of adverse perinatal outcome in GDM( OR =6.197,P< 0.001, 95% Cl: 2.514 ~ 15.453). ⑤The RAGE protein expression in the placenta was also higher in the abnormal perinatal group than that in normal perinatal group and control group. Conclusions: High serum AGEs is a negative factor for the GDM perinatal outcome, High levels of AGEs can be used as a abnormal perinatal outcome predictor in GDM patients.%目的:探讨妊娠期糖尿病(GDM)孕妇血清晚期糖基化终产物(AGEs)水平与围生儿结局间的关系,并观察晚期糖基化终产物受体(RAGE)蛋白在胎盘组织中的蛋白表达.方法:选择孕24~28周来我院产前检查被诊断患有GDM的孕妇100例为研究对象(GDM组),另选择同孕期、相应年龄的正常妊娠妇女50例作为正常对照组.

  14. Neurocognitive outcome of children exposed to perinatal mother-to-child Chikungunya virus infection: the CHIMERE cohort study on Reunion Island.

    Directory of Open Access Journals (Sweden)

    Patrick Gérardin

    2014-07-01

    Full Text Available Little is known about the neurocognitive outcome in children exposed to perinatal mother-to-child Chikungunya virus (p-CHIKV infection.The CHIMERE ambispective cohort study compared the neurocognitive function of 33 p-CHIKV-infected children (all but one enrolled retrospectively at around two years of age with 135 uninfected peers (all enrolled prospectively. Psychomotor development was assessed using the revised Brunet-Lezine scale, examiners blinded to infectious status. Development quotients (DQ with subscores covering movement/posture, coordination, language, sociability skills were calculated. Predictors of global neurodevelopmental delay (GND, DQ ≤ 85, were investigated using multivariate Poisson regression modeling. Neuroradiologic follow-up using magnetic resonance imaging (MRI scans was proposed for most of the children with severe forms.The mean DQ score was 86.3 (95%CI: 81.0-91.5 in infected children compared to 100.2 (95%CI: 98.0-102.5 in uninfected peers (P<0.001. Fifty-one percent (n = 17 of infected children had a GND compared to 15% (n = 21 of uninfected children (P<0.001. Specific neurocognitive delays in p-CHIKV-infected children were as follows: coordination and language (57%, sociability (36%, movement/posture (27%. After adjustment for maternal social situation, small for gestational age, and head circumference, p-CHIKV infection was found associated with GND (incidence rate ratio: 2.79, 95%CI: 1.45-5.34. Further adjustments on gestational age or breastfeeding did not change the independent effect of CHIKV infection on neurocognitive outcome. The mean DQ of p-CHIKV-infected children was lower in severe encephalopathic children than in non-severe children (77.6 versus 91.2, P<0.001. Of the 12 cases of CHIKV neonatal encephalopathy, five developed a microcephaly (head circumference <-2 standard deviations and four matched the definition of cerebral palsy. MRI scans showed severe restrictions of white matter areas

  15. The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients.......The Medtronic Sprint Fidelis Lead Advisory Notification Has No Adverse Impact on Patient Reported Outcomes in Danish Implantable Cardioverter Defibrillator Patients....

  16. The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne Møller; Versteeg, Henneke; Nielsen, Jens C.;

    The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients.......The Medtronic Sprint Fidelis Lead Advisory Notification has no adverse impact on patient reported outcomes in Danish implantable cardioverter defibrillator patients....

  17. The joint influence of area income, income inequality, and immigrant density on adverse birth outcomes: a population-based study

    Directory of Open Access Journals (Sweden)

    Giraud Julie

    2009-07-01

    Full Text Available Abstract Background The association between area characteristics and birth outcomes is modified by race. Whether such associations vary according to social class indicators beyond race has not been assessed. Methods This study evaluated effect modification by maternal birthplace and education of the relationship between neighbourhood characteristics and birth outcomes of newborns from 1999–2003 in the province of Québec, Canada (N = 353,120 births. Areas (N = 143 were defined as administrative local health service delivery districts. Multi-level logistic regression was used to model the association between three area characteristics (median household income, immigrant density and income inequality and the two outcomes preterm birth (PTB and small-for-gestational age (SGA birth. Effect modification by social class indicators was evaluated in analyses stratified according to maternal birthplace and education. Results Relative to the lowest tertile, high median household income was associated with SGA birth among Canadian-born mothers (odds ratio (OR 1.13, 95% confidence interval (CI 1.06, 1.20 and mothers with high school education or less (OR 1.13, 95% CI 1.02, 1.24. Associations between median household income and PTB were weaker. Relative to the highest tertile, low immigrant density was associated with a lower odds of PTB among foreign-born mothers (OR 0.79, 95% CI 0.63, 1.00 but a higher odds of PTB among Canadian-born mothers (OR 1.14, 95% CI 1.07, 1.21. Associations with income inequality were weak or absent. Conclusion The association between area factors and birth outcomes is modified by maternal birthplace and education. Studies have found that race interacts in a similar manner. Public health policies focussed on perinatal health must consider the interaction between individual and area characteristics.

  18. Adverse Outcomes Among Asian Indian Singleton Births in New Jersey, 2008-2011.

    Science.gov (United States)

    Kurtyka, Karen; Gaur, Sunanda; Mehrotra, Naveen; Chandwani, Sheenu; Janevic, Teresa; Demissie, Kitaw

    2015-08-01

    The study determined the incidence of low birth weight (LBW), small for gestational age (SGA), preterm birth, and perinatal morbidity among Asian Indians (AI) in New Jersey (NJ), as well as identified predictors of SGA. We analyzed birth records for singletons born to mothers identified as AI and non-Hispanic white from 2008 to 2011, obtained from the NJ Department of Health. For AI, rates of LBW and SGA were elevated, rates of preterm birth were similar, and neonatal intensive care unit admission was lower, compared to whites. Factors associated with SGA in AI included nulliparity, anemia, hypertension, placental abruption, and lack of prenatal care. Maternal education, marital status, substance abuse, and timing of prenatal care were associated with SGA in whites, but not in AI. SGA incidence was higher among AI despite preterm rates similar to whites. Anemia was associated with SGA uniquely among AI. PMID:25047404

  19. Associations of prenatal exposure to five chlorophenols with adverse birth outcomes.

    Science.gov (United States)

    Guo, Jianqiu; Wu, Chunhua; Lv, Shenliang; Lu, Dasheng; Feng, Chao; Qi, Xiaojuan; Liang, Weijiu; Chang, Xiuli; Xu, Hao; Wang, Guoquan; Zhou, Zhijun

    2016-07-01

    Exposures to chlorophenols (CPs) have been linked with adverse health effects on wildlife and humans. This study aimed to evaluate prenatal exposure to five CP compounds using maternal urinary concentrations during pregnancy and the potential associations with birth outcomes of their infants at birth. A total of 1100 mother-newborn pairs were recruited during June 2009 to January 2010 in an agricultural region, China. Urinary concentrations of five CPs from dichlorophenol (DCP) to pentachlorophenol (PCP), namely, 2,5-DCP, 2,4-DCP, 2,4,5-trichlorophenol (2,4,5-TCP), 2,4,6-TCP and PCP, were measured using large-volume-injection gas chromatography-tandem mass spectrometry (LVI-GC-MS-MS), and associations between CP levels and weight, length as well as head circumference at birth were examined. Median urinary creatinine-adjusted concentrations of 2,5-DCP, 2,4-DCP, 2,4,5-TCP, 2,4,6-TCP and PCP were 3.34 μg/g, 1.03 μg/g, < LOD, 1.78 μg/g and 0.39 μg/g creatinine, respectively. We found lower birth weight 30 g [95% confidence interval (CI): -57, -3; p = 0.03] for per SD increase in log10-transformed concentrations of 2,4,6-TCP and lower birth weight 37 g (95% CI: -64, -10; p = 0.04) for PCP, respectively. Similarly, head circumference decrease in associations with creatinine-corrected 2,4,6-TCP and PCP concentrations were also achieved. Considering sex difference, the associations of lower birth weight were only found among male neonates, while head circumference was associated with 2,4-DCP and 2,5-DCP only found among female neonates. This study showed significant negative associations between CPs exposure and reduction in neonatal anthropometric measures. The biological mechanisms concerning CPs exposure on fetal growth deserved further investigations. PMID:27131805

  20. Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

    Directory of Open Access Journals (Sweden)

    Le Nhu D

    2010-09-01

    Full Text Available Abstract Background To determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs from British Columbia, Canada (BC. Methods Female RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213. The identifier file was linked to Canadian cancer registries. An RN offspring cohort from 1986 was created by linkages with the BC Birth and Health Status Registries. Exposure was assessed by work history in oncology or cancer agencies (method 1 and by estimating weighted duration of exposure developed from a survey of pharmacists and nursing unit administrators of all provincial hospitals and treatment centers and the work history of the nurses (method 2. Relative risks (RR were calculated using Poisson regression for cancer incidence and odds ratios (OR were calculated for congenital anomaly, stillbirth, low birth weight, and prematurity incidence, with 95% confidence intervals. Results In comparison with other female RNs, method 1 revealed that RNs who ever worked in a cancer center or in an oncology nursing unit had an increased risk of breast cancer (RR = 1.83; 95% CI = 1.03 - 3.23, 12 cases and their offspring were at risk for congenital anomalies of the eye (OR = 3.46, 95% CI = 1.08 - 11.14, 3 cases. Method 2 revealed that RNs classified as having the highest weighted durations of exposure to antineoplastic drugs had an excess risk of cancer of the rectum (RR = 1.87, 95% CI = 1.07 - 3.29, 14 cases. No statistically significant increased risks of leukemia, other cancers, stillbirth, low birth weight, prematurity, or other congenital anomalies in the RNs' offspring were noted. Conclusions Female RNs having had potential exposure to antineoplastic drugs were not found to have an excess risk of leukemia, stillbirth, or congenital

  1. Establishment of Exposure-response Functions of Air Particulate Matter and Adverse Health Outcomes in China and Worldwide

    Institute of Scientific and Technical Information of China (English)

    HAI-DONG KAN; BING-HENG CHEN; CHANG-HONG CHEN; BING-YAN WANG; QING-YAN FU

    2005-01-01

    Objective To obtain the exposure-response functions that could be used in health-based risk assessment of particulate air pollution in China. Methods Meta analysis was conducted on the literatures on air particulate matter and its adverse health outcomes in China and worldwide. Results For each health outcome from morbidity to mortality changes, the relative risks were estimated when the concentration of air particulate matter increased to some certain units. Conclusion The exposure-response functions recommended here can be further applied to health risk assessment of air particulate matter in China.

  2. Systems Toxicology of Male Reproductive Development: Profiling 774 Chemicals for Molecular Targets and Adverse Outcomes

    Science.gov (United States)

    Adverse trends in male reproductive health have been reported for increased rates of testicular germ cell tumor, low semen quality, cryptorchidism, and hypospadias. An association with prenatal environmental exposure has been inferred from human and animal studies underlying male...

  3. Adverse Outcome Pathways for Regulatory Applications: Examination of Four Case Studies With Different Degrees of Completeness and Scientific Confidence

    OpenAIRE

    PERKINS Edward; Antczak, Philipp; Burgoon, Lyle; Falciani, Francesco; GARCIA-REYERO Natalia; GUTSELL Steve; HODGES Geoff; KIENZLER AUDE; Knapen, Dries; McBride, Mary; Willett, Catherine

    2015-01-01

    Adverse outcome pathways (AOPs) offer a pathway-based toxicological framework to support hazard assessment and regulatory decision-making. However, little has been discussed about the scientific confidence needed, or how complete a pathway should be, before use in a specific regulatory application. Here we review four case studies to explore the degree of scientific confidence and extent of completeness (in terms of causal events) that is required for an AOP to be useful for a spe...

  4. Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study

    OpenAIRE

    Fidler, M M; Frobisher, C; Guha, J; K. Wong; Kelly, J; Winter, D. L.; Sugden, E; Duncan, R.; Whelan, J; Reulen, R C; Hawkins, M. M.

    2015-01-01

    Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study. Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital st...

  5. Indoor Exposure and Adverse Birth Outcomes Related to Fetal Growth, Miscarriage and Prematurity—A Systematic Review

    OpenAIRE

    Evridiki Patelarou; Kelly, Frank J.

    2014-01-01

    The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed ind...

  6. Adverse mental health outcomes associated with emotional abuse in young rural South African women: a cross-sectional study

    OpenAIRE

    Jina, Ruxana; Jewkes, Rachel; Hoffman, Susie; Dunkle, Kristen L.; Nduna, Mzikazi; Shai, Nwabisa J.

    2011-01-01

    There is a lack of data on the prevalence of emotional abuse in youth. The aim of this study was thus to estimate the prevalence of emotional abuse in intimate partnerships among young women in rural South Africa and to measure the association between lifetime experience of emotional abuse (with and without the combined experience of physical and/or sexual abuse) and adverse health outcomes. Between 2002 and 2003, young women from 70 villages were recruited to participate in the cluster rando...

  7. Prevalence of Adverse Pregnancy Outcomes, by Maternal Diabetes Status at First and Second Deliveries, Massachusetts, 1998–2007

    OpenAIRE

    Kim, Shin Y.; Kotelchuck, Milton; Wilson, Hoyt G.; Diop, Hafsatou; Shapiro-Mendoza, Carrie K.; England, Lucinda J.

    2015-01-01

    Introduction: Understanding patterns of diabetes prevalence and diabetes-related complications across pregnancies could inform chronic disease prevention efforts. We examined adverse birth outcomes by diabetes status among women with sequential, live singleton deliveries. Methods: We used data from the 1998–2007 Massachusetts Pregnancy to Early Life Longitudinal Data System, a population-based cohort of deliveries. We restricted the sample to sets of parity 1 and 2 deliveries. We created 8 di...

  8. Prevalence of Adverse Pregnancy Outcomes, by Maternal Diabetes Status at First and Second Deliveries, Massachusetts, 1998–2007

    OpenAIRE

    Kim, Shin Y.; Kotelchuck, Milton; Wilson, Hoyt G.; Diop, Hafsatou; Shapiro-Mendoza, Carrie K.; England, Lucinda J.

    2015-01-01

    Introduction Understanding patterns of diabetes prevalence and diabetes-related complications across pregnancies could inform chronic disease prevention efforts. We examined adverse birth outcomes by diabetes status among women with sequential, live singleton deliveries. Methods We used data from the 1998–2007 Massachusetts Pregnancy to Early Life Longitudinal Data System, a population-based cohort of deliveries. We restricted the sample to sets of parity 1 and 2 deliveries. We created 8 diab...

  9. Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey

    OpenAIRE

    Heaman Maureen I; O'Campo Patricia J; Urquia Marcelo L; Janssen Patricia A; Thiessen Kellie R

    2011-01-01

    Abstract Background Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence ...

  10. Trends in perinatal health after assisted reproduction

    DEFF Research Database (Denmark)

    Henningsen, Anna-Karina Aaris; Gissler, M.; Skjaerven, R.;

    2015-01-01

    STUDY QUESTIONS Has the perinatal outcome of children conceived after assisted reproductive technology (ART) improved over time? SUMMARY ANSWER The perinatal outcomes in children born after ART have improved over the last 20 years, mainly due to the reduction of multiple births. WHAT IS KNOWN AND...... ART outcome and health data from Denmark, Finland, Norway and Sweden. PARTICIPANTS, SETTING AND METHODS We analysed the perinatal outcome of 62 379 ART singletons and 29 758 ART twins, born from 1988 to 2007 in four Nordic countries. The ART singletons were compared with a control group of 362 215...... affected the observed trends. WIDER IMPLICATIONS OF THE FINDINGS It is assuring that data from four countries confirm an overall improvement over time in the perinatal outcomes of children conceived after ART. Furthermore, data show the beneficial effect of single embryo transfer, not only in regard to...

  11. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review.

    Science.gov (United States)

    Goldstein, Christina L; Macwan, Kevin; Sundararajan, Kala; Rampersaud, Y Raja

    2016-03-01

    OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias. PMID:26565767

  12. Diagnóstico, Conduta Obstétrica e Resultados Perinatais em Fetos com Hidrocefalia Diagnosis, Obstetrical Management and Perinatal Outcome in Hydrocephalus

    Directory of Open Access Journals (Sweden)

    Renato Passini Júnior

    1998-08-01

    Full Text Available Objetivo: avaliar os métodos para diagnóstico, características da gestação, complicações maternas e resultados perinatais em casos de hidrocefalia congênita, correlacionando-os com variáveis gestacionais e do parto. Método: avaliaram-se 116 gestações com este diagnóstico antes ou após o parto, dos quais 112 ocorridos na Maternidade do CAISM da UNICAMP no período de 1986 a 1995. Para as variáveis perinatais, utilizaram-se os dados completos de 82 recém-nascidos. Para a análise dos dados, calcularam-se as distribuições e médias, usando-se os testes de c² e exato de Fisher. Resultados: geralmente o diagnóstico foi anterior ao parto, confirmado pelo exame ecográfico, e o parto foi por cesárea na maioria dos casos. A cefalocentese foi realizada em 11 casos e as complicações no parto vaginal foram mais freqüentes que na cesárea. O índice de Apgar baixo foi mais freqüente entre os recém-nascidos de parto vaginal. A hidrocefalia congênita esteve também associada a importante morbidade e mortalidade neonatal e perinatal, outras malformações e número muito pequeno de crianças sem seqüelas. Conclusões: a avaliação destes fatores pode ser de grande utilidade para o obstetra acompanhar gestantes com esta malformação fetal, dando maior respaldo às decisões que, além de médicas e éticas, devem levar em conta a relação risco-benefício das medidas a serem tomadas.Objective: to evaluate the diagnosis, characteristics of pregnancy, maternal complications and perinatal outcome in cases of congenital hydrocephalus, and to associate them with pregnancy and delivery variables. Methods: 116 pregnancies with this diagnosis were evaluated before or after delivery, 112 of them occurring at the Maternity ward of CAISM/UNICAMP during the period between 1986 and 1995. For perinatal variables, complete data of 82 newborns were used. For data analysis, distributions and means were calculated and c² and Fisher exact tests

  13. Inflammatory and Epigenetic Pathways for Perinatal Depression.

    Science.gov (United States)

    Garfield, Lindsey; Mathews, Herbert L; Janusek, Linda Witek

    2016-05-01

    Depression during the perinatal period is common and can have adverse consequences for women and their children. Yet, the biobehavioral mechanisms underlying perinatal depression are not known. Adverse early life experiences increase the risk for adult depression. One potential mechanism by which this increased risk occurs is epigenetic embedding of inflammatory pathways. The purpose of this article is to propose a conceptual model that explicates the linkage between early life adversity and the risk for maternal depression. The model posits that early life adversity embeds a proinflammatory epigenetic signature (altered DNA methylation) that predisposes vulnerable women to depression during pregnancy and the postpartum period. As proposed, women with a history of early life adversity are more likely to exhibit higher levels of proinflammatory cytokines and lower levels of oxytocin in response to the demands of pregnancy and new motherhood, both of which are associated with the risk for perinatal depression. The model is designed to guide investigations into the biobehavioral basis for perinatal depression, with emphasis upon the impact of early life adversity. Testing this model will provide a better understanding of maternal depressive risk and improve identification of vulnerable women who would benefit from targeted interventions that can reduce the impact of perinatal depression on maternal-infant health. PMID:26574573

  14. CHARACTERIZATION OF THE MATERNAL AND NEONATAL ADVERSE OUTCOMES AFTER CAESAREAN SECTION IN THE CLÍNICA DE MATERNIDAD RAFAEL CALVO

    Directory of Open Access Journals (Sweden)

    Rubio-Hoyos Sandra M

    2015-01-01

    Full Text Available Introduction: the World Health Organization (WHO recommends that the incidence of cesarean must not exceed 15%; however, its use has increased in the last two decades, which implies a public health problem. Objective: to characterize the maternal and neonatal adverse outcomes of caesarean in the Clínica Maternidad Rafael Calvo (CMRC,Cartagena-Colombia. Methodology: a descriptive cross-sectional study, where after cesarean maternal and neonatal adverse outcomes were characterized. Results: 1.804 cesarean sections (46.5% and 2.073 vaginal deliveries (53.5% were performed. The most common indications for cesarean section were before cesarean (35.5%, cephalo pelvic disproportion (30.6% and oligoamnios (10.8%. The most common adverse maternal outcomes were bleeding requiring transfusion (9.17%, surgical wound hematoma (3.28% and admission to ICU (1.5%. The most common adverse neonatal outcomes were APGAR <7 per minute (21.3%, transient tachypnea of the newborn (9.6% and Apgar <7 at 5 ‘(4.3%. Prenatal care (PNC was protective factor for uterine bleeding requiring transfusion (OR crude 0.54, CI 0.38 to 0.76, OR adjusted 0.53 IC 0.38 to 0.76, uterine bleeding which required hysterectomy (OR crude 0.20, CI 0.01 to 0.72, OR adjusted 0.11, IC: 0.11 to 0.72, obstetric shock (OR crude 0.06, IC: 0.00 to 0.55 ,OR adjusted 0.04, CI 0.04 to 0.38 and destination (rooming (OR 0.66, IC 0.49 to 0.90, APGAR <7 at 1 ‘( OR 0.78 IC 0.44 to 0.72, Apgar <7 at 5 ‘(adjusted OR 0.48, IC 0.28 to 0.82 and the presence of respiratory distress (OR crude 0,28 IC, 0.15 to 0.51; OR adjusted 0.53, IC 0.28 to 0.98 Conclusions: the proportion of cesarean sections performed in the CMRC (46.5% is above 15% recommended by WHO. Cesarean section leads to increased maternal and fetal morbidity. The CNP acted as a protective factor against the occurrence of adverse maternal and neonatal outcomes. Rev.cienc.biomed. 2015;6(2:241-250 KEYWORDS Cesarean; Obstetric; Hemorrhage.

  15. Prevalence of maternal near miss and adverse pregnancy outcomes in Zhejiang province%浙江省危重孕产妇监测及其结局分析

    Institute of Scientific and Technical Information of China (English)

    马袁英; 戴红燕; 邱丽倩; 徐键; 邱灵

    2014-01-01

    目的 通过浙江省危重孕产妇监测系统掌握危重孕产妇发生水平及不良妊娠结局情况.方法 通过横断面调查选取2012至2013年浙江省危重孕产妇监测医院入院的所有危重孕产妇,网络直报危重孕产妇个案表,包括孕产妇的个人信息,妊娠合并症和并发症,危重孕产妇抢救措施和抢救过程,孕产妇及围产儿的不良结局发生情况.结果 共监测孕产妇161 660,共收集危重孕产妇826例,危重孕产妇的发病率5.6‰,危重孕产妇中妊娠期高血压疾病排首位,164例占19.9%;第2位是子宫收缩乏力,162例占19.6%;第3位为前置胎盘,146例占17.7%.危重孕产妇严重孕产结局中,子宫切除139例,子宫切除率16.8%.围产儿死亡81例,围产儿死亡率为10.4%,早产279例,早产出生率39.9%.结论 危重孕产妇监测有利于掌握危重孕产妇发生的流行病学情况,督促医疗机构改善产科质量,降低危重孕产妇发生率,早产儿出生率和围产儿死亡率.%Objective To explore the prevalence of maternal near miss (MNM) and adverse pregnancy outcomes in Zhejiang province by MNM surveillance system.Methods A cross-sectional study was conducted during 2012 and 2013.All MNM cases were recruited from the MNM surveillance system.The information was reported by direct network report system,including personal information,obstetric complications,maternal rescue measures,rescue process and severe maternal and perinatal outcomes.Results A total of 826 MNM patients were recruited.The MNM rate was 5.6 cases/1 000 live births (LB).Maternal gestational hypertension was the most common disease among MNM,accounting for 19.9% (n =164).The second prevalent one was insufficient uterine contraction,accounting for 19.6% (n =162).Placenta previa was the third one accounting for 17.7% (n =146).Among adverse pregnancy outcomes,139 cases underwent hysterectomy (n =139,16.8%).There were 81 perinatal deaths with a perinatal

  16. The Adverse Effect of Spasticity on 3-Month Poststroke Outcome Using a Population-Based Model

    OpenAIRE

    Belagaje, S. R.; C. Lindsell; Moomaw, C. J.; Alwell, K.; Flaherty, M. L.; Woo, D; Dunning, K; P. Khatri; Adeoye, O.; D. Kleindorfer; Broderick, J.; Kissela, B

    2014-01-01

    Several devices and medications have been used to address poststroke spasticity. Yet, spasticity's impact on outcomes remains controversial. Using data from a cohort of 460 ischemic stroke patients, we previously published a validated multivariable regression model for predicting 3-month modified Rankin Score (mRS) as an indicator of functional outcome. Here, we tested whether including spasticity improved model fit and estimated the effect spasticity had on the outcome. Spasticity was define...

  17. Association between vitamin D insufficiency and adverse pregnancy outcome: global comparisons

    Directory of Open Access Journals (Sweden)

    Bener A

    2013-09-01

    Full Text Available Abdulbari Bener,1,2 Abdulla OAA Al-Hamaq,3 Najah M Saleh4 1Department of Medical Statistics and Epidemiology, Hamad General Hospital, Doha, Qatar; 2Institute of Population Health, University of Manchester, Manchester, UK; 3Qatar Diabetic Association, Doha, Qatar; 4Department of Obstetrics and Gynecology, Women's Hospital, Doha, Qatar Background: Vitamin D insufficiency has been associated with a number of adverse pregnancy outcomes, and has been recognized as a public health concern. Aim: The objective of this study was to determine the impact of vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM, anemia, iron deficiency, and preeclampsia among pregnant women. Subjects and methods: This was a cohort study undertaken at antenatal clinics at the Women's Hospital of Hamad Medical Corporation in Doha. A total of 2,487 Arab pregnant women above 24 weeks' gestation with any maternal complication were approached, and 1,873 women (75.3% consented to participate in the study. Data on sociodemographic and clinical characteristics by interview and biochemistry parameters were retrieved from medical records. Multivariate logistic regression analysis was performed to determine the associated risk factors. Results: Of the studied pregnant women, nearly half of them had vitamin D deficiency (48.4%. Younger women below 30 years old (43.2%, P = 0.032, housewives (65.3%, P = 0.008, and those on low monthly household incomes (QR5,000–9,999 (49.2%, P = 0.03 were significantly more likely to have lower vitamin D compared with those who had sufficient vitamin D levels. Exposure to sunlight (63.4%, P = 0.05, daily physical activity (64.4%, P = 0.05, and vitamin D supplement intake (89.7%, P < 0.001 were significantly lower in deficient pregnant women. In the study sample of pregnant women, 13.9% had GDM, 11.5% had anemia, 8.6% had iron deficiency, and 6.9% had preeclampsia. Severe vitamin D deficiency was significantly higher in

  18. Below knee angioplasty in elderly patients: Predictors of major adverse clinical outcomes.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-03-01

    To determine predictors of clinical outcome following percutaneous transluminal angioplasty (PTA) in elderly patients with below knee atherosclerotic lesions causing intermittent claudication (IC) or critical limb ischaemia (CLI).

  19. Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series

    Science.gov (United States)

    Buchan, Sarah; Spaans, Johanna N.; Balfour, Louise

    2016-01-01

    Background. The prevalence and associated risks with adverse obstetrical outcomes among women living with HIV are not well measured. The objective of this study was to longitudinally investigate the prevalence and correlates of adverse obstetrical outcomes among women with HIV. Methods. This 20-year (1990–2010) clinical case series assessed the prevalence of adverse obstetrical outcomes among pregnant women with HIV receiving care at The Ottawa Hospital (TOH). General estimating equation modeling was used to identify factors independently associated with adverse obstetrical outcomes, while controlling for year of childbirth clustering. Results. At TOH, there were 127 deliveries among 94 women (1990–2010): 22 preterm births, 9 births with low birth weight, 12 births small for gestational age, and 4 stillbirths. Per year, the odds of adverse obstetrical outcomes increased by 15% (OR: 1.15, 95% CI: 1.03–1.30). Psychiatric illness (AOR: 2.64, 95% CI: 1.12–6.24), teen pregnancy (AOR: 3.35, 95% CI: 1.04–1.46), and recent immigrant status (AOR: 7.24, 95% CI: 1.30–40.28) were the strongest correlates of adverse obstetrical outcomes. Conclusions. The increasing number and proportion of adverse obstetrical outcomes among pregnant women with HIV over the past 20 years highlight the need for social supports and maternal and child health interventions, especially among adolescents, new immigrants, and those with a history of mental illness. PMID:27528877

  20. Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data.

    Science.gov (United States)

    Lucenko, Barbara A; Sharkova, Irina V; Huber, Alice; Jemelka, Ron; Mancuso, David

    2015-09-01

    This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12-17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach. PMID:26234784

  1. Adverse outcomes after major surgery in patients with pressure ulcer: a nationwide population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Chia-Lun Chou

    Full Text Available Postoperative adverse outcomes in patients with pressure ulcer are not completely understood. This study evaluated the association between preoperative pressure ulcer and adverse events after major surgeries.Using reimbursement claims from Taiwan's National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of 17391 patients with preoperative pressure ulcer receiving major surgery in 2008-2010. With a propensity score matching procedure, 17391 surgical patients without pressure ulcer were selected for comparison. Eight major surgical postoperative complications and 30-day postoperative mortality were evaluated among patients with pressure ulcer of varying severity.Patients with preoperative pressure ulcer had significantly higher risk than controls for postoperative adverse outcomes, including septicemia, pneumonia, stroke, urinary tract infection, and acute renal failure. Surgical patients with pressure ulcer had approximately 1.83-fold risk (95% confidence interval 1.54-2.18 of 30-day postoperative mortality compared with control group. The most significant postoperative mortality was found in those with serious pressure ulcer, such as pressure ulcer with local infection, cellulitis, wound or treatment by change dressing, hospitalized care, debridement or antibiotics. Prolonged hospital or intensive care unit stay and increased medical expenditures were also associated with preoperative pressure ulcer.This nationwide propensity score-matched retrospective cohort study showed increased postoperative complications and mortality in patients with preoperative pressure ulcer. Our findings suggest the urgency of preventing and managing preoperative pressure ulcer by a multidisciplinary medical team for this specific population.

  2. Does CT scan performed at one week of age help predict neurodevelopmental outcome following perinatal hypoxic-ischaemic injury in term infants?

    International Nuclear Information System (INIS)

    Full text: Cerebral imaging may be used as an adjunct to clinical assessment to help prognostician following a perinatal hypoxic ischaemic insult. A good correlation has been shown between MRI and neurologic outcome but data obtained using CT is less clear. The aim of this study was to determine whether CT of the brain performed at one week of age was prognostic for neurodevelopmental outcome in term infants with hypoxic ischaemic encephalopathy. Term infants with an umbilical artery pH<7.1 or Apgar score <6 at 5 minutes plus evidence of encephalopathy and no evidence of major congenital anomalies were reviewed and data obtained. Nearly all of the infants in the study (35) were part of a trial of selective head cooling. CT scans were randomised and reviewed independently by three practising neuroradiologists on two occasions. The CTs were graded as 0) normal; 1) white matter oedema; 2a) mild watershed infarction; 2b) moderate watershed infarction; 3) severe generalised infarction; 4) involvement of basal ganglia. Follow up neurological examination was performed at regular intervals, until 18 months of age, by a neonatologist. Developmental testing at 18 months using the revised Bailey Scales of Infant Development was performed by a psychologist. The study group consisted of 36 infants. Mean birth weight was 3555 (SD+/- 510)g, gestational age was 39.7 (+/- 1.4) weeks, umbilical or first arterial pH was 6.9 (+/- 0.2) and 5 min Apgar scores was 4.3 (+/- 1.9). Neurological outcome was designated as cerebral palsy (7), tone abnormalities before 12 months but only mild abnormality or normal examination at 18 months (2), developmental delay but normal physical examination (1) and functionally normal at 18 months (24). In 27% of infants the images were with normal limits. In only 17% there was overt basal ganglia damage and in 56% there was some degree of white matter abnormality. Overall, an abnormal CT had a sensitivity of 78%, and a specificity of 91% for the prediction

  3. Influences of polycystic ovary syndrome on perinatal outcomes of overweight or obese women.%多囊卵巢综合征对超重或肥胖孕妇围产结局的影响

    Institute of Scientific and Technical Information of China (English)

    张莉; 李光辉; 张为远

    2011-01-01

    探讨多囊卵巢综合征( PCOS)对超重或肥胖孕妇国产结局的影响.方法对2008年5月至2010年7月在北京妇产医院产科门诊初次就诊孕妇进行PCOS史的筛查,将55例体重指数(BMI) ≥24 PCOS合并妊娠的单胎孕妇作为研究组,将对照组按年龄及孕前BMI和研究组进行2:1配对,即110例符合条件的非PCOS孕妇被纳入对照组,随访两组的妊娠结局到分娩.多胎妊娠、原有高血压、糖尿病、高血脂、甲状腺功能异常、心脏病、肾脏病等慢性疾病者未纳入本研究.结果BMI≥24 PCOS孕妇早产的发生率(20.0%)明显高于对照组(5.5%),两组差异有统计学意义,P<0.01.而妊娠期糖尿病(GDM)、妊娠期高血压、子痫前期、产后出血等妊娠并发症及新生儿并发症发生率两组比较差异无统计学意义(P>0.05).结论PCOS没有增加超重或肥胖孕妇GDM及妊娠期高血压疾病及其他不良围产结局发生的危险,但早产发生的危险显著增高.%Objective To determine the effect of polycystic ovary syndrome ( PCOS) on perinatal outcomes of overweight or obese pregnancy women. Methods The screening of PCOS was performed when they were at first prenatal visit in Beijing Obstetrics and Gynecology Hospital, Capital Medical University between May, 2008 and July,2010. 55 PCOS women of pregnancy women with BMI^24 were considered as the study subjects, and 110 pregnancy women without P-COS matched by age and pre-pregnancy body mass index ( BMI) were selected as the control ones. Patients with history of pre-pregnancy diabetes, hypertension, cardiovascular disease, renal diseases and multiple pregnancies were excluded from the study. We followed pregnancy outcomes of two groups until delivery. Results PCOS women with BMI ≥24 had a significantly higher rate of preterm compared with the controls, P 0. 05 ). Conclusion PCOS is not at increased risk of GDM, pregnancy hypertension disorder and other adverse perinatal outcomes

  4. Biomarkers of effect in endocrine disruption: how to link a functional assay to an adverse outcome pathway

    Directory of Open Access Journals (Sweden)

    Stefano Lorenzetti

    2015-06-01

    Full Text Available The development of in vitro testing strategies may achieve a cost-effective generation of comprehensive datasets on a large number of chemicals, according to the requirements of the European Regulation REACH. Much emphasis is placed on in vitro methods based on subcellular mechanisms (e.g., nuclear receptor interaction, but it is necessary to define the predictive value of molecular or biochemical changes within an adverse outcome pathway (AOP. AOP pivots on the description of the flow from a molecular initiating event through a cascade of intermediate events needed to produce a specific adverse effect at organism level: downstream responses at cell level are, therefore, essential to define an AOP. Several in vitro assays are based on human cell lines representative of endocrine-targeted tissues (e.g., prostate and on functional biomarkers of clinical relevance (e.g., PSA secretion in human prostate epithelial cells. We discuss the implementation of such functional biomarkers in the AOP context.

  5. The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

    Science.gov (United States)

    Berger, Katherine E; Masterson, James; Mascardo, Joy; Grapa, Jayvee; Appanaitis, Inger; Temengil, Everlynn; Watson, Berry Moon; Cash, Haley L

    2016-08-01

    The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking. PMID:26994610

  6. Estudo do sonograma do ducto venoso em fetos com centralização hemodinâmica: avaliação de repercussões perinatais Study of ductus venosus in fetuses with brain sparing reflex: evaluation of perinatal outcomes

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Nassar de Carvalho

    2006-04-01

    Full Text Available OBJETIVO: avaliar a associação da relação sístole ventricular/atrial (S/A do ducto venoso (DV com resultados perinatais em fetos prematuros com centralização de fluxo à dopplervelocimetria. MÉTODOS: o estudo foi delineado como um estudo observacional, transversal, com os dados colhidos de forma prospectiva. A relação S/A do DV foi estudada em 41 fetos centralizados com idade gestacional (IG entre 25 e 33ª semana completa, no período de novembro de 2002 a julho de 2005. Os recém-nascidos foram acompanhados até o 28º dia pós-parto na UTI da Clínica Perinatal Laranjeiras, buscando-se complicações neonatais. A população de estudo foi dividida em dois grupos a partir do resultado do DV. Foram incluídos no grupo normal os fetos com relação S/A menor ou igual a 3,6 e no grupo alterado aqueles com valores de S/A maiores que 3,6. A comparação entre os grupos foi realizada com os testes estatísticos de Mann-Whitney, chi2 e exato de Fisher. Todos os resultados foram considerados estatisticamente significativos se p3,6. Não houve diferença significativa entre os grupos quanto à IG ao nascimento e Apgar PURPOSE: to evaluate the relationship between S/A ratio in ductus venosus (DV and perinatal outcomes in fetuses with brain sparing reflex. METHODS: the study was designed as an observational, sectional study with prospectively collected data. Forty-one fetuses with brain sparing reflex and gestational age between 25 and 33 weeks were studied between November 2002 and July 2005. The newborns were observed during the neonatal period in the intensive care unit of "Clínica Perinatal Laranjeiras" in order to find adverse outcomes. The study population was divided into two groups according to DV assessment. In the normal group all the fetuses with S/A ratio values of 3.6 or less were included, and in the abnormal group the fetuses with values of S/A ratio greater than 3.6. The statistical analysis was performed by the Mann-Whitney U

  7. The role of lupus nephritis in development of adverse maternal and fetal outcomes during pregnancy

    OpenAIRE

    Alimohammad Fatemi; Reyhaneh Motamedi Fard; Zahra Sayedbonakdar; Ziba Farajzadegan; Mina Saber

    2013-01-01

    Background: We aimed to investigate the relationship of lupus nephritis (LN) with fetal and maternal outcomes of pregnant patients with systemic lupus erythematosus (SLE). Methods: In a retrospective study, profiles of pregnant women with SLE were selected. Before pregnancy and at the end of first, second and third trimesters, SLE disease activity index-2K was assessed. Clinical and laboratory evaluations were carried out regularly. Maternal and fetal outcomes were recorded. Assessments o...

  8. Depression as a risk factor for adverse outcomes in coronary heart disease

    OpenAIRE

    Freedland, Kenneth E.; Carney, Robert M.

    2013-01-01

    Background Depression is firmly established as an independent predictor of mortality and cardiac morbidity in patients with coronary heart disease (CHD). However, it has been difficult to determine whether it is a causal risk factor, and whether treatment of depression can improve cardiac outcomes. In addition, research on biobehavioral mechanisms has not yet produced a definitive causal model of the relationship between depression and cardiac outcomes. Discussion Key challenges in this line ...

  9. Adverse pregnancy outcome in rats following exposure to a Salacia reticulata (Celastraceae) root extract

    OpenAIRE

    Ratnasooriya W.D.; Jayakody J.R.A.C.; Premakumara G.A.S.

    2003-01-01

    The root extract of Salacia reticulata Wight (family: Celastraceae) is used in Sri Lanka by traditional practitioners as a herbal therapy for glycemic control even during pregnancy. It is recognized that some clinically used antidiabetic drugs have harmful effects on pregnancy but the effects of the S. reticulata root extract on reproductive outcome is unknown and deserves examination. We determined the effects of the S. reticulata root extract on the reproductive outcome of Wistar rats (250-...

  10. Predictive value of AGEs and their receptor RAGE and sRAGE for perinatal outcome of gestational diabetes%血清中晚期糖基化终产物及其受体对妊娠期糖尿病围产儿结局的预测价值

    Institute of Scientific and Technical Information of China (English)

    汤栩文; 林斯; 谢晓斌

    2012-01-01

    end products (AGEs)-advanced glycation end products receptor (RAGE) axis mediated by oxidative stress and perinatal outcome and biological effects of serum soluble advanced glycation end product receptor (sRAGE) levels of AGEs-of RAGE axis play. Methods Select pregnant women who prenatal care in Guangzhou Women and Children "s Medical Center between January 2011 and December 2011 , The recruitment of pregnant women diagnosed with GDM between 24-28 weeks gestational age, A total of 100 cases. Recruitment of another 50 cases of normal pregnant women of corresponding age as the study control. Extracted blood samples of pregnant women, measure glycation index: blood glucose , HbAl c, AGEs, sRAGE. Collected after delivery of placenta for the analysis of tissue expression of RAGE protein. And collection of maternal and infant clinical information, perinatal abnormalities were divided into normal group of perinatal and perinatal abnormal group. Results GDM groups had higher serum AGEs levels (50. 44 ± 16. 21) ng/L and fasting blood glucose compared with those of their respective controls(32. 69 ± 10. 13)ng/L (P 0. 05) , but the level of serum AGEs remained high. GDM group maternal serum AGEs and sRAGE level was negatively correlated (r =-0. 582,P < 0.01). Abnormal perinatal outcome in GDM had significantly higher maternal serum AGEs level (67.39 ± 14. 75)ng/L than that(41. 59 ± 12. 26) ng/L in controls with normal perinatal outcome (P < 0. 05) . Logistic regression analysis showed that AGEs was a p redictor of adverse perinatal outcome in GDM(OR = 6. 197 ,P < 0. 001, 95% CI 2. 514 ~ 15. 453). SRAGE was a p redictor of adverse perinatal outcome in GDM (OR =0. 498,P <0. 05,95% CI 0.217 ~ 0. 925) . Determined western blotting of RAGE protein expression in the placenta (0. 993 ± 0. 085) is also higher in the GDM perinatal outcomes (0. 611 ±0. 047) in the abnormal group(0. 247 ±0. 018) (P <0. 01) . Conclusion High serum AGEs is negative factor for the GDM perinatal outcome

  11. Maternal alcohol intake up to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort

    OpenAIRE

    Nykjaer, C; Alwan, NA; Greenwood, DC; Simpson, NAB; Hay, AWM; White, KLM; Cade, JE

    2013-01-01

    Background High maternal alcohol consumption has been linked to adverse birth outcomes such as small for gestational age and preterm birth, which in turn have been linked to increased risk of development of cardiovascular diseases and type 2 diabetes in adulthood. The UK Department of Health (DH) recommends that pregnant women and those trying to conceive should avoid alcohol and never drink more than 1GÇô2 units once or twice a week. This study aimed to investigate the association between al...

  12. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States.

    Science.gov (United States)

    Fejzo, Marlena S; MacGibbon, Kimber W; Mullin, Patrick M

    2016-07-01

    This is an analysis of fetal outcome in pregnancies exposed to ondansetron to treat Hyperemesis Gravidarum (HG). In this retrospective cohort study, U.S. data on outcome were collected on 1070 pregnancies exposed to ondansetron and compared to outcomes in two control groups: 771 pregnancies in women with a history of HG with no ondansetron exposure and 1555 pregnancies with neither a history of HG nor ondansetron exposure. Ventricular septal defects were reported in 2/952 of infants in the HG/Ondansetron-exposure group and 4/1286 in the No HG/No Ondansetron-exposure group. Cleft palate was reported in 1/952 live births in the HG/Ondansetron and 2/1286 in the No HG/No Ondansetron-exposure groups. Women with a history of HG who took ondansetron reported less miscarriages and terminations, and higher live birth rates. The overall results do not support evidence of teratogenicity of ondansetron. PMID:27151373

  13. Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

    OpenAIRE

    Barthélémy Tandu-Umba; Robert Laala Tshibangu; Andy Mbangama Muela

    2013-01-01

    Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intrace...

  14. Adolescence as risk factor for adverse pregnancy outcome in Central Africa--a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Florian Kurth

    Full Text Available BACKGROUND: Sub-Saharan Africa has the highest rates of maternal and neonatal mortality worldwide. Young maternal age at delivery has been proposed as risk factor for adverse pregnancy outcome, yet there is insufficient data from Sub-Saharan Africa. The present study aimed to investigate the influence of maternal adolescence on pregnancy outcomes in the Central African country Gabon. METHODOLOGY AND PRINCIPAL FINDINGS: Data on maternal age, parity, birth weight, gestational age, maternal Plasmodium falciparum infection, use of bednets, and intake of intermittent preventive treatment of malaria in pregnancy were collected in a cross-sectional survey in 775 women giving birth in three mother-child health centers in Gabon. Adolescent women (≤16 years of age had a significantly increased risk to deliver a baby with low birth weight in univariable analysis (22.8%, 13/57, vs. 9.3%, 67/718, OR: 2.9, 95% CI: 1.5-5.6 and young maternal age showed a statistically significant association with the risk for low birth weight in multivariable regression analysis after correction for established risk factors (OR: 2.7; 95% CI: 1.1-6.5. In further analysis adolescent women were shown to attend significantly less antenatal care visits than adult mothers (3.3±1.9 versus 4.4±1.9 mean visits, p<0.01, n = 356 and this difference accounted at least for part of the excess risk for low birth weight in adolescents. CONCLUSION: Our data demonstrate the importance of adolescent age as risk factor for adverse pregnancy outcome. Antenatal care programs specifically tailored for the needs of adolescents may be necessary to improve the frequency of antenatal care visits and pregnancy outcomes in this risk group in Central Africa.

  15. Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban population.

    Science.gov (United States)

    Wade, Roy; Cronholm, Peter F; Fein, Joel A; Forke, Christine M; Davis, Martha B; Harkins-Schwarz, Mary; Pachter, Lee M; Bair-Merritt, Megan H

    2016-02-01

    Adverse Childhood Experiences (ACEs), which include family dysfunction and community-level stressors, negatively impact the health and well being of children throughout the life course. While several studies have examined the impact of these childhood exposures amongst racially and socially diverse populations, the contribution of ACEs in the persistence of socioeconomic disparities in health is poorly understood. To determine the association between ACEs and health outcomes amongst a sample of adults living in Philadelphia and examine the moderating effect of Socioeconomic Status (SES) on this association, we conducted a cross-sectional survey of 1,784 Philadelphia adults, ages 18 and older, using random digit dialing methodology to assess Conventional ACEs (experiences related to family dysfunction), Expanded ACEs (community-level stressors), and health outcomes. Using weighted, multivariable logistic regression analyses along with SES stratified models, we examined the relationship between ACEs and health outcomes as well as the modifying effect of current SES. High Conventional ACE scores were significantly associated with health risk behaviors, physical and mental illness, while elevated Expanded ACE scores were associated only with substance abuse history and sexually transmitted infections. ACEs did have some differential impacts on health outcomes based on SES. Given the robust impact of Conventional ACEs on health, our results support prior research highlighting the primacy of family relationships on a child's life course trajectory and the importance of interventions designed to support families. Our findings related to the modifying effect of SES may provide additional insight into the complex relationship between poverty and childhood adversity. PMID:26726759

  16. Association between nutritional risk and routine clinical laboratory measurements and adverse outcomes: a prospective study in hospitalized patients of wuhan tongji hospital

    OpenAIRE

    Chen, Z. Y.; Gao, C.; Ye, T; Zuo, X Z; G. H. Wang; Xu, X. S.; Yao, Y

    2014-01-01

    Background/Objectives: Nutritional risk screening (NRS-2002) and routine clinical laboratory measurements (RCLMs) had been shown to have a predictive value in adverse outcomes in some studies, respectively. This study analyzed the association between NRS-2002 and RCLMs and estimated their prospective value in predicting adverse outcomes. Subjects/Methods: A total of 916 hospitalized patients were screened on admission with NRS-2002 and Subjective Global Assessment; RCLMs, which include blood ...

  17. Urinary Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) • Insulin-Like Growth Factor-Binding Protein 7 (IGFBP7) Predicts Adverse Outcome in Pediatric Acute Kidney Injury

    OpenAIRE

    Westhoff, Jens H.; Tönshoff, Burkhard; Waldherr, Sina; Pöschl, Johannes; Teufel, Ulrike; Westhoff, Timm H.; Fichtner, Alexander

    2015-01-01

    Background The G1 cell cycle inhibitors tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been identified as promising biomarkers for the prediction of adverse outcomes including renal replacement therapy (RRT) and mortality in critically ill adult patients who develop acute kidney injury (AKI). However, the prognostic value of urinary TIMP-2 and IGFBP7 in neonatal and pediatric AKI for adverse outcome has not been investigated yet...

  18. Testing the association between psychosocial job strain and adverse birth outcomes--design and methods

    DEFF Research Database (Denmark)

    Larsen, Ann D; Hannerz, Harald; Obel, Carsten;

    2011-01-01

    A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the...... risk of giving birth to a child born preterm or small for gestational age....

  19. Women with Intellectual Disability at Risk of Adverse Pregnancy and Birth Outcomes

    Science.gov (United States)

    Mcconnell, D.; Mayes, R.; Llewellyn, G.

    2008-01-01

    Background: An increasing number of women with intellectual disability (ID) have children. Cross-sectional, clinical population data suggest that these women face an increased risk of delivering preterm and/or low birthweight babies. The aim of this study was to explore the prevalence of poor pregnancy and birth outcomes in women with ID and/or…

  20. Low Plasma alpha-Tocopherol Concentrations and Adverse Clinical Outcomes in Diabetic Hemodialysis Patients

    NARCIS (Netherlands)

    Espe, Katharina M.; Raila, Jens; Henze, Andrea; Blouin, Katja; Schneider, Andreas; Schmiedeke, Daniel; Krane, Vera; Pilz, Stefan; Schweigert, Florian J.; Hocher, Berthold; Wanner, Christoph; Drechsler, Christiane

    2013-01-01

    Background and objectives Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of alpha-tocopherol and specific clinical outcomes in diabet

  1. Adverse Outcome Pathways for Regulatory Applications: Examination of Four Case Studies With Different Degrees of Completeness and Scientific Confidence.

    Science.gov (United States)

    Perkins, Edward J; Antczak, Philipp; Burgoon, Lyle; Falciani, Francesco; Garcia-Reyero, Natàlia; Gutsell, Steve; Hodges, Geoff; Kienzler, Aude; Knapen, Dries; McBride, Mary; Willett, Catherine

    2015-11-01

    Adverse outcome pathways (AOPs) offer a pathway-based toxicological framework to support hazard assessment and regulatory decision-making. However, little has been discussed about the scientific confidence needed, or how complete a pathway should be, before use in a specific regulatory application. Here we review four case studies to explore the degree of scientific confidence and extent of completeness (in terms of causal events) that is required for an AOP to be useful for a specific purpose in a regulatory application: (i) Membrane disruption (Narcosis) leading to respiratory failure (low confidence), (ii) Hepatocellular proliferation leading to cancer (partial pathway, moderate confidence), (iii) Covalent binding to proteins leading to skin sensitization (high confidence), and (iv) Aromatase inhibition leading to reproductive dysfunction in fish (high confidence). Partially complete AOPs with unknown molecular initiating events, such as 'Hepatocellular proliferation leading to cancer', were found to be valuable. We demonstrate that scientific confidence in these pathways can be increased though the use of unconventional information (eg, computational identification of potential initiators). AOPs at all levels of confidence can contribute to specific uses. A significant statistical or quantitative relationship between events and/or the adverse outcome relationships is a common characteristic of AOPs, both incomplete and complete, that have specific regulatory uses. For AOPs to be useful in a regulatory context they must be at least as useful as the tools that regulators currently possess, or the techniques currently employed by regulators. PMID:26500288

  2. A spatial bivariate probit model for correlated binary data with application to adverse birth outcomes.

    Science.gov (United States)

    Neelon, Brian; Anthopolos, Rebecca; Miranda, Marie Lynn

    2014-04-01

    Motivated by a study examining geographic variation in birth outcomes, we develop a spatial bivariate probit model for the joint analysis of preterm birth and low birth weight. The model uses a hierarchical structure to incorporate individual and areal-level information, as well as spatially dependent random effects for each spatial unit. Because rates of preterm birth and low birth weight are likely to be correlated within geographic regions, we model the spatial random effects via a bivariate conditionally autoregressive prior, which induces regional dependence between the outcomes and provides spatial smoothing and sharing of information across neighboring areas. Under this general framework, one can obtain region-specific joint, conditional, and marginal inferences of interest. We adopt a Bayesian modeling approach and develop a practical Markov chain Monte Carlo computational algorithm that relies primarily on easily sampled Gibbs steps. We illustrate the model using data from the 2007-2008 North Carolina Detailed Birth Record. PMID:22599322

  3. How Does the Fast Track Intervention Prevent Adverse Outcomes in Young Adulthood?

    Science.gov (United States)

    Sorensen, Lucy C; Dodge, Kenneth A

    2016-03-01

    Numerous studies have shown that childhood interventions can foster improved outcomes in adulthood. Less well understood is precisely how-that is, through which developmental pathways-these interventions work. This study assesses mechanisms by which the Fast Track project (n = 891), a randomized intervention in the early 1990s for high-risk children in four communities (Durham, NC; Nashville, TN; rural PA; and Seattle, WA), reduced delinquency, arrests, and general and mental health service utilization in adolescence through young adulthood (ages 12-20). A decomposition of treatment effects indicates that about a third of Fast Track's impact on later crime outcomes can be accounted for by improvements in social and self-regulation skills during childhood (ages 6-11), such as prosocial behavior, emotion regulation, and problem solving. These skills proved less valuable for the prevention of general and mental health problems. PMID:26670938

  4. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    OpenAIRE

    Kraft, Robert; Herndon, David N; Williams, Felicia N.; Al-Mousawi, Ahmed M.; Finnerty, Celeste C.; Jeschke, Marc G.

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on bod...

  5. Is ABO blood group truly a risk factor for thrombosis and adverse outcomes?

    OpenAIRE

    Zhou, Shan; Welsby, Ian

    2014-01-01

    ABO blood type is one of the most readily available laboratory tests, and serves as a vital determinant in blood transfusion and organ transplantation. The ABO antigens are expressed not only on red blood cell membranes, determining the compatibility of transfusion, but also on the surface of other human cells, including epithelium, platelet and vascular endothelium, therefore extending the research into other involvements of cardiovascular disease and postoperative outcomes. ABO blood group ...

  6. Women's perception of risks of adverse fetal pregnancy outcomes: a large-scale multinational survey

    OpenAIRE

    Petersen, Irene; McCrea, Rachel; Lupattelli, Angela; Nordeng, Hedvig Marie Egeland

    2015-01-01

    Objective To determine pregnant women and new mothers’ perception of risks in pregnancy. Design, settings and participants This was a large-scale multinational survey including 9113 pregnant women and new mothers from 18 countries in Europe, North America and Australia. Main outcomes Risk perception scores (0–10) for harmful effects to the fetus were derived for: (1) medicines (over-the-counter medicine and prescribed medicine), (2) food substances (eggs and blue veined chee...

  7. Role of Genetic Susceptibility in Development of Treatment-related Adverse Outcomes in Cancer Survivors

    OpenAIRE

    Bhatia, Smita

    2011-01-01

    Clear and unambiguous associations have been established between therapeutic exposures and specific complications. However, considerable inter-individual variability is observed in the risk of developing an outcome for a given therapeutic exposure. Genetic predisposition and especially its interaction with therapeutic exposures can potentially exacerbate the toxic effect of treatment on normal tissues and organ systems, and can possibly explain the inter-individual variability. This article p...

  8. Adverse neurodevelopmental outcomes after exposure to phenobarbital and levetiracetam for the treatment of neonatal seizures

    OpenAIRE

    Maitre, Nathalie L.; Smolinsky, Ciaran; Slaughter, James C.; Stark, Ann R.

    2013-01-01

    Objective Compare neurodevelopment after levetiracetam (LEV) and phenobarbital (PB) for neonatal seizures. Study design Retrospective study of infants who received antiepileptic drugs (AEDs) for neonatal seizures. Effect of cumulative exposure to LEV and PB on outcomes of death, cerebral palsy (CP), and Bayley Scales of Infant Development (BSID) scores were evaluated at 24 months corrected age. Analyses were adjusted for number of electrographic seizures and gestational age. Results In 280 in...

  9. The Violence Proneness Scale of the DUSI-R Predicts Adverse Outcomes Associated with Substance Abuse

    OpenAIRE

    Kirisci, Levent; Tarter, Ralph; Reynolds, Maureen

    2009-01-01

    Accuracy of the Violence Proneness Scale (VPS) of the Drug Use Screening Inventory (DUSI-R)1 was evaluated in 328 boys for predicting use of illegal drugs, DUI, selling drugs, sexually transmitted disease, car accident while under acute effects of drugs/alcohol, trading drugs for sex, injuries from a fight, and traumatic head injury. Boys were prospectively tracked from age 16 to 19 at which time these outcomes were documented in the interim period. The results demonstrated that the VPS score...

  10. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes

    OpenAIRE

    Murphy, V E; Clifton, V.L.; Gibson, P G

    2006-01-01

    Exacerbations of asthma during pregnancy represent a significant clinical problem and may be related to poor pregnancy outcomes. A systematic review of the literature was conducted for publications related to exacerbations during pregnancy. Four studies with a control group (no asthma) and two groups of women with asthma (exacerbation, no exacerbation) were included in meta‐analyses using fixed effects models. During pregnancy, exacerbations of asthma which require medical intervention occur ...

  11. Sex-specific and strain-dependent effects of early life adversity on behavioral and epigenetic outcomes

    Directory of Open Access Journals (Sweden)

    FrancesAChampagne

    2013-08-01

    Full Text Available Early life adversity can have a significant long-term impact with implications for the emergence of psychopathology. Disruption to mother-infant interactions is a form of early life adversity that may, in particular, have profound programming effects on the developing brain. However, despite converging evidence from human and animal studies, the precise mechanistic pathways underlying adversity-associated neurobehavioral changes has yet to be elucidated. One approach to the study of mechanism is exploration of epigenetic changes associated with early life experience. In the current study, we examined the effects of postnatal maternal separation in mice and assessed the behavioral, brain gene expression, and epigenetic effects of this manipulation in offspring. Importantly, we included two different mouse strains (B6 and Balb/c and both male and female offspring to determine strain- and/or sex-associated differential response to maternal separation. We found both strain-specific and sex-dependent effects of maternal separation in early adolescent offspring on measures on open-field exploration, sucrose preference, and social behavior. Analyses of cortical and hippocampal mRNA levels of the glucocorticoid receptor (Nr3c1 and brain-derived neurotrophic factor (Bdnf genes revealed decreased hippocampal Bdnf expression in maternally-separated B6 females and increased cortical Bdnf expression in maternally separated male and female Balb/c offspring. Analyses of Nr3c1and Bdnf (IV and IX CpG methylation indicated increased hippocampal Nr3c1 methylation in maternally separated B6 males and increased hippocampal Bdnf IX methylation in male and female maternally separated Balb/c mice. Overall, though effect sizes were modest, these findings suggest a complex interaction between early life adversity, genetic background, and sex in the determination of neurobehavioral and epigenetic outcomes that may account for differential vulnerability to later life

  12. Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset

    Directory of Open Access Journals (Sweden)

    Nuwayhid Bahij S

    2009-03-01

    Full Text Available Abstract Background The primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE, placental insufficiency, and a prolonged length of stay (PLOS, in women who delivered throughout Florida, USA. Methods Cross-sectional analyses were conducted using a statewide hospital database. Prevalence odds ratios (OR were calculated to quantify the association between elevated antiphospholipid antibody titers and four outcomes in 141,286 women who delivered in Florida in 2001. The possibility that the relationship between elevated antiphospholipid antibody titers and the outcomes of preeclampsia/eclampsia, placental insufficiency, and PLOS, may have been modified by the presence of SLE was evaluated in a multiple logistic regression model by creating a composite interaction term. Results Women with elevated antiphospholipid antibody titers (n = 88 were older, more likely to be of white race and not on Medicaid than women who did not have elevated antiphospholipid antibody titers. Women who had elevated antiphospholipid antibody titers had an increased adjusted odds ratio for preeclampsia and eclampsia, (OR = 2.93 p = 0.0015, SLE (OR = 61.24 p Conclusion This exploratory epidemiologic investigation found moderate to very strong associations between elevated antiphospholipid antibody titers and four important outcomes in a large sample of women.

  13. Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lauren A V Orenstein

    Full Text Available BACKGROUND: Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa. METHODS: We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM, low birth weight (LBW, prematurity, and major congenital malformations (MCM in Sub-Saharan African countries were also performed. FINDINGS: Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3 per 1,000 total births, and the most common causes were hemorrhage (34%, dystocia (22%, and severe hypertensive disorders of pregnancy (22%. Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4 or premature (median 15.4%, IQR: 10.6-19.1 were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6, with the musculoskeletal system comprising 30%. INTERPRETATION: Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies

  14. Obstetrician-Gynecologists and Perinatal Infections: A Review of Studies of the Collaborative Ambulatory Research Network (2005–2009)

    OpenAIRE

    Meaghan A. Leddy; Bernard Gonik; Jay Schulkin

    2010-01-01

    Background. Maternal infection is associated with adverse pregnancy outcomes, and ob-gyns are in a unique position to help prevent and treat infections. Methods. This paper summarizes studies completed by the Research Department of the American College of Obstetricians and Gynecologists regarding perinatal infections that were published between 2005 and 2009. Results. Obstetrician-gynecologists are routinely screening for hepatitis B and HIV, and many counsel prenatal patients regarding hepat...

  15. Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy

    International Nuclear Information System (INIS)

    Purpose: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs

  16. Adverse Outcomes After Palliative Radiation Therapy for Uncomplicated Spine Metastases: Role of Spinal Instability and Single-Fraction Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Tai-Chung, E-mail: lamtaichung@gmail.com [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Uno, Hajime [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Krishnan, Monica [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Lutz, Steven [Department of Radiation Oncology, Blanchard Valley Regional Medical Center, Findlay, Ohio (United States); Groff, Michael [Department of Neurosurgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Cheney, Matthew [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Balboni, Tracy [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2015-10-01

    Purpose: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs.

  17. Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure - retrospective cohort study in an urban obstetric population in Ireland

    LENUS (Irish Health Repository)

    Mullally, Aoife

    2011-04-11

    Abstract Background Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. Methods A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). Results Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups. Conclusions Public Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population.

  18. Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure - retrospective cohort study in an urban obstetric population in Ireland

    Directory of Open Access Journals (Sweden)

    Fahey Tom P

    2011-04-01

    Full Text Available Abstract Background Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. Methods A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week, moderate (6-20 units per week and high (>20 units per week. Results Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80, Irish nationality OR 16.5 (95% CI 14.9 to 18.3, private health care OR 5.83 (95% CI 5.38 to 6.31 and smoking OR 1.86 (95% CI 1.73 to 2.01. Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91 and illicit drug use OR 6.46 (95% CI 3.32 to 12.60. High consumption was associated with very preterm birth ( Conclusions Public Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population.

  19. Recent immigration and adverse pregnancy outcomes in an urban setting in Spain.

    Science.gov (United States)

    Garcia-Subirats, Irene; Pérez, Glòria; Rodríguez-Sanz, Maica; Salvador, Joaquín; Jané, Mireia

    2011-07-01

    To describe social and economic inequalities in non-fatal pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in the neighbourhoods of the city of Barcelona (Spain), according to maternal age and maternal country of origin, between 1991 and 2005. A cross-sectional ecological study was carried out using the 38 neighbourhoods of Barcelona as the unit of analysis. The study population comprises the 192,921 live births to resident women aged 12-49 residing from 1991 to 2005. Information was gathered from births registry. Prevalence of low birth-weight, preterm birth and small for gestational age, was calculated for each of the 38 neighbourhoods of mothers' residence, stratifying results by maternal age and country of origin. The indicator of neighbourhood socio-economic level was the unemployment rate. Quartile maps along with Spearman correlation coefficients and linear regression were performed between indicators. The present study reports socio-economic inequalities in pregnancy outcomes among neighbourhoods in Barcelona (Spain): the more disadvantaged neighbourhoods have worse pregnancy outcomes (low birth weight, preterm birth and small for gestational age births) in all women age groups. These inequalities do not exist among immigrant women, and some groups of foreign mothers even have lower rates of low birth weight, preterm birth, and small for gestational age births than autochthonous women. The existing inequalities suggest that policy efforts to reduce these inequalities are not entirely successful and should focus on improving pregnancy and delivery care in less privileged women in a country with universal access to health care. PMID:20440546

  20. Testing the association between psychosocial job strain and adverse birth outcomes - design and methods

    OpenAIRE

    Thulstrup Ane M; Obel Carsten; Hannerz Harald; Larsen Ann D; Bonde Jens P; Hougaard Karin S

    2011-01-01

    Abstract Background A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the risk of giving birth to a child born preterm or small for gestational age. Methods and design We will use the Danish National Birth Cohort where 100.000 children are included at bas...

  1. Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

    International Nuclear Information System (INIS)

    To compare the management outcome of induction of labor with expectant management in patients with term pre labor rupture of membranes (PROM). Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25th July 2010 to 25th January 2011. Methods: A total of 384 patients were selected for this study, which were divided into two groups by lottery method. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma. Results: The mean duration between PROM to onset of active labor in group A was significantly less (8.4 ± 2.3 hours) as compared to group B in which it was (9.6±2.1 hours) (p = 0.000). The mean duration between PROM to delivery in group A was significantly less in group A (17.4 ± 2.0) versus group B (22.2 ± 2.0 hours) (p = 0.000). The spontaneous vaginal delivery (SVD) rate was considerably higher (p=0.056) in group A in which 161 (83.8%) patients delivered by SVD and 31 (16.1%) patients by LSCS. In group B, 146 (76.0%) patients delivered by SVD and 46 (23.9%) patients by LSCS. In group A, 8 (4.1%) patients developed chorioamnionitis and 13 (6.7%) patients in group B (p = 0.262). In group A there were 178 (92.7%) neonates with APGAR score of > 5 at 1 minute in contrast to 173 (90.1%) in group B with (p = 0.363). Similarly in group A at 5 minutes, there were 178 (92.7%) neonates with APGAR score of > 7 and 173 (90.1%) in group B (p = 0.460). There were 9 (4.6%) cases of neonatal sepsis in group A, in comparison with 12 (6.2%) patients in group B (p = 0.501). Conclusion: The mean duration of labor in induced patients was less as compared to patients with expectant management. (author)

  2. Two pathways through adversity: Predicting well-being and housing outcomes among homeless service users.

    Science.gov (United States)

    Walter, Zoe C; Jetten, Jolanda; Dingle, Genevieve A; Parsell, Cameron; Johnstone, Melissa

    2016-06-01

    People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service (T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being. PMID:26333919

  3. Role of genetic susceptibility in development of treatment-related adverse outcomes in cancer survivors.

    Science.gov (United States)

    Bhatia, Smita

    2011-10-01

    Clear and unambiguous associations have been established between therapeutic exposures and specific complications. However, considerable interindividual variability is observed in the risk of developing an outcome for a given therapeutic exposure. Genetic predisposition and especially its interaction with therapeutic exposures can potentially exacerbate the toxic effect of treatment on normal tissues and organ systems, and can possibly explain the interindividual variability. This article provides a brief overview of the current knowledge about the role of genomic variation in the development of therapy-related complications. Relatively common outcomes with strong associations with therapeutic exposures, including cardiomyopathy, obesity, osteonecrosis, ototoxicity, and subsequent malignancies are discussed here. To develop a deeper understanding of the molecular underpinnings of therapy-related complications, comprehensive and near-complete collection of clinically annotated samples is critical. Methodologic issues such as study design, definition of the endpoints or phenotypes, identification of appropriate and adequately sized study population together with a reliable plan for collecting and maintaining high-quality DNA, and selection of an appropriate approach or platform for genotyping are also discussed. Understanding the etiopathogenetic pathways that lead to the morbidity is critical to developing targeted prevention and intervention strategies, optimizing risk-based health care of cancer survivors, thus minimizing chronic morbidities and improving quality of life. PMID:21980013

  4. A workflow to investigate exposure and pharmacokinetic influences on high-throughput in vitro chemical screening based on adverse outcome pathways, OpenTox USA 2015 Poster

    Science.gov (United States)

    Adverse outcome pathways (AOP) link known population outcomes to a molecular initiating event (MIE) that can be quantified using high-throughput in vitro methods. Practical application of AOPs in chemical-specific risk assessment requires consideration of exposure and absorption,...

  5. Outcomes of offspring born to mothers with gestational diabetes.

    Science.gov (United States)

    Somasundaram, Noel Pratheepan; Subasinghe, Chandrika Jayakanthi; Maheshi Gimhani Amarawardena, Wickrama Kankanamge

    2016-09-01

    With the global explosion of Diabetes and obesity at epidemic proportions, keeping Asia at its epicenter, 1 in 7 live births get complicated with hyperglycaemia; either pre-existing Diabetes or Gestational Diabetes. In utero, exposure to an adverse metabolic environment with nutrient excess or deficiencies and toxic metabolites with teratogenic potential, leads to short and long term consequences to the offspring. Multisystemic congenital malformations, macrosomia associated obstetric complications and perinatal metabolic derangements complicate the early neonatal stage. Epigenetic changes taking place during foetal development initiate foetal metabolic programming and create adverse metabolic memory leading to childhood obesity, metabolic syndrome and Diabetes. Hyperglycaemia and poor metabolic parameters throughout pregnancy correlate with adverse offspring outcomes. Novel management strategies targeting near normoglycaemia have achieved marked improvements in rates of perinatal mortality and other adverse outcomes. Therapies for management of Diabetes in pregnancy should be carefully selected upon the safety profile for the offspring. PMID:27582165

  6. Eating for Two in Pregnancy: Health outcomes in pregnant women and their children

    OpenAIRE

    Tielemans, Myrte

    2016-01-01

    textabstractAdverse pregnancy and birth outcomes such as pre-eclampsia and preterm birth are prevalent worldwide and are important causes of maternal and perinatal mortality and morbidity. To reduce the occurrence of these adverse outcomes, risk factors should be identified that could be modified in pregnancy. Such modifiable risk factors may be maternal nutrition and gestational weight gain. However, not all aspects of maternal diet during pregnancy have been studied in relation with pregnan...

  7. The 2011 survey on hypertensive disorders of pregnancy (HDP in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes.

    Directory of Open Access Journals (Sweden)

    Chun Ye

    Full Text Available Hypertensive disorders of pregnancy (HDP are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44% and Central China showed the lowest (1.23%. Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.

  8. Testing the association between psychosocial job strain and adverse birth outcomes - design and methods

    Directory of Open Access Journals (Sweden)

    Thulstrup Ane M

    2011-04-01

    Full Text Available Abstract Background A number of studies have examined the effects of prenatal exposure to stress on birth outcomes but few have specifically focused on psychosocial job strain. In the present protocol, we aim to examine if work characterised by high demands and low control, during pregnancy, is associated with the risk of giving birth to a child born preterm or small for gestational age. Methods and design We will use the Danish National Birth Cohort where 100.000 children are included at baseline. In the present study 49,340 pregnancies will be included. Multinomial logistic regression will be applied to estimate odds ratios for the outcomes: preterm; full term but small for gestational age; full term but large for gestational age, as a function of job-strain (high strain, active and passive versus low strain. In the analysis we control for maternal age, Body Mass Index, parity, exercise, smoking, alcohol use, coffee consumption, type of work (manual versus non-manual, maternal serious disease and parents' heights as well as gestational age at interview. Discussion The prospective nature of the design and the high number of participants strengthen the study. The large statistical power allows for interpretable results regardless of whether or not the hypotheses are confirmed. This is, however, not a controlled study since all kinds of 'natural' interventions takes place throughout pregnancy (e.g. work absence, medical treatment and job-redesign. The analysis will be performed from a public health perspective. From this perspective, we are not primarily interested in the effect of job strain per se but if there is residual effect of job strain after naturally occurring preventive measures have been taken.

  9. Oxygen desaturation in 6-min walk test is a risk factor for adverse outcomes in COPD.

    Science.gov (United States)

    Waatevik, Marie; Johannessen, Ane; Gomez Real, Francisco; Aanerud, Marianne; Hardie, Jon Andrew; Bakke, Per Sigvald; Lind Eagan, Tomas Mikal

    2016-07-01

    The 6-min walk test (6MWT) is an exercise test that measures functional status in chronic obstructive pulmonary disease (COPD) patients and provides information on oxygen desaturation. We investigated oxygen desaturation during 6MWT as a risk factor for important COPD outcomes: mortality, frequency of exacerbations, decline in lung function and decline in lean body mass.433 COPD patients were included in the Bergen COPD Cohort Study 2006-2009, and followed-up for 3 years. Patients were characterised using spirometry, bioelectrical impedance measurements, Charlson comorbidity score, exacerbation history, smoking and arterial blood gases. 370 patients completed the 6MWT at the baseline of the study. Information on all-cause mortality was collected in 2011.Patients who experienced oxygen desaturation during the 6MWT had an approximately twofold increased risk of death (hazard ratio 2.4, 95% CI 1.2-5.1), a 50% increased risk for experiencing later COPD exacerbations (incidence rate ratio 1.6, 95% CI 1.1-2.2), double the yearly rate of decline in both forced vital capacity and forced expiratory volume in 1 s (3.2% and 1.7% versus 1.7% and 0.9%, respectively) and manifold increased yearly rate of loss of lean body mass (0.18 kg·m(-2) versus 0.03 kg·m(-2) among those who did not desaturate).Desaturating COPD patients had a significantly worse prognosis than non-desaturating COPD patients, for multiple important disease outcomes. PMID:27076586

  10. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

    Directory of Open Access Journals (Sweden)

    Hogan David B

    2012-09-01

    Full Text Available Abstract Background Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items, the Cardiovascular Health Study (CHS frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL residents followed over one year. Methods The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+ participating in the Alberta Continuing Care Epidemiological Studies (ACCES. Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS. The area under the ROC curve (AUC was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Results Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items showing no significant association. For death and long-term care placement, the addition of frailty (however derived or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items showed significantly better performance over the other measures in predicting long

  11. Adverse pregnancy outcome in rats following exposure to a Salacia reticulata (Celastraceae root extract

    Directory of Open Access Journals (Sweden)

    Ratnasooriya W.D.

    2003-01-01

    Full Text Available The root extract of Salacia reticulata Wight (family: Celastraceae is used in Sri Lanka by traditional practitioners as a herbal therapy for glycemic control even during pregnancy. It is recognized that some clinically used antidiabetic drugs have harmful effects on pregnancy but the effects of the S. reticulata root extract on reproductive outcome is unknown and deserves examination. We determined the effects of the S. reticulata root extract on the reproductive outcome of Wistar rats (250-260 g when administered orally (10 g/kg during early (days 1-7 and mid- (days 7-14 pregnancy. The root extract significantly (P<0.05 enhanced post-implantation losses (control vs treatment: early pregnancy, 4.7 ± 2.4 vs 49.3 ± 13%; mid-pregnancy, 4.7 ± 2.4 vs 41.7 ± 16.1%. Gestational length was unaltered but the pups born had a low birth weight (P<0.05 (early pregnancy, 6.8 ± 0.1 vs 5.3 ± 0.1 g; mid-pregnancy, 6.8 ± 0.1 vs 5.0 ± 0.1 g and low birth index (P<0.05 (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9%; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1%, fetal survival ratio (P<0.05 (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1, and viability index (P<0.05 (early pregnancy, 94.9 ± 2.6 vs 49.5 ± 12.5%; mid-pregnancy, 94.9 ± 2.6 vs 57.1 ± 16.1%. However, the root extract was non-teratogenic. We conclude that the S. reticulata root extract can be hazardous to successful pregnancy in women and should not be used in pregnancy complicated by diabetes.

  12. Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist.

    Science.gov (United States)

    Nwanodi, Oroma B

    2016-01-01

    Globally, preeclampsia-eclampsia (PE-E) is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10-24 can cut the incidence of PE-E in half. Antepartum low molecular weight heparin combined with low-dose aspirin prophylaxis can cut the incidence of early onset PE-E and fetuses that are small for their gestational age in half. Despite predictive antepartum models for PE-E prophylaxis, said prophylaxis is not routinely provided. Therefore, magnesium sulfate secondary prevention of eclampsia remains the globally recommended intervention. Implementation of a PE-E checklist is a continuous quality improvement (CQI) tool facilitating appropriate antepartum PE-E prophylaxis and maternal care from the first trimester through the postpartum fourth trimester inter-partum interval. A novel clinical PE-E checklist and implementation strategy are presented below. CQI PE-E checklist implementation and appropriate PE-E prophylaxis provides clinicians and healthcare systems an opportunity to achieve Millennium Development Goals 4 and 5, reducing child mortality and improving maternal health. While CQI checklist implementation may be a tedious ongoing process requiring healthcare team resiliency, improved healthcare outcomes are well worth the effort. PMID:27417614

  13. Sexual hookups and adverse health outcomes: a longitudinal study of first-year college women.

    Science.gov (United States)

    Fielder, Robyn L; Walsh, Jennifer L; Carey, Kate B; Carey, Michael P

    2014-01-01

    "Hookups" are sexual encounters between partners who are not in a romantic relationship and do not expect commitment. We examined the associations between sexual hookup behavior and depression, sexual victimization (SV), and sexually transmitted infections (STIs) among first-year college women. In this longitudinal study, 483 women completed 13 monthly surveys assessing oral and vaginal sex with hookup and romantic partners, depression, SV, and self-reported STIs. Participants also provided biological specimens that were tested for STIs. During the study, 50% of participants reported hookup sex and 62% reported romantic sex. Covariates included previous levels of the outcome, alcohol use, impulsivity, sensation seeking, and romantic sex. Autoregressive cross-lagged models showed that, controlling for covariates, hookup behavior during college was correlated with depression, Bs = .21, ps sexual hookup behavior among college women was positively correlated with experiencing depression, SV, and STIs, but the nature of these associations remains unclear, and hooking up did not predict future depression. PMID:24350600

  14. Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes

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    Andrea Olmos-Ortiz

    2015-01-01

    Full Text Available Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes.

  15. 产前焦虑情绪对胎儿血流循环及围产结局的影响%Effect of prenatal anxiety on fetal hemodynamic circulation and perinatal outcome

    Institute of Scientific and Technical Information of China (English)

    蔡东阁; 周妮; 赵晓桂; 王倩; 邬晋芳

    2015-01-01

    Objective To investigate the prevalence of maternal anxiety and its relationship with fetal dynamic blood flow circulation and perinatal outcome during the pregnancy. Methods A total of 323 pregnant women with 37 -40 gestational weeks were recruited. Face to face interviews were conducted on these pregnant women. The state trait anxiety inventory( STAI) was used to assess the mater-nal anxiety status. Ultrasound Doppler was used to measure the blood flow changes in maternal-fetal circulation. The delivery way, the birth weight, the Apgar score and the nucleated red blood cell count in umbilical cord blood were recorded. The subjects were divided into control group and anxiety group according to the scores of the state trait anxiety inventory. Statistical analysis was performed with Chi-square test and t test. Two-tailed P values0. 05). Conclusion The results suggest that the high maternal trait anxiety during pregnancy has an adverse effect on maternal-fetal circulation, which can reduce the fetal oxy-genation, lead to hypoxia and increase the incidences of cesarean delivery and low birth weight.%目的 调查孕妇产前的心理焦虑状况,探讨产前焦虑与胎儿脐血流循环及围产结局的相关性,为孕期心理保健与干预提供科学依据. 方法 采用焦虑状态-特质问卷对323名孕妇于37-40孕周时进行产前问卷调查,以多普勒超声脐血流仪测定脐血流S/D值、RI值,记录分娩方式,新生儿评分、出生体重,并检测脐动脉血中胎儿有核红细胞的含量,以问卷评分≥57分为界限,得分≥57分为焦虑组,得分0. 05). 结论 孕期焦虑情绪对胎儿发育有不利影响,可导致胎儿宫内慢性缺氧,增加产妇手术助产率,并可导致低出生体重发生风险增高. 应重视孕期的负性生活事件和心理压力,加强宣教,缓解焦虑情绪,以利胎儿发育及正常分娩.

  16. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

    Science.gov (United States)

    Kraft, Robert; Herndon, David N.; Williams, Felicia N.; Al-Mousawi, Ahmed M; Finnerty, Celeste C.; Jeschke, Marc G

    2011-01-01

    Hypothesis Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients. Design Retrospective, single-center study. Subjects Five hundred ninety-two severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ≥ 85th percentile (n = 277) and normal (n = 315) weight groups based on body mass index percentiles. Results Patients stratified below (normal) and ≥ 85th percentile had similar age, gender distribution, and total burn size. No significant differences were detected in the incidence of sepsis (11% for obese vs. 10% for normal), the incidence of multiple organ failure (21% for obese and 16% for normal), or mortality (11% for obese vs. 8% for normal). Compared to the normal group, the ≥ 85th percentile group had low levels of constitutive proteins (α2macroglobulin and Apolipoprotein A-1) (p < 0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (p < 0.05 for both) up to 60 days after injury. Patients ≥ 85th percentile showed a significant higher loss of bone mineral density and lipolysis compared to normal individuals. Stepwise logistic regression analysis revealed that body mass index had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (p < 0.001). Conclusions BMI ≥ 85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, multiple organ failure, or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered inflammatory response occurs already in patients starting at the 85th percentile BMI. PMID:22143622

  17. Co-morbidity, not age predicts adverse outcome in clostridium difficile colitis

    Institute of Scientific and Technical Information of China (English)

    TS Dharmarajan; M Sipalay; R Shyamsundar; EP Norkus; CS Pitchumoni

    2000-01-01

    AIM To examine whether age alone or comorbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd)colitis during hospitalization.METHODS A retrospective, observational study design was performed in our Lady of Mercy Medical Center, a 650-bed, urban,community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23- 97 years) were studied, and data pertinent to demographic variables,medical history, co-morbidity, physical examination, and laboratory results were collected. Age was examined as a continuous variable and stratified into Age1 (<80 vs 80 + );Age2 ( < 60, 60 - 69, 70 - 79 and 80 + ); or Age3 (< 60, 60 - 69, 70 - 79, 80 - 89, 90 + ).RESULTS Cd colitis occurs more frequently with advancing age (55% of cases >80 years).However, age, per se, had no effect on mortality. A history of cardiac disease (P= 0.036), recurrent or refractory infection >4 weeks (P--0.007), Iow serum total protein (P=0.034), Iow serum albumin (P=0.001),antibiotic use >4 weeks (P<0.010), use of over 4 antibiotics (P=0.026), and use of certain classes of antibiotics (P = 0.035 - 0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like antibiotics plus clindamycin, in the presence of hypoalbuminemia, refractory sepsis, and cardiac disease ( P = 0.00005). CONCLUSION Cd colitis is common in the very old. However, unlike co-morbidity, age alone does not affect the clinical outcome (survival vs death).

  18. Evolução da gravidez e resultados perinatais em transplantadas renais Pregnancy and perinatal outcomes in women with renal transplantation

    Directory of Open Access Journals (Sweden)

    Leandro Gustavo de Oliveira

    2005-06-01

    . Hipertensão arterial crônica foi observada em 82% dos casos, anemia em 77% e infecção do trato urinário em 38,5%. A incidência de disfunção do enxerto foi de 47,4%, tendo sido a pré-eclampsia a sua principal causa. Perda do transplante ocorreu em 10,2% dos casos. Quanto à via de parto, a cesariana foi realizada em 53,8%, tendo como principais indicações as síndromes hipertensivas. Pré-eclampsia ocorreu em 28,2% das transplantadas. Quanto aos resultados perinatais, prematuridade ocorreu em 46,1% dos casos, apresentando relação significativa com os níveis de creatinina maiores ou iguais a 1,5 mg/dL no primeiro trimestre. Outra intercorrência observada foi restrição de crescimento intra-uterino, verificada em 41,0% das gestações. A mesma não apresentou, entretanto, relação com os níveis séricos de creatinina. CONCLUSÕES: o grupo de estudo foi constituído por pacientes jovens. Hipertensão arterial crônica, anemia e infecção do trato urinário foram intercorrências clínicas bastante freqüentes. Disfunção do enxerto ocorreu em quase metade dos casos, devendo ser rastreada durante o pré-natal. Essas pacientes podem ainda evoluir para a perda do transplante, cujas causas podem ser obstétricas ou não. Quanto à via de parto, a cesariana teve incidência elevada, entretanto lembramos que a via de parto deve ser sempre de indicação obstétrica. Pré-eclampsia ocorreu de forma significativamente maior, devendo ser essas pacientes consideradas como condição de risco para essa complicação. Prematuridade e restrição de crescimento intra-uterino permanecem como importantes complicações perinatais, sendo que a prematuridade se relaciona com a função do transplante.PURPOSE: to evaluate the relationship between renal transplantation and pregnancy through the analysis of clinical and obstetric intercurrent events and perinatal outcomes. METHODS: a retrospective series of 39 cases of pregnancy in 37 women with renal transplantation from

  19. Urine Injury Biomarkers and Risk of Adverse Outcomes in Recipients of Prevalent Kidney Transplants: The Folic Acid for Vascular Outcome Reduction in Transplantation Trial.

    Science.gov (United States)

    Bansal, Nisha; Carpenter, Myra A; Weiner, Daniel E; Levey, Andrew S; Pfeffer, Marc; Kusek, John W; Cai, Jianwen; Hunsicker, Lawrence G; Park, Meyeon; Bennett, Michael; Liu, Kathleen D; Hsu, Chi-Yuan

    2016-07-01

    Recipients of kidney transplants (KTR) are at increased risk for cardiovascular events, graft failure, and death. It is unknown whether urine kidney injury biomarkers are associated with poor outcomes among KTRs. We conducted a post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial using a case-cohort study design, selecting participants with adjudicated cardiovascular events, graft failure, or death. Urine neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), IL-18, and liver-type fatty acid binding protein (L-FABP) were measured in spot urine samples and standardized to urine creatinine concentration. We adjusted for demographics, cardiovascular risk factors, eGFR, and urine albumin-to-creatinine ratio. Patients had 291 cardiovascular events, 257 graft failure events, and 359 deaths. Each log increase in urine NGAL/creatinine independently associated with a 24% greater risk of cardiovascular events (adjusted hazard ratio [aHR], 1.24; 95% confidence interval [95% CI], 1.06 to 1.45), a 40% greater risk of graft failure (aHR, 1.40; 95% CI, 1.16 to 1.68), and a 44% greater risk of death (aHR, 1.44; 95% CI, 1.26 to 1.65). Urine KIM-1/creatinine and IL-18/creatinine independently associated with greater risk of death (aHR, 1.29; 95% CI, 1.03 to 1.61 and aHR, 1.25; 95% CI, 1.04 to 1.49 per log increase, respectively) but not with risk of cardiovascular events or graft failure. Urine L-FABP did not associate with any study outcomes. In conclusion, among prevalent KTRs, higher urine NGAL, KIM-1, and IL-18 levels independently and differentially associated with greater risk of adverse outcomes. PMID:26538631

  20. Indoor exposure and adverse birth outcomes related to fetal growth, miscarriage and prematurity-a systematic review.

    Science.gov (United States)

    Patelarou, Evridiki; Kelly, Frank J

    2014-06-01

    The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in "westernized" countries that have assessed indoor air pollution and all-day personal exposure with specific quantitative methods. This comprehensive literature search identified 16 independent studies which were deemed relevant for further review and two additional studies were added through searching the reference lists of all included studies. Two reviewers independently and critically appraised all eligible articles using the Critical Appraisal Skills Programme (CASP) tool. Of the 18 selected studies, 14 adopted a prospective cohort design, three were case-controls and one was a retrospective cohort study. In terms of pollutants of interest, seven studies assessed exposure to electro-magnetic fields, four studies assessed exposure to polycyclic aromatic hydrocarbons, four studies assessed PM2.5 exposure and three studies assessed benzene, phthalates and noise exposure respectively. Furthermore, 12 studies examined infant growth as the main birth outcome of interest, six examined spontaneous abortion and three studies assessed gestational age at birth and preterm delivery. This survey demonstrates that there is insufficient research on the possible association of indoor exposure and early life effects and that further research is needed. PMID:24896737

  1. Indoor Exposure and Adverse Birth Outcomes Related to Fetal Growth, Miscarriage and Prematurity—A Systematic Review

    Directory of Open Access Journals (Sweden)

    Evridiki Patelarou

    2014-06-01

    Full Text Available The purpose of this review was to summarize existing epidemiological evidence of the association between quantitative estimates of indoor air pollution and all-day personal exposure with adverse birth outcomes including fetal growth, prematurity and miscarriage. We carried out a systematic literature search of MEDLINE and EMBASE databases with the aim of summarizing and evaluating the results of peer-reviewed epidemiological studies undertaken in “westernized” countries that have assessed indoor air pollution and all-day personal exposure with specific quantitative methods. This comprehensive literature search identified 16 independent studies which were deemed relevant for further review and two additional studies were added through searching the reference lists of all included studies. Two reviewers independently and critically appraised all eligible articles using the Critical Appraisal Skills Programme (CASP tool. Of the 18 selected studies, 14 adopted a prospective cohort design, three were case-controls and one was a retrospective cohort study. In terms of pollutants of interest, seven studies assessed exposure to electro-magnetic fields, four studies assessed exposure to polycyclic aromatic hydrocarbons, four studies assessed PM2.5 exposure and three studies assessed benzene, phthalates and noise exposure respectively. Furthermore, 12 studies examined infant growth as the main birth outcome of interest, six examined spontaneous abortion and three studies assessed gestational age at birth and preterm delivery. This survey demonstrates that there is insufficient research on the possible association of indoor exposure and early life effects and that further research is needed.

  2. Endocrine-Disrupting Activity of Hydraulic Fracturing Chemicals and Adverse Health Outcomes After Prenatal Exposure in Male Mice.

    Science.gov (United States)

    Kassotis, Christopher D; Klemp, Kara C; Vu, Danh C; Lin, Chung-Ho; Meng, Chun-Xia; Besch-Williford, Cynthia L; Pinatti, Lisa; Zoeller, R Thomas; Drobnis, Erma Z; Balise, Victoria D; Isiguzo, Chiamaka J; Williams, Michelle A; Tillitt, Donald E; Nagel, Susan C

    2015-12-01

    Oil and natural gas operations have been shown to contaminate surface and ground water with endocrine-disrupting chemicals. In the current study, we fill several gaps in our understanding of the potential environmental impacts related to this process. We measured the endocrine-disrupting activities of 24 chemicals used and/or produced by oil and gas operations for five nuclear receptors using a reporter gene assay in human endometrial cancer cells. We also quantified the concentration of 16 of these chemicals in oil and gas wastewater samples. Finally, we assessed reproductive and developmental outcomes in male C57BL/6J mice after the prenatal exposure to a mixture of these chemicals. We found that 23 commonly used oil and natural gas operation chemicals can activate or inhibit the estrogen, androgen, glucocorticoid, progesterone, and/or thyroid receptors, and mixtures of these chemicals can behave synergistically, additively, or antagonistically in vitro. Prenatal exposure to a mixture of 23 oil and gas operation chemicals at 3, 30, and 300 μg/kg · d caused decreased sperm counts and increased testes, body, heart, and thymus weights and increased serum testosterone in male mice, suggesting multiple organ system impacts. Our results suggest possible adverse developmental and reproductive health outcomes in humans and animals exposed to potential environmentally relevant levels of oil and gas operation chemicals. PMID:26465197

  3. Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies

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    Luciano Potena

    2013-01-01

    Full Text Available HLA antibodies (HLA ab in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52±13y; 16% females; 47% ischemic etiology, 32 (18% showed pretransplant HLA ab, and 12 (7% tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65±9 versus 82±3%; P=0.02, accounting for a doubled independent mortality risk (P=0.04. In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P=0.05 and late cellular rejection (29 versus 11%; P=0.03. Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR, the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P=0.04. By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.

  4. Intervillous macrophage migration inhibitory factor is associated with adverse birth outcomes in a study population in Central India.

    Directory of Open Access Journals (Sweden)

    Puspendra P Singh

    Full Text Available Macrophage migration inhibitory factor (MIF is a pluripotent factor produced by a variety of cells. It plays an important biological role in the regulation of pregnancy and has been shown to influence malaria pathogenesis. In this study, the levels of MIF in the peripheral, cord and placental intervillous blood (IVB plasma collected from women residing in a malaria endemic region of Central India was determined and its association with malaria in pregnancy and birth outcomes was investigated. MIF levels were significantly different in IVB, peripheral, and cord plasma, with IVB plasma having the highest MIF levels and peripheral plasma having the lowest. Placental malaria positive women had significantly higher IVB plasma MIF levels than placental malaria negative women, but this relationship was not seen in peripheral or cord plasma MIF levels. In addition, the odds of stillbirth and low birth weight deliveries for the uppermost placental MIF quartile (irrespective of placental malaria status was significantly higher than that of the lowest placental MIF quartile, supporting the hypothesis that elevated concentrations of placental MIF may be associated with an increased risk of adverse birth outcome.

  5. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    Science.gov (United States)

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks. PMID:26862725

  6. Increased expression of EphA7 correlates with adverse outcome in primary and recurrent glioblastoma multiforme patients

    International Nuclear Information System (INIS)

    Malignant gliomas are lethal cancers, highly dependent on angiogenesis and treatment options and prognosis still remain poor for patients with recurrent glioblastoma multiforme (GBM). Ephs and ephrins have many well-defined functions during embryonic development of central nervous system such as axon mapping, neural crest cell migration, hindbrain segmentation and synapse formation as well as physiological and abnormal angiogenesis. Accumulating evidence indicates that Eph and ephrins are frequently overexpressed in different tumor types including GBM. However, their role in tumorigenesis remains controversial, as both tumor growth promoter and suppressor potential have been ascribed to Eph and ephrins while the function of EphA7 in GBM pathogenesis remains largely unknown. In this study, we investigated the immunohistochemical expression of EphA7 in a series of 32 primary and recurrent GBM and correlated it with clinical pathological parameters and patient outcome. In addition, intratumor microvascular density (MVD) was quantified by immunostaining for endothelial cell marker von Willebrand factor (vWF). Overexpression of EphA7 protein was predictive of the adverse outcome in GBM patients, independent of MVD expression (p = 0.02). Moreover, high density of MVD as well as higher EphA7 expression predicted the disease outcome more accurately than EphA7 variable alone (p = 0.01). There was no correlation between MVD and overall survival or recurrence-free survival (p > 0.05). However, a statistically significant correlation between lower MVD and tumor recurrence was observed (p = 0.003). The immunohistochemical assessment of tissue EphA7 provides important prognostic information in GBM and would justify its use as surrogate marker to screen patients for tyrosine kinase inhibitor therapy

  7. Increased expression of EphA7 correlates with adverse outcome in primary and recurrent glioblastoma multiforme patients

    Directory of Open Access Journals (Sweden)

    Rose Frank

    2008-03-01

    Full Text Available Abstract Background Malignant gliomas are lethal cancers, highly dependent on angiogenesis and treatment options and prognosis still remain poor for patients with recurrent glioblastoma multiforme (GBM. Ephs and ephrins have many well-defined functions during embryonic development of central nervous system such as axon mapping, neural crest cell migration, hindbrain segmentation and synapse formation as well as physiological and abnormal angiogenesis. Accumulating evidence indicates that Eph and ephrins are frequently overexpressed in different tumor types including GBM. However, their role in tumorigenesis remains controversial, as both tumor growth promoter and suppressor potential have been ascribed to Eph and ephrins while the function of EphA7 in GBM pathogenesis remains largely unknown. Methods In this study, we investigated the immunohistochemical expression of EphA7 in a series of 32 primary and recurrent GBM and correlated it with clinical pathological parameters and patient outcome. In addition, intratumor microvascular density (MVD was quantified by immunostaining for endothelial cell marker von Willebrand factor (vWF. Results Overexpression of EphA7 protein was predictive of the adverse outcome in GBM patients, independent of MVD expression (p = 0.02. Moreover, high density of MVD as well as higher EphA7 expression predicted the disease outcome more accurately than EphA7 variable alone (p = 0.01. There was no correlation between MVD and overall survival or recurrence-free survival (p > 0.05. However, a statistically significant correlation between lower MVD and tumor recurrence was observed (p = 0.003. Conclusion The immunohistochemical assessment of tissue EphA7 provides important prognostic information in GBM and would justify its use as surrogate marker to screen patients for tyrosine kinase inhibitor therapy.

  8. Research progress of environmental factors of adverse pregnancy outcomes%不良妊娠结局的环境因素研究进展

    Institute of Scientific and Technical Information of China (English)

    姜波玲; 卢媛

    2013-01-01

    妊娠不良结局的相关因素很多,这些危险因素影响着孕妇的健康,增加不良妊娠结局风险,包括早产、低出生体重、出生缺陷等。导致妊娠不良结局的原因目前主要分为母体、胎儿、环境三方面。研究环境因素与不良妊娠结局的关系,减少孕妇高危环境暴露,提前采取干预措施,可避免不良妊娠结局的发生。该文就不良妊娠结局的环境因素研究进展进行综述。%There are many related risk factors of adverse pregnancy outcomes , which affect the health of pregnant women and lead to the increase of adverse pregnancy outcomes , including preterm delivery, low birth weight, birth defects, etc.The causes of adverse pregnancy outcomes are mainly from the aspects of parent , fetus and environment .Studying on the relationship between environmental factors and adverse pregnancy outcomes of pregnant women , reducing environment exposure of pregnant women and taking preventive measures beforehand can avoid adverse pregnancy outcomes .This article gave an overview of research progress on environmental factors in adverse pregnancy outcome .

  9. Análise dos Testes de Vitalidade Fetal e dos Resultados Perinatais em Gestações de Alto Risco com Oligoidrâmnio Analysis of Fetal Well-being and Perinatal Outcome in the High-risk Pregnancies Complicated by Oligohydramnios

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2002-07-01

    Full Text Available Objetivos: analisar, em gestações de alto risco com diagnóstico de oligoidrâmnio, os resultados dos testes de avaliação da vitalidade fetal e os resultados perinatais. Métodos: foram selecionadas retrospectivamente 572 gestações de alto risco com diagnóstico de oligoidrâmnio, caracterizado por ILA inferior ou igual a 5,0 cm. Destas, 220 apresentavam diagnóstico de oligoidrâmnio grave (ILA Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm. The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%, abnormal biophysical profile score (10.5%, abnormal results of middle cerebral artery dopplervelocimetry (54.5%, small for gestational age infants (32.7% and meconial amniotic fluid (27.9% when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%, abnormal biophysical profile score (4.3%, abnormal results of middle cerebral artery dopplervelocimetry (33.9%, small for gestational age infants (21.0% and meconial amniotic fluid (16.8%. Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.

  10. An exploratory investigation of various modes of action and potential adverse outcomes of fluoxetine in marine mussels

    International Nuclear Information System (INIS)

    Highlights: • Mode of action (MOA) related endpoints and biomarkers of toxicity were assessed in mussels exposed to fluoxetine (FX). • Significant FX bioaccumulation was observed in tissues of mussels exposed to 30 and 300 ng/L FX. • Alterations of cAMP-related cell signaling were observed in exposed mussels as part of the MOA of FX. • FX reduced the health status of mussels inducing lysosomal effects in digestive gland and antioxidant responses in gills. • The importance of considering additional MOAs and adverse outcome pathways for FX impacts on mussels is highlighted. - Abstract: The present study investigated possible adverse outcome pathways (AOPs) of the antidepressant fluoxetine (FX) in the marine mussel Mytilus galloprovincialis. An evaluation of molecular endpoints involved in modes of action (MOAs) of FX and biomarkers for sub-lethal toxicity were explored in mussels after a 7-day administration of nominal FX concentrations encompassing a range of environmentally relevant values (0.03–300 ng/L). FX bioaccumulated in mussel tissues after treatment with 30 and 300 ng/L FX, resulting in bioconcentration factor (BCF) values ranging from 200 to 800, which were higher than expected based solely on hydrophobic partitioning models. Because FX acts as a selective serotonin (5-HT) re-uptake inhibitor increasing serotonergic neurotransmission at mammalian synapses, cell signaling alterations triggered by 5-HT receptor occupations were assessed. cAMP levels and PKA activities were decreased in digestive gland and mantle/gonads of FX-treated mussels, consistent with an increased occupation of 5-HT1 receptors negatively coupled to the cAMP/PKA pathway. mRNA levels of a ABCB gene encoding the P-glycoprotein were also significantly down-regulated. This membrane transporter acts in detoxification towards xenobiotics and in altering pharmacokinetics of antidepressants; moreover, it is under a cAMP/PKA transcriptional regulation in mussels. Potential stress

  11. An exploratory investigation of various modes of action and potential adverse outcomes of fluoxetine in marine mussels

    Energy Technology Data Exchange (ETDEWEB)

    Franzellitti, Silvia, E-mail: silvia.franzellitti@unibo.it [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); University of Bologna, Department of Biological, Geological, and Environmental Sciences, via Selmi 3, 40100 Bologna (Italy); Buratti, Sara; Capolupo, Marco [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); Du, Bowen; Haddad, Samuel P. [Department of Environmental Science, Baylor University, Waco, TX 76798 (United States); Chambliss, C. Kevin [Department of Chemistry and Biochemistry, Baylor University, Waco, TX 76798 (United States); Brooks, Bryan W. [Department of Environmental Science, Baylor University, Waco, TX 76798 (United States); Fabbri, Elena [University of Bologna, Interdepartment Centre for Environmental Science Research, via S. Alberto 163, 48123 Ravenna (Italy); University of Bologna, Department of Biological, Geological, and Environmental Sciences, via Selmi 3, 40100 Bologna (Italy)

    2014-06-01

    Highlights: • Mode of action (MOA) related endpoints and biomarkers of toxicity were assessed in mussels exposed to fluoxetine (FX). • Significant FX bioaccumulation was observed in tissues of mussels exposed to 30 and 300 ng/L FX. • Alterations of cAMP-related cell signaling were observed in exposed mussels as part of the MOA of FX. • FX reduced the health status of mussels inducing lysosomal effects in digestive gland and antioxidant responses in gills. • The importance of considering additional MOAs and adverse outcome pathways for FX impacts on mussels is highlighted. - Abstract: The present study investigated possible adverse outcome pathways (AOPs) of the antidepressant fluoxetine (FX) in the marine mussel Mytilus galloprovincialis. An evaluation of molecular endpoints involved in modes of action (MOAs) of FX and biomarkers for sub-lethal toxicity were explored in mussels after a 7-day administration of nominal FX concentrations encompassing a range of environmentally relevant values (0.03–300 ng/L). FX bioaccumulated in mussel tissues after treatment with 30 and 300 ng/L FX, resulting in bioconcentration factor (BCF) values ranging from 200 to 800, which were higher than expected based solely on hydrophobic partitioning models. Because FX acts as a selective serotonin (5-HT) re-uptake inhibitor increasing serotonergic neurotransmission at mammalian synapses, cell signaling alterations triggered by 5-HT receptor occupations were assessed. cAMP levels and PKA activities were decreased in digestive gland and mantle/gonads of FX-treated mussels, consistent with an increased occupation of 5-HT1 receptors negatively coupled to the cAMP/PKA pathway. mRNA levels of a ABCB gene encoding the P-glycoprotein were also significantly down-regulated. This membrane transporter acts in detoxification towards xenobiotics and in altering pharmacokinetics of antidepressants; moreover, it is under a cAMP/PKA transcriptional regulation in mussels. Potential stress

  12. ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and foetal outcomes in glucose tolerant women classified using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria

    LENUS (Irish Health Repository)

    Dennedy, MC

    2011-09-15

    Background and aims: Raised maternal body mass index (BMI), in association with hyperglycaemia is associated with adverse pregnancy outcome. Whether BMI has an independent effect on adverse pregnancy outcome is not clear. We aimed to investigate the effects of raised maternal BMI on pregnancy outcome in glucose tolerant women, classified using the IADPSG criteria.\\r\

  13. 高龄产妇妊娠晚期血脂水平与围产结局%Serum lipid levels in Advanced maternal during late pregnancy and perinatal outcome

    Institute of Scientific and Technical Information of China (English)

    丁宁; 王超; 李琳

    2014-01-01

    目的:探讨高龄产妇妊娠血脂水平与围产结局。方法:将在本院住院治疗的113例妊娠晚期高龄孕产妇(研究组)作为观察对象,与同期妊娠的孕产妇(对照组)比较,对两组妊娠期孕产妇的晚期血脂水平与围产结局进行观察。结果:妊娠晚期高龄产妇较正常组血清血脂水平在总胆固醇(TC),低密度脂蛋白(LDL-C),高密度脂蛋白(HDL-C),统计学上差异无意义(P>0.05);而在甘油三酯(TG)方面差异明显(P0.05);while it had significant difference in the triglyceride (TG) (P<0.05). It also had significant differences in the perinatal outcome of fetal distress, cesarean section and pregnancy induced hypertension, diabetes and other complications (P<0.05). Conclusion:The effective control of serum lipid levels can improve the perinatal outcome of women with advanced maternal age.

  14. A prospective clinical study of feto-maternal outcome in pregnancies with abnormal liquor volume

    Directory of Open Access Journals (Sweden)

    Rutwa J. Chavda

    2014-02-01

    Conclusions: A good clinical examination can pick up most subjects of abnormal liquor volume. Abnormal liquor volumes are associated with increased maternal morbidity and adverse perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 181-184

  15. Effects of pre-pregnancy body mass index of gestational diabetes mellitus on perinatal outcomes%妊娠期糖尿病孕前体质指数对围产期母婴结局的影响

    Institute of Scientific and Technical Information of China (English)

    孙影; 吴艳芳; 李秀琴; 吴亚雪

    2014-01-01

    Objective To discuss the effects of pre-pregnancy body mass index (BMI) of gestational diabetes mellitus on perinatal outcomes.Methods Two hundred and thirty-eight cases of pregnant women with gestational diabetes mellitus, regularly checked-up and delivery in Navy Gene-ral Hospital during April 2012 to March 2013, were divided into four groups based on the pre-preg-nancy BMI.BMI0.05).The incidence of cesarean section and the ratio without formal treatment increased sig-nificantly in the overweight group than those in the low body weight and normal group (P0.05).The weight gain and the BMI growth during the period of gestation decreased significantly in the obesity group than those in the other three groups (P0.05).Conclusion The pre-pregnancy body mass index of gestational diabetes mellitus has significant correlation with the perinatal outcomes.The BMI should be controlled between 18.5- 25.0 kg/m 2 before pregnancy.We should strengthen the management on the pre-pregnancy overweight and obese groups, control the weight gain during pregnancy to reduce the adverse pregnancy outcomes.%目的:探讨妊娠期糖尿病孕前体质指数(body mass indes,BMI)对围产期母婴结局的影响。方法选取2012年4月-2013年3月在海军总医院正规产检、分娩的238例妊娠期糖尿病孕妇,按照孕前 BMI 分组,BMI<18.5 kg/m 2为低体质量组、18.5 kg/m 2≤BMI<25.0 kg/m 2为正常组、25.0 kg/m 2≤BMI<28.0 kg/m 2为超重组、BMI≥28.0 kg/m2为肥胖组,分析各组间早产率、巨大儿发生率、剖宫产率、新生儿出生体质量、新生儿血糖水平等围产结局,分析各组间未接受正规治疗的比例。结果各组间巨大儿发生率、剖宫产率以及未接受正规治疗的比例差异有统计学意义,其中超重组和肥胖组巨大儿发生率与正常组比较明显升高(P<0.05),但与低体质量组比较差异无统计学意义(P>0.05)。超重组剖

  16. 妊娠期糖尿病孕前体质指数对围产期母婴结局的影响%Effects of pre-pregnancy body mass index of gestational diabetes mellitus on perinatal outcomes

    Institute of Scientific and Technical Information of China (English)

    孙影; 吴艳芳; 李秀琴; 吴亚雪

    2014-01-01

    ratio without formal treatment increased sig-nificantly in the overweight group than those in the low body weight and normal group (P0.05).The weight gain and the BMI growth during the period of gestation decreased significantly in the obesity group than those in the other three groups (P0.05).Conclusion The pre-pregnancy body mass index of gestational diabetes mellitus has significant correlation with the perinatal outcomes.The BMI should be controlled between 18.5- 25.0 kg/m 2 before pregnancy.We should strengthen the management on the pre-pregnancy overweight and obese groups, control the weight gain during pregnancy to reduce the adverse pregnancy outcomes.

  17. H-Y Antigen Incompatibility Not Associated with Adverse Immunologic Graft Outcomes: Deceased Donor Pair Analysis of the OPTN Database

    Directory of Open Access Journals (Sweden)

    Douglas Scott Keith

    2011-01-01

    Full Text Available Background. H-Y antigen incompatibility adversely impacts bone marrow transplants however, the relevance of these antigens in kidney transplantation is uncertain. Three previous retrospective studies of kidney transplant databases have produced conflicting results. Methods. This study analyzed the Organ Procurement and Transplantation Network database between 1997 and 2009 using male deceased donor kidney transplant pairs in which the recipient genders were discordant. Death censored graft survival at six months, five, and ten years, treated acute rejection at six months and one year, and rates of graft failure by cause were the primary endpoints analyzed. Results. Death censored graft survival at six months was significantly worse for female recipients. Analysis of the causes of graft failure at six months revealed that the difference in death censored graft survival was due primarily to nonimmunologic graft failures. The adjusted and unadjusted death censored graft survivals at five and ten years were similar between the two genders as were the rates of immunologic graft failure. No difference in the rates of treated acute rejection at six months and one year was seen between the two genders. Conclusions. Male donor to female recipient discordance had no discernable effect on immunologically mediated kidney graft outcomes in the era of modern immunosuppression.

  18. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

    Directory of Open Access Journals (Sweden)

    Adeladza K Amegah

    Full Text Available BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES. Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. METHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. RESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145 reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87, low education (187 g; 95% CI: 355-20, studentship during pregnancy (291 g; 95% CI: 506-76 and low income (147 g; 95% CI: 277-17. In causal pathway analysis, malaria infection (6-20%, poor nutrition (2-51% and indoor air pollution (10-62% mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21 risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56 of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49 and 278% (RR: 3.78; 95% CI: 1.39-10.27 increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. CONCLUSION: We provide evidence of the effects of socioeconomic deprivation

  19. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.

    Directory of Open Access Journals (Sweden)

    Seung Mi Lee

    Full Text Available BACKGROUND: The objective of this study was to determine whether acute histologic chorioamnionitis is associated with adverse neonatal outcomes in late preterm infants who were born after preterm PROM. METHODOLOGY/PRINCIPAL FINDINGS: The relationship between the presence of acute histologic chorioamnionitis and adverse neonatal outcome was examined in patients with preterm PROM who delivered singleton preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Nonparametric statistics were used for data analysis. The frequency of acute histologic chorioamnionitis was 24% in patients with preterm PROM who delivered preterm newborns between 34 weeks and 36 6/7 weeks of gestation. Newborns born to mothers with histologic chorioamnionitis had significantly higher rates of adverse neonatal outcome (74% vs 51%; p<0.005 than those without histologic chorioamnionitis. This relationship remained significant after adjustment for gestational age at preterm PROM, gestational age at delivery, and exposure to antenatal corticosteroids. CONCLUSIONS/SIGNIFICANCE: The presence of acute histologic chorioamnionitis is associated with adverse neonatal outcome in late preterm infants born to mothers with preterm PROM.

  20. A three-tiered approach for linking pharmacokinetic considerations to the adverse outcome pathway framework for chemical-specific risk assessment

    Science.gov (United States)

    The power of the adverse outcome pathway (AOP) framework arises from its utilization of pathway-based data to describe the initial interaction of a chemical with a molecular target (molecular initiating event; (MIE), followed by a progression through a series of key events that l...

  1. Screening for markers of frailty and perceived risk of adverse outcomes using the Risk Instrument for Screening in the Community (RISC).

    LENUS (Irish Health Repository)

    O Caoimh, Rónán

    2014-09-19

    Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC).

  2. Role of the Varroa mite in honeybee (Apis mellifera) colony loss: A case study for adverse outcome pathway development with a nonchemical stressor

    Science.gov (United States)

    Significant honeybee colony losses have been reported across North America and Europe in recent years. A number of factors, both chemical and nonchemical, have been associated with such losses. Adverse outcome pathways (AOPs) provide a conceptual framework to describe and evalu...

  3. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort : population attributive fractions for Amsterdam

    NARCIS (Netherlands)

    Djelantik, A. A. A. M. J.; Kunst, A. E.; van der Wal, M. F.; Smit, H. A.; Vrijkotte, T. G. M.

    2012-01-01

    Objective To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. Design Prospective multi-ethnic community-based cohort study. Setting The prevalence of exces

  4. Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

    Directory of Open Access Journals (Sweden)

    Urelija Rodin

    2015-01-01

    Full Text Available Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM was reduced by 31%, fetal mortality (FM by 32%, and early neonatal mortality (ENM by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks gestational age (GA was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

  5. Stromal Cell-Derived Factor 1 Gene Polymorphism Is Associated with Susceptibility to Adverse Long-Term Allograft Outcomes in Non-Diabetic Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Chung-Jieh Wang

    2014-07-01

    Full Text Available Although the genetic polymorphism of Stromal Cell-Derived Factor 1 (SDF-1 is associated with higher mortality of liver allograft recipients, the role of SDF-1 in the modulation of renal allograft outcomes is unclear. Between March 2000 and January 2008, we recruited 252 non-diabetic renal transplant recipients (RTRs. Baseline characteristics and blood chemistry were recorded. Genomic DNA extraction with polymerase chain reaction-restriction fragment length polymorphism was utilized to analyze the genetic polymorphisms of SDF-1 (rs1801157. The influence of SDF-1 on an adverse renal allograft outcome, defined as either a doubling of serum creatinine, graft failure, or patient death was evaluated. Sixteen patients with the SDF-1 AA/AG genotype and nine with the SDF-1 GG genotype reached an adverse outcome. According to Kaplan-Meier analysis, patients carrying the SDF-1 AA/AG genotype or A allele showed a significantly higher risk of reaching an adverse outcome than those carrying the SDF-1 GG genotype or G allele (p = 0.041; p = 0.0051, respectively; log rank test. Stepwise multivariate Cox proportional regression analysis revealed that patients carrying the SDF-1 AA/AG genotype and A allele had a 2.742-fold (95% CI. 1.106–6.799, p = 0.03 and 2.306-fold (95% CI. 1.254–4.24, p = 0.008 risk of experiencing an adverse outcome. The SDF-1 AA/AG genotype and A allele have a detrimental impact on the long-term outcome of RTRs.

  6. A systematic review of patient-reported outcome instruments of dermatologic adverse events associated with targeted cancer therapies

    Science.gov (United States)

    Chan, Alexandre; Cameron, Michael C.; Garden, Benjamin; Boers-Doets, Christine B.; Schindler, Katja; Epstein, Joel B.; Choi, Jennifer; Beamer, Laura; Roeland, Eric; Russi, Elvio G.; Bensadoun, René-Jean; Teo, Yi Ling; Chan, Raymond J.; Shih, Vivianne; Bryce, Jane; Raber-Durlacher, Judith; Gerber, Peter Arne; Freytes, César O.; Rapoport, Bernardo; LeBoeuf, Nicole; Sibaud, Vincent; Lacouture, Mario E.

    2016-01-01

    Purpose Dermatologic adverse events (dAE) in cancer treatment are frequent with use of targeted therapies. These dAEs have been shown to have significant impact on health-related quality of life (HRQoL). While standardized assessment tools have been developed for physicians to assess severity of dAEs, there is a discord between objective and subjective measures. The identification of patient-reported outcome (PRO) instruments useful in the context of targeted cancer therapies is therefore important in both the clinical and research settings for the overall evaluation of dAEs and their impact on HRQoL. Methods A comprehensive, systematic literature search of published articles was conducted by two independent reviewers in order to identify PRO instruments previously utilized in patient populations with dAEs from targeted cancer therapies. The identified PRO instruments were studied to determine which HRQoL issues relevant to dAEs were addressed, as well as the process of development and validation of these instruments. Results Thirteen articles identifying six PRO instruments met the inclusion criteria. Four instruments were general dermatology (Skindex-16©, Skindex-29©, Dermatology Life Quality Index [DLQI], and DIELH-24), and two were symptom-specific (Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitors-18 [FACT-EGFRI-18] and Hand-Foot Syndrome 14 [HFS-14]). Conclusions While there are several PRO instruments that have been tested in the context of targeted cancer therapy, additional work is needed to develop new instruments and to further validate the instruments identified in this study in patients receiving targeted therapies. PMID:25564221

  7. Study of Risk Factors of Perinatal Death in Pregnancy Induced Hypertension (PIH

    Directory of Open Access Journals (Sweden)

    Mehul T Parmar, Harsha M Solanki, Vibha V Gosalia

    2012-01-01

    Full Text Available Background: Hypertensive disorders are common complication occurring during pregnancy responsible for maternal & fetal mortality & morbidity. Though the condition is on decline, still stands a public health problem. Objectives: To determine risk factors of perinatal death in women with pregnancy induced hypertension. Materials & Method: A cross-sectional study was conducted over period of one year in the department of Obstetrics & Gynecology in NHL municipal college, Ahmadabad. A total of 100 pregnant women with PIH were enrolled in the study. A pre-tested structured Performa was prepared & women were interviewed to collect necessary information such as detailed history, clinical examination findings & investigations performed. Results were analyzed using MS Excel & Epi Info. Results: In the present study, 29%, 21% & 50 % were of mild PIH, moderate PIH & severe PIH respectively. The incidence of PIH was found more among teenage pregnancy, among primigravidas, those from low socio-economic status, those with history of PIH in previous pregnancy, having family history of PIH & those who were found obese. Emergency delivery, having diastolic blood pressure > 90 mm Hg, higher degree of proteinuria & low birth weight among PIH cases had an adverse perinatal outcome in terms of higher perinatal death. The findings were statistically significant On Univariate analysis; diastolic blood pressure & degree of proteinuria were found to be significant risk factors responsible for perinatal mortality among PIH women. Conclusion: Pregnancy induced hypertension is a common medical disorder associated with pregnancy. In the present study, PIH cases who delivered in emergency, with raised diastolic blood pressure & more proteinuria & neonate with low birth weight were found risk factors for perinatal death. Fetal morbidity & mortality can be reduced by early recognition & institutional management.

  8. Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies.

    Science.gov (United States)

    Corbella, Stefano; Taschieri, Silvio; Francetti, Luca; De Siena, Francesca; Del Fabbro, Massimo

    2012-07-01

    Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case-control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case-control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case-control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review. PMID:21739194

  9. Cardiotocografia em gestações com diástole zero ou reversa nas artérias umbilicais: análise dos resultados perinatais Cardiotocography in pregnancies with absent or reversed end-diastolic velocity in the umbilical arteries: analisys of perinatal outcome

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomura

    2003-01-01

    deceleration was associated to (p<0.05: acidemia at birth (79.3%, newborn intubation at delivery (69% and early neonatal death (17.2%. Prolonged deceleration was associated to (p<0.05 newborn intubation at delivery (70.6%. Pseudo sinusoidal pattern was associated to (p<0.05 early neonatal death (60%. CONCLUSION: The AREDV represents a severe fetal compromise with high risk to neonatal morbidity and mortality, and correlation between cardiotocography abnormalities and adverse perinatal outcome was demonstrated.

  10. The contribution of perinatal emotion management to delivery outcome and reduction of maternal depression%围产期情绪管理对孕产妇抑郁情绪和分娩结局的影响

    Institute of Scientific and Technical Information of China (English)

    张丽芳

    2014-01-01

    目的:探讨围产期情绪管理对孕产妇抑郁情绪和分娩结局的的影响,为围产期护理提供参考依据。方法对80例初产妇给予1个月的围产期情绪管理干预,比较产前1周、产后1周的病人健康问卷-9评分( PHQ-9)、各产程持续时间和妊娠结局。结果产后1周初产妇的PHQ-9评分为(5.62±1.34),显著低于产前1周(P <0.05);80例初产妇中顺产65例(81.25%),无一例产妇及围生儿死亡,新生儿Apgar评分平均为(9.3±0.2)分;第二产程平均时间为(52.84±6.74) min。结论通过围产期情绪管理干预可以显著减轻初产妇的负面情绪,有助于减少剖宫产和第二产程。%Objective To investigate the effect of perinatal emotion management on maternal depression and delivery outcome and develop scientific knowledge for perinatal care.Method 80 cases of primipara were provided with perinatal emotion management intervention.The length of intervention time was one month.The PHQ-9 score, the duration of the delivery stage and the outcome of pregnancy one week prenatal were compared to those obtained one week postpartum. Findings Primipara PHQ-9 score was (5.62 ±1.34) one week postpartum, significantly lower than that one week prenatal (P<0.05).Among the 80 cases of primipara, there were 65 cases of vaginal delivery(81.25%).No cases of primipara or perinatal death were reported.The neonatal Apgar score average was (9.3 ±0.2).The average time of the second stage of labor was (52.84 ±6.74) min.Conclusion The perinatal emotion management intervention can significantly reduce the negative emotions of primipara.It also can reduce the cesarean section and the second stage of labor.

  11. 妊娠期肾病综合征62例临床特点及围生结局分析%Clinical Feature and Perinatal Outcomes of 62 Cases with Nephritic Syndrome of Pregnancy

    Institute of Scientific and Technical Information of China (English)

    刘丹; 邓小艳; 谢纲

    2012-01-01

    目的:分析妊娠期肾病综合征的临床特点及其围生结局.方法:回顾性分析2009年1月至2010年12月在湘潭市妇幼保健院住院的273例重度子痫前期患者,将62例妊娠期肾病综合征和随机选择的70例重度子痫前期无合并肾病综合征患者分别作为肾病组和对照组,分析两组临床资料,比较血压、低蛋白血症情况、肾功能指标和围生结局.结果:肾病组多为年龄较轻的初产妇,病情重,以舒张压升高为主.肾病组血浆总蛋白和白蛋白低于对照组(P<0.05);24小时尿蛋白定量、尿素氮和肌酐均高于对照组(P<0.05).肾病组早产率、小于胎龄儿发生率、围生儿死亡率和新生儿并发症发生率高于对照组,差异均有统计学意义(P<0.05).结论:妊娠期肾病综合征病情重、进展快,对母婴的影响大,适时终止妊娠可减少妊娠期并发症及围生儿发病率和死亡率.%Objective: To analyze the clinical feature and perinatal outcomes of nephritic syndrome of pregnancy(NSP). Methods:273 pregnant women with severe preeclampsia who were hospitalized in Maternal and Child Health Hospital of Xiangtan City from January 2009 to December 2010 were retrospectively analyzed. The patients were divided into two groups according to preeclampsia with nephritic syndrome or without nephritic syndrome; nephritic group included 62 cases, and control group included 211 cases. Clinical data including blood pressure, hypoproteinemia situation, biochemical indicators and perinatal outcomes were compared between two groups. Results :NSP was more likely to happen in younger primipara, with severely increased diastolic pressure. The serum total protein and albumin in NSP group were lower than control group(P<0.05). Duantitation of urine protein for 24 hours, urine nitrogen and creatinine in NSP group were higher than control group (P < 0.05). The preterm delivery rate, incidence of fetus with small for ges-tational age, perinatal

  12. Perinatal Antidepressant Use: Understanding Women’s Preferences and Concerns

    OpenAIRE

    Battle, Cynthia L.; Salisbury, Amy L.; SCHOFIELD, CASEY A.; ORTIZ-HERNANDEZ, SAMIA

    2013-01-01

    Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women’s concerns and treatment decisionmaking patterns have not been well documented. Deve...

  13. Perinatal asphyxia as the leading cause of death and brain injury of newborns: prognosis and neuroprotection of long-term outcomes [

    Directory of Open Access Journals (Sweden)

    Herrera-Marschitz, Mario

    2007-11-01

    Full Text Available [english] Interruption of oxygen availability and re-oxygenation at birth implies a severe metabolic insult, affecting the development of the central nervous system (CNS, increasing its vulnerability to challenges occurring at adult stages. It has been reported that perinatal asphyxia produces regionally specific neuronal decrease and neurite atrophy in basal ganglia, and hippocampus. In hippocampus, a concomitant increase of neurogenesis and neurite hypertrophy has also been observed. The potential neuroprotection of nicotinamide, a non-selective inhibitor of poly (ADP-ribose polymerase (PARP-1, has been investigated, finding functional and morphological improvements when administered 24h after the insult (0.8 mmol/kg, i.p., 24, 48 and 72 h after birth.. The main effect of nicotinamide has been seen in neostriatum, preventing an asphyxia-induced decrease of the number of nNOS cells, and nNOS- and dopamine-like neurite atrophy. The present results support the idea that nicotinamide can prevent the effects elicited by a sustained energy-failure condition, as occurring during perinatal asphyxia, enlightening the enzyme PARP-1 as a novel target for neuronal protection. The support by FONDECYT, ICBM-Enlace, DAAD-CONICYT Programme-2007 grants is acknowledged.

  14. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis

    International Nuclear Information System (INIS)

    important scientific, economic and health challenges. In order to meet these challenges and pursue cost-effective scientific approaches that can provide evidence necessary to support policy needs (e.g. the European Marine Strategy Framework Directive), it is widely recognised that there is a need to (i) provide marine exposure assessments for priority contaminants using a range of validated models, passive samplers and biomarkers; (ii) integrate chemical monitoring data with biological effects data across spatial and temporal scales (including quality controls); and (iii) strengthen the evidence base to understand the relationship between exposure to complex chemical mixtures, biological and ecological impacts through integrated approaches and molecular data (e.g. genomics, proteomics and metabolomics). Additionally, we support the widely held view that (iv) that rather than increasing the analytical chemistry monitoring of large number of emerging contaminants, it will be important to target analytical chemistry towards key groups of chemicals of concern using effects-directed analysis. It is also important to evaluate to what extent existing biomarkers and bioassays can address various classes of emerging chemicals using the adverse outcome pathway (AOP) approach now being developed by the Organization for Economic Cooperation and Development (OECD) with respect to human toxicology and ecotoxicology

  15. AN OBSERVATIONAL STUDY ON THALASSAEMIA IN PREGNANCY AND ITS EFFECT S WITH A VIEW TO FIND MEASURES FOR REDUCTION OF ITS COMPLICATIONS AND IMPROVEMENT OF MATERNAL AND PERINATAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Samrat

    2014-01-01

    Full Text Available The thalassemia syndrome is the commonest genetic blood disorder , clinically divided into three broad groups: thalassemia major , intermedia and minor. Now - a - days , with adequate transfusion and chelation therapy , survival is prolonged into teens and early 20s and few successful pregnancies are possible. But , only a few st udies are available on the effects of thalassemia in pregnancy. This study was conducted in the Department of G&O , NRS medical college , Kolkata with an objective to determine the frequencies of different types of thalassemia in pregnancy , its effects on pr egnancy , find out measures to reduce the complications attributable to it during pregnancy , and to improve maternal and perinatal outcome

  16. Maternal serum disintegrin and metalloprotease protein-12 in early pregnancy as a potential marker of adverse pregnancy outcomes.

    Directory of Open Access Journals (Sweden)

    Jiexia Yang

    Full Text Available OBJECTIVES: The aim of this study was to determine whether the concentration of disintegrin and metalloprotease protein12 (ADAM12 in first trimester maternal serum can be used as a marker for first-trimester complete spontaneous abortions, missed abortions, ectopic pregnancies and hydatidiform moles. METHODS: The maternal serum concentrations of ADAM12 were measured in the range of 5-9+6 weeks of gestation using an automated AutoDelfia immunoassay platform in 9 cases of complete spontaneous abortion, 27 cases of missed abortions, 56 cases of ectopic pregnancies, 12 cases of hydatidiform moles, and 100 controls. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcomes in early pregnancy. Screening performance was assessed using receiver operating characteristic curves. RESULTS: Two hundred and four women were enrolled in the study. In the control group, the level of ADAM12 increased with gestational age. The median ADAM12 levels in the spontaneous abortion (0.430 MoM, ectopic pregnancy (0.460 MoM and hydatidiform mole (0.037 MoM groups were lower than that in the control group, while the median ADAM12 level in the missed abortion group (1.062 MoM was not significant from the controls (1.002 MoM. Logistic regression analysis demonstrated that the level of ADAM12 in maternal serum facilitated the detection of ectopic pregnancies (OR = 0.909; 95% CI = 0.841 ∼ 0.982 and complete spontaneous abortion (OR = 0.863; 95% CI = 0.787 ∼ 0.946. CONCLUSIONS: In complete spontaneous abortion and ectopic pregnancy, ADAM12 maintained at low levels in early pregnancies, and there were significant differences compared to normal pregnancies. ADAM12 is a promising marker for the diagnosis of complete spontaneous abortion and ectopic pregnancy in symptomatic women, and under certain conditions, ADAM12 can diagnose ectopic pregnancy and spontaneous abortion before an ultrasonographic detection of the

  17. Experiences of violence before and during pregnancy and adverse pregnancy outcomes: An analysis of the Canadian Maternity Experiences Survey

    Directory of Open Access Journals (Sweden)

    Heaman Maureen I

    2011-06-01

    Full Text Available Abstract Background Abuse and violence against women constitute a global public health problem and are particularly important among women of reproductive age. The literature is not conclusive regarding the impact of violence against pregnant women on adverse pregnancy outcomes, such as preterm birth, small for gestational age and postpartum depression. Most studies have been conducted on relatively small samples of high-risk women. Our objective was to investigate what dimensions of violence against pregnant women were associated with preterm birth, small for gestational age and postpartum depression in a nationally representative sample of Canadian women. Methods We analysed data of the Maternity Experiences Survey, a nationally representative survey of Canadian women giving birth in 2006. The comprehensive questionnaire included a 19-item section to collect information on different dimensions of abuse and violence, such as type, frequency, timing and perpetrator of violence. The survey design is a stratified simple random sample from the 2006 Canadian Census sampling frame. Participants were 6,421 biological mothers (78% response rate 15 years and older who gave birth to a singleton live birth and lived with their infant at the time of the survey. Logistic regression was used to compute Odds Ratios. Survey weights were used to obtain point estimates and 95% confidence intervals were obtained with the jacknife method of variance estimation. Covariate control was informed by use of directed acyclic graphs. Results No statistically significant associations were found for preterm birth or small for gestational age, after adjustment. Most dimensions of violence were associated with postpartum depression, particularly the combination of threats and physical violence starting before and continuing during pregnancy (Adjusted Odds Ratio = 4.1, 95% confidence interval: 1.9, 8.9 and perpetrated by the partner (4.3: 2.1, 8.7. Conclusions Our findings

  18. Adverse events associated with poor neurological outcome during targeted temperature management and advanced critical care after out-of-hospital cardiac arrest

    OpenAIRE

    Kim, Young-Min; Youn, Chun Song; Kim, Soo Hyun; Lee, Byung Kook; Cho, In Soo; Cho, Gyu Chong; Jeung, Kyung Woon; Oh, Sang Hoon; Choi, Seung Pill; Shin, Jong Hwan; Cha, Kyoung-Chul; Oh, Joo Suk; Yim, Hyeon Woo; Park, Kyu Nam; ,

    2015-01-01

    Introduction The aim of this study was to investigate the association of adverse events (AEs) during targeted temperature management (TTM) and other AEs and concomitant treatments during the advanced critical care period with poor neurological outcome at hospital discharge in adult out-of-hospital cardiac arrest (OHCA) patients. Methods This was a retrospective study using Korean Hypothermia Network registry data of adult OHCA patients treated with TTM in 24 teaching hospitals throughout Sout...

  19. 抗梅毒治疗对妊娠结局及新生儿预后的影响%Effect of anti-syphilis treatment on perinatal outcomes and neonatal prognosis in pregnant women complicated with syphilis

    Institute of Scientific and Technical Information of China (English)

    周敏; 陈竹; 曾义岚; 何克静; 祝昭惠; 黄海霞

    2013-01-01

    目的 探讨不同抗梅毒治疗方法对妊娠梅毒患者的妊娠结局及新生儿预后的影响.方法 选择2010年1月至2012年1月成都市传染病医院收治的妊娠合并梅毒患者198例.根据孕期治疗情况,将患者分为规范治疗组(98例)、未规范治疗组(59例)和未治疗组(41例).采用Pearsonx2和卡方分割法比较各组的妊娠结局、新生儿预后及快速血浆反应环状卡片试验(RPR)转阴率等情况.结果 流产、早产、死胎、死产、新生儿畸形等不良妊娠结局的发生率在规范治疗组、未规范治疗组及未治疗组分别为4.08%,27.12%和63.41%.先天梅毒儿、低体重儿、窒息儿、新生儿死亡等发生率在规范治疗组、未规范治疗组及未治疗组中逐渐升高,其中先天梅毒儿的发生率分别为2.06%,18.75%和35.29%.RPR高滴度(≥1∶8)的梅毒孕妇所产新生儿RPR滴度进行比较,规范治疗组较未规范治疗组和未治疗组明显下降,其差异具有统计学意义(x2=37.122,P<0.01).新生儿RPR转阴率在规范治疗组、未规范治疗组及未治疗组中分别为100.00%,59.26%和25.00%,差异有统计学意义(x2=18.839,P<0.01).结论 规范的抗梅毒治疗是改善妊娠结局、新生儿预后及降低先天梅毒发生率的关键.%Objective To investigate the effect of anti-syphilis treatment on the perinatal outcomes and neonatal prognosis in pregnant women complicated with syphilis.Methods One hundred and ninety eight pregnant women complicated with syphilis were collected from Chengdu Hospital of Infectious Diseases during January 2010 and January 2012,including 98 cases received standard treatment,59 cases received nonstandard treatment and 41 cases did not receive treatment.Pearson x2 and partition of chi-square were used for the comparison of pregnant outcomes,neonatal prognosis and negative rates of rapid plasma circle card test (RPR) among 3 groups.Results The incidence of adverse pregnancy

  20. Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status

    OpenAIRE

    Racape, Judith; Schoenborn, Claudia; Sow, Mouctar; Alexander, Sophie; De Spiegelaere, Myriam

    2016-01-01

    Background Increasing studies show that immigrants have different perinatal health outcomes compared to native women. Nevertheless, we lack a systematic examination of the combined effects of immigrant status and socioeconomic factors on perinatal outcomes. Our objectives were to analyse national Belgian data to determine 1) whether socioeconomic status (SES) modifies the association between maternal nationality and perinatal outcomes (low birth weight and perinatal mortality); 2) the effect ...

  1. Evolução da gravidez e resultados perinatais em transplantadas renais Pregnancy and perinatal outcomes in women with renal transplantation

    OpenAIRE

    Leandro Gustavo Oliveira; Nelson Sass; Luiz Camano; José Osmar Medina Pestana

    2005-01-01

    OBJETIVO: avaliar as inter-relações recíprocas entre o transplante renal e a gravidez por meio da análise das intercorrências clínicas e obstétricas, bem como da investigação do desfecho perinatal. MÉTODOS: foi analisada série retrospectiva de 39 casos de gestação em 37 portadoras de transplante renal no período de janeiro de 1997 a dezembro de 2003. Foi criado um grupo controle composto por 66 grávidas sem doenças clínicas prévias, que freqüentaram pré-natal e deram à luz em 2002 e 2003. Ess...

  2. The Maternal Microbiome and Pregnancy Outcomes that Impact Infant Health: A Review

    OpenAIRE

    Dunlop, Anne L.; Mulle, Jennifer G.; Ferranti, Erin P.; Edwards, Sara; Dunn, Alexis B.; Corwin, Elizabeth J

    2015-01-01

    The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This manuscript provides a summary review of research investigating: (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and e...

  3. Comparative evaluation of screening tests for maternal and fetal outcome in gestational diabetes

    Directory of Open Access Journals (Sweden)

    Shivi Saxena

    2015-06-01

    Results: 75 gm GTT had higher specificity, positive and negative predictive values as compared to 50 gm GCT for both maternal and fetal outcome. However 50 gm GCT was more sensitive for predicting maternal and fetal complications. Conclusions: 75 gm GTT is better than 50 gm GCT for predicting adverse maternal and perinatal outcome in gestational diabetic patients. [Int J Res Med Sci 2015; 3(6.000: 1363-1367

  4. Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan

    OpenAIRE

    Priyanka Kalra; Chetan Prakash Kachhwaha; Hilda Victoria Singh

    2013-01-01

    Background: Gestational diabetes mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. Hence, it is imperative that an early detection and management of the disease is done to ensure better maternal and fetal outcomes. Aims: This study was done to evaluate the prevalence of gestational diabetes using diabetes in pregnancy Study Group India (DI...

  5. Adverse outcomes of pregnancy in HIV-positive women in the era of HAART: a perspective from an outer London centre in the UK

    Directory of Open Access Journals (Sweden)

    P Thayaparan

    2012-11-01

    Full Text Available Background: Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods: It is a retrospective case note review of all the women attended our unit and had HIV care from 2008–2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results: Mean age was 34 yrs ranging from 20–43 yrs. Majority (91% were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti-retroviral therapy (ART during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11% and late presentation (9%. 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post-partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P<0.05 with having a foetal complication such as prematurity 8%, low birth weight 7% or

  6. Impacto da idade materna sobre os resultados perinatais e via de parto Impact of maternal age on perinatal outcomes and mode of delivery

    Directory of Open Access Journals (Sweden)

    Graciete Helena Nascimento dos Santos

    2009-07-01

    ício tardio e menor número de consultas no pré-natal, uso de abortivo no início da gestação, baixa escolaridade, ausência de companheiro, baixo peso ao nascer, prematuridade e menor incidência de desproporção céfalo-pélvica e pré-eclâmpsia. No grupo de gestantes com idade avançada houve maior freqüência de diabetes, pré-eclâmpsia, ruptura prematura das membranas, índice de Apgar no quinto minuto menor que sete e maior frequência de parto operatório cesáreo.PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old, adults (20 to 34 years old, and aged women (>35 years old. Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR or the cross product ratio, with confidence intervals (CI of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88, and low birth weight (OR=1.47; CI95%=1.13- 1.90, higher incidence of normal delivery as compared to the other groups (65.2%, besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43, lower number of appointments (OR=2.03; CI95%=1.57-2.63, and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98. Among aged women, there was strong association with diabetes mellitus

  7. Risk of Performance Decrements and Adverse Health Outcomes Resulting from Sleep Loss, Circadian Desynchronization, and Work Overload

    Science.gov (United States)

    Flynn-Evans, Erin; Gregory, Kevin; Arsintescu, Lucia; Whitmire, Alexandra

    2016-01-01

    Sleep loss, circadian desynchronization, and work overload occur to some extent for ground and flight crews, prior to and during spaceflight missions. Ground evidence indicates that such risk factors may lead to performance decrements and adverse health outcomes, which could potentially compromise mission objectives. Efforts are needed to identify the environmental and mission conditions that interfere with sleep and circadian alignment, as well as individual differences in vulnerability and resiliency to sleep loss and circadian desynchronization. Specifically, this report highlights a collection of new evidence to better characterize the risk and reveals new gaps in this risk as follows: Sleep loss is apparent during spaceflight. Astronauts consistently average less sleep during spaceflight relative to on the ground. The causes of this sleep loss remain unknown, however ground-based evidence suggests that the sleep duration of astronauts is likely to lead to performance impairment and short and long-term health consequences. Further research is needed in this area in order to develop screening tools to assess individual astronaut sleep need in order to quantify the magnitude of sleep loss during spaceflight; current and planned efforts in BHP's research portfolio address this need. In addition, it is still unclear whether the conditions of spaceflight environment lead to sleep loss or whether other factors, such as work overload lead to the reduced sleep duration. Future data mining efforts and continued data collection on the ISS will help to further characterize factors contributing to sleep loss. Sleep inertia has not been evaluated during spaceflight. Ground-based studies confirm that it takes two to four hours to achieve optimal performance after waking from a sleep episode. Sleep inertia has been associated with increased accidents and reduced performance in operational environments. Sleep inertia poses considerable risk during spaceflight when emergency

  8. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    2012-11-26

    In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

  9. Drinking Before Going to Licensed Premises: An Event-Level Analysis of Predrinking, Alcohol Consumption, and Adverse Outcomes

    NARCIS (Netherlands)

    Labhart, F.; Graham, K.; Wells, S.; Kuntsche, E.N.

    2013-01-01

    Background Research in the United States and the United Kingdom indicates that drinking before going out (commonly called predrinking) is common among young people and associated with increased harm. On the basis of Swiss data, this study investigates differences in alcohol consumption and adverse o

  10. Perinatal risk factors including malformation

    International Nuclear Information System (INIS)

    The study gives a survey of the factors most frequently mentioned in the literature as factors likely to adversely affect a pregnancy. One essential aspect is the discussion of those factors that can be counted among the causes of malformations, as among others, prenatal radiation exposure. The study prepared within the framework of the research project 'Radiobiological environmental monitoring in Bavaria' is intended to serve as a basis for a retrospective and prospective evaluation of infant mortality, perinatal conditions and occurrence of malformations in Bavaria, with the principal idea of drawing up an environment - related health survey. The study therefore, in addition to ionizing radiation also takes into account other detectable risks within the ecologic context, as e.g. industrial installations, refuse incineration plants or waste dumps, or urbanity. (orig./MG)

  11. Adverse Reproductive and Developmental Health Outcomes Following Prenatal Exposure to a Hydraulic Fracturing Chemical Mixture in Female C57Bl/6 Mice.

    Science.gov (United States)

    Kassotis, Christopher D; Bromfield, John J; Klemp, Kara C; Meng, Chun-Xia; Wolfe, Andrew; Zoeller, R Thomas; Balise, Victoria D; Isiguzo, Chiamaka J; Tillitt, Donald E; Nagel, Susan C

    2016-09-01

    Unconventional oil and gas operations using hydraulic fracturing can contaminate surface and groundwater with endocrine-disrupting chemicals. We have previously shown that 23 of 24 commonly used hydraulic fracturing chemicals can activate or inhibit the estrogen, androgen, glucocorticoid, progesterone, and/or thyroid receptors in a human endometrial cancer cell reporter gene assay and that mixtures can behave synergistically, additively, or antagonistically on these receptors. In the current study, pregnant female C57Bl/6 dams were exposed to a mixture of 23 commonly used unconventional oil and gas chemicals at approximately 3, 30, 300, and 3000 μg/kg·d, flutamide at 50 mg/kg·d, or a 0.2% ethanol control vehicle via their drinking water from gestational day 11 through birth. This prenatal exposure to oil and gas operation chemicals suppressed pituitary hormone concentrations across experimental groups (prolactin, LH, FSH, and others), increased body weights, altered uterine and ovary weights, increased heart weights and collagen deposition, disrupted folliculogenesis, and other adverse health effects. This work suggests potential adverse developmental and reproductive health outcomes in humans and animals exposed to these oil and gas operation chemicals, with adverse outcomes observed even in the lowest dose group tested, equivalent to concentrations reported in drinking water sources. These endpoints suggest potential impacts on fertility, as previously observed in the male siblings, which require careful assessment in future studies. PMID:27560547

  12. Substandard factors in perinatal care in The Netherlands : a regional audit of perinatal deaths

    NARCIS (Netherlands)

    Wolleswinkel-van den Bosch, JH; Vredevoogd, CB; Borkent-Polet, M; van Eyck, J; Fetter, WPF; Lagro-Janssen, TLM; Rosink, IH; Treffers, PE; Amelink, M; Richardus, JH; Verloove-Vanhorick, P; Mackenbach, JP

    2002-01-01

    Background. To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between

  13. An Increased Number of Replaced Embryos Counteracts the Adverse Effect of Hydrosalpinges on IVF/ET Outcome

    OpenAIRE

    Abd-El-Maeboud, Karim Hassanein Ismail; Khalifa, Essam Al-Dein M.; El-Hussein, El-Sir

    1998-01-01

    Purpose:The relationship between the number of replaced embryos and the outcome of IVF-ET in patients with hydro-salpinges was investigated in a retrospective, nonrandom-ized study performed at a governmental IVF center.

  14. Can postponement of an adverse outcome be used to present risk reductions to a lay audience? A population survey

    OpenAIRE

    Kristiansen Ivar; Gyrd-Hansen Dorte; Dahl Rasmus; Nexøe Jørgen; Bo Nielsen Jesper

    2007-01-01

    Abstract Background For shared decision making doctors need to communicate the effectiveness of therapies such that patients can understand it and discriminate between small and large effects. Previous research indicates that patients have difficulties in understanding risk measures. This study aimed to test the hypothesis that lay people may be able to discriminate between therapies when their effectiveness is expressed in terms of postponement of an adverse disease event. Methods In 2004 a ...

  15. High Prevalence of Vitamin D Deficiency and Adverse Pregnancy Outcomes in Yazd, a Central Province of Iran

    OpenAIRE

    Pirdehghan, Azar; Vakili, Mahmood; Dehghan, Reyhane; Zare, Fatemeh

    2016-01-01

    Background: There is a growing concern about the high prevalence of vitamin D deficiency and its relationship with variety of diseases worldwide. The objective of this study was to determine the prevalence of vitamin D deficiency and its relationship with pregnancy adverse effects in Yazd. Methods: This was a cross sectional study conducted among 200 nulliparous women from October 2013 to April 2014. Data containing socio-demographic and personal details, vitamin D level, pregnancy complicati...

  16. Can the Non-pneumatic Anti-Shock Garment (NASG reduce adverse maternal outcomes from postpartum hemorrhage? Evidence from Egypt and Nigeria

    Directory of Open Access Journals (Sweden)

    Mourad-Youssif Mohammed

    2010-09-01

    Full Text Available Abstract Background Postpartum hemorrhage (PPH is the leading cause of maternal mortality and severe maternal morbidity. The Non-pneumatic Anti-Shock Garment (NASG, a first-aid lower-body compression device, may decrease adverse outcomes from obstetric hemorrhage. This article is the first to report the effect of the NASG for PPH. Methods This pre-intervention/NASG study of 854 women was conducted in four referral facilities in Nigeria and two in Egypt between 2004-2008. Entry criteria were women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥ 750 mL and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. The Wilcoxon rank-sum test and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss, emergency hysterectomy, mortality, morbidity (each individually, and a combined variable, "adverse outcomes", defined as severe morbidity and mortality. A multiple logistic regression model was fitted to test the independent association between the NASG and the combined severe morbidity and mortality outcome. Results Measured blood loss decreased by 50% between phases; women experienced 400 mL of median blood loss after study entry in the pre-intervention and 200 mL in the NASG phase (p Conclusion In this non-randomized study, in which bias is inherent, the NASG showed promise for reducing blood loss, emergency hysterectomy, morbidity and mortality associated with PPH in referral facilities in Egypt and Nigeria.

  17. Perinatal episodes across the mood disorder spectrum.

    Science.gov (United States)

    Di Florio, Arianna; Forty, Liz; Gordon-Smith, Katherine; Heron, Jess; Jones, Lisa; Craddock, Nicholas; Jones, Ian

    2013-02-01

    CONTEXT Affective disorders are common in women, with many episodes having an onset in pregnancy or during the postpartum period. OBJECTIVE To investigate the occurrence and timing of perinatal mood episodes in women with bipolar I disorder, bipolar II disorder, and recurrent major depression (RMD). SETTING AND PATIENTS Women were recruited in our ongoing research on the genetic and nongenetic determinants of major affective disorders. Participants were interviewed and case notes were reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. The 1785 parous women identified included 1212 women with bipolar disorder (980 with type I and 232 with type II) and 573 with RMD. Data were available on 3017 live births. MAIN OUTCOME MEASURES We report the lifetime occurrence of perinatal mood episodes, the rates of perinatal episodes per pregnancy/postpartum period, and the timing of the onset of episodes in relation to delivery. RESULTS More than two-thirds of all diagnostic groups reported at least 1 lifetime episode of illness during pregnancy or the postpartum period. Women with bipolar I disorder reported an approximately 50% risk of a perinatal major affective episode per pregnancy/postpartum period. Risks were lower in women with RMD or bipolar II disorder, at approximately 40% per pregnancy/postpartum period. Mood episodes were significantly more common in the postpartum period in bipolar I disorder and RMD. Most perinatal episodes occurred within the first postpartum month, with mania or psychosis having an earlier onset than depression. CONCLUSIONS Although episodes of postpartum mood disorder are more common in bipolar I disorder and manic and psychotic presentations occur earlier in the postpartum period, perinatal episodes are highly prevalent across the mood disorder spectrum. PMID:23247604

  18. Clinical Analysis of Maternal and Perinatal Outcome of 44 Patients with Twin Pregnancy%双胎妊娠44例妊娠结局临床分析

    Institute of Scientific and Technical Information of China (English)

    陈凤霞

    2014-01-01

    目的:探讨改善双胎妊娠的产妇和围产儿的预后。方法回顾分析该院2001年1月-2013年10月病案资料,包括双胎妊娠孕妇基本资料、妊娠并发症、新生儿并发症及新生儿结局,数据经统计学处理。结果双胎妊娠女性年龄相对较大,有较高的平均身高和较重平均体重。虽然没有孕产妇死亡,但妊娠并发症均显着较高,其中早产发生率(36.3%),妊娠期高血压疾病(9.1%),胎膜早破(27.2%),贫血(29.5%),产后出血(15.9%),产前出血(6.8%),妊娠糖尿病(11.3%),羊水过多(4.5%),大多数患者有一个以上并发症。只有8%的患者没有任何并发症。剖宫产与阴道分娩相比没有显著减少或增加围产儿结局。产科医生及时有效的判断行紧急剖宫产可有效降低新生儿死亡率及严重并发症的发病率。结论双胎妊娠具有较高的妊娠并发症和新生儿并发症,剖宫产与阴道分娩相比没有显著减少或增加围产儿结局。%Objective To explore the measures of improving the maternal and perinatal outcome of twin pregnancy by analyzing the treatment and outcome of 44 puerperants with twin pregnancy retrospectively. Methods The clinical data during January, 2001 to October, 2013 in our hospital, including the basic data of puerperants with twin pregnancy, pregnancy complications, neonatal complications and neonatal outcome, were analyzed retrospectively and treated statistically. Results The results showed that the women with twin pregnancy were relatively older, had a higher average height and a heavier body weight. Although there was no maternal mortality, pregnancy complications were remarkably higher, pregnancy complicated by preterm labor(36.3%), hypertensive disorders in pregnancy (9.1%), premature rupture of membrane(27.2%), anaemia(29.5%), postpartum hemorrhage (15.9%), antepar-tum hemorrhage(6.8%), gestational diabetes(11.3%), polyhydramnios(4.5%). Most of the patients had

  19. Effect of RAAS blockers on adverse clinical outcomes in high CVD risk subjects with atrial fibrillation: A meta-analysis and systematic review of randomized controlled trials.

    Science.gov (United States)

    Chaugai, Sandip; Sherpa, Lhamo Yanchang; Sepehry, Amir A; Arima, Hisatomi; Wang, Dao Wen

    2016-06-01

    Recent studies have demonstrated that atrial fibrillation significantly increases the risk of adverse clinical outcomes in high cardiovascular disease risk subjects. Application of renin-angiotensin-aldosterone system blockers for prevention of recurrence of atrial fibrillation and adverse clinical outcomes in subjects with atrial fibrillation is a theoretically appealing concept. However, results of clinical trials evaluating the effect of renin-angiotensin-aldosterone blockers on adverse clinical outcomes in high cardiovascular disease risk subjects with atrial fibrillation remain inconclusive.A pooled study of 6 randomized controlled trials assessing the efficacy of renin-angiotensin-aldosterone blockers on subjects with atrial fibrillation was performed.A total of 6 randomized controlled trials enrolled a total of 53,510 patients followed for 1 to 5 years. RAAS blockade therapy was associated with 14% reduction in the incidence of heart failure (OR: 0.86, [95%CI: 0.76- 0.97], P=0.018) and 17% reduction in the incidence of CVE (OR: 0.83, [95%CI: 0.70-0.99], P = 0.038). The corresponding decline in absolute risk against heart failure (ARR: 1.4%, [95%CI: 0.2-2.6%], P = 0.018) and CVE (ARR: 3.5%, [95%CI: 0.0-6.9%], P = 0.045) in the AF group was much higher than the non-AF group for heart failure (ARR: 0.4%, [95%CI: 0.0-0.7%], P = 0.057) and CVE (ARR: 1.6%, [95%CI: -0.1% to 3.3%], P = 0.071). No significant effect was noted on all-cause or cardiovascular mortality, stroke, or myocardial infarction.This study suggests that RAAS blockade offers protection against heart failure and cardiovascular events in high cardiovascular disease risk subjects with atrial fibrillation. PMID:27368043

  20. Why are children born to teen mothers at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study.

    Science.gov (United States)

    Jaffee, S; Caspi, A; Moffitt, T E; Belsky, J; Silva, P

    2001-01-01

    This 20-year longitudinal study showed that the young adult offspring of teen mothers are at risk for a range of adverse outcomes including early school leaving, unemployment, early parenthood, and violent offending. We tested how much the effect of teen childbearing on offspring outcomes could be accounted for by social selection (in which a woman's characteristics that make her an inadequate parent also make her likely to bear children in her teens) versus social influence (in which the consequences of becoming a teen mother also bring harm to her children, apart from any characteristics of her own). The results provided support for both mechanisms. Across outcomes, maternal characteristics and family circumstances together accounted for approximately 39% of the effect of teen childbearing on offspring outcomes. Consistent with a social-selection hypothesis, maternal characteristics accounted for approximately 18% of the effect of teen childbearing on offspring outcomes; consistent with a social-influence hypothesis, family circumstances accounted for 21% of the teen childbearing effect after controlling for maternal characteristics. These results suggest that public policy initiatives should be targeted not only at delaying childbearing in the population but at supporting individual at-risk mothers and their children. PMID:11393652