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Sample records for adverse pregnancy outcomes

  1. Adverse pregnancy outcomes following syphilis treatment in pregnancy in the UK.

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    Wallace, Harriet E; Isitt, Catherine E; Broomhall, Harriet M; Perry, Alison E; Wilson, Janet D

    2016-10-01

    Syphilis infection in pregnancy is known to cause a number of severe adverse pregnancy outcomes, including second-trimester miscarriage, stillbirth, very pre-term delivery and neonatal death, in addition to congenital syphilis. A retrospective review of women with positive syphilis serology and a pregnancy outcome between 2005 and 2012 in Leeds, UK, was performed. In all, 57 cases of positive syphilis serology in pregnancy were identified: 24 with untreated syphilis treated in the current pregnancy (Group 1); seven with reported but unconfirmed prior treatment who were retreated (Group 2); and 26 adequately treated prior to pregnancy (Group 3). The rate of severe adverse pregnancy outcomes in Group 1 at 21% was significantly higher than the 0% outcome of Group 3 (p = 0.02). The severe adverse pregnancy outcomes were two second-trimester miscarriages, two pre-term births at 25 and 28 weeks and one stillbirth at 32 weeks. There were no cases of term congenital syphilis or term neonatal death, but we observed high rates of other adverse pregnancy outcomes despite treatment during pregnancy. Rapid referral for treatment is needed before 18 weeks in order to minimise adverse pregnancy outcomes. © The Author(s) 2016.

  2. A critical assessment of adverse pregnancy outcome and periodontal disease.

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    Wimmer, Gernot; Pihlstrom, Bruce L

    2008-09-01

    Pre-term birth is a major cause of infant mortality and morbidity that has considerable societal, medical, and economic costs. The rate of pre-term birth appears to be increasing world-wide and efforts to prevent or reduce its prevalence have been largely unsuccessful. To review the literature for studies investigating periodontal disease as a possible risk factor for pre-term birth and adverse pregnancy outcomes. Variability among studies in definitions of periodontal disease and adverse pregnancy outcomes as well as widespread inadequate control for confounding factors and possible effect modification make it difficult to base meaningful conclusions on published data. However, while there are indications of an association between periodontal disease and increased risk of adverse pregnancy outcome in some populations, there is no conclusive evidence that treating periodontal disease improves birth outcome. Based on a critical qualitative review, available evidence from clinical trials indicates that, although non-surgical mechanical periodontal treatment in the second trimester of pregnancy is safe and effective in reducing signs of maternal periodontal disease, it does not reduce the rate of pre-term birth. Clinical trials currently underway will further clarify the potential role of periodontal therapy in preventing adverse birth outcomes. Regardless of the outcomes of these trials, it is recommended that large, prospective cohort studies be conducted to assess risk for adverse pregnancy outcome in populations with periodontal disease. It is critical that periodontal exposure and adverse birth outcomes be clearly defined and the many potential confounding factors and possible effect modifiers for adverse pregnancy outcome be controlled in these studies. If periodontal disease is associated with higher risk of adverse pregnancy outcome in these specific populations, large multicenter randomized-controlled trials will be needed to determine if prevention or

  3. Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age

    DEFF Research Database (Denmark)

    Frederiksen, Line Elmerdahl; Ernst, Andreas; Brix, Nis

    2018-01-01

    prediction chart showed that advanced maternal age, use of assisted reproductive technology, nulliparous pregnancy, smoking during pregnancy, and obesity increased the absolute predictive risk of an adverse pregnancy outcome. CONCLUSION: Women older than 40 years have a higher risk of chromosomal......OBJECTIVE: To study the possible associations between advanced maternal age and risk of selected adverse pregnancy outcomes. METHODS: The study used a nationwide cohort of 369,516 singleton pregnancies in Denmark followed from 11-14 weeks of gestation to delivery or termination of pregnancy....... Pregnant women aged 35 years or older were divided into two advanced maternal age groups, 35-39 years and 40 years or older, and compared with pregnant women aged 20-34 years. Adverse pregnancy outcomes were chromosomal abnormalities, congenital malformations, miscarriage, stillbirth, and birth before 34...

  4. Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?

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    Xiong, Xu; Buekens, Pierre; Goldenberg, Robert L; Offenbacher, Steven; Qian, Xu

    2011-08-01

    Several large randomized controlled clinical trials failed to find that standard periodontal therapy during pregnancy reduces the incidence of adverse pregnancy outcomes (eg, preterm birth and low birthweight). However, treating periodontal disease during pregnancy may be too late to reduce the inflammation that is related to the adverse pregnancy outcomes. Moreover, periodontal treatment during pregnancy can cause bacteremia, which itself may initiate the pathway leading to the adverse pregnancy outcomes. Finally, the periodontal treatments provided during pregnancy are not always effective in preventing the progression of periodontal disease during pregnancy. Pregnancy may not be an appropriate period for periodontal intervention(s). We hypothesize that periodontal treatment before pregnancy may reduce the rates of adverse pregnancy outcomes. Future randomized controlled trials are needed to test if treating periodontal disease in the prepregnancy period reduces the rate of adverse pregnancy outcomes. Copyright © 2011 Mosby, Inc. All rights reserved.

  5. Periodontal disease and adverse pregnancy outcomes: a systematic review.

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    Xiong, X; Buekens, P; Fraser, W D; Beck, J; Offenbacher, S

    2006-02-01

    Recent studies suggest that periodontal disease, as a source of subclinical and persistent infection, may induce systemic inflammatory responses that increase the risk of adverse pregnancy outcomes. To examine the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes. Published studies identified via searches of the MEDLINE, EMBASE, CINAHL, and Current Contents full-text databases. We identified and selected observational studies (i.e. case-control, cross-sectional, and cohort) and nonrandomised controlled studies or randomised controlled trials that examined periodontal disease as a risk factor for adverse pregnancy outcomes. Odds ratios (OR) or risk ratios (RR) were extracted or calculated from the studies' data. We calculated pooled effect size for two clinical controlled trials but not for the observational studies due to the heterogeneity in definitions for periodontal disease and adverse pregnancy outcomes across studies. Twenty-five studies (13 case-control, 9 cohort, and 3 controlled trials) were identified. The studies focused on preterm low birthweight, low birthweight, preterm birth, birthweight by gestational age, miscarriage or pregnancy loss, and pre-eclampsia. Of the chosen studies, 18 suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (ORs ranging from 1.10 to 20.0) and 7 found no evidence of an association (ORs ranging from 0.78 to 2.54). Three clinical trial studies suggest that oral prophylaxis and periodontal treatment can lead to a 57% reduction in preterm low birthweight (pooled RR 0.43; 95% CI 0.24-0.78) and a 50% reduction in preterm births (RR 0.5; 95% CI 0.20-1.30). Periodontal disease may be associated with an increased risk of adverse pregnancy outcome. However, more methodologically rigorous studies are needed for confirmation.

  6. Periodontal infection and adverse pregnancy outcomes: a systematic review of epidemiological studies

    Directory of Open Access Journals (Sweden)

    Vettore Mario Vianna

    2006-01-01

    Full Text Available The objective of this systematic review was to evaluate analytical studies on periodontal disease as a possible risk factor for adverse pregnancy outcomes. A literature search of the MEDLINE, SciELO, and LILACS bibliographic databases and CAPES thesis database was conducted up to December 2005, covering epidemiological studies of periodontal disease and adverse pregnancy outcomes. Of the 964 papers identified, 36 analytical studies met the inclusion criteria. Twenty-six epidemiological studies reported associations between periodontal disease and adverse pregnancy outcomes. There was a clear heterogeneity between studies concerning measurement of periodontal disease and selection of type of adverse pregnancy outcome. Therefore no meta-analysis was performed. Most studies did not control for confounders, thus raising serious doubts about their conclusions. The methodological limitations of most studies did not allow conclusions concerning the effects of periodontal disease on adverse pregnancy outcomes. Larger and methodologically rigorous analytical studies using reliable outcomes and exposure measures are recommended.

  7. [Severe Adverse Pregnancy Outcomes in Placenta Previa and Prior Cesarean Delivery].

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    Zhou, Mi; Chen, Meng; Zhang, Li; He, Guo-Lin; He, Lei; Wei, Qiang; Li, Tao; Liu, Xing-Hui

    2017-09-01

    To investigate the severe adverse pregnancy outcomes in pregnancies with placenta previa and prior cesarean delivery and its risk factors. This retrospective casecontrol study reviewed all pregnancies with placenta previa and prior cesarean delivery delivered by repeat cesarean section in our institution between January 2005 and June 2015,and investigated the incidence of severe adverse pregnancy outcome. A composite of severe adverse pregnancy outcomes (including transfusion of 10 units or more red blood cells,maternal ICU admission,unanticipated injuries,repeat operation,hysterectomy,and maternal death) and other maternal and neonatal outcomes were described. Univariate and multivariable logistic regression analysis were used to quantify the effects of risk factors on severe adverse pregnancy outcomes. There were 478 women with placenta previa and prior cesarean delivery in our hospital over the last decade. The average age of them was 32.5±4.8 years old,most women were beyond 30 years old,the average gravidity and parity were 4 and 1,131 cases (27.4%) had severe adverse pregnancy outcomes. Transfusion of 10 units or more red blood cells happened in 75 cases (15.7%,75/478); 44 cases (9.2%,44/478) necessitated maternal ICU admission; unanticipated bladder injury occurred in 11 cases,but non ureter or bowel injury happened; All 4 repeat operations were due to delayed hemorrhage after conservative management during cesarean delivery,and an emergent hysterectomy was performed for all of the 4 cases. Hysterectomy (107 cases,22.4%) was the most common severe adverse pregnancy outcome. Among all 311 morbidly adherent placenta cases finally confirmed by pathological or surgical findings or both,only 172 (55.3%) were suspected before delivery. Multivariable logistic regression analysis showed that the risk of severe adverse pregnancy outcomes was significantly increased by pernicious placenta previa (i.e. anterior placenta overlying the prior cesarean scar),suspicion of

  8. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Adriana Campos Passanezi Sant'Ana

    2011-04-01

    Full Text Available OBJECTIVES: The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. MATERIAL AND METHODS: Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG - "no intervention" (n=17 or IG- "intervention" (n=16. IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP, professional prophylaxis (PROPH and oral hygiene instruction (OHI. NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD, clinical attachment level (CAL, plaque index (PI and sulcular bleeding index (SBI at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (0.05 at IG and worsening of all periodontal parameters at NIG (p<0.0001, except for PI. Signifcant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001. The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. CONCLUSIONS: Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

  9. Urinary tract infection and adverse outcome of pregnancy.

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    Dimetry, Shaira R; El-Tokhy, Hanan M; Abdo, Nagla M; Ebrahim, Moustafa A; Eissa, Mohammed

    2007-01-01

    Urinary tract infections (UTIs) during pregnancy are among the commonest health problems world wide, specially in developing countries, including Egypt. It has several adverse outcomes not only on the mother but also on the fetus as well.. The aim of this study is to determine the incidence of UTIs during pregnancy, study the main risk factors associated with such infections and find the impact of these infections on some pregnancy outcomes namely the gestational age and birth weight. A follow-up study on 249 pregnant women attending the ante natal care clinic at Zagazig university hospital. They were recruited over a period from 1st of September to 30th of or November, 2005. The outcome could be recorded for 201 of them. Data were collected through a pretested questionnaire, repeated urine analyses and recording of outcome of pregnancy. The study revealed that the incidence of UTIs during pregnancy was 31.3%. The commonest organisms were Klebsiella and E-coli. Several socio-demographic characteristics were found significantly associated with UTIs, age being 30 years and more, illiterates and low educational level, low socio-economic level and those with unsatisfactory personal hygiene and those using underwear clothes other than cotton. Significant associations with UTIs were also found in multigravidae 4th and more, those having more than one child and those who previously suffered UTIs. The only predicting variable with UTIs was low socio-economic level. The study revealed that the probability of delivering premature infants and low birth weights was significantly higher among those who experienced UTIs during pregnancy. Multivariate analysis revealed that UTI was one of the main contributors to pre-mature deliveries. Urinary tract infections with pregnancy still constitute a big problem with high incidence. It has a great impact on pregnancy outcome mainly pre-mature labor. So, the study recommends health education about personal hygiene, repeated urine

  10. Periodontal Disease: A Possible Risk-Factor for Adverse Pregnancy Outcome.

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    Parihar, Anuj Singh; Katoch, Vartika; Rajguru, Sneha A; Rajpoot, Nami; Singh, Pinojj; Wakhle, Sonal

    2015-07-01

    Bacterial invasion in subgingival sites especially of gram-negative organisms are initiators for periodontal diseases. The periodontal pathogens with persistent inflammation lead to destruction of periodontium. In recent years, periodontal diseases have been associated with a number of systemic diseases such as rheumatoid arthritis, cardiovascular-disease, diabetes mellitus, chronic respiratory diseases and adverse pregnancy outcomes including pre-term low-birth weight (PLBW) and pre-eclampsia. The factors like low socio-economic status, mother's age, race, multiple births, tobacco and drug-abuse may be found to increase risk of adverse pregnancy outcome. However, the same are less correlated with PLBW cases. Even the invasion of both aerobic and anerobic may lead to inflammation of gastrointestinal tract and vagina hence contributing to PLBW. The biological mechanism involved between PLBW and Maternal periodontitis is the translocation of chemical mediators of inflammation. Pre-eclampsia is one of the commonest cause of both maternal and fetal morbidity as it is characterized by hypertension and hyperprotenuria. Improving periodontal health before or during pregnancy may prevent or reduce the occurrences of these adverse pregnancy outcomes and, therefore, reduce the maternal and perinatal morbidity and mortality. Hence, this article is an attempt to review the relationship between periodontal condition and altered pregnancy outcome.

  11. Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial.

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    Sant'Ana, Adriana Campos Passanezi; Campos, Marinele R de; Passanezi, Selma Campos; Rezende, Maria Lúcia Rubo de; Greghi, Sebastião Luiz Aguiar; Passanezi, Euloir

    2011-04-01

    The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG--"no intervention" (n=17) or IG--"intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (pperiodontal conditions of IG and NIG were observed at 2nd examination (ppregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

  12. Association of maternal periodontal health with adverse pregnancy outcome.

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    Kumar, Ashok; Basra, Minu; Begum, Nargis; Rani, Vigya; Prasad, Sudha; Lamba, Arundeep Kaur; Verma, Mahesh; Agarwal, Sarita; Sharma, Shashi

    2013-01-01

    The present study aims to determine the association of periodontal disease (identified early in pregnancy) and adverse pregnancy outcomes in a North Indian population.   A total of 340 primigravida women, aged 20-35 years with single live pregnancy were recruited at 14-20 weeks period of gestation from the antenatal clinic. These women had undergone periodontal examination at time of recruitment. The pregnancy outcomes were recorded. Out of 340 primigravida women, 147 (43.23%) women had gingivitis and 61 (17.94%) women had periodontitis. Periodontitis was found to be significantly associated with pre-eclampsia, intrauterine growth restriction, preterm delivery, and low birthweight with odds ratios (95% confidence interval) of 7.48 (2.72-22.42), 3.35 (1.20-9.55), 2.72 (1.30-5.68) and 3.03 (1.53-5.97), respectively. The study shows a significant association between periodontitis (but not with gingivitis) and adverse pregnancy outcomes. Maternal periodontitis is associated with an increased risk of pre-eclampsia, intrauterine growth restriction, preterm delivery and low birthweight infants. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  13. Periodontal disease and bacterial vaginosis increase the risk for adverse pregnancy outcome.

    OpenAIRE

    Oittinen, Juha; Kurki, Tapio; Kekki, Minnamaija; Kuusisto, Minna; Pussinen, Pirkko; Vilkuna-Rautiainen, Tiina; Nieminen, Anja; Asikainen, Sirkka; Paavonen, Jorma

    2005-01-01

    OBJECTIVES: To determine whether periodontal disease or bacterial vaginosis (BV) diagnosed before pregnancy increase the risk for adverse pregnancy outcome. METHODS: We enrolled a total of 252 women who had discontinued contraception in order to become pregnant. The first 130 pregnant women were included in the analyses. RESULTS: Multivariate analysis showed a strong association between periodontal disease and adverse pregnancy outcome (OR 5.5, 95% confidence interval 1.4-21.2; p = 0.014), an...

  14. Periodontal Disease and Bacterial Vaginosis Increase the Risk for Adverse Pregnancy Outcome

    OpenAIRE

    Oittinen, Juha; Kurki, Tapio; Kekki, Minnamaija; Kuusisto, Minna; Pussinen, Pirkko; Vilkuna-Rautiainen, Tiina; Nieminen, Anja; Asikainen, Sirkka; Paavonen, Jorma

    2005-01-01

    Objectives. To determine whether periodontal disease or bacterial vaginosis (BV) diagnosed before pregnancy increase the risk for adverse pregnancy outcome.Methods. We enrolled a total of 252 women who had discontinued contraception in order to become pregnant. The first 130 pregnant women were included in the analyses.Results. Multivariate analysis showed a strong association between periodontal disease and adverse pregnancy outcome (OR 5.5, 95% confidence interval 1.4–21.2; p = 0.014), and ...

  15. Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes.

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    Staneva, Aleksandra A; Morawska, Alina; Bogossian, Fiona; Wittkowski, Anja

    2018-01-01

    Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p pregnancy and an orientation toward a Regulator mothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy.

  16. Anti-prothrombin antibodies are associated with adverse pregnancy outcome.

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    Marozio, Luca; Curti, Antonella; Botta, Giovanni; Canuto, Emilie M; Salton, Loredana; Tavella, Anna Maria; Benedetto, Chiara

    2011-11-01

    Women with antiphospholipid antibodies (aPL) such as lupus anticoagulant, anticardiolipin antibodies, and anti-β(2) glycoprotein-1 antibodies are at high risk of late pregnancy complications, such as severe pre-eclampsia, placental insufficiency, and fetal loss. It has been observed that aPL consists of a heterogeneous group of antibodies targeting several phospholipid-binding plasma proteins, including also anti-prothrombin (anti-PT), anti-protein S (anti-PS), and anti-protein C (anti-PC) antibodies. Their potential role in late pregnancy complications is not known. The aim of this work was to investigate the association between those autoantibodies and histories for adverse pregnancy outcome. Anti-PT, anti-PS, and anti-PC antibodies were evaluated in 163 patients with previous severe pre-eclampsia, fetal death, and/or placental abruption and in as many women with previous uneventful pregnancies, negative for aPL. The prevalence of anti-PT antibodies was higher in cases than in controls (OR, 95% CI: 10.92, 4.52-26.38). The highest prevalence was observed in subjects with fetal death. Anti-PT antibodies appear to be associated with adverse pregnancy outcome, irrespectively of aPL. © 2011 John Wiley & Sons A/S.

  17. 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......-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....

  18. Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes.

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    Cetin, I; Pileri, P; Villa, A; Calabrese, S; Ottolenghi, L; Abati, S

    2012-06-01

    In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms "small for gestational age (SGA)," "preeclampsia," "preterm labor," and "periodontal disease." Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E(2) (PGE(2)) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal-fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.

  19. ADVERSE PREGNANCY OUTCOMES ASSOCIATED WITH MATERNAL ENALAPRIL ANTIHYPERTENSIVE TREATMENT

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    Enalapril, one of several antihypertensive drugs that act as angiotensin-converting enzyme (ACE) inhibitors, is often used for treatment of hypertension in women of reproductive age. Adverse birth outcomes following the use of ACE inhibitors, including enalapril, during pregnanc...

  20. Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes.

    Science.gov (United States)

    Turton, Mervyn; Africa, Charlene W J

    2017-06-01

    Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes. © 2016 FDI World Dental Federation.

  1. 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

    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......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...

  2. The Prevalence Of Sexually Transmitted Infections On Teen Pregnancies And Their Association To Adverse Pregnancy Outcomes.

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    Rodriguez Gonzalez, Zaskia M; Leavitt, Karla; Martin, Jose; Benabe, Erika; Romaguera, Josefina; Negrón, Ivette

    2015-01-01

    Based on our population data, the teen pregnancy rate and the prevalence of sexually transmitted infections (STIs) reported during pregnancy are worrisome. STIs appear to pose a threat to pregnancy outcomes including preterm birth (PTB), neonatal low birth weight (NLBW) and premature rupture of membranes (PROM). The objective of this study is to determine the prevalence of STIs in pregnant teens and the association of this variable to adverse pregnancy outcomes. We performed a cross sectional study to assess the prevalence of STIs among pregnant teens during a 4-year period at our institution. Birth outcomes such as gestational age at delivery, PROM and NLBW were analyzed and compared with adults. In the four years of our study, teen pregnancy rate fluctuated from 21.7% in 2010 to 16.8% in 2013. The rate of STIs for adult and teen pregnancies was similar, 21% and 23%, respectively. Chlamydia was the most common STI (67.3%) for both groups. PTB was more prevalent among adults affected with STIs than teens, 13.8% and 11.5%, respectively. NLBW was similar among teens and adults with STIs. PROM complicated 9.1% of teen pregnancies with STIs, compared to 6.7% in adults. There was no significant correlation between the STIs and adverse pregnancy outcomes on teen pregnancies for our population, except for PROM. This age group is associated with a high-risk sexual behavior and poor adherence to treatment. They would benefit from efforts to prevent unintended pregnancies and infectious diseases.

  3. Does Uterine Fibroid Adversely Affect Obstetric Outcome of Pregnancy?

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    Hend S. Saleh

    2018-01-01

    Full Text Available Background. Fibroid is the most common benign tumor of the uterus and if associated with pregnancy may adversely affect the outcome of pregnancy. Objective of the present study was to assess the obstetric outcome (maternal and fetal in pregnancy with fibroid. Methods. A prospective observational study was performed over a period from May 2015 to August 2017 at Obstetrics and Gynecology Department in Zagazig University Hospitals, Egypt. 64 pregnant patients with >2 cm fibroid were taken in the study. Routine fundamental investigations were done for all. They were followed during antenatal period clinically and scanned by ultrasonogram which was done at booking visit and during subsequent visits to assess the change in the size of the fibroid and other obstetric complications. Maternal age, parity, size of fibroid, complications during pregnancy, and mode of delivery were noted. Results. 64 pregnant patients with uterine fibroids were recruited; 47 of them completed the study to the end. The average age was 31.80±3.27 years, body mass index (BMI [calculated as weight in kilograms divided by the square of height in meters] was 24.67±2.46, primigravida was 23.4%, multigravida was 76.6%, duration of menstrual cycle/day was 29.68±3.10, and duration of menstrual period/day was 6.46±1.12. The percentage of spontaneous conception was 59.57% and 40.43% for using assisted reproductive technology. The results of obstetric outcome were spontaneous abortion in 2%, premature delivery in 27.7%, and delivery at 37–41 weeks of pregnancy in 70.2%. The mode of delivery was vaginal delivery in 15% and cesarean sections in 85%. Also, 34% had threatened miscarriage, 21% had preterm labor, 2% had antepartum bleeding in the form of placenta previa, 4% had abdominal pain needing admission, one of them underwent laparotomy and was diagnosed as red degeneration, 2 (4% had postpartum hemorrhage, and only one needed blood transfusion. Cesarean sections were done in

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

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    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.

  5. Teen Pregnancy: Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

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    van Veen, Teelkien R; Haeri, Sina; Baker, Arthur M

    2015-12-01

    The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1 institution, we compared nulliparous women with a history of a prior abortion (cases) to those without a spontaneous loss or abortion of pregnancy (referent) for adverse perinatal outcomes, including preterm birth and fetal growth restriction. Of the 654 included nulliparous adolescent deliveries, 102 (16%) had an abortion before the index pregnancy. Compared with the referent group, adolescents with a history of a abortion were older (17.8 ± 0.8 vs 16.7 ± 1.2 years, P = .0001), enrolled earlier for prenatal care (14.4 ± 5.6 vs 17.2 ± 7.6 weeks, P = .0004), along with a higher incidence of African American race (95% vs 88%, P = .05). The groups did not differ with respect to other maternal demographics. Perinatal outcomes, including spontaneous preterm birth, abnormal placentation, birth weight, and gestational age at delivery, did not differ between the 2 groups. Compared with adolescent women who had just delivered and did not have a prior abortion, women who had just delivered and had a previous abortion were more likely to be older at the age of their first pregnancy and more likely to initiate early prenatal care. Thus, having a prior abortion may improve the health of a pregnancy though adverse outcomes do not differ between the 2 groups. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  6. Maternal low thyroxin levels are associated with adverse pregnancy outcomes in a Chinese population.

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    Yong Zhang

    Full Text Available Although thyroid dysfunction in early pregnancy may have adverse effects on pregnancy outcomes, few studies have examined the relationship between maternal low free thyroxin (FT4 levels in both first and third trimesters of pregnancy and the incidence of adverse pregnancy outcomes. We hypothesized that low FT4 levels in either first or third trimesters of pregnancy may have different effects on pregnancy outcomes. The study included 6,031 mothers who provided both first and third pregnancy serum samples for analyses of thyroid function. Adverse pregnancy outcomes, such as gestational diabetes mellitus (GDM, pregnancy-induced hypertension and preeclampsia, were diagnosed using the oral glucose tolerance test, blood pressure and urine protein test. Serum metabolites like adenosine and its analogues were identified using hydrophilic interaction liquid chromatography (HILIC-tandem mass spectrometry (MS/MS. The incidence of hypothyroidism in pregnant women tended to increase with age and pre-pregnancy body mass index (BMI. The incidence of GDM was negatively correlated with maternal FT4 levels during early pregnancy while the incidence of preeclampsia was negatively correlated with maternal FT4 levels during late pregnancy. The incidence of pregnancy-induced hypertension was not significantly correlated with maternal FT4 levels. The women who had isolated maternal hypothyroxemia (IMH in the third trimester of pregnancy had an increased risk of developing preeclampsia. Some metabolites like adenosine and its analogues in the serum were significantly changed in pregnant mothers with IMH. In conclusion, low FT4 levels during pregnancy are a risk factor for GDM and preeclampsia. Adenosine and its analogues may be important bridges between IMH and preeclampsia.

  7. Association between Intimate Partner Violence during Pregnancy and Adverse Pregnancy Outcomes in Vietnam

    DEFF Research Database (Denmark)

    Thanh Nguyen Hoang; Toan Ngo Van; Gammeltoft, Tine

    2016-01-01

    Background: Violence against pregnant women is an increasing public health concern particularly in low- and middle-income countries. The purpose of this study was to measure the association between intimate partner violence (IPV) during pregnancy and the risk of adverse birth outcomes. Methods: P...

  8. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis.

    Science.gov (United States)

    Harris, Nathaniel; Eudy, Amanda; Clowse, Megan

    2018-06-15

    While increased rheumatic disease activity during pregnancy has been associated with adverse pregnancy outcomes, this activity is typically assessed by the physician. Little is known, however, about the association between patient-reported measures of disease activity and pregnancy outcomes. Univariate and multivariable regression models were used to assess the relationship between patient and physician-reported measures of disease activity and adverse pregnancy outcomes in 225 patients with lupus or rheumatoid arthritis (RA) enrolled in a prospective registry at a single academic center from 2008-2016. In women with RA, patient-reported disease activity is associated with preterm birth (OR 5.9 (1.5-23.9)), and gestational age (beta -1.5 weeks (-2.6, -0.4 weeks)). The physician assessment of disease activity also predicted preterm (OR 2.1 (1.2-3.5)), small for gestational age births (OR 1.8 (1.03-3.1), and gestational age in weeks (beta -0.6 weeks (-0.9, -0.02 weeks)). On the other hand, SLE patient-reported disease activity measures, including the HAQ, pain or global health measures, are not associated with adverse pregnancy outcomes. However, physician measures of SLE disease activity are associated with preterm birth (OR 2.9 (1.-6.3)), cesarean delivery (OR 2.3 (1.0-5.3)), and preeclampsia (OR 2.8 (1.3-6.3)). The results do not appear to be driven by lupus nephritis or antiphospholipid syndrome. For women with RA, patient-reported measures of disease activity may be useful adjuncts to physician-reported measures in identifying pregnancies at greater risk. In contrast, in SLE, no patient-reported measures were associated with adverse outcomes while physician measures of disease activity helped predict several adverse pregnancy outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes.

    Science.gov (United States)

    Salow, Arturo D; Pool, Lindsay R; Grobman, William A; Kershaw, Kiarri N

    2018-03-01

    Previous analyses utilizing birth certificate data have shown environmental factors such as racial residential segregation may contribute to disparities in adverse pregnancy outcomes. However, birth certificate data are ill equipped to reliably differentiate among small for gestational age, spontaneous preterm birth, and medically indicated preterm birth. We sought to utilize data from electronic medical records to determine whether residential segregation among Black women is associated with an increased risk of adverse pregnancy outcomes. The study population was composed of 4770 non-Hispanic Black women who delivered during the years 2009 through 2013 at a single urban medical center. Addresses were geocoded at the level of census tract, and this tract was used to determine the degree of residential segregation for an individual's neighborhood. Residential segregation was measured using the Gi* statistic, a z-score that measures the extent to which the neighborhood racial composition deviates from the composition of the larger surrounding area. The Gi* statistic z-scores were categorized as follows: low (z  1.96). Adverse pregnancy outcomes included overall preterm birth, spontaneous preterm birth, medically indicated preterm birth, and small for gestational age. Hierarchical logistic regression models accounting for clustering by census tract and repeated births among mothers were used to estimate odds ratios of adverse pregnancy outcomes associated with segregation. In high segregation areas, the prevalence of overall preterm birth was significantly higher than that in low segregation areas (15.5% vs 10.7%, respectively; P < .001). Likewise, the prevalence of spontaneous preterm birth and medically indicated preterm birth were higher in high (9.5% and 6.0%) vs low (6.2% and 4.6%) segregation neighborhoods (P < .001 and P = .046, respectively). The associations of high segregation with overall preterm birth (odds ratio, 1.31; 95% confidence interval, 1

  10. 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...... 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 (periodontal treatment was not efficacious for any of the outcomes...

  11. Teen Pregnancy : Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

    NARCIS (Netherlands)

    van Veen, Teelkien R.; Haeri, Sina; Baker, Arthur M.

    2015-01-01

    Study Objective: The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. Methods: In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1

  12. Association between Intimate Partner Violence during Pregnancy and Adverse Pregnancy Outcomes in Vietnam: A Prospective Cohort Study

    Science.gov (United States)

    Van, Toan Ngo; Gammeltoft, Tine; W. Meyrowitsch, Dan; Nguyen Thi Thuy, Hanh; Rasch, Vibeke

    2016-01-01

    Background Violence against pregnant women is an increasing public health concern particularly in low- and middle-income countries. The purpose of this study was to measure the association between intimate partner violence (IPV) during pregnancy and the risk of adverse birth outcomes. Methods Prospective cohort study of 1276 pregnant women in Dong Anh district, Vietnam. Women with gestational age less than 24 weeks were enrolled and interviewed. Repeated interviews were performed at 30–34 weeks gestation to assess experience of IPV during pregnancy and again 48 hours post-delivery to assess the birth outcome including birth weight and gestational age at delivery. Results There was a statistically significant association between exposure to physical violence during pregnancy and preterm birth (PTB) or low birth weight (LBW). After adjustment for age, education, occupation, body mass index (BMI), haemoglobin level, previous adverse pregnancy outcomes, the pregnant women who were exposed to physical violence during pregnancy were five times more likely to have PTB (AOR = 5.5; 95%CI: 2.1–14.1) and were nearly six times more likely to give birth to a child of LBW (AOR = 5.7; 95%CI: 2.2–14.9) as compared to those who were not exposed to physical violence. Conclusion Exposure to IPV during pregnancy increases the risk of PTB and LBW. Case-finding for violence in relation to antenatal care may help protect pregnant women and improve pregnancy outcomes. PMID:27631968

  13. The oral microbiome and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Cobb CM

    2017-08-01

    Full Text Available Charles M Cobb,1 Patricia J Kelly,2 Karen B Williams,3 Shilpa Babbar,4 Mubashir Angolkar,5 Richard J Derman6 1Department of Periodontics, School of Dentistry, 2Department of Public Health Nursing, School of Nursing and Health Studies, 3Department of Biomedical & Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, 4Department of Obstetrics, Gynecology & Women’s Health, Division of Maternal & Fetal Medicine, School of Medicine, Saint Louis University, St Louis, MO, USA; 5Department of Public Health, Jawaharlal Nehru Medical College (JNMC, KLE University, Karnataka, India; 6Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Abstract: Significant evidence supports an association between periodontal pathogenic bacteria and preterm birth and preeclampsia. The virulence properties assigned to specific oral pathogenic bacteria, for example, Fusobacterium nucleatum, Porphyromonas gingivalis, Filifactor alocis, Campylobacter rectus, and others, render them as potential collaborators in adverse outcomes of pregnancy. Several pathways have been suggested for this association: 1 hematogenous spread (bacteremia of periodontal pathogens; 2 hematogenous spread of multiple mediators of inflammation that are generated by the host and/or fetal immune response to pathogenic bacteria; and 3 the possibility of oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. As periodontal disease is, for the most part, preventable, the medical and dental public health communities can address intervention strategies to control oral inflammatory disease, lessen the systemic inflammatory burden, and ultimately reduce the potential for adverse pregnancy outcomes. This article reviews the oral, vaginal, and placental microbiomes, considers their potential impact on preterm labor, and the future

  14. A thick placenta: a predictor of adverse pregnancy outcomes.

    Science.gov (United States)

    Miwa, Ichiro; Sase, Masakatsu; Torii, Mayumi; Sanai, Hiromi; Nakamura, Yasuhiko; Ueda, Kazuyuki

    2014-01-01

    The aim of this study is to evaluate the efficacy of an ultrasonographic measurement of placental thickness and the correlation of a thick placenta with adverse perinatal outcome. Placental thickness was measured in single gravidas, 16 to 40 weeks of gestation, between 2005 and 2009. Placentas were considered to be thick if their measured thickness were above the 95th percentile for gestational age. The incidence of thick placentas was 4.3% (138/3,183). Perinatal morbidity and neonatal conditions were worse in cases with thick placenta rather than without thick placenta. Ultrasonographic measurement of placental thickness is a simple method to estimate placental size. Thick placenta may be a useful predictor of adverse pregnancy outcomes.

  15. Prediction of adverse pregnancy outcomes using uterine artery Doppler imaging at 22-24 weeks of pregnancy: A North Indian experience

    Directory of Open Access Journals (Sweden)

    Deepti Verma

    2016-06-01

    Full Text Available Objective: The aim of this study was to assess the predictive value of uterine artery Doppler imaging at 22-24 weeks of gestation for adverse pregnancy outcomes. Materials and Methods: This was a prospective study in which uterine artery Doppler was performed at 22-24 weeks of gestation in 165 pregnant women with singleton pregnancies. A pulsatility index (PI more than 1.45 or bilateral uterine notching was labeled as abnormal Doppler. The pregnancy outcome was assessed in terms of normal outcome, preeclampsia, fetal growth restriction (FGR, low birth weight, spontaneous preterm delivery, oligohydramnios, fetal loss or at least one adverse outcome. Results: Out of 165 patients, 35 (21.2% had abnormal second trimester uterine artery Doppler. In pregnancies that resulted in preeclampsia (PE, (n=21, FGR, (n=21, and low birth weight (n=39, the median uterine artery PI was higher (1.52, 1.41, and 1.27 respectively. In the presence of abnormal Doppler, the risk of PE [OR=10.7, 95% confidence interval (CI: (3.91-29.1; p<0.001], FGR [OR=4.34, 95% CI: (1.62-11.6; p=0.002], low birth weight [OR=6.39, 95% CI: (3.16-12.9; p<0.001] and the risk of at least one obstetric complication [OR=8.73, 95% CI: (3.5-21.3; p<0.001] was significantly high. The positive predictive value of abnormal uterine artery Doppler was highest for preeclampsia (36.84% among all adverse pregnancy outcomes assessed. Conclusion: Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a significant predictor of at least one adverse pregnancy outcome, with the highest prediction for preeclampsia.

  16. Women's health: periodontitis and its relation to hormonal changes, adverse pregnancy outcomes and osteoporosis.

    Science.gov (United States)

    Krejci, Charlene B; Bissada, Nabil F

    2012-01-01

    To examine the literature with respect to periodontitis and issues specific to women's health, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. The literature was evaluated to review reported associations between periodontitis and genderspecific issues, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. Collectively, the literature provided a large body of evidence that supports various associations between periodontitis and hormonal changes, adverse pregnancy outcomes and osteoporosis; however, certain shortcomings were noted with respect to biases involving definitions, sample sizes and confounding variables. Specific cause and effect relationships could not be delineated at this time and neither could definitive treatment interventions. Future research must include randomised controlled trials with consistent definitions, adequate controls and sufficiently large sample sizes in order to clarify specific associations, identify cause and effect relationships, define treatment options and determine treatment interventions which will lessen the untoward effects on the at-risk populations.

  17. Periodontal disease, atherosclerosis, adverse pregnancy outcomes, and head-and-neck cancer

    NARCIS (Netherlands)

    Han, Y.W.; Houcken, W.; Loos, B.G.; Schenkein, H.A.; Tezal, M.

    2014-01-01

    Interrelationships between periodontal infection and systemic conditions such as cardiovascular disease, adverse pregnancy outcomes, and head-and-neck cancer have become increasingly appreciated in recent years. Periodontitis is associated with cardiovascular disease (CVD) and, experimentally, with

  18. Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

    Science.gov (United States)

    Uwitonze, Anne Marie; Uwambaye, Peace; Isyagi, Moses; Mumena, Chrispinus H; Hudder, Alice; Haq, Afrozul; Nessa, Kamrun; Razzaque, Mohammed S

    2018-01-16

    Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort.

    Science.gov (United States)

    Bengtson, May-Bente; Martin, Christopher F; Aamodt, Geir; Vatn, Morten H; Mahadevan, Uma

    2017-08-01

    Malnutrition and weight loss are common features of patients with inflammatory bowel disease (IBD). To explore the impact of inadequate gestational weight gain (GWG) on adverse outcomes among IBD mothers in the prospective US pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort. The PIANO cohort comprises 559 and 363 pregnant mothers with Crohn's disease (CD) and ulcerative colitis (UC), respectively, enrolled between 2006 and 2014. The mothers were followed during and after pregnancy to ascertain medication, measurement of disease activity and complications during pregnancy and at delivery. Inadequate GWG was based on US Institute of Medicine recommendations. The associations between inadequate GWG and adverse pregnancy outcomes in maternal IBD were analyzed, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. Maternal CD and UC with inadequate GWG had a 2.5-fold increased risk of preterm birth (OR 2.5, CI 1.3, 4.9 and OR 2.5, CI 1.2, 5.6). Furthermore, an increased risk of intrauterine growth restriction and a trend for small for gestational age were demonstrated in CD but not in UC (OR 3.3, CI 1.1, 10.0, OR 4.5, CI 0.8, 24.3, p = 0.08). Flares increased risk of inadequate GWG (OR 1.6, CI 1.2, 2.3, p = 0.002) but did not change the associations between inadequate GWG and adverse pregnancy outcomes in our models. The US PIANO cohort demonstrated that inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD mothers.

  20. 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

  1. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review.

    Science.gov (United States)

    Ide, Mark; Papapanou, Panos N

    2013-04-01

    There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association. Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases. Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (pregnancy loss or miscarriage, or pre-eclampsia. Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders. Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis "case definitions," these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. There is a high degree of variability in study populations, recruitment

  2. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: a multicentre retrospective study.

    Science.gov (United States)

    Lin, Li; Wei, Yumei; Zhu, Weiwei; Wang, Chen; Su, Rina; Feng, Hui; Yang, Huixia

    2018-04-23

    Anaemia in pregnant women is a public health problem, especially in developing countries. The aim of this study was to assess the prevalence and related risk factors of anaemia during pregnancy in a large multicentre retrospective study (n = 44,002) and to determine the adverse pregnancy outcomes in women with or without anaemia. The study is a secondary data analysis of a retrospective study named "Gestational diabetes mellitus Prevalence Survey (GPS) study in China". Structured questionnaires were used to collect socio-demographic characteristics, haemoglobin levels and pregnancy outcomes from all the participants. Anaemia in pregnancy is defined as haemoglobin anaemia and associated adverse pregnancy outcomes. The overall prevalence of anaemia was 23.5%. Maternal anaemia was significantly associated with maternal age ≥ 35 years (AOR = 1.386), family per capita monthly incomepregnancy BMI pregnancy outcomes, including GDM, polyhydramnios, preterm birth, low birth weight (anaemia than those without. The results indicated that anaemia continues to be a severe health problem among pregnant women in China. Anaemia is associated with adverse pregnancy outcomes. Pregnant women should receive routine antenatal care and be given selective iron supplementation when appropriate.

  3. Tissue factor pathway inhibitor for prediction of placenta-mediated adverse pregnancy outcomes in high-risk women: AngioPred study.

    Directory of Open Access Journals (Sweden)

    Aurélie Di Bartolomeo

    Full Text Available The study aimed to evaluate if the rate of tissue factor pathway inhibitor during pregnancy and following delivery could be a predictive factor for placenta-mediated adverse pregnancy outcomes in high-risk women.This was a prospective multicentre cohort study of 200 patients at a high risk of occurrence or recurrence of placenta-mediated adverse pregnancy outcomes conducted between June 2008 and October 2010. Measurements of tissue factor pathway inhibitor resistance (normalized ratio and tissue factor pathway inhibitor activity were performed for the last 72 patients at 20, 24, 28, 32, and 36 weeks of gestation and during the postpartum period.Overall, 15 patients presented a placenta-mediated adverse pregnancy outcome. There was no difference in normalized tissue factor pathway inhibitor ratios between patients with and without placenta-mediated adverse pregnancy outcomes during pregnancy and in the post-partum period. Patients with placenta-mediated adverse pregnancy outcomes had tissue factor pathway inhibitor activity rates that were significantly higher than those in patients without at as early as 24 weeks of gestation. The same results were observed following delivery.Among high-risk women, the tissue factor pathway inhibitor activity of patients with gestational vascular complications is higher than that in other patients. Hence, these markers could augment a screening strategy that includes an analysis of angiogenic factors as well as clinical and ultrasound imaging with Doppler measurement of the uterine arteries.

  4. 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

  5. Periodontal Disease: A Possible Risk-Factor for Adverse Pregnancy Outcome

    OpenAIRE

    Parihar, Anuj Singh; Katoch, Vartika; Rajguru, Sneha A; Rajpoot, Nami; Singh, Pinojj; Wakhle, Sonal

    2015-01-01

    Bacterial invasion in subgingival sites especially of gram-negative organisms are initiators for periodontal diseases. The periodontal pathogens with persistent inflammation lead to destruction of periodontium. In recent years, periodontal diseases have been associated with a number of systemic diseases such as rheumatoid arthritis, cardiovascular-disease, diabetes mellitus, chronic respiratory diseases and adverse pregnancy outcomes including pre-term low-birth weight (PLBW) and pre-eclampsi...

  6. Periodontal disease, atherosclerosis, adverse pregnancy outcomes, and head-and-neck cancer.

    Science.gov (United States)

    Han, Y W; Houcken, W; Loos, B G; Schenkein, H A; Tezal, M

    2014-05-01

    Interrelationships between periodontal infection and systemic conditions such as cardiovascular disease, adverse pregnancy outcomes, and head-and-neck cancer have become increasingly appreciated in recent years. Periodontitis is associated with cardiovascular disease (CVD) and, experimentally, with measures of atherosclerosis and endothelial dysfunction. Periodontal therapy may reduce atherosclerotic changes and improve endothelial function. Preliminary findings suggest a role for the genetic locus ANRIL in the pathobiology of both CVD and periodontitis. Periodontal pathogens induce anticardiolipin in periodontitis patients by molecular mimicry of the serum protein β-2 glycoprotein I. These antibodies have biological and pathological activities consistent with those reported for other infection-induced antiphospholipid antibodies. Anticardiolipin may explain some of the observed associations between periodontitis and systemic conditions such as CVD and adverse pregnancy outcomes. The oral commensal Fusobacterium nucleatum (Fn) becomes pathogenic on migration to extra-oral sites. Fn infection of the fetal-placental unit has been linked to pregnancy complications, including preterm birth, stillbirth, and early-onset neonatal sepsis. Reagents aimed at inhibiting or resolving inflammatory responses may be used to treat or prevent pregnancy complications due to bacterial infection. Chronic periodontitis may be independently associated with head-and-neck squamous cell carcinoma (HNSCC) through direct toxic effects of bacteria and their products, and/or through indirect effects of inflammation. Additionally, chronic periodontitis may facilitate the acquisition and persistence of oral HPV infection, a recently emerged risk factor for HNSCC.

  7. Mycoplasma, Ureaplasma, and Adverse Pregnancy Outcomes: A Fresh Look

    Directory of Open Access Journals (Sweden)

    Bryan Larsen

    2010-01-01

    Full Text Available Recent work on the Molicutes that associate with genital tract tissues focuses on four species that may be of interest in potential maternal, fetal, and neonatal infection and in contributing to adverse pregnancy outcomes. Mycoplasma hominis and Ureaplasma urealyticum have historically been the subject of attention, but Mycoplasma genitalis which causes male urethritis in addition to colonizing the female genital tract and the division of Ureaplasma into two species, urealyticum and parvum, has also added new taxonomic clarity. The role of these genital tract inhabitants in infection during pregnancy and their ability to invade and infect placental and fetal tissue is discussed. In particular, the role of some of these organisms in prematurity may be mechanistically related to their ability to induce inflammatory cytokines, thereby triggering pathways leading to preterm labor. A review of this intensifying exploration of the mycoplasmas in relation to pregnancy yields several questions which will be important to examine in future research.

  8. Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes

    Science.gov (United States)

    Boyd, Heather A.; Basit, Saima; Harpsøe, Maria C.; Wohlfahrt, Jan; Jess, Tine

    2015-01-01

    Background and Objectives Existing data on pregnancy complications in inflammatory bowel disease (IBD) are inconsistent. To address these inconsistencies, we investigated potential associations between IBD, IBD-related medication use during pregnancy, and pregnancy loss, pre-eclampsia, preterm delivery, Apgar score, and congenital abnormalities. Methods We conducted a cohort study in >85,000 Danish National Birth Cohort women who were pregnant in the period 1996-2002 and had information on IBD, IBD-related medication use (systemic or local corticosteroids, 5-aminosalicylates), pregnancy outcomes and potential confounders. We evaluated associations between IBD and adverse pregnancy/birth outcomes using Cox regression and log-linear binomial regression. Results IBD was strongly and significantly associated with severe pre-eclampsia, preterm premature rupture of membranes and medically indicated preterm delivery in women using systemic corticosteroids during pregnancy (hazard ratios [HRs] >7). IBD was also associated with premature preterm rupture of membranes in women using local corticosteroid medications (HR 3.30, 95% confidence interval [CI] 1.33-8.20) and with medically indicated preterm delivery (HR 1.91, 95% CI 0.99-3.68) in non-medicated women. Furthermore, IBD was associated with low 5-minute Apgar score in term infants (risk ratio [RR] 2.19, 95% CI 1.03-4.66). Finally, Crohn’s disease (but not ulcerative colitis) was associated with major congenital abnormalities in the offspring (RR 1.85, 95% CI 1.06-3.21). No child with a congenital abnormality born to a woman with IBD was exposed to systemic corticosteroids in utero. Conclusion Women with IBD are at increased risk of severe pre-eclampsia, medically indicated preterm delivery, preterm premature rupture of membranes, and delivering infants with low Apgar score and major congenital malformations. These associations are only partly explained by severe disease as reflected by systemic corticosteroid use

  9. Intrauterine hematomas in the second and third trimesters associated with adverse pregnancy outcomes: a retrospective study.

    Science.gov (United States)

    Ji, Wanqing; Li, Weidong; Mei, Shanshan; He, Ping

    2017-09-01

    To carry out a retrospective study of the clinical features of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors for poor pregnancy outcomes. A total of 398 patients who underwent routine examination in our hospital from January 2011 to December 2015 were classified into normal pregnancy (NP) group (N = 265) and adverse pregnancy (AP) group (N = 133), according to their pregnancy outcomes. Maternal clinical demographics, gestational age, location of hematoma, volume of hematoma, and accompanying contraction and vaginal bleeding were recorded. The average age of pregnant women in the NP and AP groups was 28.25 ± 4.06 and 29.5 ± 5.06 years, respectively (p = 0.007). Gestational age at first detection of hematoma was 15.11 ± 5.13 weeks in the NP group compared with 21.22 ± 8.25 weeks in the AP group (p hematoma (54.1%) and palpable contractions (62.8%) was significantly higher than in the NP group (25.7% and 12.1%, respectively; p hematoma and incidence of vaginal bleeding were found. Intrauterine hematoma in the second and third trimesters is a sign of pathological pregnancy, resulting in adverse outcomes. Maternal age, gestational age at first diagnosis, location of hematoma and accompanying contraction are risk factors for poor pregnancy outcomes.

  10. Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study.

    Science.gov (United States)

    Räisänen, Sari; Georgiadis, Leena; Harju, Maija; Keski-Nisula, Leea; Heinonen, Seppo

    2012-12-01

    To identify risk factors associated with velamentous cord insertion (VCI) and to evaluate the association between adverse pregnancy outcomes and VCI in singleton pregnancies. The total population of women (n=26,849) with singleton pregnancies delivered in Kuopio University Hospital during the study period between 2000 and 2011 was reviewed. Risk factors and the risk of adverse pregnancy outcomes (admission to a neonatal unit, fetal death, preterm delivery, low birth weight (LBWprematurity and impaired fetal growth. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

    DEFF Research Database (Denmark)

    Nielsen, Stine Yde; Henriksen, T B; Hjøllund, Niels Henrik Ingvar

    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....../or domestic exposure to livestock and a reference group of women with no animal contact was sampled. Outcome measures were miscarriage, very preterm birth (before gestational week 32), preterm birth (before 37 gestational weeks), small for gestational age (SGA), and perinatal death. Adverse reproductive...... outcomes were assessed in four different exposure groups of women with occupational or domestic exposure to livestock with no association found between exposure to livestock and miscarriage, preterm birth, SGA or perinatal death. These findings should diminish general occupational health concerns...

  12. Adverse Pregnancy Outcomes of Patients with History of First-Trimester Recurrent Spontaneous Abortion

    Directory of Open Access Journals (Sweden)

    Jing Yang

    2017-01-01

    Full Text Available Although a history of first-trimester recurrent spontaneous abortion (FRSA is regarded as a risk factor in antenatal care, the characteristic of subsequent pregnancy outcome is not clearly elucidated. Here, a retrospective analysis was performed on the clinical data of 492 singleton pregnant women. 164 of them with the history of FRSA were enrolled in study group, compared to 328 deliveries without the history of FRSA. For maternal outcomes, patients in the study group delivered earlier with mean gestational age and the incidences of cesarean section and postpartum hemorrhage were higher compared to the control group. For placental outcomes, the incidence of placenta-mediated pregnancy complications (PMPC in the study group increased in terms of late-onset preeclampsia, oligohydramnios, early-onset fetal growth restriction, and second-trimester abortion. Patients in the study group were more likely to suffer from placenta accreta, placenta increta, and placenta percreta. For perinatal outcomes, the proportion of birth defects of newborns in the study group was greater. At last, logistic regression analyses showed that the history of FRSA was an independent risk factor for cesarean section and pregnancy complications. In conclusion, women with the history of FRSA are often exposed to an elevated incidence of maternal-placental-perinatal adverse pregnancy outcomes.

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

    LENUS (Irish Health Repository)

    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.

  14. Association between periodontal disease and adverse pregnancy outcomes in a cohort of pregnant women in Jordan.

    Science.gov (United States)

    Alchalabi, H A; Al Habashneh, R; Jabali, O Al; Khader, Y S

    2013-01-01

    The relationship between periodontal disease (PD) and adverse pregnancy outcomes remain unclear. The authors' objective was to assess the risk of adverse pregnancy outcomes in Jordanian women with periodontal disease compared to those without. Between April 2009 and June 2010, 277 pregnant women with no systemic diseases at gestational age Pregnancy outcomes were obtained by phone contact and review of medical records. The incidence of periodontal disease in the pregnant women enrolled was 31%. Women with PD were at higher risk for developing preeclampsia (PE), preterm birth (PB), and low birth weight (LBW). The rate of PE in women with PD was 18.6% compared to 7.3% in the control group (p = 0.005) (OR = 2.7, 95% CI: 1.2, 6.0). The OR for PB was (4.4, 95% CI: 1.7, 11.7) and for LBW was (3.5, 95% CI: 1.6, 7.5). PD is associated with increased risk of PE, PB, and LBW in healthy Jordanian women.

  15. Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

    Science.gov (United States)

    Feng, Ru; Liu, Lu; Zhang, Yuan-Yuan; Yuan, Zhong-Shang; Gao, Ling; Zuo, Chang-Ting

    2018-05-05

    Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes. The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses. The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ 2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001). Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

  16. Pre-existing diabetes mellitus and adverse pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

  18. A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics.

    Science.gov (United States)

    Turton, Mervyn Sydney; Henkel, Ralf Reinhold; Africa, Charlene Wilma Joyce

    2017-12-01

    Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics. At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki. Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

  19. Population attributable risk for adverse pregnancy outcomes related to smoking in adolescents and adults

    NARCIS (Netherlands)

    Delpisheh, A.; Kelly, Y.; Rizwan, S.; Attia, E.; Drammond, S.; Brabin, B. J.

    2007-01-01

    BACKGROUND: Little is known about how population-attributable risks (PAR) for adverse birth outcomes due to smoking differ in adolescent and adult pregnancies. METHODS: An analysis of community and hospital-based cross-sectional studies in Liverpool was undertaken to estimate the PAR values of low

  20. [Relationship between pesticide exposure and adverse pregnancy outcomes among reproductive couples in rural areas of China].

    Science.gov (United States)

    Qu, Y M; Chen, S; Li, J J; Jin, R R; Pan, H; Jiang, Y

    2017-06-10

    Objective: To analyze the association between pesticide exposure and adverse pregnancy outcomes in women from the rural areas of China. Methods: Data of "National Free Preconception Health Examination Project (NFPHEP)" from January 2010 to December 2012 was used for analysis. A total of 248 501 families that were planning to deliver a baby in the next 6 months were enrolled. Data on paternal exposure to pesticides before or during pregnancy was collected through questionnaires, with related outcomes on pregnancy recorded by doctors. Results: Among all the 248 501 participants, 1 806 (0.74 % ) women and 2 653 (1.09 % ) men reported to have been exposed to pesticide before pregnancy, with 505 (0.21 % ) reported of having been exposed to pesticide during the period of pregnancy. Maternal exposure to pesticide was found a risk factor related to stillbirth ( OR =3.37, 95 %CI : 2.05-5.55), peculiar smell pregnancy ( OR =3.17, 95 %CI :1.18-8.55) and low birth weight ( OR =7.56, 95 % CI : 5.36-10.66). Paternal exposure to pesticide was also found related to miscarriage ( OR =1.37, 95 % CI : 1.03-1.80), low birth weight ( OR =3.65, 95 % CI :1.51-8.84), or giant infant ( OR =0.64, 95 %CI : 0.44-0.93). Maternal exposure to pesticide during pregnancy appeared a risk factor on miscarriage ( OR =4.65, 95 % CI : 3.47-6.24). Other adverse outcomes on pregnancy would include premature birth and high birth weight. Conclusion: Parental pesticide exposure appeared a risk factor on stillbirth, peculiar smell pregnancy, low birth weight and miscarriage.

  1. Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women.

    Science.gov (United States)

    Ho, Yi-Ran; Wang, Panchalli; Lu, Mei-Chun; Tseng, Shih-Ting; Yang, Chun-Pai; Yan, Yuan-Horng

    2017-01-01

    The objective of this study was to investigate the associations among the mid-pregnancy glycated hemoglobin A1c (HbA1c) level, gestational diabetes (GDM), and risk of adverse pregnancy outcomes in women without overt diabetes and with positive 50-g, 1-h glucose challenge test (GCT) results (140 mg/dL or greater). This prospective study enrolled 1,989 pregnant Taiwanese women. A two-step approach, including a 50-g, 1-h GCT and 100-g, 3-h oral glucose tolerance test (OGTT), was employed for the diagnosis of GDM at weeks 23-32. The mid-pregnancy HbA1c level was measured at the time the OGTT was performed. A receiver operating characteristic (ROC) curve was used to determine the relationship between the mid-pregnancy HbA1c level and GDM. Multiple logistic regression models were implemented to assess the relationships between the mid-pregnancy HbA1c level and adverse pregnancy outcomes. An ROC curve demonstrated that the optimal mid-pregnancy HbA1c cut-off point to predict GDM, as diagnosed by the Carpenter-Coustan criteria using a two-step approach, was 5.7%. The area under the ROC curve of the mid-pregnancy HbA1c level for GDM was 0.70. Compared with the levels of 4.5-4.9%, higher mid-pregnancy HbA1c levels (5.0-5.4, 5.5-5.9, 6.0-6.4, 6.5-6.9, and >7.0%) were significantly associated with increased risks of gestational hypertension or preeclampsia, preterm delivery, admission to the neonatal intensive care unit, low birth weight, and macrosomia (the odds ratio [OR] ranges were 1.20-9.98, 1.31-5.16, 0.88-3.15, 0.89-4.10, and 2.22-27.86, respectively). The mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. However, it lacked adequate sensitivity and specificity to replace the two-step approach in the diagnosis of GDM. The current study comprised a single-center prospective study; thus, additional, randomized control design studies are required.

  2. First trimester maternal serum pregnancy-specific beta-1-glycoprotein (SP1) as a marker of adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Pihl, Kasper; Larsen, Torben; Laursen, Inga

    2009-01-01

    MBP and PAPP-A. METHODS: A case-control study was conducted in a primary hospital setting. The SP1 concentration was measured in first trimester maternal serum in pregnancies with small-for-gestational age fetuses (SGA) (n = 150), spontaneous preterm delivery (n = 88), preeclampsia (n = 40) and in controls (n...... = 500). Concentrations were converted to multiples of the median (MoM) in controls and groups were compared using Mann-Whitney U-test. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcome. Screening performance was assessed using receiver...

  3. 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

  4. Prevalence of abortion and adverse pregnancy outcomes among working women in Korea: A cross-sectional study.

    Science.gov (United States)

    Park, Chulyong; Kang, Mo-Yeol; Kim, Dohyung; Park, Jaechan; Eom, Huisu; Kim, Eun-A

    2017-01-01

    To investigate incidence and distribution of major adverse reproductive health problems related to various kinds of industries in Korea and to compare risks for major reproductive outcomes to assess maternal health in working and non-working women. We requested claim data from the Korean National Health Insurance. We defined reference groups as (1) non-working women and (2) workers in the education field. Women working in each industry were compared with reference groups regarding rates of miscarriage, threatened abortion, preterm labor, and intrauterine growth restriction. Logistic regression was used for multivariate analysis, and age and income adjustment was performed. The percentages of all adverse obstetric outcomes were higher in working women than in non-working women. Working women had higher and statistically significant adjusted odds ratios (ORs) for miscarriage in 18 of the 21 industries. The age and income-adjusted OR for miscarriage for all working women was 1.26 (95% confidence interval, 1.23-1.28). Business facilities management and business support services, manufacturing, human health and social work activities, wholesale and retail trade, and professional, scientific, and technical activities were major industries with higher adjusted ORs for adverse obstetric outcomes. We confirmed that compared to non-working women, working women have a higher risk for adverse pregnancy outcomes. Thus, adverse pregnancy outcomes such as threatened abortion, preterm labor, and intrauterine growth restriction may be associated with working status. This exploratory study identified several industries where in-depth studies are required in future to improve occupational safety in women of reproductive age.

  5. Prevalence of abortion and adverse pregnancy outcomes among working women in Korea: A cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Chulyong Park

    Full Text Available To investigate incidence and distribution of major adverse reproductive health problems related to various kinds of industries in Korea and to compare risks for major reproductive outcomes to assess maternal health in working and non-working women.We requested claim data from the Korean National Health Insurance. We defined reference groups as (1 non-working women and (2 workers in the education field. Women working in each industry were compared with reference groups regarding rates of miscarriage, threatened abortion, preterm labor, and intrauterine growth restriction. Logistic regression was used for multivariate analysis, and age and income adjustment was performed.The percentages of all adverse obstetric outcomes were higher in working women than in non-working women. Working women had higher and statistically significant adjusted odds ratios (ORs for miscarriage in 18 of the 21 industries. The age and income-adjusted OR for miscarriage for all working women was 1.26 (95% confidence interval, 1.23-1.28. Business facilities management and business support services, manufacturing, human health and social work activities, wholesale and retail trade, and professional, scientific, and technical activities were major industries with higher adjusted ORs for adverse obstetric outcomes.We confirmed that compared to non-working women, working women have a higher risk for adverse pregnancy outcomes. Thus, adverse pregnancy outcomes such as threatened abortion, preterm labor, and intrauterine growth restriction may be associated with working status. This exploratory study identified several industries where in-depth studies are required in future to improve occupational safety in women of reproductive age.

  6. Vitamin D and adverse pregnancy outcomes: beyond bone health and growth.

    Science.gov (United States)

    Brannon, Patsy M

    2012-05-01

    Concerns exist about adequacy of vitamin D in pregnant women relative to both maternal and fetal adverse health outcomes. Further contributing to these concerns is the prevalence of inadequate and deficient vitamin D status in pregnant women, which ranges from 5 to 84% globally. Although maternal vitamin D metabolism changes during pregnancy, the mechanisms underlying these changes and the role of vitamin D during development are not well understood. Observational evidence links low maternal vitamin D status with an increased risk of non-bone health outcome in the mother (pre-eclampsia, gestational diabetes, obstructed labour and infectious disease), the fetus (gestational duration) and the older offspring (developmental programming of type 1 diabetes, inflammatory and atopic disorders and schizophrenia); but the totality of the evidence is contradictory (except for maternal infectious disease and offspring inflammatory and atopic disorders), lacking causality and, thus, inconclusive. In addition, recent evidence links not only low but also high maternal vitamin D status with increased risk of small-for-gestational age and schizophrenia in the offspring. Rigorous and well-designed randomised clinical trials need to determine whether vitamin D has a causal role in non-bone health outcomes in pregnancy.

  7. Proteomic signature of periodontal disease in pregnancy: Predictive validity for adverse outcomes.

    Science.gov (United States)

    Ramchandani, Manisha; Siddiqui, Muniza; Kanwar, Raveena; Lakha, Manwinder; Phi, Linda; Giacomelli, Luca; Chiappelli, Francesco

    2011-01-06

    The rate of preterm birth is a public health concern worldwide because it is increasing and efforts to prevent it have failed. We report a Clinically Relevant Complex Systematic Review (CSCSR) designed to identify and evaluate the best available evidence in support of the association between periodontal status in women and pregnancy outcome of preterm low birth weight. We hypothesize that the traditional limits of research synthesis must be expanded to incorporate a translational component. As a proof-of-concept model, we propose that this CSCSR can yield greater validity of efficacy and effectiveness through supplementing its recommendations with data of the proteomic signature of periodontal disease in pregnancy, which can contribute to addressing specifically the predictive validity for adverse outcomes. For this CRCSR, systematic reviews were identified through The National Library of MedicinePubmed, The Cochrane library, CINAHL, Google Scholar, Web of Science, and the American Dental Association web library. Independent reviewers quantified the relevance and quality of this literature with R-AMSTAR. Homogeneity and inter-rater reliability testing were supplemented with acceptable sampling analysis. Research synthesis outcomes were analyzed qualitatively toward a Bayesian inference, and converge to demonstrate a definite association between maternal periodontal disease and pregnancy outcome. This CRCSR limits heterogeneity in terms of periodontal disease, outcome measure, selection bias, uncontrolled confounders and effect modifiers. Taken together, the translational CRCSR model we propose suggests that further research is advocated to explore the fundamental mechanisms underlying this association, from a molecular and proteomic perspective.

  8. Glyphosate and adverse pregnancy outcomes, a systematic review of observational studies

    Directory of Open Access Journals (Sweden)

    Jessica S. A. de Araujo

    2016-06-01

    Full Text Available Abstract Background A study in frog and chicken embryos, and reports of a high incidence of birth defects in regions of intensive GM-soy planting have raised concerns on the teratogenic potential of glyphosate-based herbicides. These public concerns prompted us to conduct a systematic review of the epidemiological studies testing hypotheses of associations between glyphosate exposure and adverse pregnancy outcomes including birth defects. Methods A systematic and comprehensive literature search was performed in MEDLINE, TOXLINE, Bireme-BVS and SCOPUS databases using different combinations of exposure and outcome terms. A case–control study on the association between pesticides and congenital malformations in areas of extensive GM soy crops in South America, and reports on the occurrence of birth defects in these regions were reviewed as well. Results The search found ten studies testing associations between glyphosate and birth defects, abortions, pre-term deliveries, small for gestational date births, childhood diseases or altered sex ratios. Two additional studies examined changes of time-to-pregnancy in glyphosate-exposed populations. Except for an excess of Attention Deficit Hyperactivity Disorder - ADHD (OR = 3.6, 1.3-9.6 among children born to glyphosate appliers, no significant associations between this herbicide and adverse pregnancy outcomes were described. Evidence that in South American regions of intensive GM-soy planting incidence of birth defects is high remains elusive. Conclusions Current epidemiological evidence, albeit limited to a few studies using non-quantitative and indirect estimates and dichotomous analysis of exposures, does not lend support to public concerns that glyphosate-based pesticides might pose developmental risks to the unborn child. Nonetheless, owing to methodological limitations of existing analytical observational studies, and particularly to a lack of a direct measurement (urine and/or blood levels

  9. Adolescence as risk factor for adverse pregnancy outcome in Central Africa--a cross-sectional study.

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    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.

  10. The proform of eosinophil major basic protein: a new maternal serum marker for adverse pregnancy outcome

    DEFF Research Database (Denmark)

    Pihl, Kasper; Larsen, Torben; Rasmussen, Steen

    2009-01-01

    OBJECTIVE: To establish the first trimester serum levels of the proform of eosinophil major basic protein (proMBP) in pregnancies with adverse outcome. Furthermore, to determine the screening performance using proMBP alone and in combination with other first trimester markers. METHODS: A case-control...... study was conducted in a primary hospital setting. The proMBP concentration was measured in cases with small-for-gestational age (SGA) (n = 150), spontaneous preterm delivery (n = 88), preeclampsia (n = 40), gestational hypertension (n = 10) and in controls (n = 500). Concentrations were converted...... to multiples of the median (MoM) in controls and groups were compared using Mann-Whitney U-test. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcome. Screening performance was assessed using receiver operating characteristic curves. RESULTS: The pro...

  11. 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.

  12. Inter-pregnancy interval and pregnancy outcomes among HIV ...

    African Journals Online (AJOL)

    owner

    Abstract Background: Both short and long inter-pregnancy intervals have been associated with higher risk of adverse pregnancy outcomes. More so, short inter- pregnancy interval among HIV- positive women implies higher birth rate and subsequently a higher number of neonates exposed to HIV and potentially at.

  13. Gynecologists' knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes.

    Science.gov (United States)

    Hashim, Raghad; Akbar, Madiha

    2014-12-01

    A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health care during pregnancy and the association of periodontal disease with adverse pregnancy outcomes. A questionnaire consisting of 16 questions was designed and pilot tested. One hundred and fifty gynecologists practicing in the private sector of United Arab Emirates (UAE) were approached to voluntarily participate and fill up the questionnaire during February-March 2014. Data retrieved were entered into Excel database and analyzed using SPSS. Of the 150 gynecologists approached, 108 filled the questionnaire, yielding a response rate of 72%. The majority (95.4%) acknowledged a connection between oral health and pregnancy and 75.9% agreed that periodontal disease can affect the outcome of pregnancy. Moreover, most of the gynecologists (85.2%) advised their pregnant patients to visit the dentist during pregnancy. Almost three-quarter of the participants (73%) regarded dental radiographs to be unsafe during pregnancy and more than half (59.3%) considered administration of local anesthesia to be unsafe during pregnancy. The present study demonstrated that gynecologists have a relatively high degree of knowledge with respect to the relationship of periodontal disease to pregnancy outcome. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and the medical community, and misconceptions regarding the types of dental treatments during pregnancy should be clarified.

  14. Risk of adverse pregnancy outcomes in women with periodontal disease and the effectiveness of interventions in decreasing this risk: protocol for systematic overview of systematic reviews.

    Science.gov (United States)

    Vanterpool, Sizzle F; Tomsin, Kathleen; Reyes, Leticia; Zimmermann, Luc J; Kramer, Boris W; Been, Jasper V

    2016-02-01

    Periodontal disease is an inflammatory disease of the tissues supporting the teeth. Women who have periodontal disease while pregnant may be at risk of adverse pregnancy outcomes. Although the association between periodontal disease and adverse pregnancy outcomes has been addressed in a considerable number of systematic reviews and meta-analyses, there are important differences in the conclusions of these reviews. Systematic reviews assessing the effectivity of various therapeutic interventions to treat periodontal disease during pregnancy to try and reduce adverse pregnancy outcomes have also arrived at different conclusions. We aim to provide a systematic overview of systematic reviews comparing the frequency of adverse pregnancy outcomes between women with and without periodontal disease and/or evaluating the effect of preventive and therapeutic interventions for periodontal disease before or during pregnancy on adverse pregnancy outcomes. We will include systematic reviews reporting on studies comparing adverse pregnancy outcomes: (i) between women with or without periodontal disease before (pregnancy and/or (ii) according to preventive or therapeutic interventions for periodontal disease. Eligible interventions include (combinations of) the following: oral hygiene education, use of antibiotics, subgingival scaling, and root planing. For preventive and/or therapeutic reviews, the following comparisons will be considered: no intervention, a placebo intervention, or an alternative intervention. Our primary adverse pregnancy outcomes of interests are maternal mortality, preterm delivery, and perinatal mortality. Two reviewers will independently identify eligible published and unpublished systematic reviews from six electronic databases and using hand searching of reference lists and citations. Data items extracted from included systematic reviews are based on the Cochrane Effective Practice and Organization of Care checklist and the preferred reporting items for

  15. Association between adverse pregnancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia.

    Science.gov (United States)

    Turpin, Cornelius A; Sakyi, Samuel A; Owiredu, William K B A; Ephraim, Richard K D; Anto, Enoch O

    2015-08-25

    Gestational hypertension (GH) and Preeclampsia, (PE) are the most complicated amongst hypertensive disorders of pregnancy. The mechanism that links hypertension in pregnancy to adverse maternal outcomes is not fully understood though some relate this to endothelial dysfunction originating from an imbalanced angiogenic regulators and oxidative stress biomarkers. This study assessed the correlation between angiogenic regulators and oxidative stress biomarker levels with adverse pregnancy outcomes among GH and PE participants. A cohort of pregnant women who received antenatal care at the Obstetrics and Gynaecology department of the Komfo Anokye Teaching Hospital (KATH) were followed. During their antenatal visits, 100 developed PE and 70 developed GE, of these, 50 PE and 50 GH gave informed consent. Their blood samples were taken at time of diagnosis and 48 h post-partum. 50 other aged-matched women who did not develop neither GH nor PE were selected as controls. Placental growth factor (PLGF), soluble fms-like tyrosine kinase 1 (sFlt-1) and 8-epi-prostaglandin F2alpha (8-epi-PGF2α) levels were estimated by ELISA and total antioxidant capacity (T-AOC) was measured spectrophotometrically. Graphpad Prism was used for data analysis. Median levels of sFlt-1, 8-epi-PGF2α and sFlt-1/PLGF were elevated among participants with PE co-existing with intrauterine fetal death (IUFD), placental abruptio, placental previa, HELLP syndrome and intrauterine growth restriction (IUGR) compared to PE without adverse outcomes (p = 0.041, p = 0.005, p = 0.0002). Levels of PLGF, T-AOC and PLGF/sFlt-1 were significantly reduced among participants with PE co-existing with IUFD, placental abruptio, placental previa, HELLP syndrome and IUGR compared to PE without adverse outcomes (p = 0.0013, p = 0.006, p < 0.0001). A significant negative correlation of IUGR (p = 0.0030; p < 0.0001), placental abruptio (p < 0.0001; p < 0.0001), IUFD (p < 0.0001; p

  16. Oral health status and adverse pregnancy outcomes among pregnant women in Haryana, India: A prospective study

    Directory of Open Access Journals (Sweden)

    Puneet Singh Talwar

    2015-01-01

    Full Text Available Background: Women′s oral health is affected by certain conditions such as pregnancy, puberty, menstrual cycle, menopause and nonphysiological conditions such as hormonal contraception and hormonal therapy. This study was conducted to assess the oral health status and treatment needs of pregnant women and to correlate periodontal health with adverse pregnancy outcomes like preterm birth (PTB and low birth weight (LBW. Materials and Methods: A prospective study was undertaken at a Government Hospital in Haryana. Pregnant women who were in their third trimester of pregnancy and visited the hospital for routine ante-natal check-up constituted the final sample size (223. Dental caries and periodontal status were assessed using a WHO Proforma-1997. None of the subjects were in the habit of taking alcohol, chewing and smoking tobacco. The main outcome measures were gestational age and weight of the newborn. Data were analyzed using SPSS package version 13. Results: Decayed, missing and filled teeth index of the subjects was 2.87. Extraction was indicated in younger subjects when compared to the older ones. Bleeding was the main finding, which was present in 47.5% of the study subjects, followed by calculus. 63 more than 60% of subjects of subjects with 4-5 mm attachment loss belonged to 20-24 years age-group. There was a statistically significant association of probing depths and attachment loss with adverse pregnancy outcomes (P < 0.05 (PTB and LBW. Conclusion: There is a significant association between maternal periodontitis and pregnancy outcomes in the present study. It is recommended that suitable measures be undertaken by various health organizations to prevent periodontal problems among this particular group.

  17. Infertility, Pregnancy Loss and Adverse Birth Outcomes in Relation to Maternal Secondhand Tobacco Smoke Exposure

    Science.gov (United States)

    Meeker, John D.; Benedict, Merle D.

    2013-01-01

    A substantial proportion of the etiology involved in female infertility and adverse pregnancy outcomes remains idiopathic. Recent scientific research has suggested a role for environmental factors in these conditions. Secondhand tobacco smoke (STS) contains a number of known or suspected reproductive toxins, and human exposure to STS is prevalent worldwide. Robust evidence exists for the toxic effects of active smoking on fertility and pregnancy, but studies of passive exposure are much more limited in number. While the association between maternal STS exposure and declined birth weight has been fairly well-documented, only recently have epidemiologic studies begun to provide suggestive evidence for delayed conception, altered menstrual cycling, early pregnancy loss (e.g. spontaneous abortion), preterm delivery, and congenital malformations in relation to STS exposure. There is also new evidence that developmental exposures to tobacco smoke may be associated with reproductive effects in adulthood. To date, most studies have estimated maternal STS exposure through self-report even though exposure biomarkers are less prone to error and recall bias. In addition to utilizing biomarkers of STS exposure, future studies should aim to identify vital windows of STS exposure, important environmental co-exposures, individual susceptibility factors, and specific STS constituents associated with female infertility and adverse pregnancy outcomes. The role of paternal exposures/factors should also be investigated. PMID:23888128

  18. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie

    2015-01-01

    pregnant women referred to two Danish clinics of occupational medicine (Copenhagen and Aarhus) from 1984 to 2010 were compared with the referred women's 1,077 non-referred pregnancy outcomes and with the pregnancy outcomes of 345,467 gainfully employed women from the same geographical areas and time period.......72-1.17). CONCLUSION: The women who are referred for occupational risk assessment at two large occupational university departments are not at an increased risk of preterm birth or of delivering low birth weight children. This may reflect that reproductive hazards in Danish workplaces are limited and....../or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study...

  19. 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.

  20. 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.

  1. Risk of adverse pregnancy outcomes in women with periodontal disease and the effectiveness of interventions in decreasing this risk: Protocol for systematic overview of systematic reviews

    NARCIS (Netherlands)

    S.F. Vanterpool (Sizzle); K. Tomsin (Kathleen); L. Reyes (Leticia); L.J.I. Zimmermann (Luc); B.W. Kramer (Boris); J.V. Been (Jasper V.)

    2016-01-01

    textabstractBackground: Periodontal disease is an inflammatory disease of the tissues supporting the teeth. Women who have periodontal disease while pregnant may be at risk of adverse pregnancy outcomes. Although the association between periodontal disease and adverse pregnancy outcomes has been

  2. Changes in inflammatory mediators in gingival crevicular fluid following periodontal disease treatment in pregnancy: relationship to adverse pregnancy outcome.

    Science.gov (United States)

    Penova-Veselinovic, Blagica; Keelan, Jeffrey A; Wang, Carol A; Newnham, John P; Pennell, Craig E

    2015-11-01

    Periodontal disease (PD) in pregnancy is associated with an increased risk of adverse pregnancy outcomes including miscarriage and preterm birth. Evidence exists that periodontal disease treatment may reduce inflammatory mediators in gingival crevicular fluid (GCF) and the risk of inflammation-associated pregnancy complications. The aim was to determine if periodontal disease treatment during mid-pregnancy alters local inflammation in GCF and has beneficial effects on clinical dental parameters. Eighty pregnant women with clinically diagnosed PD were recruited from a randomised controlled trial on the treatment of periodontal disease in pregnancy conducted in Perth, Australia. The treatment group underwent intensive PD treatment (20-28 weeks' GA), while the control group underwent the same treatment postnatally. GCF was collected at 20 and 28 weeks' gestation and concentrations of cytokines determined by multiplex assay: IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, TNF-α and MCP-1. Periodontal treatment significantly reduced the GCF levels of IL-1β, IL-10, IL-12p70 and IL-6 at 28 weeks' GA compared with controls, while levels of MCP-1, IL-8 and TNF-α exhibited a significant gestational age-dependent increase, but no treatment response. Post-treatment clinical parameters improved with significant reductions in bleeding on probing, clinical attachment loss, and probing depth. No changes in pregnancy-related outcomes were observed, although the severity of periodontal disease was significantly associated with an increased risk of infants born small for gestational age. PD treatment in pregnancy reduces the levels of some inflammatory mediators in the GCF and improves dental parameters, with no overt effects on pregnancy outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. 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...... exposed, and of non-laboratory employees unexposed (n = 1,909). Exposure data were obtained by questionnaires to research group leaders. Logistic regression analysis estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Paternal laboratory work in general showed no statistically...

  4. Does tea consumption during early pregnancy have an adverse effect on birth outcomes?

    Science.gov (United States)

    Lu, Jin-Hua; He, Jian-Rong; Shen, Song-Ying; Wei, Xue-Ling; Chen, Nian-Nian; Yuan, Ming-Yang; Qiu, Lan; Li, Wei-Dong; Chen, Qiao-Zhu; Hu, Cui-Yue; Xia, Hui-Min; Bartington, Suzanne; Cheng, Kar Keung; Lam, Kin Bong Hubert; Qiu, Xiu

    2017-09-01

    Tea, a common beverage, has been suggested to exhibit a number of health benefits. However, one of its active ingredients, caffeine, has been associated with preterm birth and low birthweight. We investigated whether tea consumption during early pregnancy is associated with an increased risk of preterm birth and abnormal fetal growth. A total of 8775 pregnant women were included from the Born in Guangzhou Cohort Study. Tea consumption (type, frequency, and strength) during their first trimester and social and demographic factors were obtained by way of questionnaires administered during pregnancy. Information on birth outcomes and complications during pregnancy was obtained from hospital medical records. Overall habitual tea drinking (≥1 serving/week) prevalence among pregnant women was low, at 16%. After adjustment for potential confounding factors (eg, maternal age, educational level, monthly income) tea drinking during early pregnancy was not associated with an increased risk of preterm birth or abnormal fetal growth (small or large for gestational age) (P>.05). We did not identify a consistent association between frequency of tea consumption or tea strength and adverse birth outcomes among Chinese pregnant women with low tea consumption. Our findings suggest that occasional tea drinking during pregnancy is not associated with increased risk of preterm birth or abnormal fetal growth. Given the high overall number of annual births in China, our findings have important public health significance. © 2017 Wiley Periodicals, Inc.

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

    International Nuclear Information System (INIS)

    Mjoen, Geir; Saetre, Dag Ottar; Lie, Rolv T.; Tynes, Tore; Blaasaas, Karl Gerhard; Hannevik, Merete; Irgens, Lorentz M.

    2006-01-01

    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

  6. Adverse pregnancy outcomes in deliveries prior to, at and beyond 39 weeks; low- and high-risk women.

    Science.gov (United States)

    Moussa, Hind N; Hosseini Nasab, Susan; Amro, Farah H; Hoayek, Jennifer; Haidar, Ziad A; Blackwell, Sean C; Sibai, Baha M

    2017-07-18

    Hypertensive disorders are associated with maternal and neonatal complications. Though they are more common in women with history of prior preeclampsia, they can occur in uncomplicated pregnancies. To determine the proportion of adverse pregnancy outcomes in deliveries prior to or at ≥39 weeks, in uncomplicated singleton nulliparous women (low-risk), as well as women with history of preeclampsia in a prior gestation (high-risk). This was a secondary analysis from the multicenter trials of low dose aspirin for preeclampsia prevention in low and high-risk pregnancies. The proportion of adverse pregnancy outcomes including hypertensive disorders in pregnancy, small for gestational age, placental abruption, neonatal intensive critical unit admission, and respiratory distress syndrome were evaluated in the two groups. Adverse pregnancy outcomes were stratified by gestational age at delivery (39 weeks and ≥39 weeks). Descriptive statistics were performed, and results reported as percentages. Three thousand twenty-one pregnancies were included in the low risk group, and 600 in the high risk one. In the low risk group 362 (12%) had hypertensive disorders, with 58% occurring at ≥39 weeks. In the low risk group, the rate of small for gestational age was of 5.9%, placental abruption 0.4%, neonatal intensive care unit admission 9%, and respiratory distress syndrome 3.5%. Sixty percent of all small for gestational age, 31% of all placenta abruptions, 44% of all neonatal intensive care unit admissions and 33% of respiratory distress syndrome cases, occurred at ≥39 weeks in the low risk group. In contrast in the high risk group, 197 (33%) patients developed a hypertensive disorder, with 35.5% occurring at ≥39 weeks. The overall rate of small for gestational age was 9.2%, abruption 2%, neonatal intensive care unit admission 15.5%, and respiratory distress syndrome 5%. In this group, 24% of all small for gestational age, 8.3% of all placental abruptions, 16% of all

  7. 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 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.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.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%.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 that quantify population-based background rates of

  8. Thyroid dysfunction and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Sima Nazarpour

    2015-07-01

    Full Text Available Background: Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high. Objective: The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes. Materials and Methods: In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective, case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded. Results: Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects. Conclusion: While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly

  9. Outcome of pregnancy in survivors of Wilms' tumor

    International Nuclear Information System (INIS)

    Li, F.P.; Gimbrere, K.; Gelber, R.D.; Sallan, S.E.; Flamant, F.; Green, D.M.; Heyn, R.M.; Meadows, A.T.

    1987-01-01

    Outcome of pregnancy was reported by 99 patients who were cured of childhood Wilms' tumor at seven pediatric cancer centers during 1931 to 1979. These patients carried or sired 191 singleton pregnancies of at least 20 weeks in duration. Among the 114 pregnancies in women who had received abdominal radiotherapy for Wilms' tumor, an adverse outcome occurred in 34 (30%). There were 17 perinatal deaths (five in premature low-birth-weight infants) and 17 other low-birth-weight infants. Compared with white women in the United States, the irradiated women had an increased perinatal mortality rate (relative risk, 7.9) and an excess of low-birth-weight infants (relative risk, 4.0). In contrast, an adverse outcome was found in two (3%) of the 77 pregnancies in nonirradiated female patients with Wilms' tumor and wives of male patients. The high risk of adverse pregnancy outcome should be considered in the counseling and prenatal care of women who have received abdominal radiotherapy for Wilms' tumor

  10. Periodontal Disease and Pregnancy Outcomes

    OpenAIRE

    Babalola, Dolapo A.; Omole, Folashade

    2010-01-01

    An increasing number of studies are confirming an association between periodontal disease (PD) and adverse outcomes in pregnancy. PD places pregnant women at greater risk for preterm birth than alcohol consumption or smoking. This underscores the importance of offering dental screening to women who are pregnant or contemplating pregnancy and the need for physicians who provide obstetric care to be aware of the possible connection between poor dental health and poor pregnancy outcomes.

  11. Contribution of overweight and obesity to adverse pregnancy outcomes among immigrant and non-immigrant women in Berlin, Germany.

    Science.gov (United States)

    Reiss, Katharina; Breckenkamp, Jürgen; Borde, Theda; Brenne, Silke; David, Matthias; Razum, Oliver

    2015-10-01

    Maternal excessive weight and smoking are associated with an increased risk of pregnancy complications and adverse pregnancy outcomes. In Germany, immigrant women have a higher prevalence of pre-pregnancy overweight/obesity compared with autochthonous women. We compared the contribution of pre-pregnancy overweight/obesity to adverse pregnancy outcomes among immigrant and autochthonous women in Berlin/Germany. Data from 2586 immigrant women (from Turkey, Lebanon, other countries of origin) and 2676 autochthonous women delivering in three maternity hospitals of Berlin within 12 months (2011/2012) was used. Cox regression models were applied to estimate the association between overweight/obesity and smoking with the outcomes large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth (PTB) and extreme preterm-birth (E-PTB). Population attributive fractions (PAF) were calculated to quantify the proportion of the outcomes attributable to overweight/obesity and smoking, respectively. Prevalence of overweight and obesity was 33.4% among autochthonous and 53.6% among Turkish women. Prevalence risk ratios of excessive weight were highest for LGA infants among immigrant and autochthonous women. The PAFs were -11.8% (SGA), +16.3% (LGA), +3.6% (PTB) and +16.5% (E-PTB) for the total study population. Overweight/obesity is strongly associated with an increased risk of delivering an LGA infant among both immigrant and autochthonous women. Compared with autochthonous women, the contribution of excessive weight to LGA is even higher among immigrant women, in whom PAFs of overweight/obesity even exceed those of smoking for some outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  12. The adverse effects of hypothyroidism and hyperthyroidism during pregnancy

    Directory of Open Access Journals (Sweden)

    Mahnaz Boroumand Rezazadeh

    2015-06-01

    Full Text Available Due to the important role of thyroid disorders on reproductive health of the women of childbearing age, pregnancy outcome, fetal health, and neurodevelopment of the infant, providing comprehensive assessment of the treatments used for preventing hyperthyroidism and hypothyroidism seems to be essential. Therefore, evaluating the efficacy of different treatments of the thyroid disorders would be beneficial in better managing and controlling the disease during pregnancy. Hypothyroidism (a deficiency of thyroid hormone is a common thyroid disorder, which might increase the incidence rate of miscarriage, pre-eclampsia, placental abruption, and preterm delivery. Hyperthyroidism, which is not a common disorder during the pregnancy not only leads to similar adverse effects as hypothyroidism but also can result in stillbirth and intrauterine growth restriction. Levothyroxine is the preferred treatment of hypothyroidism and the only drug therapy recommended for treating hyperthyroidism during pregnancy. In this study, we aimed to briefly review the adverse effects of hyperthyroidism and hypothyroidism during pregnancy and review the effects of recent suggested treatments for controlling thyroid disorders on pregnancy outcomes.

  13. Periodontal disease and pregnancy outcomes: time to move on?

    Science.gov (United States)

    Srinivas, Sindhu K; Parry, Samuel

    2012-02-01

    Maternal periodontal disease is a highly prevalent condition that has been studied extensively in relation to adverse pregnancy outcomes, including preterm delivery, preeclampsia, and low birth weight. Investigators speculate that hematogenous transport of bacteria and/or pro-inflammatory mediators from sites of periodontal infection into the placenta, fetal membranes, and amniotic cavity induces pathological processes that lead to these adverse outcomes. Preliminary observational studies supported this hypothesis, but more recent work by our group and others do not demonstrate an increased risk of adverse pregnancy outcomes among women with periodontal disease, and most randomized trials fail to demonstrate improved perinatal outcomes following treatment of periodontal disease in pregnancy.

  14. Chronic hypertension and the risk for adverse pregnancy outcome after superimposed pre-eclampsia.

    Science.gov (United States)

    Vanek, M; Sheiner, E; Levy, A; Mazor, M

    2004-07-01

    To determine the risk factors and pregnancy outcome of patients with chronic hypertension during pregnancy after controlling for superimposed preeclampsia. A comparison of all singleton term (>36 weeks) deliveries occurring between 1988 and 1999, with and without chronic hypertension, was performed. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. Chronic hypertension complicated 1.6% (n=1807) of all deliveries included in the study (n=113156). Using a multivariable analysis, the following factors were found to be independently associated with chronic hypertension: maternal age >40 years (OR=3.1; 95% CI 2.7-3.6), diabetes mellitus (OR=3.6; 95% CI 3.3-4.1), recurrent abortions (OR=1.5; 95% CI 1.3-1.8), infertility treatment (OR=2.9; 95% CI 2.3-3.7), and previous cesarean delivery (CD; OR=1.8 CI 1.6-2.0). After adjustment for superimposed preeclampsia, using the Mantel-Haenszel technique, pregnancies complicated with chronic hypertension had higher rates of CD (OR=2.7; 95% CI 2.4-3.0), intra uterine growth restriction (OR=1.7; 95% CI 1.3-2.2), perinatal mortality (OR=1.6; 95% CI 1.01-2.6) and post-partum hemorrhage (OR=2.2; 95% CI 1.4-3.7). Chronic hypertension is associated with adverse pregnancy outcome, regardless of superimposed preeclampsia.

  15. Periodontal Disease and Pregnancy Outcomes

    Directory of Open Access Journals (Sweden)

    Dolapo A. Babalola

    2010-01-01

    Full Text Available An increasing number of studies are confirming an association between periodontal disease (PD and adverse outcomes in pregnancy. PD places pregnant women at greater risk for preterm birth than alcohol consumption or smoking. This underscores the importance of offering dental screening to women who are pregnant or contemplating pregnancy and the need for physicians who provide obstetric care to be aware of the possible connection between poor dental health and poor pregnancy outcomes.

  16. 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\

  17. No excess risk of adverse pregnancy outcomes among women with serological markers of previous infection with Coxiella burnetii

    DEFF Research Database (Denmark)

    Nielsen, Stine Yde; Andersen, Anne-Marie Nybo; Mølbak, Kåre

    2013-01-01

    Q fever caused by Coxiella burnetii is transmitted to humans by inhalation of aerosols from animal birth products. Q fever in pregnancy is suspected to be a potential cause of fetal and maternal morbidity and fetal mortality but the pathogenesis is poorly understood, and even in Q fever endemic...... areas, the magnitude of a potential association is not established.We aimed to examine if presence of antibodies to C. burnetii during pregnancy or seroconversion were associated with adverse pregnancy outcomes....

  18. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes : a systematic review

    NARCIS (Netherlands)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-01-01

    BACKGROUND: Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes.

  19. Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight.

    Science.gov (United States)

    Beltran, Alyssa J; Wu, Jun; Laurent, Olivier

    2013-12-20

    The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies.

  20. Inter-pregnancy interval and pregnancy outcomes among HIV ...

    African Journals Online (AJOL)

    Background: Both short and long inter-pregnancy intervals have been associated with higher risk of adverse pregnancy outcomes. More so, short interpregnancy interval among HIVpositive women implies higher birth rate and subsequently a higher number of neonates exposed to HIV and potentially at r i s k o f mo t h e r ...

  1. 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.

  2. Etiology of adverse prenatal Outcome in overweight women

    Directory of Open Access Journals (Sweden)

    Ameneh Safarzadeh

    2016-09-01

    Full Text Available To survey the etiology of adverse prenatal outcome in overweight. This comparative cohort study was conducted from 2010 to 2012. Total 440 gravid women 220were overweight and 220 normal weight pregnant women during at the first visit of pregnancy and third trimester were assessed. The risks for preterm labor, gestational hypertension, pre-eclampsia, gestational diabetes, caesarian section and Macrosomia were higher for those who were overweight at the third trimester of pregnancy (P < 0.05. Maternal BMI was associated with a higher risk for gestational hypertension, gestational diabetes, preterm labor, preeclampsia, caesarian section and fetal macrosomia (P< 0.05. This research demonstrates that maternal BMI was associated with increased risks for adverse pregnancy outcomes.

  3. The risk of adverse pregnancy outcome after bariatric surgery

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Lauenborg, Jeannet; Breum, Birger Michael

    2013-01-01

    The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery.......The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery....

  4. Adequate Prenatal Care Reduces the Risk of Adverse Pregnancy Outcomes in Women with History of Infertility: A Nationwide Population-Based Study

    Science.gov (United States)

    Alibekova, Raushan; Huang, Jian-Pei; Chen, Yi-Hua

    2013-01-01

    Objectives To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. Study Design A retrospective cohort study. Methods Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. Results Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight (VLBW) babies, preterm births, labor complications, and cesarean sections (CSs) compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. Conclusions Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility. PMID:24358347

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

    Science.gov (United States)

    Bautista-Castaño, Inmaculada; Henriquez-Sanchez, Patricia; Alemán-Perez, Nestor; Garcia-Salvador, Jose J; Gonzalez-Quesada, Alicia; García-Hernández, Jose A; Serra-Majem, Luis

    2013-01-01

    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. 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. 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 (pApgar 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). 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 women who intend to get pregnant and to provide appropriate advice to the obese women of the risks of obesity at the start of the pregnancy.

  6. Peri-conceptional HbA1c and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes

    DEFF Research Database (Denmark)

    Jensen, Dorte M; Korsholm, Lars; Ovesen, Per

    2009-01-01

    Objectives : To study the association between peri-conceptional HbA1c and serious adverse pregnancy outcome (congenital malformations and perinatal mortality). Methods: Prospective data collection in 933 singleton pregnancies complicated by type 1 diabetes. Results: The risk of serious adverse ou...... malformation rate increased significantly at HbA1c above 10.4% whereas perinatal mortality was increased even at Hba1c below 6.9%. Conclusions: These results support recent guidelines of pre-conceptional HbA1c levels below 7% in women with type 1 diabetes....

  7. Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa.

    Science.gov (United States)

    Kuznik, Andreas; Habib, Abdulrazaq G; Manabe, Yukari C; Lamorde, Mohammed

    2015-07-01

    Untreated syphilis in pregnancy is associated with adverse clinical outcomes to the infant. The study aimed to estimate the public health burden resulting from adverse pregnancy outcomes due to syphilis infection among pregnant women not screened for syphilis in 43 countries in sub-Saharan Africa. Estimated country-specific incidence of syphilis was generated from annual number of live births, the proportion of women with at least 1 antenatal care (ANC) visit, the syphilis prevalence rate, and the proportion of women screened for syphilis during ANC.Adverse pregnancy outcome data (stillbirth, neonatal death, low birth weight, and congenital syphilis) were obtained from published sources. Disability-adjusted life-year (DALY) estimates were calculated using undiscounted local life expectancy, the neonatal standard loss function, and relevant disability weights. The model assessed the potential impact of raising ANC coverage to at least 95% and syphilis screening to at least 95% (World Health Organization targets). For all 43 sub-Saharan Africa countries, the estimated incidence of adverse pregnancy outcomes was 205,901 (95% confidence interval [CI], 113,256-383,051) per year, including stillbirth (88,376 [95% CI, 60,854-121,713]), neonatal death (34,959 [95% CI, 23,330-50,076]), low birth weight (22,483 [95% CI, 0-98,847]), and congenital syphilis (60,084 [95% CI, 29,073-112,414]), resulting in approximately 12.5 million DALYs. Countries with the greatest burden are (in DALYs, millions) Democratic Republic of the Congo (1.809), Nigeria (1.598), Ethiopia (1.466), and Tanzania (0.961). Attaining World Health Organization targets could reduce the burden by 8.5 million DALYs. Substantial infant mortality and morbidity results from maternal syphilis infection concentrated in countries with low access to ANC or low rates of syphilis screening.

  8. Anaemia in Pregnancy: Prevalence, Risk Factors, and Adverse Perinatal Outcomes in Northern Tanzania.

    Science.gov (United States)

    Stephen, Grace; Mgongo, Melina; Hussein Hashim, Tamara; Katanga, Johnson; Stray-Pedersen, Babill; Msuya, Sia Emmanueli

    2018-01-01

    Anaemia in pregnancy is a public health problem in developing countries. This study aimed to determine the prevalence, risk factors, and adverse perinatal outcomes of anaemia among pregnant women in Moshi Municipal, Northern Tanzania. This was a follow-up study conducted from October 2013 to June 2015. A total of 539 pregnant women were enrolled in this study. Interviews were conducted followed by determination of haemoglobin level. Women were followed up at delivery and at 7 days and 28 days after delivery. A total of 529 women were included in this analysis. Their mean age was 25.8 (SD 5.73). The prevalence of anaemia was 18.0% and 2% had severe anaemia. The clinic of recruitment and low education level of the women were the factors that were independently associated with anaemia during pregnancy. At delivery, there were 10 stillbirths, 16 low birth weight (LBW) newborns, and 2 preterm birth cases. No association was found between anaemia and LBW, preterm birth, or stillbirths. Anaemia in pregnancy was a mild public health problem in the study setting of Northern Tanzania.

  9. The association between adverse pregnancy outcomes and maternal human papillomavirus infection: a systematic review protocol.

    Science.gov (United States)

    Niyibizi, Joseph; Zanré, Nadège; Mayrand, Marie-Hélène; Trottier, Helen

    2017-03-11

    Human papillomavirus (HPV) is the most prevalent genital infection, especially in young women of reproductive age. In vitro and animal model experiments provide compelling evidence of the harmful effect of HPV on pregnancy outcomes, but results from epidemiologic studies are inconclusive. We aim to determine the strength of the relationship between adverse pregnancy outcomes (APO) and HPV infection and assess its consistency across studies, by systematically reviewing the literature. The search strategy has been developed on the basis of the PICOS framework: Population (pregnant women); Exposure (HVP infection confirmed by HPV testing); Comparator (pregnant women without HPV infection); Outcomes (miscarriage, spontaneous preterm birth, low birth weight, preterm premature rupture of membranes, pregnancy-induced hypertensive disorders and intrauterine growth restriction) and Study design (observational studies). We will search three information sources: (1) electronic databases (MEDLINE, EMBASE, and EBM Reviews databases); (2) Grey literature (Google Scholar and Web of Science conference proceedings); and (3) citing and cited articles of included studies. Two reviewers (JN, NZ) will independently and in duplicate screen identified articles, select eligible studies, and extract data. Discrepancies will be resolved by consensus and otherwise by discussion with the other authors (MHM, HT). Quality of included studies will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. We will narratively synthesize extracted data whether meta-analysis is conducted or not. Meta-analysis of each outcome will be performed, and where appropriate, an average measure of association will be computed. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess and grade the strength of confidence in cumulative estimate. Comprehensive and high-quality evidence of a negative

  10. Increased risk of adverse pregnancy outcomes for hospitalisation of women with lupus during pregnancy: a nationwide population-based study.

    Science.gov (United States)

    Chen, C-Y; Chen, Y-H; Lin, H-C; Chen, S-F; Lin, H-C

    2010-01-01

    Using a nationwide population-based dataset to examine the risk of adverse pregnancy outcomes in women with systemic lupus erythematosus (SLE), with and without SLE hospitalisation during pregnancy. We identified 1,010 pregnant women who had SLE during 2001 2003 as the study cohort and 5,050 randomly selected pregnant women (five for every woman with SLE) as a comparison cohort. Conditional logistic regression analyses were performed to explore the relationship between women with and without SLE and the risk of low birth weight (LBW), preterm birth, and babies small for gestational age (SGA), after adjusting for the characteristics of the infant, mother, and father. We found that there were significant differences in the risk of LBW (14.9% vs. 7.2%), preterm birth (14.4% vs. 8.5%), and SGA (28.5% vs. 17.5%) for women with SLE compared to women without. In addition, the adjusted odds of LBW, preterm birth, and SGA babies for women who had SLE during pregnancy were 6.15 (95% CI=4.15-9.13), 4.19 (95% CI=2.77-6.36), and 4.25 (95% CI=2.95-6.11) times, respectively, compared to women without any chronic illness. The adjusted odds of LBW, preterm birth, and SGA babies for women who had SLE but were not hospitalized during pregnancy were 1.80 (95% CI=1.43-2.26), 1.62 (95% CI=1.30-2.03), and 1.63 (95% CI=1.38-1.94) times, respectively, compared to unaffected mothers. We conclude that SLE can impact the pregnancy outcomes, especially if hospitalisation occurs during the pregnancy.

  11. 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

    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 ...

  12. Periodontal disease and pregnancy outcomes: state-of-the-science.

    Science.gov (United States)

    Xiong, Xu; Buekens, Pierre; Vastardis, Sotirios; Yu, Stell M

    2007-09-01

    To examine the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes, we conducted a systematic review of studies published up to December 2006. Studies published in full text were identified by searching computerized databases (e.g., MEDLINE, EMBASE). A meta-analysis was performed to pool the effect size of the clinical trials. Forty-four studies were identified (26 case-control studies, 13 cohort studies, and 5 controlled trials). The studies focused on preterm low birth weight, low birth weight, preterm birth, birth weight by gestational age, miscarriage or pregnancy loss, preeclampsia, and gestational diabetes mellitus. Of the chosen studies, 29 suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (odds ratios [ORs] ranging from 1.10 to 20.0) and 15 found no evidence of an association (ORs ranging from 0.78 to 2.54). A meta-analysis of the clinical trials suggested that oral prophylaxis and periodontal treatment may reduce the rate of preterm low birth weight (pooled risk ratio (RR): 0.53, 95% confidence interval [CI]: 0.30-0.95, P 0.05) or low birth weight (pooled RR: 0.86, 95% CI: 0.58%1.29, P > 0.05). The authors conclude that periodontal disease may be associated with increased risk of adverse pregnancy outcomes. More methodologically rigorous studies are needed in this field. Currently, there is insufficient evidence to support the provision of periodontal treatment during pregnancy for the purpose of reducing adverse pregnancy outcomes. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to state that the published literature is not vigorous to clinically link periodontal disease and/or its treatment to specific adverse pregnancy outcomes, and explain that more rigorous studies with world-wide agreed-upon definitions are particularly needed before periodontal disease treatment can be recommended.

  13. Interleukin-6 -174 genotype, periodontal disease and adverse pregnancy outcomes: a pilot study.

    Science.gov (United States)

    Dashash, M; Nugent, J; Baker, P; Tansinda, D; Blinkhorn, F

    2008-05-01

    This study was undertaken to investigate whether maternal periodontal disease and variant genotypes of IL-6 gene are associated with adverse pregnancy outcomes. A total of 145 pregnant women were recruited from St Mary's Hospital, Manchester, UK. Bleeding on probing (BOP) and pocket depth indices were recorded on all teeth. Amplification refractory mutation system-polymerase chain reaction was used for -174 IL-6 genotyping. Birth weight was assessed using the individualized birth ratio (IBR) with intrauterine growth restriction (IUGR) defined as an IBR below the fifth percentile. The G/G genotype results in more BOP % sites in Caucasian (P periodontal disease, and IUGR.

  14. 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.

  15. Maternal Tenofovir Disoproxil Fumarate Use During Pregnancy Is Not Associated With Adverse Perinatal Outcomes Among HIV-infected East African Women: A Prospective Study.

    Science.gov (United States)

    Pintye, Jillian; Baeten, Jared M; Celum, Connie; Mugo, Nelly; Ngure, Kenneth; Were, Edwin; Bukusi, Elizabeth A; John-Stewart, Grace; Heffron, Renee A

    2017-12-19

    Tenofovir disoproxil fumarate (TDF) is commonly used in antiretroviral treatment (ART) and pre-exposure prophylaxis regimens. We evaluated the relationship between adverse perinatal outcomes and prenatal TDF use. Longitudinal data were analyzed from human immunodeficiency virus (HIV)-infected women who became pregnant during 2 HIV prevention studies conducted among HIV-serodiscordant couples in Kenya and Uganda. Pregnancies included were singleton, not terminated by an induced abortion, and had documented 3-drug ART use. Multivariate generalized estimating equation models were used to determine the association of prenatal TDF and perinatal outcomes. The most frequent ART regimens were TDF/3TC/EFV (39%) and AZT/3TC/NVP (34%); 49% of pregnancies had prenatal TDF exposure and 6% used a protease inhibitor. Neonatal death, preterm birth, and pregnancy loss occurred in 2%, 8%, and 12% of pregnancies, respectively. No differences were observed between pregnancies with and without exposure to TDF in the frequency of pregnancy loss (adjusted prevalence rate ratio [aPRR] 1.19, P = .8) or neonatal death (aPRR 0.68, P = .6). Preterm birth occurred less frequently among pregnancies exposed to TDF (aPRR, 0.34, P = .02). Maternal TDF use did not adversely affect perinatal outcomes. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  16. Anaemia in Pregnancy: Prevalence, Risk Factors, and Adverse Perinatal Outcomes in Northern Tanzania

    Directory of Open Access Journals (Sweden)

    Grace Stephen

    2018-01-01

    Full Text Available Background and Objective. Anaemia in pregnancy is a public health problem in developing countries. This study aimed to determine the prevalence, risk factors, and adverse perinatal outcomes of anaemia among pregnant women in Moshi Municipal, Northern Tanzania. Methods. This was a follow-up study conducted from October 2013 to June 2015. A total of 539 pregnant women were enrolled in this study. Interviews were conducted followed by determination of haemoglobin level. Women were followed up at delivery and at 7 days and 28 days after delivery. Results. A total of 529 women were included in this analysis. Their mean age was 25.8 (SD 5.73. The prevalence of anaemia was 18.0% and 2% had severe anaemia. The clinic of recruitment and low education level of the women were the factors that were independently associated with anaemia during pregnancy. At delivery, there were 10 stillbirths, 16 low birth weight (LBW newborns, and 2 preterm birth cases. No association was found between anaemia and LBW, preterm birth, or stillbirths. Conclusion. Anaemia in pregnancy was a mild public health problem in the study setting of Northern Tanzania.

  17. Diagnostic accuracy of spot urine protein-to-creatinine ratio for proteinuria and its association with adverse pregnancy outcomes in Chinese pregnant patients with pre-eclampsia.

    Science.gov (United States)

    Cheung, H C; Leung, K Y; Choi, C H

    2016-06-01

    International guidelines have endorsed spot urine protein-to-creatinine ratio of >30 mg protein/mmol creatinine as an alternative to a 24-hour urine sample to represent significant proteinuria. This study aimed to determine the accuracy of spot urine protein-to-creatinine ratio in predicting significant proteinuria and adverse pregnancy outcome. This case series was conducted in a regional obstetric unit in Hong Kong. A total of 120 Chinese pregnant patients with pre-eclampsia delivered at Queen Elizabeth Hospital from January 2011 to December 2013 were included. Relationship of spot urine protein-to-creatinine ratio and 24-hour proteinuria; accuracy of the ratio against 24-hour urine protein at different cut-offs; and relationship of such ratio and adverse pregnancy outcome were studied. Spot urine protein-to-creatinine ratio was correlated with 24-hour urine protein with Pearson correlation coefficient of 0.914 (Pcreatinine ratio for diagnosing proteinuria in Chinese pregnant patients (33 mg/mmol) was similar to that stated in the international literature (30 mg/mmol). A cut-off of 20 mg/mmol provided a 100% sensitivity, and 52 mg/mmol provided a 100% specificity. There was no significant difference in spot urine protein-to-creatinine ratio between cases with and without adverse pregnancy outcome. Spot urine protein-to-creatinine ratio had a positive and significant correlation with 24-hour urine results in Chinese pre-eclamptic women when the ratio was <200 mg/mmol. Nonetheless, this ratio was not predictive of adverse pregnancy outcome.

  18. Adolescent deliveries in semi-urban Cameroon: prevalence and adverse neonatal outcomes.

    Science.gov (United States)

    Njim, Tsi; Agbor, Valirie Ndip

    2017-06-26

    Adolescent pregnancies are high risk due to the increased probability of adverse outcomes; as adolescents are usually considered to be ill-equipped to deal with the burden of pregnancy. We sought to determine the prevalence of adolescent deliveries in a secondary-level care hospital in semi-urban Cameroon-Bamenda, the adverse neonatal outcomes and to assess if previous obstetric history could preclude adolescents from having adverse outcomes in their present pregnancy. The prevalence of adolescent deliveries was 8.7% (95% CI 7.01-10.73%). The neonates of adolescent mothers were more likely to have severe asphyxia (OR 4.0; 95% CI 1.2-12.9; p = 0.03) and low birth weight (OR 2.4; 95% CI 1.3-4.4; p adolescents were just as likely to have complications as multipara adolescents. The prevalence of adolescent deliveries (8.7%) in the Regional Hospital Bamenda is high. Their babies are at a high risk of adverse neonatal outcomes irrespective of their previous obstetric history (previous delivery) emphasising that adolescents are generally ill-prepared to deal with pregnancy. Strategies to reduce the prevalence of adolescent deliveries should be investigated and implemented in view of attaining the sustainable development goals.

  19. Association of previous severe low birth weight with adverse perinatal outcomes in a subsequent pregnancy among HIV-prevalent urban African women.

    Science.gov (United States)

    Smid, Marcela C; Ahmed, Yusuf; Stoner, Marie C D; Vwalika, Bellington; Stringer, Elizabeth M; Stringer, Jeffrey S A

    2017-02-01

    To evaluate the association between severity of prior low birth weight (LBW) delivery and adverse perinatal outcomes in the subsequent delivery among an HIV-prevalent urban African population. A retrospective cohort study was conducted among 41 109 women who had undergone two deliveries in Lusaka, Zambia, between February 1, 2006, and May 31, 2013. The relationship between prior LBW delivery (<2500 g) and a composite measure of adverse perinatal outcome in the second pregnancy was assessed using multivariate logistic regression. Women with prior LBW delivery (n=4259) had an increased risk of LBW in the second delivery versus those without prior LBW delivery (n=37 642). Such risk correlated with the severity of first delivery LBW. The adjusted odds ratio (AOR) was 2.89 (95% confidence interval [CI] 2.05-4.09) for a birth weight of 1000-1499 g, 3.05 (95% CI 2.42-3.86) for a birth weight of 1500-1999 g, and 2.02 (95% CI 1.81-2.27) for a birth weight of 2000-2499 g. Previous LBW delivery also increased the risk of adverse perinatal outcome, with an AOR of 1.4 (95% CI 1.2-1.7). Severe prior LBW delivery conferred substantial risk for adverse perinatal outcomes in a subsequent pregnancy. © 2016 International Federation of Gynecology and Obstetrics.

  20. [Chorionicity and adverse perinatal outcome].

    Science.gov (United States)

    Ferreira, Isabel; Laureano, Carla; Branco, Miguel; Nordeste, Ana; Fonseca, Margarida; Pinheiro, Adelaide; Silva, Maria Isabel; Almeida, Maria Céu

    2005-01-01

    Considering the highest rate of morbidity and mortality in diamniotic monochorionic twins, the authors evaluated and compared the adverse obstetric and perinatal outcome in twin pregnancies according to chorionicity. A retrospective study was conducted in all twin deliveries that occurred in the Obstetric Unit of Maternidade Bissaya-Barreto, for a period of tree years (from the 1st of January 1999 until the 31st of December 2001). From de 140 diamniotic twin pregnancies studied, we considered two groups according to the chorionicity: monochorionic and dichorionic. We compared multiple parameters as, epidemiologic data, adverse obstetric outcome, gestacional delivery age, type of delivery and the morbidity, the mortality and the follow-up of the newborn. The statistic tests used were the X2 and the t student. From the 140 twin pregnancies included in the study, 66% (92 cases) presented dichorionic placentation and 34% (48 cases) were monochorionic. In the group of monochorionic pregnancies, we observed highly difference related to pathology of amniotic fluid (14.5% vs 2.2%), discordant fetal growth (41.6% vs 22.8%) and rate of preterm delivery (66.6% vs 32.6%). Related to the newborn we verified that they had a lower average birth weight (1988g vs 2295g), a highly rate of weight discordancy (23% vs 15.3%), intraventricular haemorrhage (2.2% vs 0%) and IUGR (6.6% vs 1.6%), statistically significant in the monochorionic group. Also the perinatal mortality rate was significantly higher in the monochorionic pregnancies (93.7 per thousand vs 21.7 per thousand). The high rate of morbidity and mortality related to the monochorionic twin pregnancies, implies the need of a correct identification of the type of chorionicity and also a high standard of prenatal surveillance in prenatal specialised health centers.

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

    International Nuclear Information System (INIS)

    Munim, S.; Maheen, H.

    2012-01-01

    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)

  2. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding.

    Science.gov (United States)

    Schatz, Frederick; Guzeloglu-Kayisli, Ozlem; Arlier, Sefa; Kayisli, Umit A; Lockwood, Charles J

    2016-06-01

    Human pregnancy requires robust hemostasis to prevent hemorrhage during extravillous trophoblast (EVT) invasion of the decidualized endometrium, modification of spiral arteries and post-partum processes. However, decidual hemorrhage (abruption) can occur throughout pregnancy from poorly transformed spiral arteries, causing fetal death or spontaneous preterm birth (PTB), or it can promote the aberrant placentation observed in intrauterine growth restriction (IUGR) and pre-eclampsia; all leading causes of perinatal or maternal morbidity and mortality. In non-fertile cycles, the decidua undergoes controlled menstrual bleeding. Abnormal uterine bleeding (AUB) accompanying progestin-only, long-acting, reversible contraception (pLARC) accounts for most discontinuations of these safe and highly effective agents, thereby contributing to unwanted pregnancies and abortion. The aim of this study was to investigate the role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. We conducted a critical review of the literature arising from PubMed searches up to December 2015, regarding in situ and in vitro expression and regulation of several specific proteins involved in uterine hemostasis in decidua and cycling endometrium. In addition, we discussed clinical and molecular mechanisms associated with pLARC-induced AUB and pregnancy complications with abruptions, chorioamnionitis or pre-eclampsia. Progestin-induced decidualization of estradiol-primed human endometrial stromal cells (HESCs) increases in vivo and in vitro expression of tissue factor (TF) and type-1 plasminogen activator inhibitor (PAI-1) while inhibiting plasminogen activators (PAs), matrix metalloproteinases (MMPs), and the vasoconstrictor, endothelin-1 (ET-1). These changes in decidual cell-derived regulators of hemostasis, fibrinolysis, extracellular matrix (ECM) turnover, and vascular tone prevent hemorrhage during EVT invasion and

  3. Antenatal care attendance, a surrogate for pregnancy outcome? The case of Kumasi, Ghana.

    Science.gov (United States)

    Asundep, Ntui N; Jolly, Pauline E; Carson, April; Turpin, Cornelius A; Zhang, Kui; Tameru, Berhanu

    2014-07-01

    Antenatal care (ANC) has been shown to influence infant and maternal outcomes. WHO recommends 4 ANC visits for uncomplicated pregnancies. However, pregnant women in Ghana are required to attend 8-13 antenatal visits. We investigated the association of ANC attendance with adverse pregnancy outcomes (defined as low infant birth weight, stillbirth, preterm delivery or small for gestational age). A quantitative cross-sectional study was conducted on 629 women, age 19-48 years who presented for delivery at two selected public hospitals and 16 traditional birth attendants from July to November 2011. Socio-demographic and antenatal information were collected using a structured questionnaire. ANC attendance, medical and obstetric/gynecological history were abstracted from maternal antenatal records. Data were analyzed using Chi square and logistic regression. Twenty-two percent of the women experienced an adverse outcome. Eleven percent of the women attended 5 children) was also associated with adverse birth outcomes. Women screened for syphilis or use of insecticide-treated bed nets had a 40 and 36% (p = 0.0447 and p = 0.0293) reduced likelihood of experiencing an adverse pregnancy outcome respectively. After adjusting for confounders, attending pregnancy outcome compared with ≥4 ANC visits (Adjusted OR 2.55; 95% CI 1.16-5.63; p = 0.0202). Attending pregnancy outcomes for uncomplicated pregnancies.

  4. Periodontal Disease and Adverse Pregnancy Outcomes: A Prospective Study in a Low-Risk Population.

    Science.gov (United States)

    Soucy-Giguère, Laurence; Tétu, Amélie; Gauthier, Simon; Morand, Marianne; Chandad, Fatiha; Giguère, Yves; Bujold, Emmanuel

    2016-04-01

    Periodontal disease has been associated with systemic inflammation and adverse pregnancy outcomes, including preeclampsia and preterm birth. To examine the relationship between periodontal disease in early pregnancy and the risk of amniotic inflammation, preterm birth, and preeclampsia. We performed a prospective cohort study of women undergoing amniocentesis for fetal karyotype between 15 and 24 weeks' gestation. Participants underwent periodontal examination by a certified dentist, and a sample of amniotic fluid was collected. Periodontal disease was defined as the presence of one or more sites with probing depths ≥ 4 mm and ≥ 10% bleeding on probing. Matrix metalloproteinase-8 and interleukin-6 concentrations in the amniotic fluid were measured. Medical charts were reviewed for perinatal outcomes. Univariate and multivariate logistic regression analyses were used to assess the association between periodontal disease and adverse pregnancy outcomes. We recruited 273 women at a median gestational age of 16 weeks (range 15 to 24), and 258 (95%) agreed to undergo periodontal examination. Periodontal disease was observed in 117 of the participants (45%). We observed no significant association between periodontal disease and preterm birth (relative risk [RR] 2.27; 95% CI 0.74 to 6.96) or spontaneous preterm birth (RR 0.90; 95% CI 0.20 to 4.11). However, women with periodontal disease were more likely to develop preeclampsia, and this association remained significant after adjustment for potential confounders (adjusted RR 5.89; 95% CI 1.24 to 28.05). Periodontal disease was not associated with significant differences in the intra-amniotic concentration of matrix metalloproteinase-8 (13.0 ± 46.6 vs 5.7 ± 10.4 ng/mL, P = 0.098) or interleukin-6 (3.3 ± 20.3 vs 1.0 ± 1.6 ng/mL, P = 0.23), although a non-significant trend was observed. Periodontal disease is associated with preeclampsia but not with spontaneous preterm birth. The current study cannot exclude an

  5. Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis.

    Science.gov (United States)

    Morris, R Katie; Bilagi, Ashwini; Devani, Pooja; Kilby, Mark D

    2017-03-01

    To determine association, and predictive ability, of first trimester maternal serum pregnancy associated plasma protein A (PAPP-A) with adverse pregnancy outcomes. Searches of Medline, Embase and CINAHL (inception September 2015) for studies including pregnant women with first trimester PAPP-A and assessment of pregnancy outcomes. Study characteristics, quality and results extracted. Meta-analysis of odds ratios (ORs), and likelihood ratios (LRs) and 95% confidence intervals (CI). Thirty-two studies including 175 240 pregnancies. PAPP-A <5th centile had a moderate association with: birth weight <10th centile OR 2.08 (95% CI 1.89-2.29), <5th centile OR 2.83 (95% CI 2.52-3.18); pre-eclampsia OR 1.94 (95% CI 1.63-2.30), preterm birth <37 weeks OR 2.09 (95% CI 1.87-2.33), and composite adverse outcome OR 3.31 (95% CI 1.80-5.11). The predictive ability was poor: Birth weight <10th centile LR + ve 1.96 (95% CI 1.58-2.43), LR-ve 0.93 (95% CI 0.89-0.98); birth weight <5th centile LR + ve 2.65 (95% CI 2.35-2.99), LR-ve 0.85 (95% CI 0.74-0.98); PTB <37 weeks LR + ve 1.84 (95% CI 1.41-2.39), LR-ve 0.92 (95% CI 0.87-0.98). First trimester low maternal serum PAPP-A is associated with adverse pregnancy outcome, but predictive values are poor. Further work should address PAPP-A as a continuous variable in combination with other prognostic markers as a prediction model. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

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

    Directory of Open Access Journals (Sweden)

    Inmaculada Bautista-Castaño

    Full Text Available 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.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.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.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 women who intend to get pregnant and to

  7. A RETROSPECTIVE STUDY OF OBSTETRIC OUTCOME IN TEENAGE PREGNANCY AND OLDER PREGNANCIES

    Directory of Open Access Journals (Sweden)

    Anita Valsaladevi

    2017-07-01

    Full Text Available BACKGROUND Younger age pregnancy of the group 18 years to 19 years is characterized by adverse maternal outcomes like anaemia, hypertension, low birth weight babies and intra uterine growth restriction. A comparative retrospective study on the obstetric outcome in teenage mothers and older women was carried out. Data for the study was obtained from a hospital where considerable teenage pregnancy is reported. Evidence obtained in this study regarding antenatal complications and birth weight shows that good antenatal care and support by family and caregivers can bring down the incidence of anaemia and low birth weight babies in teenage pregnancy. The aim of the study is to compare the obstetric outcome of pregnancy in teenagers and older women in a tertiary care hospital. MATERIALS AND METHODS This was a retrospective study conducted in Government Medical College, Manjeri, Malappuram, Kerala, India for a period of three months from March 2017 to May 2017. This is a teaching hospital with annual delivery rate of around 3500. Obstetric outcome of young mothers in the age group 18 -19 years were compared to older women (20-38 years delivering in the same hospital. A total of 843 deliveries were considered, out of which 87 belonged to teenage group. They were compared in terms of social and educational data, age, number of pregnancy, antenatal care, complications, mode of delivery, birth weight, episiotomy and perineal tears. RESULTS The incidence of teenage pregnancy was fairly high. (10.3% Most of them were in their first pregnancy. A significant number of teenage pregnant mothers (72.4% had completed higher secondary education as compared to (27.6% in older women. Contrary to many prior studies, teenage pregnancies showed less anaemia (6.9% versus 12% and lesser incidence of low birth weight babies in comparison to older women. Preterm birth was higher in teenage group (33.1% and incidence of hypertensive disorders and intrauterine growth

  8. Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes.

    Science.gov (United States)

    Baud, David; Regan, Lesley; Greub, Gilbert

    2008-02-01

    This review considers the roles of Chlamydia spp. and newly identified Chlamydia-like organisms in miscarriage, stillbirths and preterm labour in both animals and humans. The cause of miscarriage, stillbirth and preterm labour often remains unexplained. Intracellular bacteria that grow either poorly or not at all on media used routinely to detect human pathogens could be the aetiological agents of these obstetrical conditions. There is growing evidence that Chlamydia trachomatis, Chlamydophila abortus, Chlamydophila psittaci and Chlamydophila pneumoniae infections may result in adverse pregnancy outcomes in humans and/or animals. Waddlia, a Chlamydia-like organism first isolated from an aborted bovine, has emerged as an agent of abortion in cattle. Recently, Waddlia was also implicated in human foetal death. Moreover, Parachlamydia acanthamoebae is also abortigenic in ruminants. Whether additional novel Chlamydia-like organisms, such as Protochlamydia amoebophila, Neochlamydia hartmanellae, Criblamydia sequanensis, Rhabdochlamydia crassificans and Simkania negevensis, are involved in foetal loss or premature delivery remains to be determined. This review provides an update on the consequences of chlamydial infection during pregnancy and summarizes current evidence suggesting that some Chlamydia-related organisms are probably emerging obstetrical pathogens.

  9. Misuse of antenatal care and its association with adverse outcomes of pregnancy in a Southern rural area of Vietnam.

    Science.gov (United States)

    Ngo, Thi-Thuy-Dung; Nguyen, The-Dung; Goyens, Philippe; Robert, Annie

    2018-04-01

    Researchers in Vietnam reported a high percentage of pregnant women attending ANC at least once, but an insufficient utilization of ANC services remains. The evidence demonstrating how the utilization of these services affect pregnancy outcome is not documented in Vietnam. We investigated the association between the misuse of ANC services and pregnancy outcome, and assessed other determinants associated with ANC services utilization. We conducted a prospective community-based study in Trang Bom district, Dong Nai, during 12 consecutive months. Data were collected using a structured questionnaire and medical records. Women were followed up to delivery. Misuse of ANC services, related factors and its association with adverse events were assessed using logistic regression. Out of 3301 pregnant women, 91% initiated an ANC visit within first trimester, 95% attended at least three ANC visits, but a low percentage of pregnant women underwent blood and urine tests at least once (20% and 39%, respectively). Factors significantly associated with a higher risk of adverse outcomes were lack of blood test and urine test, parity ≥ 3, ANC visits ANC attendance, and women with a low number of ANC visits. Despite a high percentage of early entry into ANC and of at least three ANC visits, misuse of ANC services still exists and contributes to adverse outcomes. There is a need to increase the awareness of women on the benefits of ANC services by educating young women as well as women with several children. Health workers should be encouraged to propose suitable ANC services to pregnant women.

  10. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes.

    Science.gov (United States)

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

    2017-01-01

    To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m 2 . The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.

  11. Nurse practitioner's and certified nurse midwives' knowledge, opinions and practice behaviors regarding periodontal disease and adverse pregnancy outcomes.

    Science.gov (United States)

    Wooten, Katherine T; Lee, Jessica; Jared, Heather; Boggess, Kim; Wilder, Rebecca S

    2011-01-01

    The purpose of this study was to assess the knowledge, opinions and practice behaviors of nurse practitioners (NP) and certified nurse midwives (CNM) regarding periodontal disease and adverse pregnancy outcomes. A 45 item survey was developed, approved, pretested, revised and mailed to 404 North Carolina NPs and CNMs who provide prenatal care. Data was entered into an excel database and transferred to SPSS for Windows for complete analysis. Linear regression modeling was used to determine statistical significance. A total of 219 NPs and CNMs responded to the mailed survey, achieving a response rate of 54%. NPs and CNMs reported having limited knowledge regarding oral health. The majority felt they should collaborate with oral health care professionals to screen patients for periodontal disease. Most agreed they needed more information about periodontal disease and adverse pregnancy outcomes. NPs and CNMs who frequently examine women could serve an important role in screening for oral health problems and making appropriate dental health referrals. Increased basic and continuing education could prepare these professionals for collaborative care with oral health care professionals. This study suggests that collaboration between NPs and CNMs with dental professionals could lead to improved oral health care for pregnant patients.

  12. The sFlt-1/PlGF ratio associates with prolongation and adverse outcome of pregnancy in women with (suspected) preeclampsia: analysis of a high-risk cohort.

    Science.gov (United States)

    Saleh, Langeza; Verdonk, Koen; Jan Danser, A H; Steegers, Eric A P; Russcher, Henk; van den Meiracker, Anton H; Visser, Willy

    2016-04-01

    To evaluate the additive value of the sFlt-1/PlGF ratio for diagnosing preeclampsia (PE) and predicting prolongation of pregnancy and adverse outcome in a cohort of women with PE or at high risk of PE. Patients with suspected or confirmed clinical PE were recruited. At time of inclusion blood for measurement of sFlt-1and PlGF was taken. Values were determined after delivery. A cut-off ratio of ≥85 was defined as a positive test. A total of 107 patients were included. Of the patients, 62 (58%) met the clinical criteria of PE at time of blood sampling. In 10% of these patients (n=6) the ratio was ratio was ≥85 (false positive), resulting in positive and negative predictive values of 95% and 88% respectively. One patient with false positive ratio developed superimposed PE and 2 developed gestational hypertension, and adverse outcome occurred in all three. An adverse pregnancy outcome was only encountered in 1 of the 6 patients with a false negative ratio. Using a binary regression model with adjustment for gestational age ratio (P=0.036). The additive value of an increased ratio for diagnosing PE is limited since most patients with clinical PE also have a positive ratio. However, an elevated ratio is superior to the clinical diagnosis of PE for predicting an adverse pregnancy outcome. Furthermore, irrespective of clinical PE, a low ratio is inversely correlated with prolongation of pregnancy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms.

    Science.gov (United States)

    Madianos, Phoebus N; Bobetsis, Yiorgos A; Offenbacher, Steven

    2013-04-01

    To evaluate the evidence on potential biological pathways underlying the possible association between periodontal disease (PD) and adverse pregnancy outcomes (APOs). Human, experimental and in vitro studies were evaluated. Periodontal pathogens/byproducts may reach the placenta and spread to the foetal circulation and amniotic fluid. Their presence in the foeto-placental compartment can stimulate a foetal immune/inflammatory response characterized by the production of IgM antibodies against the pathogens and the secretion of elevated levels of inflammatory mediators, which in turn may cause miscarriage or premature birth. Moreover, infection/inflammation may cause placental structural changes leading to pre-eclampsia and impaired nutrient transport causing low birthweight. Foetal exposure may also result in tissue damage, increasing the risk for perinatal mortality/morbidity. Finally, the elicited systemic inflammatory response may exacerbate local inflammatory responses at the foeto-placental unit and further increase the risk for APOs. Further investigation is still necessary to fully translate the findings of basic research into clinical studies and practice. Understanding the systemic virulence potential of the individual's oral microbiome and immune response may be a distinctly different issue from categorizing the nature of the challenge using clinical signs of PD. Therefore, a more personalized targeted therapy could be a more predictive answer to the current "one-size-fits-all" interventions.

  14. A randomized clinical trial on the effects of remote intercessory prayer in the adverse outcomes of pregnancies.

    Science.gov (United States)

    da Rosa, Maria Inês; Silva, Fabio Rosa; Silva, Bruno Rosa; Costa, Luciana Carvalho; Bergamo, Angela Mendes; Silva, Napoleão Chiaramonte; Medeiros, Lidia Rosi de Freitas; Battisti, Iara Denise Endruweit; Azevedo, Rafael

    2013-08-01

    The scope of this article was to investigate whether intercessory prayer (IP) influences the adverse outcomes of pregnancies. A double-blind, randomized clinical trial was conducted with 564 pregnant women attending a prenatal public health care service. The women were randomly assigned to an IP group or to a control group (n = 289 per group). They were simultaneously and randomly assigned to practice prayer off-site or not. The following parameters were evaluated: Apgar scores, type of delivery and birth weight. The mean age of the women was 25.1 years of age (± 7.4), and the average gestational age was 23.4 weeks (± 8.1). The average number of years of schooling for the women was 8.1 years (± 3.1). The women in the IP and control groups presented a similar number of adverse medical events with non-significant p. No significant differences were detected in the frequency of adverse outcomes in pregnant women who practiced IP and those in the control group.

  15. Ambient Air Pollution and Adverse Pregnancy Outcomes in Wuhan, China.

    Science.gov (United States)

    Qian, Zhengmin; Zhang, Bin; Liang, Shengwen; Wang, Jing; Yang, Shaoping; Hu, Ke; Trevathan, Edwin; Yang, Rong; Li, Qijie; Flick, Louise H; Hu, Ronghua; Huang, Zhen; Zhang, Yimin; Hu, Shixiang; Wang, Jing; Shen, Longjiao; Lu, Yuan; Peng, Hui; Yu, Yuzhen; Yang, Li; Chen, Wei; Liu, Wenjin; Zhang, Wei

    2016-09-01

    Several recent studies have suggested that maternal exposures to air pollution and temperature extremes might contribute to low birth weight (LBW), preterm birth (PTB), and other outcomes that can adversely affect infant health. At the time the current study began, most other studies had been conducted in the United States or Europe. Dr. Zhengmin Qian proposed to extend work he had done on ambient particulate air pollution and daily mortality in Wuhan, China (Qian et al. 2010), as part of the HEIsponsored Public Health and Air Pollution in Asia program, to study adverse birth outcomes. Wuhan is the capital city of Hubei province, has a large population of about 6.4 million within the urban study area, experiences temperature extremes, and generally has higher air pollution levels than those observed in the United States and Europe, thus providing a good opportunity to explore questions about air pollution and health. Qian and colleagues planned a cohort and nested case–control design with four specific aims, examining whether increased exposures to air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) during vulnerable pregnancy periods were associated with increased rates of PTB, LBW (air pollution and daily weather data for August 2010 to June 2013 from nine monitoring stations representing background air pollution sites in seven Wuhan inner-city districts. Only two of these stations provided PM2.5 data. For the cohort study, the investigators assigned exposures to mothers according to the daily mean concentrations from the monitor nearest the residential community in which the mother lived at the time of the birth. For the case–control study, they assigned exposures based on the inverse distance weighted average of daily mean concentrations from the three nearest monitors, for all but PM2.5 for which the method was not specified. They also collected data on various factors that might confound or modify the impact of the pollutants on the adverse outcomes

  16. Global estimates of syphilis in pregnancy and associated adverse outcomes: analysis of multinational antenatal surveillance data.

    Directory of Open Access Journals (Sweden)

    Lori Newman

    Full Text Available The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC coverage for women with syphilis.Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963 adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716 stillbirths (>28 wk or early fetal deaths (22 to 28 wk, 91,764 (76,141; 107,397 neonatal deaths, 65,267 (56,929; 73,605 preterm or low birth weight infants, and 151,547 (117,848; 185,245 infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and

  17. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.

    Science.gov (United States)

    Ganchimeg, T; Ota, E; Morisaki, N; Laopaiboon, M; Lumbiganon, P; Zhang, J; Yamdamsuren, B; Temmerman, M; Say, L; Tunçalp, Ö; Vogel, J P; Souza, J P; Mori, R

    2014-03-01

    To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Twenty-nine countries in Africa, Latin America, Asia and the Middle East. Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Risk of adverse pregnancy outcomes among adolescent mothers. A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  18. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC

    Directory of Open Access Journals (Sweden)

    Barbara Torlinska

    2018-03-01

    Full Text Available Severe iodine deficiency during pregnancy has been associated with pregnancy/neonatal loss, and adverse pregnancy outcomes; however, the impact of mild–to–moderate iodine insufficiency, though prevalent in pregnancy, is not well-documented. We assessed whether mild iodine deficiency during pregnancy was associated with pregnancy/infant loss, or with other adverse pregnancy outcomes. We used samples and data from the Avon Longitudinal Study of Parents and Children (ALSPAC, from 3140 singleton pregnancies and from a further 42 women with pregnancy/infant loss. The group was classified as mildly-to-moderately iodine deficient with a median urinary iodine concentration of 95.3 µg/L (IQR 57.0–153.0; median urinary iodine-to-creatinine ratio (UI/Creat 124 µg/g, IQR 82–198. The likelihood of pregnancy/infant loss was not different across four UI/Creat groups (<50, 50–149, 150–250, >250 µg/g. The incidence of pre-eclampsia, non-proteinuric gestational hypertension, gestational diabetes, glycosuria, anaemia, post-partum haemorrhage, preterm delivery, mode of delivery, being small for gestational age, and large for gestational age did not differ significantly among UI/Creat groups, nor were there any significant differences in the median UI/Creat. We conclude that maternal iodine status was not associated with adverse pregnancy outcomes in a mildly-to-moderately iodine-deficient pregnant population. However, in view of the low number of women with pregnancy/infant loss in our study, further research is required.

  19. Antiretroviral therapy during pregnancy and the risk of an adverse outcome.

    Science.gov (United States)

    Tuomala, Ruth E; Shapiro, David E; Mofenson, Lynne M; Bryson, Yvonne; Culnane, Mary; Hughes, Michael D; O'Sullivan, M J; Scott, Gwendolyn; Stek, Alice M; Wara, Diane; Bulterys, Marc

    2002-06-13

    Some studies suggest that combination antiretroviral therapy in pregnant women with human immunodeficiency virus type 1 (HIV-1) infection increases the risk of premature birth and other adverse outcomes of pregnancy. We studied pregnant women with HIV-1 infection who were enrolled in seven clinical studies and delivered their infants from 1990 through 1998. The cohort comprised 2123 women who received antiretroviral therapy during pregnancy (monotherapy in 1590, combination therapy without protease inhibitors in 396, and combination therapy with protease inhibitors in 137) and 1143 women who did not receive antiretroviral therapy. After standardization for the CD4+ cell count and use or nonuse of tobacco, alcohol, and illicit drugs, the rate of premature delivery (women who received antiretroviral therapy and those who did not (16 percent and 17 percent, respectively); the rate of low birth weight (women who received combination therapy with protease inhibitors (5 percent) had infants with very low birth weight, as compared with nine women who received combination therapy without protease inhibitors (2 percent) (adjusted odds ratio, 3.56; 95 percent confidence interval, 1.04 to 12.19). As compared with no antiretroviral therapy or monotherapy, combination therapy for HIV-1 infection in pregnant women is not associated with increased rates of premature delivery or with low birth weight, low Apgar scores, or stillbirth in their infants. The association between combination therapy with protease inhibitors and an increased risk of very low birth weight requires confirmation.

  20. Persistent ovarian masses and pregnancy outcomes.

    Science.gov (United States)

    Goh, William A; Rincon, Monica; Bohrer, Justin; Tolosa, Jorge E; Sohaey, Roya; Riaño, Rene; Davis, James; Zalud, Ivica

    2013-07-01

    To determine if persistent ovarian masses in pregnancy are associated with increased adverse outcomes. This is a retrospective cohort of 126 pregnant women with a persistent ovarian mass measuring 5 cm or greater who delivered at two university hospitals between 2001 and 2009. Maternal outcomes included gestational age (GA) at diagnosis, delivery and surgery as well as miscarriage, preterm birth (PTB), ovarian torsion and hospital admission for pain. Neonatal outcomes included birth weight, respiratory distress syndrome (RDS), intra-ventricular hemorrhage (IVH), death and sepsis. A total of 1225 ovarian masses were identified (4.9%) in 24,868 patients. A persistent ovarian mass was found in 0.7%. Average GA at diagnosis was 17.8 weeks. Miscarriage rate was 3.3%. Average GA at delivery was 37.9 weeks. Of the patients, 8.5% had ovarian torsion, 10.3% had admission for pain and 9.3% had PTBs. The mean cesarean delivery rate was 46.3%. The average neonatal weight was 3273 g. There was one neonatal death in this cohort. The rate of RDS was 2.8%, IVH 0.9% and neonatal sepsis 1.9%. The most common surgical pathologic diagnosis was dermoids (37.6%). No overt malignancies were seen. A persistent ovarian mass in pregnancy does not confer an increased risk of adverse pregnancy outcomes.

  1. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Vivatkusol Y

    2017-05-01

    Full Text Available Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG.Results: Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001. The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different.Conclusion: More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes. Keywords: prevalence, pregnancy outcome, inappropriate gestational weight gain, teenage pregnancy

  2. Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

    Science.gov (United States)

    Wyshak, Grace; Ringer, Steven A.; Johnson, Lise C.; Rivkin, Michael J.; Lieberman, Ellice

    2012-01-01

    OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores 101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied. PMID:22291120

  3. Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

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    Norman J. Blumenthal

    2017-01-01

    Full Text Available Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH (serum TSH > 2.5 mIU/L and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH, anti-thyroglobulin antibodies (TGAb, and thyroid peroxidase antibodies (TPOAb. Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. Results. There were a total of 1025 patients of whom 382 (37.5% were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy

  4. Interventions to prevent adverse fetal programming due to maternal obesity during pregnancy.

    Science.gov (United States)

    Nathanielsz, Peter W; Ford, Stephen P; Long, Nathan M; Vega, Claudia C; Reyes-Castro, Luis A; Zambrano, Elena

    2013-10-01

    Maternal obesity is a global epidemic affecting both developed and developing countries. Human and animal studies indicate that maternal obesity adversely programs the development of offspring, predisposing them to chronic diseases later in life. Several mechanisms act together to produce these adverse health effects. There is a consequent need for effective interventions that can be used in the management of human pregnancy to prevent these outcomes. The present review analyzes the dietary and exercise intervention studies performed to date in both altricial and precocial animals, rats and sheep, with the aim of preventing adverse offspring outcomes. The results of these interventions present exciting opportunities to prevent, at least in part, adverse metabolic and other outcomes in obese mothers and their offspring. © 2013 International Life Sciences Institute.

  5. Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial.

    Science.gov (United States)

    Magee, Laura A; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K; Logan, Alexander G; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G; Moutquin, Jean Marie

    2016-07-01

    For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48 h, or birthweight hypertension, preeclampsia, or delivery at blood pressure within 1 week before randomization. Continuous variables were represented continuously or dichotomized based on the smaller p-value in univariate analyses. An area-under-the-receiver-operating-curve (AUC ROC) of ≥0.70 was taken to reflect a potentially useful model. Point estimates for AUC ROC were hypertension (0.70, 95% CI 0.67-0.74) and delivery at hypertension develop an elevated blood pressure in pregnancy, or formerly normotensive women develop new gestational hypertension, maternal and current pregnancy clinical characteristics cannot predict adverse outcomes in the index pregnancy. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

  6. Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data

    Science.gov (United States)

    Newman, Lori; Kamb, Mary; Hawkes, Sarah; Gomez, Gabriela; Say, Lale; Seuc, Armando; Broutet, Nathalie

    2013-01-01

    Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was “probable active,” and for testing and treatment coverage. Conclusions Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that

  7. Inadequate Gestational Weight Gain, the Hidden Link Between Maternal IBD and Adverse Pregnancy Outcomes: Results from the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Bengtson, May-Bente; Aamodt, Geir; Mahadevan, Uma; Vatn, Morten H

    2017-07-01

    Patients with inflammatory bowel disease (IBD) are in general prone to weight loss. We explored the risk of inadequate gestational weight gain (GWG), and the impact of GWG on adverse pregnancy outcomes, among mothers with IBD in the Norwegian Mother and Child Cohort Study (MoBa). The MoBa with 95,200 mothers enrolled from 1999 to 2008, comprised 217 mothers with ulcerative colitis and 166 with Crohn's disease. Demographics were ascertained through a basic questionnaire before the first ultrasound visit and an IBD history and disease activity during pregnancy through a questionnaire mailed out in 2013. Inadequate GWG was based on the US Institute of Medicine recommendations. The associations between IBD and inadequate GWG or adverse pregnancy outcomes were explored, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. Mothers with Crohn's disease (34.3%) and ulcerative colitis (26.7%) were more frequently exposed to inadequate GWG compared with non-IBD mothers (19.4%) (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI], 1.42-2.86 and aOR = 1.46, 95% CI, 1.04-2.05, respectively). Mothers with IBD with inadequate GWG (exposed) had a 2-fold risk of small for gestational age infants compared with exposed non-IBD mothers (aOR = 1.93, 95% CI, 1.13-3.29). Exposed mothers with Crohn's disease and ulcerative colitis had a several-fold increased risk of small for gestational age compared with nonexposed IBD mothers (aOR = 4.5, 95% CI, 1.3-16.2, aOR = 5.5, 95% CI, 1.6-18.5). Disease activity was associated with reduced GWG (17.5 kg) (aOR = 3.34, 95% CI, 1.33-8.38). Inadequate GWG should be considered as a risk factor for adverse pregnancy outcomes or as a marker of disease activity.

  8. Intimate partner violence among Egyptian pregnant women: incidence, risk factors, and adverse maternal and fetal outcomes.

    Science.gov (United States)

    Ibrahim, Z M; Sayed Ahmed, W A; El-Hamid, S A; Hagras, A M

    2015-01-01

    To assess incidence and risk factors of intimate partner violence (IPV) during pregnancy among a sample of women from Egypt and to evaluate its impact on maternal and fetal adverse health outcomes. After obtaining ethical approval, a total of 1,857 women aged 18 - 43 years completed the study and were investigated using an interview questionnaire. The questionnaire contains five main items: demographic characteristics of women, intimate partner characteristics, assessment of IPV during current pregnancy, and assessment of maternal as well as fetal/neonatal adverse outcomes. Women were also examined to detect signs of violence and identify injuries. Exposure to IPV during pregnancy was reported among 44.1% of the studied women. Emotional violence was the most common form. Women exposed to violence were of younger age, higher parity, and lower educational level. Their partners were older, less educated, and more likely to be addicted to drugs and alcohol. Women were also found to have significantly higher incidence of adverse pregnancy outcomes (miscarriage, preterm labor, and premature rupture of membrane), and fetal/neonatal adverse outcomes (fetal distress, fetal death, and low birth weight). A total of 297 cases had been exposed to physical violence (15.9%) vs 32.6% and 10% exposed to emotional and sexual violence, respectively. The most common form of physical violence was kicking. Violence during pregnancy is prevalent among Egyptian women. Exposure to violence was a significant risk factor for multiple adverse maternal and fetal health outcomes.

  9. Adverse outcomes of poor micronutrient status in childhood and adolescence.

    Science.gov (United States)

    Viteri, Fernando E; Gonzalez, Horacio

    2002-05-01

    The adverse effects of micronutrient deficiencies and excesses in children up to reproductive age are presented. A summary of risks and adverse functional and health outcomes associated with deficient and excessive intakes and nutrition status of iron, iodine, zinc, vitamins A and D, folate, vitamin B12, and riboflavin is presented. Nutrient-nutrient interactions of micronutrients, age, gender, and other host and environmental conditions, such as pregnancy, genetic conditions, overall nutrition, force of infection, and social conditions are considered as covariates in trying to define causation and outcomes due to specific micronutrients. The outcomes analyzed focus on growth and development, mental and neuromotor performance, immunocompetence, physical working capacity, morbidity, and in the case of pregnancy, overall reproductive performance. The results presented include responses to specific and multiple "experimental" interventions. A brief analysis of possible public health programs is presented, with emphasis on prevention.

  10. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence.

    Science.gov (United States)

    Amegah, Adeladza K; Quansah, Reginald; Jaakkola, Jouni J K

    2014-01-01

    About 41% of households globally, mainly in developing countries rely on solid fuels for cooking with consequences for fetal growth and development. Previous reviews were limited in scope, assessing only two outcomes (birth weight, stillbirth). With important evidence accumulating, there is a need to improve the previous estimates and assess additional outcomes. We conducted a systematic review and meta-analysis to evaluate the quality and strength of available evidence on household air pollution (HAP) and the whole range of adverse pregnancy outcomes. PubMed, Ovid Medline, Scopus and CINAHL were searched from their inception to the end of April 2013. All epidemiological study designs were eligible for inclusion in the review. The random-effects model was applied in computing the summary-effect estimates (EE) and their corresponding 95% confidence interval (CI). Of 1505 studies screened, 19 studies satisfied the inclusion criteria. Household combustion of solid fuels resulted in an 86.43 g (95% CI: 55.49, 117.37) reduction in birth weight, and a 35% (EE = 1.35, 95% CI: 1.23, 1.48) and 29% (EE = 1.29, 95% CI: 1.18, 1.41) increased risk of LBW and stillbirth respectively. Combustion of solid fuels at home increases the risk of a wide range of adverse pregnancy outcomes. Access to clean household energy solutions is the surest way to combat HAP and mitigate their adverse effects.

  11. Periodontal Disease and Pregnancy Outcomes: Time to Move On?

    OpenAIRE

    Srinivas, Sindhu K.; Parry, Samuel

    2012-01-01

    Maternal periodontal disease is a highly prevalent condition that has been studied extensively in relation to adverse pregnancy outcomes, including preterm delivery, preeclampsia, and low birth weight. Investigators speculate that hematogenous transport of bacteria and/or pro-inflammatory mediators from sites of periodontal infection into the placenta, fetal membranes, and amniotic cavity induces pathological processes that lead to these adverse outcomes. Preliminary observational studies sup...

  12. Hereditary hemorrhagic telangiectasia and pregnancy: potential adverse events and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Bari O

    2017-05-01

    been associated with improved outcomes in pregnancy. Management guidelines for pregnant patients with HHT are reviewed. Keywords: arteriovenous, hereditary, hemorrhagic, malformations, pregnancy, telangiectasia

  13. Outcomes in type 1 diabetic pregnancies

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Damm, Peter; Moelsted-Pedersen, Lars

    2004-01-01

    OBJECTIVE: The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. RESEARCH DESIGN AND METHODS: This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during 1993...... mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9-5.6]), and the stillbirth rate was 2.1% compared with 0.45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background......, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS: Type 1 diabetic pregnancies are still complicated by considerably higher rates...

  14. Sickle cell disease in pregnancy: trend and pregnancy outcomes at a tertiary hospital in Tanzania.

    Science.gov (United States)

    Muganyizi, Projestine S; Kidanto, Hussein

    2013-01-01

    SCD in pregnancy is associated with increased adverse fetal and maternal outcomes. In Tanzania where the frequency of sickle cell trait is 13% there has been scanty data on SCD in pregnancy. With progressive improvement in childhood survival the burden of SCD in pregnancy will increase. We analyzed all deliveries at Muhimbili National Hospital (MNH) from 1999 to 2011. Fetal and maternal outcomes of SCD deliveries were compared with non-SCD. Data were analyzed using IBM SPSS statistics version 19. Chi square and Fisher Exact tests were used to compare proportions and the independent t-test for continuous data. To predict risks of adverse effects, odds ratios were determined using multivariate logistic regression. A p-valueMNH during the study period, of which 149 were SCD (incidence of 95 SCD per 100,000 deliveries). The incidence of SCD had increased from 76 per 100,000 deliveries in the 1999-2002 period to over 100 per 100,000 deliveries in recent years. The mean maternal age at delivery was lower in SCD (24.0±5.5 years) than in non-SCD deliveries (26.2±6.0 years), pMNH with increased adverse fetal outcomes and excessive maternal mortality mainly due to infections.

  15. p38 Mitogen Activated Protein Kinase (MAPK): A New Therapeutic Target for Reducing the Risk of Adverse Pregnancy Outcomes

    Science.gov (United States)

    Menon, Ramkumar; Papaconstantinou, John

    2016-01-01

    Introduction Spontaneous preterm birth (PTB) and preterm premature rupture of the membranes (pPROM) remain as a major clinical and therapeutic problem for intervention and management. Current strategies, based on our knowledge of pathways of preterm labor, have only been effective, in part, due to major gaps in our existing knowledge of risks and risk specific pathways. Areas covered Recent literature has identified physiologic aging of fetal tissues as a potential mechanistic feature of normal parturition. This process is affected by telomere dependent and p38 mitogen activated protein kinase (MAPK) induced senescence activation. Pregnancy associated risk factors can cause pathologic activation of this pathway that can cause oxidative stress induced p38 MAPK activation leading to senescence and premature aging of fetal tissues. Premature aging is associated with sterile inflammation capable of triggering preterm labor or preterm premature rupture of membranes. Preterm activation of p38MAPK can be considered as a key contributor to adverse pregnancies. Expert Opinion This review considers p38MAPK activation as a potential target for therapeutic interventions to prevent adverse pregnancy outcomes mediated by stress factors. In this review, we propose multiple strategies to prevent p38MAPK activation and its functional effects. PMID:27459026

  16. Preeclampsia in pregnancies complicated by systemic lupus erythematosus (SLE) nephritis: prophylactic treatment with multidisciplinary approach are important keys to prevent adverse obstetric outcomes.

    Science.gov (United States)

    Mecacci, Federico; Simeone, Serena; Cirami, Calogero Lino; Cozzolino, Mauro; Serena, Caterina; Rambaldi, Marianna Pina; Gallo, Pamela; Emmi, Lorenzo; Cammelli, Daniele; Mello, Giorgio; Matucci Cerinic, Marco

    2017-11-27

    Systemic lupus erythematosus (SLE) commonly affects women of childbearing age. Hypertension, antiphospholipid syndrome, and lupus nephritis are risk factors for adverse maternal/fetal outcome. The aim of this retrospective cohort study is to compare pregnancy outcomes in patients with and without SLE nephritis, using a multidisciplinary approach and a broad prophylaxis protocol. Data were collected from 86 pregnancies complicated by SLE. Twenty-seven women with nephropathy before pregnancy stated as the study group and 59 formed the control group. Each group received a prophylactic treatment based on their clinical characteristics. Results were expressed as mean ± SD, percentage and χ 2 -test (significant values when p 1.2 mg/dL, which was related to a risk 1.25 times higher than the risk observed in patients with serum creatinine approach in a tertiary care center and a broad prophylactic treatment protocol to patients affected by SLE and complicated by nephritis may definitively foster a successful pregnancy.

  17. 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.

  18. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review.

    Science.gov (United States)

    Harmsen, Marissa J; Browne, Joyce L; Venter, Francois; Klipstein-Grobusch, Kerstin; Rijken, Marcus J

    2017-07-11

    Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes. A systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis. Of the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5-3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0-88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception. This systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.

  19. Association of maternal serum PAPP-A levels, nuchal translucency and crown-rump length in first trimester with adverse pregnancy outcomes: retrospective cohort study.

    Science.gov (United States)

    Bilagi, Ashwini; Burke, Danielle L; Riley, Richard D; Mills, Ian; Kilby, Mark D; Katie Morris, R

    2017-07-01

    Are first trimester serum pregnancy-associated plasma protein-A (PAPP-A), nuchal translucency (NT) and crown-rump length (CRL) prognostic factors for adverse pregnancy outcomes? Retrospective cohort, women, singleton pregnancies (UK 2011-2015). Unadjusted and multivariable logistic regression. small for gestational age (SGA), pre-eclampsia (PE), preterm birth (PTB), miscarriage, stillbirth, perinatal mortality and neonatal death (NND). A total of 12 592 pregnancies: 852 (6.8%) PTB, 352 (2.8%) PE, 1824 (14.5%) SGA, 73 (0.6%) miscarriages, 37(0.3%) stillbirths, 73 perinatal deaths (0.6%) and 38 (0.30%) NND. Multivariable analysis: lower odds of SGA [adjusted odds ratio (aOR) 0.88 (95% CI 0.85,0.91)], PTB [0.92 (95%CI 0.88,0.97)], PE [0.91 (95% CI 0.85,0.97)] and stillbirth [0.71 (95% CI 0.52,0.98)] as PAPP-A increases. Lower odds of SGA [aOR 0.79 (95% CI 0.70,0.89)] but higher odds of miscarriage [aOR 1.75 95% CI (1.12,2.72)] as NT increases, and lower odds of stillbirth as CRL increases [aOR 0.94 95% CI (0.89,0.99)]. Multivariable analysis of three factors together demonstrated strong associations: a) PAPP-A, NT, CRL and SGA, b) PAPP-A and PTB, c) PAPP-A, CRL and PE, d) NT and miscarriage. Pregnancy-associated plasma protein-A, NT and CRL are independent prognostic factors for adverse pregnancy outcomes, particularly PAPP-A and SGA with lower PAPP-A associated with increased risk. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

  20. Incident pregnancy and pregnancy outcomes among HIV-infected women in Uganda and Zimbabwe.

    Science.gov (United States)

    Lancaster, Kathryn E; Kwok, Cynthia; Rinaldi, Anne; Byamugisha, Josaphat; Magwali, Tulani; Nyamapfeni, Prisca; Salata, Robert A; Morrison, Charles S

    2015-12-01

    To describe pregnancy outcomes among HIV-infected women and examine factors associated with live birth among those receiving and not receiving combination antiretroviral therapy (cART). The present analysis included women with HIV from Uganda and Zimbabwe who participated in a prospective cohort study during 2001-2009. Incident pregnancies and pregnancy outcomes were recorded quarterly. The Kaplan-Meier method was used to estimate incident pregnancy probabilities; factors associated with live birth were evaluated by Poisson regression with generalized estimating equations. Among 306 HIV-infected women, there were 160 incident pregnancies (10.1 per 100 women-years). The pregnancy rate was higher among cART-naïve women than among those receiving cART (10.7 vs 5.5 per 100 women-years; P=0.047), and it was higher in Uganda than in Zimbabwe (14.4 vs 7.7 per 100 women-years; Ppregnancy (relative risk 0.8; 95% confidence interval 0.7-1.0). Women not receiving cART have higher pregnancy rates than do those receiving cART, but cART use might not affect the risk of adverse pregnancy outcomes. Timely prenatal care and monitoring of illnesses during pregnancy should be incorporated into treatment services for HIV-infected women. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Antenatal interventions for preventing the transmission of cytomegalovirus (CMV) from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant.

    LENUS (Irish Health Repository)

    McCarthy, Fergus P

    2012-01-31

    BACKGROUND: Cytomegalovirus (CMV) is a herpesvirus and the most common cause of congenital infection in developed countries. Congenital CMV infection can have devastating consequences to the fetus. The high incidence and the serious morbidity associated with congenital CMV infection emphasise the need for effective interventions to prevent the antenatal transmission of CMV infection. OBJECTIVES: The aim of this review was to assess the benefits and harms of interventions used during pregnancy to prevent mother to fetus transmission of CMV infection. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group\\'s Trials Register (31 December 2010). SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi RCTs investigating antenatal interventions for preventing the transmission of CMV from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. MAIN RESULTS: We identified six studies from the search. None of these studies met the pre-defined criteria for inclusion in this review. AUTHORS\\' CONCLUSIONS: To date, no RCTs are available that examine antenatal interventions for preventing the transmission of CMV from the infected mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. Further research is needed to assess the efficacy of interventions aimed at preventing the transmission of CMV from the mother to fetus during pregnancy including a long-term follow-up of exposed infants and a cost effective analysis.

  2. Pregnancy Outcomes in HIV-Infected Women Receiving Long-Term Isoniazid Prophylaxis for Tuberculosis and Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Allan W. Taylor

    2013-01-01

    Full Text Available Objective. While 6- to 12-month courses of isoniazid for tuberculosis prevention are considered safe in pregnant women, the effects of longer-term isoniazid prophylaxis or isoniazid in combination with antiretroviral therapy (ART are not established in human-immunodeficiency-virus-(HIV- infected women who experience pregnancy during the course of therapy. Design. Nested study of pregnancy outcomes among HIV-infected women participating in a placebo-controlled, TB-prevention trial using 36 months daily isoniazid. Pregnancy outcomes were collected by interview and record review. Results. Among 196 pregnant women, 103 (52.6% were exposed to isoniazid during pregnancy; all were exposed to antiretroviral drugs. Prior to pregnancy they had received a median of 341 days (range 1–1095 of isoniazid. We observed no isoniazid-associated hepatitis or other severe isoniazid-associated adverse events in the 103 women. Pregnancy outcomes were 132 term live births, 42 premature births, 11 stillbirths, 8 low birth weight, 6 spontaneous abortions, 4 neonatal deaths, and 1 congenital abnormality. In a multivariable model, neither isoniazid nor ART exposure during pregnancy was significantly associated with adverse pregnancy outcome (adjusted odds ratios 0.6, 95% CI: 0.3–1.1 and 1.8, 95% CI 0.9–3.6, resp.. Conclusions. Long-term isoniazid prophylaxis was not associated with adverse pregnancy outcomes, such as preterm delivery, even in the context of ART exposure.

  3. Partner support and impact on birth outcomes among teen pregnancies in the United States.

    Science.gov (United States)

    Shah, Monisha K; Gee, Rebekah E; Theall, Katherine P

    2014-02-01

    Despite hypothesized relationships between lack of partner support during a woman's pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States. In a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes. Even after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support. Having partner support or involvement during a teenager's pregnancy may reduce the likelihood of having a poor birth outcome. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  4. Impact of antiretroviral therapy on pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    C D Aniji

    2013-11-01

    Objective. To examine the impact of ART on pregnancy outcome according to the timing of initiation of treatment. Methods. A retrospective cohort study was conducted among women delivering at a tertiary hospital from 1 October 2008 to 31 March 2009. Results. A total of 245 mothers were receiving ART: 76 mothers (31% started ART pre-conception and 169 mothers (69% started ART after the first trimester. No significant differences were observed in the rates of preterm delivery and low birth weight (LBW between the pre- and post-conception groups (21% v. 24% and 21% v. 25%, respectively. Conclusion. In this cohort of women receiving ART in pregnancy, timing of ART initiation did not have any adverse effect on the measured pregnancy outcomes such as preterm delivery and LBW.

  5. Elevated Circulating IL-1β and TNF-Alpha, and Unaltered IL-6 in First-Trimester Pregnancies Complicated by Threatened Abortion With an Adverse Outcome

    Directory of Open Access Journals (Sweden)

    Nicolaos Vitoratos

    2006-01-01

    Full Text Available The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1β (IL-1β, tumor necrosis factor alpha (TNF-alpha, and Th2-type cytokine interleukin 6 (IL-6 were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1 and discharge (group B2 and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1β and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1β, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.

  6. Elevated Circulating IL-1β and TNF-Alpha, and Unaltered IL-6 in First-Trimester Pregnancies Complicated by Threatened Abortion With an Adverse Outcome

    Science.gov (United States)

    Vitoratos, Nicolaos; Papadias, Constantinos; Economou, Emmanuel; Makrakis, Evangelos; Panoulis, Constantinos; Creatsas, George

    2006-01-01

    The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1β and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1β, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome. PMID:17047289

  7. Elevated Circulating IL-1 β and TNF-Alpha, and Unaltered IL-6 in First-Trimester Pregnancies Complicated by Threatened Abortion With an Adverse Outcome

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1 β (IL-1 β , tumor necrosis factor alpha (TNF-alpha, and Th2-type cytokine interleukin 6 (IL-6 were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1 and discharge (group B2 and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1 β and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1 β , TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.

  8. Elevated circulating IL-1beta and TNF-alpha, and unaltered IL-6 in first-trimester pregnancies complicated by threatened abortion with an adverse outcome.

    Science.gov (United States)

    Vitoratos, Nicolaos; Papadias, Constantinos; Economou, Emmanuel; Makrakis, Evangelos; Panoulis, Constantinos; Creatsas, George

    2006-01-01

    The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding levels of 31 gestational age-matched women with TACP and successful outcome at admission (group B1) and discharge (group B2) and 22 gestational age-matched women with first-trimester uncomplicated pregnancy (group C) who served as controls. Mann-Whitney U or Wilcoxon test was applied as appropriate to compare differences between groups. IL-1beta and TNF-alpha were detected with significantly higher levels in group A, compared to all other groups. On the contrary, IL-6 levels were detected with no significant difference among all the other groups studied. It is concluded that in first-trimester TACP with adverse outcome, a distinct immune response, as reflected by elevated maternal IL-1beta, TNF-alpha, and unaltered IL-6 levels, is relevant to a negative obstetric outcome.

  9. Correlation between pregnancy outcomes and hormone levels in early pregnancy of women with threatened abortion and subchorionic hematoma

    Directory of Open Access Journals (Sweden)

    Xiao-Hua Liu

    2016-02-01

    Full Text Available Objective: To investigate the correlation between pregnancy outcomes and hormone levels in early pregnancy of women with threatened abortion and subchorionic hematoma. Methods: Three groups of subjects (48 cases each were selected including the group of healthy pregnant women (Group C, and the two groups of subchorionic hematoma diagnosed via B-ultrasound examination with and without (Groups A and B positive symptoms of threatened abortion such as abdominal pain, colporrhagia etc. Chemiluminescence analysis was applied to determine serum progesterone and HCG levels of all three groups, and investigate the correlation between variations of such levels and pregnancy outcomes. Results: Statistical significance existed in the differences between serum progesterone and HCG levels of the three groups at 12, 28 and 37 weeks of gestation. In early pregnancy, serum progesterone and β-HCG levels were lower in Group A than Groups B and C, and lower in Group B than Group C. In the second trimester, the serum β-HCG level was higher, while the progesterone level lower in Group A than Groups B and C; the serum β-HCG level higher, while the progesterone level lower in Group B than Group C. And the comparative results in late pregnancy were the same as those of the second trimester. The premature birth rate, abortion rate, fetal death rate were the highest, and the full time delivery rate was the lowest in Group A among all the three groups. Adverse pregnancy outcomes of women with threatened abortion and subchorionic hematoma were closely related to serum progesterone and HCG levels in early gestation. Conclusion: Serum progesterone and HCG levels in early pregnancy of women with threatened abortion and subchorionic hematoma are positively correlated with pregnancy outcomes; the lower such levels of the two early indicators, the higher the incidence of adverse pregnancy outcomes. Therefore, tests of early pregnancy serum progesterone and HCG levels can be

  10. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie

    2015-01-01

    .72-1.17). CONCLUSION: The women who are referred for occupational risk assessment at two large occupational university departments are not at an increased risk of preterm birth or of delivering low birth weight children. This may reflect that reproductive hazards in Danish workplaces are limited and....../or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study......INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (

  11. Brucellosis in pregnancy: clinical aspects and obstetric outcomes.

    Science.gov (United States)

    Vilchez, Gustavo; Espinoza, Miguel; D'Onadio, Guery; Saona, Pedro; Gotuzzo, Eduardo

    2015-09-01

    Brucellosis is a zoonosis with high morbidity in humans. This disease has gained interest recently due to its re-emergence and potential for weaponization. Pregnant women with this disease can develop severe complications. Its association with adverse obstetric outcomes is not clearly understood. The objective of this study was to describe the obstetric outcomes of brucellosis in pregnancy. Cases of pregnant women with active brucellosis seen at the Hospital Nacional Cayetano Heredia from 1970 to 2012 were reviewed. Diagnostic criteria were a positive agglutination test and/or positive blood/bone marrow culture. Presentation and outcomes data were collected. The Chi-square test was used for nominal variables. A p-value of brucellosis in 6.4%. The most common treatment was aminoglycosides plus rifampicin (42.2% of cases). Complication rates decreased if treatment was started within 2 weeks of presentation (p brucellosis in pregnancy reported in the literature. Brucella presents adverse obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes. Copyright © 2015. Published by Elsevier Ltd.

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

    DEFF Research Database (Denmark)

    Petersen, Kasper Meidahl; Jimenez-Solem, Espen; Andersen, Jon Traerup

    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. Pregnancy Outcome of HIV-Infected Women on Anti-Retroviral ...

    African Journals Online (AJOL)

    User

    antiretroviral treatment (ARVs) to HIV-positive pregnant women. The aim of this ..... possible should be considered a vital means of reducing the maternal mortality and other adverse maternal .... load suppression, and pregnancy outcomes.

  14. Eating for Two in Pregnancy : Health outcomes in pregnant women and their children

    NARCIS (Netherlands)

    M.J. 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

  15. DOPPLER STUDY IN HIGH-RISK PREGNANCIES IN THIRD TRIMESTER OF PREGNANCIES FOR PREDICTION OF ADVERSE PERINATAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Upendranath Upadhyay

    2017-04-01

    Full Text Available BACKGROUND Our study aimed to evaluate the Doppler value in third trimester of pregnancy where the features at risk is suspected. The patient with abnormal findings are identified and intervened for timely confinement. After delivery, the neonates were also taken care and the outcome were analysed. MATERIALS AND METHODS Study conducted from June 2015 to October 2016 in Add Annex Healthcare Centre and Hi-Tech Medical College, Bhubaneswar. The case referred from the SCB Medical College, Cuttack, and Hi-Tech Medical College. Around 50 randomly selected cases beyond 28 wks. of pregnancy with foetus risk were studied. RESULTS The study shows that the abnormal perinatal outcomes are more with abnormal findings in different arteries (Umbilical ArteryUA, Middle Cerebral Artery-MCA, Maternal Uterine Artery-MUA, i.e. 10 out of 19. But, in cases with normal fetoplacental perfusion, the perinatal outcome is much better, i.e. 4 out of 14. CONCLUSION Doppler study by an expert hand offers a tremendous potential in identification of fetoplacental perfusion defect and then timely inversion of pregnancies with “foetus at risk” and decreases the neonatal deaths and maternal morbidity.

  16. 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.

  17. Adverse pregnancy outcome in rats following exposure to a Salacia reticulata (Celastraceae) root extract.

    Science.gov (United States)

    Ratnasooriya, W D; Jayakody, J R A C; Premakumara, G A S

    2003-07-01

    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 (250-260 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.

  18. Obstetric and neonatal outcomes of pregnancies conceived after preimplantation genetic diagnosis: cohort study and meta-analysis.

    Science.gov (United States)

    Hasson, Joseph; Limoni, Dana; Malcov, Mira; Frumkin, Tsvia; Amir, Hadar; Shavit, Tal; Bay, BjØrn; Many, Ariel; Almog, Benjamin

    2017-08-01

    Preimplantation genetic diagnosis (PGD) may pose risks to pregnancy outcome owing to the invasiveness of the biopsy procedure. This study compares outcome of singleton and twin clinical pregnancies conceived after fresh embryo transfers of PGD (n = 89) and matched intracytoplasmic sperm injection (ICSI) pregnancies (n = 166). The study was carried out in a single university affiliated centre. Because of the paucity of available data, a literature-based meta-analysis of studies comparing neonatal outcome of PGD and ICSI pregnancies was also conducted. In the retrospective cohort study, obstetric and neonatal outcome were available in 67 PGD and 118 ICSI pregnancies. Perinatal outcomes were comparable between PGD and ICSI pregnancies. Meta-analysis revealed similar outcomes, except for higher rate of low birth weight (<2500 g) neonates in ICSI twin pregnancies (RR 0.86, 95% CI 0.74 to 1.0). Mean birth weight, gestational age at birth, pre-term deliveries (<37 weeks) and malformations were all comparable. In this cohort study and subsequent meta-analysis, no association was found between PGD conceived pregnancies and risks of adverse neonatal or obstetrical outcomes compared with ICSI pregnancies. Hence, blastomere biopsy for PGD does not seem to increase the risk for adverse perinatal outcome compared with ICSI pregnancies. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Late recognition of pregnancy as a predictor of adverse birth outcomes.

    Science.gov (United States)

    Ayoola, Adejoke B; Stommel, Manfred; Nettleman, Mary D

    2009-08-01

    We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality. A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX). Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21). These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

  20. Pregnancy outcomes after assisted human reproduction.

    Science.gov (United States)

    Okun, Nanette; Sierra, Sony

    2014-01-01

    To review the effect of assisted human reproduction (AHR) on perinatal outcomes, to identify areas requiring further research with regard to birth outcomes and AHR, and to provide guidelines to optimize obstetrical management and counselling of prospective Canadian parents. This document compares perinatal outcomes of different types of AHR pregnancies with each other and with those of spontaneously conceived pregnancies. Clinicians will be better informed about the adverse outcomes that have been documented in association with AHR, including obstetrical complications, adverse perinatal outcomes, multiple gestations, structural congenital abnormalities, chromosomal abnormalities, and imprinting disorders. Published literature was retrieved through searches of MEDLINE and the Cochrane Library from January 2005 to December 2012 using appropriate controlled vocabulary and key words (assisted reproduction, assisted reproductive technology, ovulation induction, intracytoplasmic sperm injection, embryo transfer, and in vitro fertilization). Results were not restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies; studies of all designs published in English from January 2005 to December 2012 were reviewed, and additional publications were identified from the bibliographies of these articles. Searches were updated on a regular basis and incorporated in the guideline to August 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Summary Statements 1. There is increasing evidence that infertility or subfertility is an

  1. Intimate partner violence, forced first sex and adverse pregnancy outcomes in a sample of Zimbabwean women accessing maternal and child health care.

    Science.gov (United States)

    Shamu, Simukai; Munjanja, Stephen; Zarowsky, Christina; Shamu, Patience; Temmerman, Marleen; Abrahams, Naeemah

    2018-05-03

    .26-2.52) in the recent pregnancy and any recent pregnancy negative outcomes including LBW, premature baby, emergency caesarean section (aOR1.38,95%CI:1.03-1.83). Forced first sex (FFS) and intimate partner violence (IPV) are associated with adverse maternal and newborn health outcomes. Strengthening primary and secondary violence prevention is required to improve pregnancy-related outcomes.

  2. SUPPLEMENTATION WITH VITAMINS C AND E DURING PREGNANCY FOR THE PREVENTION OF PREECLAMPSIA AND OTHER ADVERSE MATERNAL AND PERINATAL OUTCOMES: A SYSTEMATIC REVIEW AND METAANALYSIS

    Science.gov (United States)

    CONDE-AGUDELO, Agustín; ROMERO, Roberto; KUSANOVIC, Juan Pedro; HASSAN, Sonia

    2011-01-01

    OBJECTIVE To determine whether supplementation with vitamins C and E during pregnancy reduces the risk of preeclampsia and other adverse maternal and perinatal outcomes. STUDY DESIGN Systematic review and metaanalysis of randomized controlled trials. RESULTS Nine trials involving a total of 19,810 women were included. Overall, there were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (9.6% versus 9.6%; relative risk 1.00, 95% confidence interval 0.92–1.09). Similar results were obtained when subgroup analyses were restricted to women at high risk or low/moderate risk for preeclampsia. Women supplemented with vitamins C and E were at increased risk of developing gestational hypertension and premature rupture of membranes, and a decreased risk of abruptio placentae. There were no significant differences between the vitamin and placebo groups in the risk of other adverse maternal or fetal/perinatal outcomes. CONCLUSION Supplementation with vitamins C and E during pregnancy does not prevent preeclampsia. PMID:21529757

  3. Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocol.

    Science.gov (United States)

    Ehiri, John; Alaofè, Halimatou; Asaolu, Ibitola; Chebet, Joy; Esu, Ekpereonne; Meremikwu, Martin

    2018-04-25

    Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. PROSPERO CRD42017080092.

  4. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity.

    Science.gov (United States)

    Roberts, Christine L; Ford, Jane B; Algert, Charles S; Bell, Jane C; Simpson, Judy M; Morris, Jonathan M

    2009-02-25

    Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI) developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH). We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3-5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising

  5. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity

    Directory of Open Access Journals (Sweden)

    Algert Charles S

    2009-02-01

    Full Text Available Abstract Background Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH. Methods We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Results Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000 suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3–5.3%. This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Conclusion Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was

  6. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria.

    LENUS (Irish Health Repository)

    O'Sullivan, E P

    2012-01-31

    AIMS\\/HYPOTHESIS: New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population. METHODS: The Atlantic Diabetes In Pregnancy (DIP) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24-28 weeks. GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and compared with previous WHO criteria; maternal and neonatal adverse outcomes were prospectively recorded. RESULTS: Of the participants, 12.4% and 9.4% were diagnosed with GDM using IADPSG and WHO criteria, respectively. IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes (gestational hypertension, polyhydramnios and Caesarean section) and neonatal outcomes (prematurity, large for gestational age, neonatal unit admission, neonatal hypoglycaemia and respiratory distress). The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age, body mass index and non-European ethnicity. Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes. CONCLUSIONS\\/INTERPRETATION: GDM prevalence is higher when using newer IADPSG, compared with WHO, criteria, and these women and their offspring experience significant adverse pregnancy outcomes. Higher rates of GDM pose a challenge to healthcare systems, but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child.

  7. Platelet Count in First Trimester of Pregnancy as a Predictor of Perinatal Outcome

    Directory of Open Access Journals (Sweden)

    Santiago Garcia-Tizon Larroca

    2017-02-01

    CONCLUSIONS: Maternal and pregnancy factors can poorly predict relevant changes in PLT at the first trimester of gestation. PLT at first trimester of pregnancy might predict adverse perinatal outcome in combination with other markers.

  8. Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

    Directory of Open Access Journals (Sweden)

    Deniz Şimşek

    2015-08-01

    Full Text Available Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17% had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1 and 19 patients were in the second half of the pregnancy (group 2. There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode.

  9. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie

    2015-01-01

    INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (METHODS: In a cohort study, 1,202 deliveries among....../or that the occupational risk assessment and counselling of pregnant women are preventing these selected adverse pregnancy outcomes. FUNDING: The Research Unit at Department of Occupational and Environmental Medicine at Bispebjerg Hospital supported the study financially. TRIAL REGISTRATION: not relevant. The study.......72-1.17). CONCLUSION: The women who are referred for occupational risk assessment at two large occupational university departments are not at an increased risk of preterm birth or of delivering low birth weight children. This may reflect that reproductive hazards in Danish workplaces are limited and...

  10. TEENAGE PREGNANCY: DEMOGRAPHICS, MATERNAL AND FOETAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Radhika Gollapudi

    2016-08-01

    Full Text Available BACKGROUND Pregnancy though is a physiological event in a woman’s life, it has its own associated complications. In teenage pregnancies, the physical and emotional state of stress coupled with biological immaturity leads to adverse effect both on the health of the mother and the foetus. METHODS This study is a clinical prospective study analysing the demographics, maternal health issues and the foetal outcome in teenage pregnancies. The study was conducted over a period of one year at a government tertiary care center. Pregnant women in the age group of 13-19 years who delivered during the study period were included in the study group. All pregnant women over 20 years of age who delivered during the same period were taken as control group. Women who had medical disorders complicating pregnancy were excluded from the study. Anaemia, pregnancy induced hypertension, antepartum haemorrhage and mode of delivery were the maternal outcomes that were noted. Intrauterine growth retardation, prematurity, low birth weight, APGAR score were analysed with respect to the foetus. RESULTS In this study, the total number of pregnant women who delivered during the study period were 4782, 536 were teenage mothers, constituting 11.2% of the total pregnancies. Of the 536 teenage mothers, 69.78% belonged to the rural areas and 71.64% were found to have inadequate antenatal visits to the hospital. The mean age of teenage pregnancy was 17.18 years. Incidence of anaemia was 44.2% in comparison, the control group had an incidence of 33.02%. In our study, incidence of Pregnancy induced hypertension was 18.64% in teenage mothers and 10.6% in non-teenage mothers. The incidence of Antepartum Haemorrhage in our study was 8.94% in teenage mothers. Incidence of lower segment caesarean section was 22.76% in the teenage group as compared to 14.57% in the non-teenage group. In our study, 13.05% of teenage mothers had preterm deliveries as compared to 6.40% of non-teenage mothers

  11. Deflation of gastric band balloon in pregnancy for improving outcomes.

    Science.gov (United States)

    Jefferys, Amanda E; Siassakos, Dimitrios; Draycott, Tim; Akande, Valentine A; Fox, Robert

    2013-04-30

    In line with the rise in the prevalence of obesity, an increasing number of women of childbearing age are undergoing laparoscopic adjustable gastric banding (LAGB), resulting in an increasing number of pregnancies with a band in place. Currently, there is no consensus on optimal band management in pregnancy. Some clinicians advocate leaving the band balloon inflated to reduce gestational weight gain and associated adverse perinatal outcomes. However, there are concerns that maintaining balloon inflation during pregnancy might increase the risk of band complications and adversely affect fetal development and/or growth as a result of reduced nutritional intake. To compare maternal and perinatal outcomes for elective gastric band balloon deflation versus intention to maintain balloon inflation during pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012) and the Web of Science database (1940 to September 2012). Randomised-controlled trials comparing elective deflation of the gastric band balloon with intention to maintain balloon inflation in pregnant women who have undergone LAGB. Two review authors independently assessed studies for inclusion. No studies met the criteria for inclusion in the review. To date no randomised controlled trials exist that compare elective deflation of the gastric band balloon in pregnancy versus intention to maintain balloon inflation. Further research is needed to define the optimum management of the gastric band balloon in pregnancy.

  12. HIV infection in pregnancy: maternal and perinatal outcomes in a tertiary care hospital in Calabar, Nigeria.

    Science.gov (United States)

    Ikpim, Ekott Mabel; Edet, Udo Atim; Bassey, Akpan Ubong; Asuquo, Otu Akaninyene; Inyang, Ekanem Etim

    2016-04-01

    Human immunodeficiency virus (HIV) infection is likely to have untoward effects on pregnancy and its outcome. This study assessed the impact of maternal HIV infection on pregnancy outcomes in a tertiary centre in Calabar, Nigeria. This retrospective study analysed delivery records of 258 HIV-positive and 257 HIV-negative women for pregnancy and delivery complications. Maternal and fetal outcomes of HIV-positive pregnancies were compared with those of HIV-negative controls. Adverse pregnancy outcomes significantly associated with HIV status were: anaemia: 33 (8.1%) vs. 8 (3.1%) in controls; puerperal sepsis: 18 (7%) vs. 2 (0.8%); and low birth weight: 56 (21.7%) vs. 37 (14.4%). Caesarean delivery was higher among HIV-positive women than controls: 96 (37.2%) vs. 58 (22.6%). Preterm births were higher in those HIV cohorts who did not receive antiretroviral therapy (ART): 13 (16.9%) vs. 7 (3.9%). HIV-positive status increased adverse birth outcome of pregnancy. ART appeared to reduce the risk of preterm births in HIV-positive cohorts. © The Author(s) 2015.

  13. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort.

    Directory of Open Access Journals (Sweden)

    Gwinyai Masukume

    Full Text Available Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality.The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of 'low risk' women participating in a large international multicentre prospective study (n = 5 609, to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation.The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization's definition of anaemia in pregnancy (haemoglobin < 11g/dL. Binary logistic regression with adjustment for potential confounders (country, maternal age, having a marital partner, ethnic origin, years of schooling, and having paid work was the main method of analysis.The hallmark findings were the low prevalence of anaemia (2.2%, that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78, and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score < 7 at one and five minutes. Adverse pregnancy outcomes were however more common in those with anaemia than in those without.In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia's conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy.

  14. Pregnancy, Obstetric and Neonatal Outcomes in HIV Positive ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Keywords: Pregnancy, delivery, HIV, neonate, adverse outcome. Introduction. HIV-1 infection has remained a major public health challenge in sub-Saharan Africa, accounting ... practice have greatly reduced both maternal deaths .... 2010 we reverted back to triple ARV .... between the two groups in the rates of obstetric.

  15. Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

    NARCIS (Netherlands)

    Magee, Laura A.; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean Marie

    2016-01-01

    Introduction. For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. Material and methods. This was a planned, secondary analysis

  16. A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes

    OpenAIRE

    Jiang, Hong; Xiong, Xu; Su, Yi; Zhang, Yiming; Wu, Hongqiao; Jiang, Zhijun; Qian, Xu

    2013-01-01

    Background Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized cont...

  17. Periodontal disease and adverse pregnancy outcomes.

    Science.gov (United States)

    Shub, Alexis; Swain, Jonathan R; Newnham, John P

    2006-09-01

    Periodontal disease is a common infectious disease in women of reproductive age. The disease is often not diagnosed and in studies of over 10 000 women has been associated with preterm birth, small for gestational age newborns, and preeclampsia. It has been shown in a smaller number of women that treatment of periodontal disease may reduce the rate of preterm birth. The pregnancy complications of periodontal disease may be due to lipopolysaccharide from the periodontal pockets inciting prostaglandin pathways controlling parturition. Three large randomized controlled trials of treatment of periodontal disease are underway and may provide confirmation of the importance of periodontal disease in causing complications of pregnancy.

  18. Singleton pregnancy outcomes after assisted and non-assisted reproductive technology in infertile patients.

    Science.gov (United States)

    Tsutsumi, Ryo; Fujimoto, Akihisa; Osuga, Yutaka; Ooi, Nagisa; Takemura, Yuri; Koizumi, Minako; Yano, Tetsu; Taketani, Yuji

    2012-07-01

    Singleton pregnancy after assisted reproductive technology (ART) has been associated with higher risks of adverse pregnancy outcome than naturally conceived singleton pregnancy. This study was to elucidate whether the ART procedure is responsible for abnormal pregnancy outcome comparing those after ART and non-ART in infertile patients. We compare the singleton pregnancy outcome of infertile patients in our university hospital between 2000 and 2008 following ART (351 pregnancies) and non-ART (213 pregnancies) procedures. Pregnancy outcome parameters were incidence of pregnancy induced hypertension, placenta previa, placental abruption, cesarean delivery, preterm birth, very preterm birth, stillbirth, low birth weight and very low birth weight. Most of the pregnancy outcome parameters were not significantly different between the ART group and the non-ART group. Only placenta previa was significantly higher in the ART group than in the non-ART group (odds ratio 4.0; 95 % CI 1.2-13.7). ART procedure may itself be a risk factor for the development of placenta previa. Some of the abnormal perinatal outcomes that had been previously attributed to ART, however, may be due to the baseline characteristics of infertile patients.

  19. Poor pregnancy outcome in women with type 2 diabetes

    DEFF Research Database (Denmark)

    Clausen, Tine D; Mathiesen, Elisabeth; Ekbom, Pia

    2005-01-01

    . Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996-2000, the background population, and pregnant women with type 2 diabetes during 1980-1992 from the same department. RESULTS: The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.......6%) was increased four- and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2...... diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA(1c) at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome...

  20. TEENAGE PREGNANCY AND ITS OBSTETRIC OUTCOME

    Directory of Open Access Journals (Sweden)

    Kudupudi Subba Rao

    2017-02-01

    Full Text Available BACKGROUND Teenage pregnancy is upcoming as one of the most important social and public health problem all over the world. In the present study, we have evaluated the maternal and foetal outcomes of teenage pregnancy in a tertiary teaching hospital over a period of one year. The objective of the study is to evaluate the maternal, foetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. MATERIALS AND METHODS A retrospective study was undertaken for a period of one year at KIMS, a tertiary care teaching hospital in a rural area, where on an average 3000 deliveries per year take place. Data was retrieved from hospital records. All teenage mothers aged 13-19 years were included in the study. RESULTS In this study, 626 (18.79% cases of teenage mothers were recorded out of 3330 antenatal cases. Majority of teenagers were primigravida (79.23% and multigravida 20.76%. Antenatal care was nil or inadequate in 32% of cases. Majority of the mothers were of low socioeconomic status. Complications like pregnancy-induced hypertension (11.5%, premature onset of labour (5.75%, anaemia (23.64%, others like gestational diabetes mellitus, etc. (2.56% were noted. 25.88% underwent lower segment caesarean section, the most common indication was cephalopelvic disproportion (45.68%. 5% of babies delivered to teenage mothers had higher risk of low Apgar at 5 minutes. Neonatal morbidities like asphyxia, jaundice, respiratory distress were recorded in 14% of neonates and babies were more prone to neonatal intensive care unit admissions. CONCLUSION Teenage pregnancy was associated with high risk of pregnancy-induced hypertension, eclampsia, premature onset of labour and foetal deaths. High risk of neonatal morbidity and mortality were also seen. Adequate antenatal care reduces the adverse pregnancy outcome in these mothers.

  1. Serum placental growth factor, vascular endothelial growth factor, soluble vascular endothelial growth factor receptor-1 and -2 levels in periodontal disease, and adverse pregnancy outcomes.

    Science.gov (United States)

    Sert, Tuba; Kırzıoğlu, F Yeşim; Fentoğlu, Ozlem; Aylak, Firdevs; Mungan, Tamer

    2011-12-01

    The aim of this study is the evaluation of levels of serum interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF), placental growth factor (PIGF), and soluble VEGF receptor (sVEGFR)-1 and -2 in the association between periodontal disease and adverse pregnancy outcomes. One hundred and nine mothers, who recently gave birth, and 51 women who were not recently pregnant, aged 18 to 35 years, were included in this study. The mothers were classified as term birth, preterm birth (PTB), and preterm low birth weight (PLBW) in respect to their gestational age and baby's birth weight. The birth mothers were grouped as having gingivitis or periodontitis. The non-pregnant group also included periodontally healthy patients. Venous blood samples were collected to evaluate serum IL-1β, IL-6, IL-10, TNF-α, VEGF, PIGF, and sVEGFR-1 and -2 levels. Mother's weight, education, and income level were significantly associated with pregnancy outcomes. Serum levels of IL-1β, TNF-α, IL-6, VEGF, and sVEGFR-1 and -2 showed an increase in significance when related to pregnancy. Whereas in the PLBW group IL-1β, VEGF, and sVEGFR-2 levels were increased, in the PTB group sVEGFR-1 levels were increased. Additionally, the patients in the PLBW group with periodontitis had higher serum levels of IL-1β, VEGF, sVEGFR-2, and IL-1β/IL-10. The serum levels of IL-1β, VEGF, and sVEGFR-1 and -2 may have a potential effect on the mechanism of the association between periodontal disease and adverse pregnancy outcomes.

  2. Elevated Circulating IL-1β and TNF-Alpha, and Unaltered IL-6 in First-Trimester Pregnancies Complicated by Threatened Abortion With an Adverse Outcome

    OpenAIRE

    Vitoratos, Nicolaos; Papadias, Constantinos; Economou, Emmanuel; Makrakis, Evangelos; Panoulis, Constantinos; Creatsas, George

    2006-01-01

    The purpose of the present study was to examine the profile of selected proinflammatory cytokines in maternal serum of first-trimester pregnancies complicated by threatened abortion (TACP) and its relevance to obstetric outcome. Serum levels of Th1-type cytokines interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-alpha), and Th2-type cytokine interleukin 6 (IL-6) were measured, by ELISA, in 22 women with TACP and adverse outcome at admission (group A) and compared with the corresponding...

  3. Adverse childhood experiences and risk of paternity in teen pregnancy.

    Science.gov (United States)

    Anda, Robert F; Chapman, Daniel P; Felitti, Vincent J; Edwards, Valerie; Williamson, David F; Croft, Janet B; Giles, Wayne H

    2002-07-01

    Few studies have investigated risk factors that predispose males to be involved in teen pregnancies. To provide new information on such factors, we examined the relationships of eight common adverse childhood experiences to a male's risk of impregnating a teenager. We conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man's own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education. At least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64-100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences. Adverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four

  4. Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?

    Directory of Open Access Journals (Sweden)

    Tandu-Umba B

    2014-12-01

    Full Text Available Barthélémy Tandu-Umba, Muela Andy Mbangama, Kitenge Marc Brunel Kamongola , Tchawou Armel Georges Kamgang, Mawamfumu Perthus Kivuidi, Munene Sam Kasonga, Meke Irène Kambashi, Kabasele Oscar Kapuku, Bituemi Jackson Kondoli, Kibundila Rolly Kikuni, Kuzungu Simon KasikilaDepartment of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo Objective: To determine relationships between pre-pregnancy risk factors at first antenatal visit booking and pregnancy outcomes.Study design: This was a multicenter, cross-sectional study involving women admitted for singleton delivery from July 1 until October 31 (3 months, 2013, at nine major maternity clinics in Kinshasa, Democratic Republic of Congo. All women were checked for hereditary, community, and personal medical/surgical risk situations and mother/infant problems in previous pregnancies. Maternal and perinatal complications related to current/just-terminated pregnancy were analyzed according to pre-pregnancy risk factors in order to establish their prediction concerning maternal and perinatal complications related to current/just-terminated pregnancy (odds ratios. Results are given with 95% confidence intervals, and P<0.05 was considered significant.Results: The study sample comprised 2,086 women. Primiparity (36.5%, single relationship status (26.4%, and maternal age ≥35 years (18.3% were the most important non-pathologic risk factors, while arterial hypertension in family (34.3%, previous miscarriage (33.2%, overweight/obesity (21.9%, diabetes in family (21.1%, previous cesarean section (15.7%, previous postpartum hemorrhage (13.1%, low birth weight (10%, previous macrosomia (10%, and previous premature rupture of membranes (6.2% predominated among pathologic risk factors. Major adverse outcomes recurred in some women, with recurrence rates of 21/37 (57%, 111/208 (53%, 74/208 (36%, 191/598 (32%, 132/466 (28%, 24/130 (18%, and 4/65 (6% for prematurity

  5. [Planned home versus planned hospital births: adverse outcomes comparison by reviewing the international literature].

    Science.gov (United States)

    Faucon, C; Brillac, T

    2013-06-01

    To assess the safety of planned home birth compared to hospital birth, in low-risk pregnancies. An international literature review was conducted. Mortality, adverse outcomes and medical interventions were compared. Home birth was not associated with higher mortality rates, but with lower maternal adverse outcomes. Perinatal adverse outcomes are not significantly different at home and in hospital. Medical interventions are more frequent in hospital births. Home birth attended by a well-trained midwife is not associated with increased mortality and morbidity rates, but with less medical interventions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

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

    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 project. Collaboration participants have datasets with air pollution values and birth outcomes. Eighteen research groups with data for approximately 20 locations in Asia, Australia, Europe, North America, and South America are participating, with most participating in an initial pilot study. Datasets generally cover the 1990s. Number of births is generally in the hundreds of thousands, but ranges from around 1,000 to about one million. Almost all participants have some measure of particulate matter, and most have ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Strong enthusiasm for participating and a geographically-diverse range of participants should lead to understanding uncertainties about the role of air pollution in perinatal outcomes and provide decision-makers with better tools to account for pregnancy outcomes in air pollution policies. PMID:20644693

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Reported Estimates of Adverse Pregnancy Outcomes among Women with and without Syphilis: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Qin, Jiabi; Yang, Tubao; Xiao, Shuiyuan; Tan, Hongzhuan; Feng, Tiejian; Fu, Hanlin

    2014-01-01

    Background To estimate probability of adverse pregnancy outcomes (APOs) among women with and without syphilis through a systematic review of published literatures. Methodology/Principal Findings 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 (I 2 = 93.9%; Psyphilis (I 2 = 94.8%; PSyphilis 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. PMID

  9. Impact of noise and air pollution on pregnancy outcomes

    NARCIS (Netherlands)

    Gehring, Ulrike; Tamburic, Lillian; Sbihi, Hind; Davies, Hugh W.; Brauer, Michael

    2014-01-01

    Background: Motorized traffic is an important source of both air pollution and community noise. While there is growing evidence for an adverse effect of ambient air pollution on reproductive health, little is known about the association between traffic noise and pregnancy outcomes. Methods: We

  10. Long-term neurodevelopmental outcome after selective feticide in monochorionic pregnancies.

    Science.gov (United States)

    van Klink, Jmm; Koopman, H M; Middeldorp, J M; Klumper, F J; Rijken, M; Oepkes, D; Lopriore, E

    2015-10-01

    To assess the incidence of and risk factors for adverse long-term neurodevelopmental outcome in complicated monochorionic pregnancies treated with selective feticide at our centre between 2000 and 2011. Observational cohort study. National referral centre for fetal therapy (Leiden University Medical Centre, the Netherlands). Neurodevelopmental outcome was assessed in 74 long-term survivors. Children, at least 2 years of age, underwent an assessment of neurologic, motor and cognitive development using standardised psychometric tests and the parents completed a behavioural questionnaire. A composite outcome termed neurodevelopmental impairment including cerebral palsy (GMFCS II-V), cognitive and/or motor test score of Neurodevelopmental impairment was detected in 5/74 [6.8%, 95% confidence interval (CI), 1.1-12.5] of survivors. Overall adverse outcome, including perinatal mortality or neurodevelopmental impairment was 48/131 (36.6%). In multivariate analysis, parental educational level was associated with cognitive test scores (regression coefficient B 3.9, 95% CI 1.8-6.0). Behavioural problems were reported in 10/69 (14.5%). Adverse long-term outcome in survivor twins of complicated monochorionic pregnancies treated with selective feticide appears to be more prevalent than in the general population. Cognitive test scores were associated with parental educational level. Neurodevelopmental impairment after selective feticide was detected in 5/74 (6.8%, 95% CI 1.1-12.5) of survivors. © 2015 Royal College of Obstetricians and Gynaecologists.

  11. Obstetric and perinatal outcome of multiple pregnancy

    International Nuclear Information System (INIS)

    Qazi, G.

    2011-01-01

    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)

  12. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort.

    Science.gov (United States)

    Masukume, Gwinyai; Khashan, Ali S; Kenny, Louise C; Baker, Philip N; Nelson, Gill

    2015-01-01

    Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality. The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of 'low risk' women participating in a large international multicentre prospective study (n = 5 609), to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation. The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization's definition of anaemia in pregnancy (haemoglobin prevalence of anaemia (2.2%), that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78), and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score pregnancy outcomes were however more common in those with anaemia than in those without. In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia's conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy.

  13. Adverse effects of perinatal nicotine exposure on reproductive outcomes.

    Science.gov (United States)

    Wong, Michael K; Barra, Nicole G; Alfaidy, Nadia; Hardy, Daniel B; Holloway, Alison C

    2015-12-01

    Nicotine exposure during pregnancy through cigarette smoking, nicotine replacement therapies or e-cigarette use continues to be a widespread public health problem, impacting both fetal and postnatal health. Yet, at this time, there remains limited data regarding the safety and efficacy in using these nicotine products during pregnancy. Notably, reports assessing the effect of nicotine exposure on postnatal health outcomes in humans, including reproductive health, are severely lacking. Our current understanding regarding the consequences of nicotine exposure during pregnancy is limited to a few animal studies, which do not comprehensively address the underlying cellular mechanisms involved. This paper aims to critically review the current knowledge from human and animal studies regarding the direct and indirect effects (e.g. obesity) of maternal nicotine exposure, regardless of its source, on reproductive outcomes in pregnancy and postnatal life. Furthermore, this review highlights several key cellular mechanisms involved in these adverse reproductive deficits including oxidative stress, inflammation, and endoplasmic reticulum (ER) stress. By understanding the interplay of the cellular mechanisms involved, further strategies could be developed to prevent the reproductive abnormalities resulting from exposure to nicotine in utero and influence informed clinical guidelines for pregnant women. © 2015 Society for Reproduction and Fertility.

  14. The Impact of Teenage Pregnancy on Maternal and Perinatal Outcome

    Directory of Open Access Journals (Sweden)

    Chaitra Ramachandra

    2016-05-01

    Full Text Available To study the impact of teenage pregnancy on maternal and perinatal outcome. This is a randomized prospective clinical study carried out in the Obstetrics and Gynaecology department, BGS Global Medical College, over a period of one year from January 2015 to December 2015. In study group (Group A included a total of 200 primigravid teenage mothers(age <20 years and the control group included 200 primigavid adult mothers (20- 30years of age . The maternal status, labour progress, delivery characteristics and neonatal outcomes were reviewed and analysed. Proportion of mothers in the study group who delivered vaginally was 61.5% compared to 80.5% in the control group. Instrumental delivery rate, emergency LSCS and elective LSCS rates were higher in the study group (teenage pregnancy compared to the control group. (9.5% Vs 5%, 17% Vs 9.5%, 12% Vs 5% respectively. Anaemia, Premature Rupture of Membranes, Oligohydraminos, Post partum Haemorrhage was found to be higher among teenage mothers when compared to adult mothers. PIH, polyhydraminos were found to be higher in control group than in the study group. In regard to adverse perinatal outcomes, higher risks of intra uterine growth restriction, preterm births, stillbirths, low APGAR scores, NICU admission were higher were higher in the study group compared to the control group. In this study, we found that women with teenage pregnancies were at increased risk for adverse pregnancy outcomes in regard to maternal, foetal and neonatal complications as compared with adult control mothers.

  15. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

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    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

  16. Malaria infection, poor nutrition and indoor air pollution mediate socioeconomic differences in adverse pregnancy outcomes in Cape Coast, Ghana.

    Science.gov (United States)

    Amegah, Adeladza K; Damptey, Obed K; Sarpong, Gideon A; Duah, Emmanuel; Vervoorn, David J; Jaakkola, Jouni J K

    2013-01-01

    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. 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. 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. We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition

  17. Position of the American Dietetic Association and American Society for Nutrition: obesity, reproduction, and pregnancy outcomes.

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    Siega-Riz, Anna Maria; King, Janet C

    2009-05-01

    Given the detrimental influence of maternal overweight and obesity on reproductive and pregnancy outcomes for the mother and child, it is the position of the American Dietetic Association and the American Society for Nutrition that all overweight and obese women of reproductive age should receive counseling on the roles of diet and physical activity in reproductive health prior to pregnancy,during pregnancy, and in the inter conceptional period, in order to ameliorate these adverse outcomes. The effect of maternal nutritional status prior to pregnancy on reproduction and pregnancy outcomes is of great public health importance. Obesity in the United States and worldwide has grown to epidemic proportions, with an estimated 33% of US women classified as obese. This position paper has two objectives: (a) to help nutrition professionals become aware of the risks and possible complications of overweight and obesity for fertility,the course of pregnancy, birth outcomes, and short- and long-term maternal and child health outcomes;and (b) related to the commitment to research by the American Dietetic Association and the American Society for Nutrition, to identify the gaps in research to improve our knowledge of the risks and complications associated with being overweight and obese before and during pregnancy.Only with an increased knowledge of these risks and complications can health care professionals develop effective strategies that can be implemented before and during pregnancy as well as during the inter conceptional period to ameliorate adverse outcomes.

  18. Circulating Angiogenic Factors and the Risk of Adverse Outcomes among Haitian Women with Preeclampsia.

    Directory of Open Access Journals (Sweden)

    Melissa I March

    Full Text Available Angiogenic factors are strongly associated with adverse maternal and fetal outcomes among women with preterm preeclampsia (PE in developed countries. We evaluated the role of angiogenic factors and their relationship to adverse outcomes among Haitian women with PE.We measured plasma antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1 and proangiogenic placental growth factor (PlGF levels in women with PE (n=35 compared to controls with no hypertensive disorders (NHD (n=43 among subjects with singleton pregnancies that delivered at Hospital Albert Schweitzer (HAS in Haiti. We divided the preeclamptic women into two groups, early onset (≤ 34 weeks and late onset (>34 weeks and examined relationships between sFlt1/PlGF ratios on admission and adverse outcomes (abruption, respiratory complications, stroke, renal insufficiency, eclampsia, maternal death, birth weight 34 weeks with no adverse outcome.PE-related adverse outcomes are common in women in Haiti and are associated with profound angiogenic imbalance regardless of gestational age at presentation.

  19. A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes.

    Science.gov (United States)

    Jiang, Hong; Xiong, Xu; Su, Yi; Zhang, Yiming; Wu, Hongqiao; Jiang, Zhijun; Qian, Xu

    2013-12-09

    Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized controlled trial (RCT) has examined if treating periodontal disease before pregnancy reduces adverse birth outcomes. This study aims to examine if the pre-conception treatment of periodontal disease will lead to improved periodontal status during late pregnancy and subsequent birth outcomes. A sample of 470 (235 in each arm of the study) pre-conception women who plan to conceive within one year and with periodontal disease will be recruited for the study. All participants will be randomly allocated to the intervention or control group. The intervention group will receive free therapy including dental scaling and root planning (the standard therapy), supragingival prophylaxis, and oral hygiene education. The control group will only receive supragingival prophylaxis and oral hygiene education. Women will be followed throughout their pregnancy and then to childbirth. The main outcomes include periodontal disease status in late pregnancy and birth outcomes measured such as mean birth weight (grams), and mean gestational age (weeks). Periodontal disease will be diagnosed through a dental examination by measuring probing depth, clinical attachment loss and percentage of bleeding on probing (BOP) between gestational age of 32 and 36 weeks. Local and systemic inflammatory mediators are also included as main outcomes. This will be the first RCT to test whether treating periodontal disease among pre-conception women reduces periodontal disease during pregnancy and prevents adverse birth outcomes. If

  20. Relationship between Maternal General and Specific-Pregnancy Stress, Anxiety, and Depression Symptoms and Pregnancy Outcome.

    Science.gov (United States)

    Hasanjanzadeh, Parvin; Faramarzi, Mahbobeh

    2017-04-01

    Despite scientific advances in the field of physical problems during pregnancy, the effect of mental problems on the health of pregnant women is still an important issue that needs further research. To determine the association of symptoms of stress, anxiety and depression during pregnancy and there effect on the pregnancy outcome. This was a descriptive correlational study. The population included 200 pregnant women of the urban and rural health centers affiliated with Babol University of Medical Sciences. There were 100 each in second and third trimester. Convenience multi stage cluster sampling was performed. Data collection was received through the Hospital Anxiety Depression Scale (HADS), Pregnancy Distress Questionnaire (PDQ), and Perceived Stress Scale (PSS-14) questionnaires. The correlation results showed a significant difference between variables of depression, stress, and anxiety with birth weight, birth height and head circumference and infants' APGAR score (prelationships on prediction of infant weight (B=-0.324), anxiety on prediction of infant height (B=-0.197), stress on prediction of head circumference (B=-0.350) and depression on prediction of APGAR score (B=-0.323) are effective (pdepression, anxiety and stress in pregnancy, and scheduling to avoid adverse consequences of the pregnancy outcome.

  1. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy?

    Science.gov (United States)

    Bhattacharya, S; Townend, J; Shetty, A; Campbell, D; Bhattacharya, S

    2008-12-01

    To explore pregnancy outcomes in women following an initial miscarriage. Retrospective Cohort Study. Aberdeen Maternity Hospital, Aberdeen, Scotland. All women living in the Grampian region of Scotland with a pregnancy recorded in the Aberdeen Maternity and Neonatal Databank between 1986 and 2000. (A) Maternal outcomes: Pre-eclampsia, antepartum haemorrhage, threatened miscarriage, malpresenation, induced labour, instrumental delivery, Caesarean delivery, postpartum haemorrhage and manual removal of placenta. (B) Perinatal outcomes: preterm delivery, low birth weight, stillbirth, neonatal death, Apgar score at 5 minutes. Retrospective cohort study comparing women with a first pregnancy miscarriage with (a) women with one previous successful pregnancy and (b) primigravid women. Data were extracted on perinatal outcomes in all women from the Aberdeen Maternity and Neonatal Databank between 1986 and 2000. We identified 1561 women who had a first miscarriage (1404 in the first trimester and 157 in the second trimester), 10 549 who had had a previous live birth (group A) and 21 118 primigravidae (group B). The miscarriage group faced a higher risk of pre-eclampsia (adj OR 3.3, 99% CI 2.6-4.6), threatened miscarriage (adj OR 1.7, 99% CI 1.5-2.0), induced labour (adj OR 2.2, 99% CI 1.9-2.5), instrumental delivery (adj OR 5.9, 99% CI 5.0-6.9), preterm delivery (adj OR 2.1, 99% CI 1.6-2.8) and low birthweight (adj OR 1.6, 99% CI 1.3-2.1) than group A. They were more likely to have threatened miscarriage (adj OR 1.5, 99% CI 1.4-1.7), induced labour (adj OR 1.3, 99% CI 1.2-1.5), postpartum haemorrhage (adj OR 1.4, 99% CI 1.2-1.6) and preterm delivery (adj OR 1.5, 99% CI 1.2-1.8) than group B. An initial miscarriage is associated with a higher risk of obstetric complications.

  2. Early pregnancy vitamin D status and risk for adverse maternal and infant outcomes in a bi-ethnic cohort: the Behaviors Affecting Baby and You (B.A.B.Y.) Study.

    Science.gov (United States)

    Nobles, Carrie J; Markenson, Glenn; Chasan-Taber, Lisa

    2015-12-28

    Vitamin D deficiency is common during pregnancy and higher in Hispanic as compared with non-Hispanic white women. However, the association between vitamin D deficiency and adverse pregnancy outcomes remains unclear and may vary across ethnic groups, in part because of genetic variation in the metabolism of vitamin D. Few studies have included Hispanic women. Therefore, we investigated this association among 237 participants in the Behaviors Affecting Baby and You Study, a randomised trial of an exercise intervention among ethnically diverse prenatal care patients in Massachusetts. Baseline serum 25-hydroxyvitamin D (25(OH)D) was measured at 15·2 (sd 4·7) weeks' gestation. Information on adverse pregnancy outcomes was abstracted from medical records. Mean 25(OH)D was 30·4 (sd 12·0) ng/ml; 53·2 % of participants had insufficient (<30 ng/ml) and 20·7 % had deficient (<20 ng/ml) 25(OH)D levels. After adjusting for month of blood draw, gestational age at blood draw, gestational age at delivery, age, BMI and Hispanic ethnicity, women with insufficient and deficient vitamin D had infants with birth weights 139·74 (se 69·16) g (P=0·045) and 175·52 (se 89·45) g (P=0·051) lower compared with women with sufficient vitamin D levels (≥30 ng/ml). Each 1 ng/ml increase in 25(OH)D was associated with an increased risk for gestational diabetes mellitus among Hispanic women only (relative risk 1·07; 95 % CI 1·03, 1·11) in multivariable analysis. We did not observe statistically significant associations between maternal vitamin D status and other pregnancy outcomes. Our findings provide further support for an adverse impact of vitamin D deficiency on birth weight in Hispanic women.

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

    Science.gov (United States)

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

    2015-07-01

    The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India. A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71), preterm birth (OR: 2.36; 95% CI: 1.54-3.62), and low birth weight (OR: 2.00; 95% CI: 1.24-3.23) were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79) but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73). The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility

  4. Fetal sex modifies effects of prenatal stress exposure and adverse birth outcomes.

    Science.gov (United States)

    Wainstock, Tamar; Shoham-Vardi, Ilana; Glasser, Saralee; Anteby, Eyal; Lerner-Geva, Liat

    2015-01-01

    Prenatal maternal stress is associated with pregnancy complications, poor fetal development and poor birth outcomes. Fetal sex has also been shown to affect the course of pregnancy and its outcomes. The aim of this study was to evaluate whether fetal sex modifies the association between continuous exposure to life-threatening rocket attack alarms and adverse pregnancy outcomes. A retrospective cohort study was conducted in which the exposed group was comprised of 1846 women exposed to rocket-attack alarms before and during pregnancy. The unexposed group, with similar sociodemographic characteristics, delivered during the same period of time at the same medical center, but resided out of rocket-attack range. Multivariable models for each gender separately, controlling for possible confounders, evaluated the risk associated with exposure for preterm births (PTB), low birthweight (LBW), small for gestational age and small head circumference (HC). In both univariable and multivariable analyses exposure status was a significant risk factor in female fetuses only: PTB (adj. OR = 1.43; 1.04-1.96), LBW (adj. OR = 1.41; 1.02-1.95) and HC stress.

  5. 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

    was substantial to modest for small-for-gestational age newborn (care associated with major depression, whereas SES made only a minor contribution. CONCLUSIONS: Physician-diagnosed major depression......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 history...

  6. Obstetrical APS : Is there a place for hydroxychloroquine to improve the pregnancy outcome?

    NARCIS (Netherlands)

    Mekinian, Arsene; Costedoat-Chalumeau, Nathalie; Masseau, Agathe; Tincani, Angela; De Caroli, Sara; Alijotas-Reig, Jaume; Ruffatti, Amelia; Ambrozic, Ales; Botta, Angela; Le Guern, Véronique; Fritsch-Stork, Ruth; Nicaise-Roland, Pascale; Carbonne, Bruno; Carbillon, Lionel; Fain, Olivier

    2015-01-01

    The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome.

  7. Fertility and pregnancy outcome in women with systemic sclerosis.

    Science.gov (United States)

    Steen, V D; Medsger, T A

    1999-04-01

    To determine fertility and pregnancy outcome in women with systemic sclerosis (SSc; scleroderma) who had disease onset before age 45 years. All living women with scleroderma who had first been evaluated at the University of Pittsburgh Scleroderma Clinic after January 1, 1972 were sent a detailed self-administered questionnaire in 1986 specifically concerning pregnancy outcomes and infertility. This group was compared with 2 race- and age-matched control groups, one comprising women with rheumatoid arthritis (RA) and one comprising healthy neighborhood women identified by random-digit dialing. We determined the number, history, treatment, and outcome of women who either had never been pregnant or had attempted to become pregnant unsuccessfully for more than 1 year. We also obtained data regarding pregnancy outcomes, including the frequency of miscarriage, premature births, small full-term infants, perinatal deaths, and births of live healthy infants. The study group comprised 214 women with SSc, 167 with RA, and 105 neighborhood controls. There were no significant differences in the overall rates of miscarriage, premature births, small full-term births, or neonatal deaths between the 3 groups. Women with SSc were more likely than those without SSc to have adverse outcomes of pregnancy after the onset of their rheumatic disease, particularly premature births (also seen in RA women after disease onset) and small full-term infants. Although a significantly greater number of women with SSc had never been pregnant, there were no significant differences in the frequency of never having been pregnant or of infertility in the 3 groups after adjustment for contributing factors. This study indicates that women with SSc have acceptable pregnancy outcomes compared with those of women with other rheumatic disease and healthy neighborhood controls. Infertility was not a frequent problem. We believe that there are no excessive pregnancy risks to women with SSc or their infants

  8. mHealth to promote pregnancy and interconception health among African-American women at risk for adverse birth outcomes: a pilot study.

    Science.gov (United States)

    Foster, Jennifer; Miller, Lindsey; Isbell, Sheila; Shields, Tekesia; Worthy, Natasha; Dunlop, Anne Lang

    2015-01-01

    The use of mobile phone applications (mHealth) to provide health education and behavioral prompts is 1 of the 12 common mHealth functions identified by the World Health Organization as innovations to strengthen health systems. Among low-income pregnant and parenting women, health education is widely recognized as a way to improve maternal and infant health outcomes, but the efficacy of written health education materials to change knowledge and behavior for this population is questionable. mHealth prompts, in contrast, is a promising alternative. A team of researchers in medicine/epidemiology, anthropology/midwifery, computer science/sensors, and community-based case management created and pilot tested a mHealth application (mHealth app) for African-American women at high risk for adverse birth outcomes. We tested the acceptability and feasibility of the interactive application among women during the reproductive stages of early and late pregnancy, postpartum, and interconception. Interview data from 14 women in the various reproductive stages revealed that most women found the mHealth messages helpful. Also, 62 Ob-Gyn physicians and nurses and 19 Family Medicine residents provided feedback. Women's responses to specific messages trended down over time. Women in the postpartum phase had the highest response rate to particular text messages, followed by those in the pregnancy phase. Responses dropped off dramatically during the interconception period. About 21% of women lost their phones. Unexpected findings were that all participants already had smartphones, women wanted messages about depression, and clinicians wanted the app to link to case management for individualized medical care. Logistical challenges to app management were limitations but are useful for consideration before scale-up. This study corroborates findings in the health literacy literature that women most at risk for adverse birth outcomes need additional face-to-face support with m

  9. Parameters Associated with Adverse Fetal Outcomes in Parvovirus B19 Congenital Infection.

    Science.gov (United States)

    Agra, Isabela Karine Rodrigues; Amorim Filho, Antonio Gomes; Lin, Lawrence Hsu; Biancolin, Sckarlet Ernandes; Francisco, Rossana Pulcineli Vieira; Brizot, Maria de Lourdes

    2017-11-01

    Objective  To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion. Methods  This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered non-recovery and categorized as an adverse outcome. Results  The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the non-recovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion. Conclusion  We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  10. Adverse perinatal outcomes associated with moderate or severe maternal anaemia based on parity in Finland during 2006-10.

    Science.gov (United States)

    Räisänen, Sari; Kancherla, Vijaya; Gissler, Mika; Kramer, Michael R; Heinonen, Seppo

    2014-09-01

    Anaemia during pregnancy is an important public health problem. We investigated whether the association between maternal anaemia during pregnancy and adverse perinatal outcomes differed between nulliparous and multiparous women. A retrospective population-based cohort study was conducted using data on all singleton births (n = 290 662) recorded in the Finnish Medical Birth Register during 2006-10. Maternal anaemia was defined as a maternal haemoglobin level of anaemia and adverse outcomes was assessed by logistic regression analysis. The prevalence of anaemia during pregnancy was 2.5% among nulliparous women and 2.3% among multiparous women. Among nulliparous women, anaemia was not associated with adverse perinatal outcomes. Among multiparous women, anaemia was associated with preterm delivery (adjusted odds ratio [aOR] 1.32, [95% CI 1.14, 1.53]), SGA (aOR 1.27, [95% CI 1.04, 1.55]), and admission to neonatal intensive care (aOR 1.23, [95% CI 1.10, 1.38]); there was a trend towards increased odds of major congenital anomalies (aOR 1.15, [95% CI 0.99, 1.34]). These data underscore that maternal anaemia is associated with several adverse perinatal outcomes. This association was, however, confined to multiparous women. Future research should explore in detail the timing of anaemia in these associations. © 2014 John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Bijaya K Padhi

    2015-07-01

    Full Text Available The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs. We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.A prospective cohort of pregnant women (n = 670 in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation. A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs and adjusted odds ratios (AORs and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4% preterm births, 95 (14.2% births with low birth weight, 11 (1.7% spontaneous abortions, and six (0.9% stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71, preterm birth (OR: 2.36; 95% CI: 1.54-3.62, and low birth weight (OR: 2.00; 95% CI: 1.24-3.23 were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80 and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79 but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the

  12. Early fetal size and growth as predictors of adverse outcome

    DEFF Research Database (Denmark)

    Pedersen, Nina Gros; Figueras, Francesc; Wøjdemann, Karen R

    2008-01-01

    OBJECTIVE: To evaluate the association between fetal size and growth between the first and second trimesters and subsequent adverse pregnancy outcome. METHODS: A cohort was created of 7,642 singleton pregnancies cared for in three obstetric units associated with Copenhagen University. Data were...... obtained from ultrasound measurements at 11-14 weeks (crown-rump length, biparietal diameter) and 17-21 weeks (biparietal diameter). Fetal size was assessed by gestation-specific z scores, and fetal growth between the first and second trimester was calculated individually using conditional centiles....... The main outcome measures were preterm delivery, smallness for gestational age, and perinatal death. RESULTS: Slow growth of the biparietal diameter less than the 10th and less than the 2.5th conditional centiles between first and second trimesters occurred in 10.4% and 3.6% of the population, respectively...

  13. Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome.

    Science.gov (United States)

    Henriquez, Dacia Dca; Roos-Hesselink, Jolien W; Schalij, Martin J; Klautz, Robert Jm; Helmerhorst, Frans M; de Groot, Christianne Jm

    2011-05-11

    Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear. To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles. Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy. We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy. There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy. There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

  14. [Pre-pregnancy nutritional status, maternal weight gain, prenatal care, and adverse perinatal outcomes among adolescent mothers].

    Science.gov (United States)

    Santos, Marta Maria Antonieta de Souza; Baião, Mirian Ribeiro; de Barros, Denise Cavalcante; Pinto, Alessandra de Almeida; Pedrosa, Priscila La Marca; Saunders, Claudia

    2012-03-01

    To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers. Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

  15. A STUDY ON ROLE OF DOPPLER ULTRASOUND IN NORMAL AND HIGH-RISK PREGNANCIES WITH PERINATAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Mozibur Rahman Laskar

    2016-09-01

    Full Text Available OBJECTIVES To evaluate the diagnostic value of various waveform of Doppler ultrasound of three vessels (uterine artery, middle cerebral artery and umbilical artery in high-risk pregnancies in compare to normal pregnancy related to perinatal outcome. MATERIALS AND METHODS 200 singleton pregnancies beyond 28 weeks of gestation were studied out of which 100 were normal and 100 were high-risk pregnancies with PIH and clinical suspicion of IUGR. Doppler examination was done after recording history, clinical ex and USG. RESULTS The PI, RI and S/D of Umbilical artery and Uterine artery were significantly higher in study group as compared to control group and the PI, RI and S/D of middle cerebral artery were significantly lower in study group as compared to control group. 70% of foetuses in study group had at least one adverse outcome in study group in contrast to only 10% of control group had adverse outcome. Doppler study of UA and UmbA together had a better sensitivity than individual vessel. The MCA/UmbA PI ratio of study group showed more foetuses to redistribute their cardiac output than the abnormal MCA PI or UmbA PI. The cerebroumbilical ratio provided a better predictor of high-risk pregnancies and adverse perinatal outcome than either MCA or UmbA. CONCLUSION Hence, we conclude that Doppler studies of multiple vessels in the foetoplacental circulation can help in the monitoring of compromised foetus and can help in predicting neonatal morbidity. This may be helpful in determining the optimal time of delivery in complicated pregnancies. ABBREVIATIONS UA-Uterine artery, UmbA-Umbilical artery, MCA-Middle cerebral artery, RI-Resistive index, PI-Pulsatility index, S/DSystolic/Diastolic ratio, IUGR-Intrauterine growth restriction, IUFD-Intrauterine fetal demise, LSCS-Lower segment caesarean section, SVD-Spontaneous vaginal delivery, PIH- Pregnancy-induced hypertension.

  16. Correlation of adverse perinatal out comes and placental infracts in hypertensive preterm pregnancies

    International Nuclear Information System (INIS)

    Afzal, E.; Sherin, F.; Seema, N.

    2015-01-01

    Background: The placenta can provides valuable information about the damaging effects of hypertension on pregnancy and foetal outcome. This study was conducted to study the frequency of placental infarcts in hypertensive preterm pregnancies and its effects on foetal outcomes. Method: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar and Department of Anatomy, Khyber Medical College, Peshawar from January 2008 to March 2009. The sample size consisted of hundred placentae divided into two groups. Group A consisting of 50 normal full term placentae (delivered between 37-42 weeks of gestation). Group-B consisting of 50 premature placentae from hypertensive mothers (35-37 weeks of gestation). The data was collected on a pre-designed Performa and analysis was done by SPSS-17. Results: In the placentae of premature group the incidence of placental infarcts were increased. Foetal outcome was poor in the presence of placental infarcts. Conclusion: Adverse perinatal outcomes including growth restriction and still birth is higher in hypertensive premature deliveries with placental infarcts than in normal full term deliveries. (author)

  17. Systematic review on adverse birth outcomes of climate change

    Directory of Open Access Journals (Sweden)

    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.

  18. Sickle cell disease in pregnancy: trend and pregnancy outcomes at a tertiary hospital in Tanzania.

    Directory of Open Access Journals (Sweden)

    Projestine S Muganyizi

    Full Text Available SCD in pregnancy is associated with increased adverse fetal and maternal outcomes. In Tanzania where the frequency of sickle cell trait is 13% there has been scanty data on SCD in pregnancy. With progressive improvement in childhood survival the burden of SCD in pregnancy will increase. We analyzed all deliveries at Muhimbili National Hospital (MNH from 1999 to 2011. Fetal and maternal outcomes of SCD deliveries were compared with non-SCD. Data were analyzed using IBM SPSS statistics version 19. Chi square and Fisher Exact tests were used to compare proportions and the independent t-test for continuous data. To predict risks of adverse effects, odds ratios were determined using multivariate logistic regression. A p-value<0.05 was considered significant. In total, 157,473 deliveries occurred at MNH during the study period, of which 149 were SCD (incidence of 95 SCD per 100,000 deliveries. The incidence of SCD had increased from 76 per 100,000 deliveries in the 1999-2002 period to over 100 per 100,000 deliveries in recent years. The mean maternal age at delivery was lower in SCD (24.0±5.5 years than in non-SCD deliveries (26.2±6.0 years, p<0.001. Compared with non-SCD (2.9±0.7 Kg, SCD deliveries had less mean birth-weight (2.6±0.6 Kg, p<0.001. SCD were more likely than non-SCD to deliver low APGAR score at 5 minutes (34.5% Vs 15.0%, OR = 3.0, 95%CI: 2.1-4.2, stillbirths (25.7% Vs 7.5%, OR = 4.0, 95%CI: 2.8-5.8. There was excessive risk of maternal deaths in SCD compared to non-SCD (11.4% Vs 0.4%, OR = 29, 95%CI: 17.3-48.1. The leading cause of deaths in SCD was infections in wholly 82% in contrast to only 32% in non-SCD. In conclusion SCD in pregnancy is an emerging problem at MNH with increased adverse fetal outcomes and excessive maternal mortality mainly due to infections.

  19. Impact of police-reported intimate partner violence during pregnancy on birth outcomes.

    Science.gov (United States)

    Lipsky, Sherry; Holt, Victoria L; Easterling, Thomas R; Critchlow, Cathy W

    2003-09-01

    To examine the relationship of police-reported intimate partner violence during pregnancy and adverse birth outcomes. We conducted a population-based, retrospective, cohort study in Seattle, Washington, using Seattle police data and Washington State birth certificate files from January 1995 through September 1999. Exposed subjects were women with an intimate partner violence incident reported to police during pregnancy and who subsequently had a singleton live birth or fetal death registered in the state of Washington. Unexposed subjects were randomly selected Seattle residents with a singleton live birth or fetal death in the same time period and who did not report an incident. The main outcome measures were low birth weight (LBW less than 2500 g), very LBW (VLBW less than 1500 g), preterm birth (20-36 weeks' gestation), very preterm birth (20-31 weeks), and neonatal death (before discharge). Women reporting any partner violence during pregnancy were significantly more likely to have a LBW infant (adjusted odds ratio [aOR] 1.70; 95% confidence interval [CI] 1.20, 2.40), a VLBW infant (aOR 2.54; 95% CI 1.32, 4.91), a preterm birth (aOR 1.61; 95% CI 1.14, 2.28), a very preterm birth (aOR 3.71; 95% CI 1.80, 7.63), and a neonatal death (aOR 3.49; 95% CI 1.43, 8.50). Police-reported partner violence during pregnancy is significantly associated with an increased risk of adverse birth outcomes. There is a critical need to identify pregnancy among women with reported incidents and to provide women health and social service information and referrals, particularly referrals to high-risk pregnancy programs.

  20. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies : an individual participant data meta-analysis

    NARCIS (Netherlands)

    Schuit, E; Stock, S; Rode, L; Rouse, D J; Lim, A C; Norman, J E; Nassar, A H; Serra, V; Combs, C A; Vayssiere, C; Aboulghar, M M; Wood, S; Çetingöz, E; Briery, C M; Fonseca, E B; Worda, K; Tabor, A; Thom, E A; Caritis, S N; Awwad, J; Usta, I M; Perales, A; Meseguer, J; Maurel, K; Garite, T; Aboulghar, M A; Amin, Y M; Ross, S; Cam, C; Karateke, A; Morrison, J C; Magann, E F; Nicolaides, K H; Zuithoff, N P A; Groenwold, R H H; Moons, K G M; Kwee, A; Mol, B W J

    BACKGROUND: In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES: To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies

  1. Occupational exposure to pesticides and pregnancy outcomes in gardeners and farmers: a study within the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Hjøllund, Niels Henrik Ingvar; Andersen, AM

    2006-01-01

    OBJECTIVE: We conducted a follow-up study to examine whether exposure to pesticides during pregnancy had an adverse effect on pregnancy outcomes among Danish gardeners and farmers. METHODS: Using data from the National Birth Cohort in Denmark, we identified 226 pregnancies of gardeners and 214...... regression was applied to analyze late fetal loss and congenital malformations, and logistic regression was used to analyze preterm birth and small for gestational age. RESULTS: There were no significant differences in the studied pregnancy outcomes between gardeners or farmers and all other workers, except...... for an increased risk of very preterm birth for gardeners and a favorable birth weight for farmers. With the exception of biologic approach used in gardening, neither work activities nor exposure to pesticides showed a significant increased risk of adverse birth outcomes among gardeners or farmers. CONCLUSIONS...

  2. Teenage pregnancy in type 1 diabetes mellitus.

    Science.gov (United States)

    Carmody, David; Doyle, Aoife; Firth, Richard G R; Byrne, Maria M; Daly, Sean; Mc Auliffe, Fionnuala; Foley, Micheal; Coulter-Smith, Samuel; Kinsley, Brendan T

    2010-03-01

    Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995-2007. TG booked to the combined diabetes-obstetrical service at a median gestational age of 11 weeks (range 6-22) compared to 7 weeks in CON (range 4-40, p teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high-risk group for adverse pregnancy outcomes.

  3. Pregnancy outcome of women with gestational diabetes in a tertiary level hospital of North India

    Directory of Open Access Journals (Sweden)

    Pikee Saxena

    2011-01-01

    Full Text Available Background: Women with gestational diabetes mellitus (GDM pose an important public health problem because diabetes not only affects the maternal and fetal outcome, but these women and their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Objectives: The study was conducted to determine the maternal and fetal outcomes of 50 diabetic vs 50 normoglycemic pregnancies. Materials and Methods: This was a retrospective analytical record-based study conducted in a tertiary level hospital. Detailed information regarding maternal, fetal, and labor outcome parameters was recorded in a prestructured proforma and compared in normoglycemic and diabetic pregnancies. Results: Patients with obesity, history of diabetes in the family, spontaneous abortions, and gestational diabetes in previous pregnancies had a greater incidence of GDM in current pregnancy (P<0.05 for all. Hypertension, polyhydramnios, macrosomia, fetopelvic disproportion, and cesarean sections were more (P<0.001 among diabetic pregnancies. Congenital anomalies, polycythemia, hypocalcemia, and hyperbilirubinemia were also observed to be more (P<0.05 in neonates born to diabetics, suggesting an adverse effect of hyperglycemia in utero. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring, and intervention is essential to reduce maternal and fetal short- and long-term adverse effects, especially in high-risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients.

  4. Pregnancy Outcome in Women with Obstetric and Thrombotic Antiphospholipid Syndrome-A Retrospective Analysis and a Review of Additional Treatment in Pregnancy.

    Science.gov (United States)

    Mayer-Pickel, Karoline; Eberhard, Katharina; Lang, Uwe; Cervar-Zivkovic, Mila

    2017-08-01

    Antiphospholipid syndrome (APS) is associated with pregnancy complications such as recurrent early fetal loss (RFL), fetal death, preeclampsia (PE), and intrauterine growth restriction (obstetric APS/OAPS). Other clinical manifestations are venous and/or arterial thromboses (thrombotic APS/TAPS). The data of 37 pregnancies with OAPS and 37 pregnancies with TAPS were analyzed and compared. Overall, the most frequent APS antibodies (aPl) were LA as well as "triple-positivity"; LA antibodies were significantly more frequent in women with TAPS (67.6 % TAPS vs. 29.7 % OAPS, p < 0.010), whereas "triple-positivity" was significantly more seen in women with OAPS (40.5 % OAPS vs. 13.5 % TAPS, p < 0.010). Adequate therapy has been administered in nearly all pregnancies with TAPS, whereas in 18.9 % of pregnancies with OPS, no therapy has been given at all. One woman in OAPS and four women in TAPS were treated with plasmapheresis and immunoadsorption. There was no significant association between adverse obstetric outcome and therapy. The most frequent pregnancy complications were RFL in the OAPS group (32.4 vs. 13.5 % in TAPS) and PE in the TAPS group (18.9 % in OAPS and TAPS, respectively). The data of our study showed that pregnancies with OAPS and TAPS have a similar rate of pregnancy complications. However, pregnancies with OAPS tend to have rather RFL. Although we were not able to reveal a significant association with adverse obstetric outcome, it seems that the current adequate therapy for APS in pregnancy, consisting of LDA and LMWH, might rather prevent the development of RFL. Additionally, it might be considered to divide the obstetric APS into obstetric APS with early pregnancy complications and obstetric APS with late pregnancy complications. The division into two groups of obstetric APS might facilitate the choice of additional therapy in these women.

  5. The role of Mycoplasma and Ureaplasma in adverse pregnancy outcomes.

    Science.gov (United States)

    Murtha, Amy P; Edwards, James M

    2014-12-01

    Genital mycoplasmas are frequently found in the vaginal flora across socioeconomic and ethnic groups and have been demonstrated to be involved in adverse perinatal outcomes. Both Mycoplasma and Ureaplasma spp cause inflammation potentially leading to spontaneous preterm birth and PPROM as well as postdelivery infectious complications and neonatal infections. Herein we have provided an overview of the existing literature and supportive evidence for genital mycoplasma's role in perinatal complications. Future research will need to focus on clearly delineating the species, allowing for discrimination of their effects. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Resistance training during pregnancy and perinatal outcomes.

    Science.gov (United States)

    White, Erin; Pivarnik, Jim; Pfeiffer, Karin

    2014-08-01

    Approximately 10% of women engage in resistance training during pregnancy; however there is limited research on this activity. The purpose of this study was to examine associations between resistance training and adverse outcomes. Women completed an online survey and recalled their exercise habits during each trimester of their most recent pregnancy within the previous 5 years. Women also reported pregnancy and birth outcomes. Participants were then categorized into 3 groups based on leisure-time exercise: 1) Resistance + aerobic training (RTAE), 2) Aerobic exercise only (AE), and 3) no exercise (NE). 284 women completed the survey. Women in the RTAE group resistance trained on average 2.9 days/ week for 27.3 minutes/session. The prevalences of hypertensive disorders (HD) and gestational diabetes mellitus (GDM) were significantly lower in the RTAE group when compared with the grouping of AE + NE women. Prepregnancy body mass index (BMI) was the strongest factor related to both GDM and HD. There was no difference in the risk of preterm labor, mode of delivery, or gestational age at delivery by exercise status. Our results suggest that women can safely engage in aerobic exercise and resistance training for muscular endurance 3 days/week for 30 minutes throughout gestation.

  7. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?

    Science.gov (United States)

    Mazor-Dray, Efrat; Levy, Amalia; Schlaeffer, Francisc; Sheiner, Eyal

    2009-02-01

    This population-based study was aimed to determine whether there is an association between urinary tract infections (UTI) during pregnancy, among patients in whom antibiotic treatment was recommended, and maternal and perinatal outcome. A retrospective population-based study comparing all singleton pregnancies of patients with and without UTI was performed. Multiple logistic regression models were performed to control for confounders. Out of 199,093 deliveries, 2.3% (n = 4742) had UTI during pregnancy and delivery. Patients with UTI had significantly higher rates of intra-uterine growth restriction (IUGR), pre-eclampsia, caesarean deliveries (CD) and pre-term deliveries (either before 34 weeks or 37 weeks of gestation). Although controlling for possible confounders such as maternal age and parity, using multivariable analyses, the significant association between UTI and IUGR, pre-eclampsia, CD and preterm deliveries persisted. In contrast, no significant differences in 5-min Apgar scores less than 7 or perinatal mortality were noted between the groups (0.6% vs. 0.6%; p = 0.782, and 1.5% vs. 1.4%; p = 0.704, respectively). Maternal UTI is independently associated with pre-term delivery, pre-eclampsia, IUGR and CD. Nevertheless, it is not associated with increased rates of perinatal mortality compared with women without UTI.

  8. Epidemiologic Tools to Study the Influence of Environmental Factors on Fecundity and Pregnancy-related Outcomes

    Science.gov (United States)

    Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

    2014-01-01

    Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction. PMID:24363355

  9. The Influence of Methotrexate Treatment on Male Fertility and Pregnancy Outcome After Paternal Exposure.

    Science.gov (United States)

    Grosen, Anne; Kelsen, Jens; Hvas, Christian Lodberg; Bellaguarda, Emanuelle; Hanauer, Stephen B

    2017-04-01

    Inflammatory bowel disease incidence peaks during the reproductive years. Methotrexate (MTX) is frequently used for inflammatory bowel disease, but its use during pregnancy is contraindicated in women because of teratogenic effects. The aim of this review is to investigate the influence of MTX on male fertility and pregnancy outcomes after paternal MTX exposure. A systematic literature search was performed by applying 2 focus areas, "methotrexate" and "male fertility or pregnancy outcome." Terms and keywords were used both as MeSH terms and free-text searches. Pertinent articles were searched for additional relevant references. In animal studies, MTX induces aberrations in sperm DNA that have not been identified in humans. The effects of MTX on human sperm quality have only been described in case reports. A transient adverse effect on sperm quality with low-dose MTX has been reported, but several other cases have not found harmful effects of MTX. MTX has not been measured in human sperm ejaculates; yet, the risk of a direct toxic effect on the fetus through MTX-contaminated seminal plasma seems negligible. Until now, 284 pregnancies with paternal MTX exposure have been reported. The outcomes were 248 live births and a total of 13 malformations, with no overt indication of MTX embryopathy. This review reveals the lack of studies on the safety of MTX with regard to male reproduction. It is not clear whether MTX transiently influences male fertility and sperm DNA integrity, and more studies are needed. Comparative cohort studies found no increased risk of adverse pregnancy outcomes.

  10. The Association Between Low 50 g Glucose Challenge Test Values and Adverse Pregnancy Outcomes.

    Science.gov (United States)

    Kwon, Hayan; Lee, Joonho; Lee, Byung-Wan; Kwon, Ja-Young; Kim, Young-Han

    2018-01-11

    The implications of low values on the 50 g glucose challenge test (GCT) in pregnancy are not clearly defined. Few studies have evaluated the influence of maternal low GCT values on obstetrical outcomes. This study aimed to compare pregnancy outcomes between women with low 50 g GCT values and those with normal values. Women undergoing gestational diabetes mellitus screening at 24-28 weeks of gestational age between January 2010 and December 2016 were retrospectively evaluated. Women with multifetal pregnancies, prepregnancy type I or II diabetes, GCT performed before 24 or after 28 weeks of gestational age, and women undergoing multiple GCTs in the same pregnancy were excluded. Low GCT values and normal GCT values were defined as ≤85 mg/dL and 86-130 mg/dL, respectively. Of 3875 screened subjects, 519 (13.4%) women were included in the low GCT group and 3356 (86.6%) in the normal GCT group. Low GCT women had a significantly higher rate of small for gestational age (SGA) infants than normal GCT women (10.8% vs. 7.9%, p = 0.02). Cesarean section and postpartum hemorrhage (PPH) were less frequent in low GCT women than in normal women (32.6% vs. 42.8%, p values. Low GCT values were independently associated with an increased risk of SGA.

  11. [Effect of air pollution on pregnancy outcome of women at reproductive age in Xi'an, 2010-2013].

    Science.gov (United States)

    Wang, L L; Bai, R H; Zhang, Q; Yan, H

    2016-11-10

    Objective: To compare the differences in the incidence of adverse pregnancy outcome in different area, and confirm if the incidence of adverse pregnancy outcomes is closely associated with air pollution. Methods: A cross-sectional study was conducted in the central urban area and the rural-urban area of Xi'an through a questionnaire survey conducted among the local reproductive women selected through multistage stratified random sampling during 2010-2013, all the reproductive women surveyed were in pregnancy or had definite pregnancy outcomes. Results: The annual average of SO 2 concentration in the central urban area was 38-54 μg/m 3 , higher than that in the rural-urban area (29-43 μg/m 3 ). The annual average NO 2 concentration in the central urban area was 29-87 μg/m 3 , higher than that in the rural-urban area (22-42 μg/m 3 ). The incidence of birth defects was higher in the central urban area than in the rural-urban area (2.1% vs. 1.0%), the difference was significant ( P air pollution.

  12. Physical violence against pregnant women by an intimate partner, and adverse pregnancy outcomes in Mazandaran Province, Iran

    Directory of Open Access Journals (Sweden)

    Fatemeh Abdollahi

    2015-01-01

    Full Text Available Background and Aim: Violence against women during pregnancy is linked to poor outcome of pregnancy, which is reported to have widespread in Iran. The aim of this study was to determine the prevalence of physical violence against women by an intimate partner during pregnancy, and to assess the impact of this physical violence on pregnancy outcomes. Materials and Methods: A prospective cohort study was conducted on the characteristics of pregnant women in urban areas and related violence. The modified standard World Health Organization Domestic Violence Questionnaire was used to classify pregnant women and domestic violence. A total of 1461 pregnant women were selected using cluster sampling. The association between sociodemographic with intimate partner violence (IPV and IPV with pregnancy outcomes was determined using logistic regression. Results: Of these, 206 (14.1% (confidence interval = 12.3-15.9 reported physical IPV during pregnancy. The adjusted odds ratio for IPV in illiterate women or those with primary level of education (0.001, secondary level education (0.003, and in low income households (0.0001 were significantly higher than in those women with university level education and in higher income households. After adjusting for suspected confounding factors, the women with a history of violence by partners had 1.9 fold risk of premature rupture of membranes, and a 2.9 fold risk of low birth weight compared to women who did not experience any violence from their partners. Conclusion: The results of this research indicated that the prevalence of IPV was high among pregnant women. Therefore, it is necessary to emphasize the screening of pregnant women at Primary Health Centers to prevent physical abuse.

  13. An exploratory study of whether pregnancy outcomes influence maternal self-reported history of child maltreatment.

    Science.gov (United States)

    Cammack, Alison L; Hogue, Carol J; Drews-Botsch, Carolyn D; Kramer, Michael R; Pearce, Brad D; Knight, Bettina; Stowe, Zachary N; Newport, D Jeffrey

    2018-02-22

    Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women's experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most women's reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Pregnancy course and outcome in women traveling to developing countries.

    Science.gov (United States)

    Sammour, Rami N; Bahous, Rabia; Grupper, Moti; Ohel, Gonen; Steinlauf, Shmuel; Schwartz, Eli; Potasman, Israel

    2012-01-01

    The issue of travel to developing countries during pregnancy has not been sufficiently studied. The aim of this study is to investigate the rate, course, and outcome of pregnancies in women who traveled to developing countries while pregnant, or became pregnant during such travel. Women visiting two major travel clinics in Israel for consultation within the years 2004 to 2009, who were pregnant or declared an intention of becoming pregnant during travel were contacted. This was followed by a telephone interview by an obstetrician with those women who were actually pregnant. Background characteristics, morbidity during travel, and pregnancy course and outcome were collected. Overall 52,430 travelers' records had been screened. Of these, we identified 49 women who were pregnant during their trip, but 3 declined participation. Of the remaining 46 women, 33 were pregnant at departure, and 13 conceived during travel. The incidence of pregnancy during travel was thus 0.93/1000 travelers. Thirty-three women traveled to East Asia, 8 to South and Central America, 5 to Africa. More than two thirds of women received pretravel vaccinations. Adherence to the World Health Organization recommendations regarding food and drink was high (87%) and travelers' diarrhea occurred in only 11% of women. Five of 22 women traveling to malarious areas had taken antimalarial prophylaxis. Six women required medical therapy during travel. Pregnancy outcome was not different from the normal population except for an unusually low rate of preterm delivery. In this cohort, travel to developing countries was not associated with adverse pregnancy outcome. Larger studies are needed to support these findings. © 2012 International Society of Travel Medicine.

  15. Thrombocytopenia during Pregnancy and Its Outcome – A Prospective Study

    Directory of Open Access Journals (Sweden)

    Pallavi Satish Vishwekar

    2017-01-01

    Full Text Available Background: Thrombocytopenia is second to anemia as the most common hematological abnormality during pregnancy. Accurate etiological diagnosis is essential for optimal therapeutic management and thus can prevent maternal and fetal morbidity and mortality. Aims and Objectives: To determine various etiologies of maternal thrombocytopenia, their complications and fetomaternal outcome compared with normal pregnancy. Material and Methods: A prospective study was carried out in tertiary hospital, 1460 pregnant women who attended the Antenatal clinic regularly were enrolled. All were screened for thrombocytopenia in third trimester (after 28 weeks, women with normal platelet (n=1350 were taken in control group and those with low counts less than 150 x109/L (n=130 were included in study group. Etiology and fetomaternal outcome of thrombocytopenia in third trimester of pregnancy were evaluated and compared. Results: Gestational thrombocytopenia was the commonest etiology (68.46%. Incidence of thrombocytopenia due to severe preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP syndrome in study group was 18.46% and 7.69% of them had medical cause like malarial or dengue fever. Major causes were Gestational Thrombocytopenia (GT, Idiopathic Thrombocytopenic Purpura (ITP, preeclampsia, HELLP syndrome, malaria, and dengue. Maternal complications due to bleeding tendencies like placental abruption, postpartum hemorrhage were evident in the study population. Fetal complications were significantly higher in study group. Early neonatal thrombocytopenia depended on etiology rather than severity of maternal thrombocytopenia. Conclusions: Outcome of pregnancy with moderate to severe thrombocytopenia depends mainly on the etiology of thrombocytopenia. Adverse outcomes are especially seen with pregnancy complicated by preeclampsia and HELLP syndrome. Fetomaternal outcome is favorable in gestational thrombocytopenia. Thus accurate etiological

  16. Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction.

    LENUS (Irish Health Repository)

    Levine, Terri A

    2017-06-21

    To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes.

  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. Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes.

    Science.gov (United States)

    Wang, Alex Y; Dill, Sandra K; Bowman, Mark; Sullivan, Elizabeth A

    2016-06-01

    Information on gestational surrogacy arrangement and outcomes is limited in Australia. This national population study investigates the epidemiology of gestational surrogacy arrangement in Australia: treatment procedures, pregnancy and birth outcomes. A retrospective study was conducted of 169 intended parents cycles and 388 gestational carrier cycles in Australia in 2004-2011. Demographics were compared between intended parents and gestational carrier cycles. Pregnancy and birth outcomes were compared by number of embryos transferred. Over half (54%) intended parents cycles were in women aged surrogacy treatment, including 9 liveborn twins. Of these, 22% (16) were preterm and 14% (10) were low birthweight. Preterm birth was 13% for liveborn babies following SET, lower than the 31% or liveborn babies following DET. To avoid adverse outcomes for both carriers and babies, SET should be advocated in all gestational surrogacy arrangements. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  19. Women referred for occupational risk assessment in pregnancy have no increased risk of adverse obstetric outcomes

    DEFF Research Database (Denmark)

    Bidstrup, Signe Brøker; Kaerlev, Linda; Thulstrup, Ane Marie

    2015-01-01

    .72-1.17). CONCLUSION: The women who are referred for occupational risk assessment at two large occupational university departments are not at an increased risk of preterm birth or of delivering low birth weight children. This may reflect that reproductive hazards in Danish workplaces are limited and......INTRODUCTION: Our aim was to study the association between pregnant women's referral status for occupational risk assessment, and their risk of preterm delivery (... pregnant women referred to two Danish clinics of occupational medicine (Copenhagen and Aarhus) from 1984 to 2010 were compared with the referred women's 1,077 non-referred pregnancy outcomes and with the pregnancy outcomes of 345,467 gainfully employed women from the same geographical areas and time period...

  20. Risk factors for cesarean delivery and adverse neonatal outcome in twin pregnancies attempting vaginal delivery.

    Science.gov (United States)

    Schachter-Safrai, Natali; Karavani, Gilad; Haj-Yahya, Rani; Ofek Shlomai, Noa; Porat, Shay

    2018-02-24

    Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery. A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis. The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score cesarean group compared with those delivered by the vaginal route alone. Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey

    Science.gov (United States)

    Akgun, Nilufer; Keskin, Huseyin L.; Ustuner, Isık; Pekcan, Gulden; Avsar, Ayse F.

    2017-01-01

    Objectives: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry. Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications. PMID:28439600

  2. Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990-2013.

    Science.gov (United States)

    Margerison-Zilko, Claire E; Li, Yu; Luo, Zhehui

    2017-11-15

    We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Physical violence during pregnancy and pregnancy outcomes in Ghana

    NARCIS (Netherlands)

    Pool, M.S.; Otupiri, E.; Owusu-Dabo, E.; de Jonge, J.; Agyemang, C.

    2014-01-01

    Background: In pregnancy, violence can have serious health consequences that could affect both mother and child. In Ghana there are limited data on this subject. We sought to assess the relationship between physical violence during pregnancy and pregnancy outcomes (early pregnancy loss, perinatal

  4. Adverse pregnancy and neonatal outcomes in polycystic ovary syndrome women

    Directory of Open Access Journals (Sweden)

    Roshan Nikbakht

    2016-02-01

    Full Text Available Background: Polycystic ovary syndrome (PCOS is the most common endocrine disorders in reproductive age women. These women confer with complications of pregnancy such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and neonatal complications such as small for gestational diabetes (SGA are more prevalence in women with PCOS. The aim of this study was to evaluate the incidence of complications associated with PCOS in pregnant women. Methods: This was an observational and prospective study which recruited 205 pregnant women with PCOS from Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences (AJUMS between 2013 and 2014. Inclusion criteria were women with PCOS and gestational age over 20 weeks. The demographic and clinical variables including mother's age, body mass index (BMI and conditions of pregnancy including pregnancy-induced hypertension, preeclampsia, gestational diabetes and overt diabetes and neonatal complications such as preterm labor (PTL, SGA and intrauterine fetal death (IUFD were recorded. Results: The prevalence of hypertension disorders, preeclampsia, gestational diabetes and overt diabetes were observed in 44 (21.5%, 18 (8.8%, 29 (14% and 22 (11% patients, respectively. The history of familial diabetes was shown in 28 patients (13.6%. In addition, the history of pregnancy induced hypertension was reported in 25 patients (12.1%. Only 6 patients (2.9% had history of gestational diabetes. Among neonatal complications due to PCOS, SGA with 15.3% and then PTL with 12.6% had highest prevalence. IUFD was shown only in 2 patients. Conclusion: Pregnant women with PCOS are at the higher risk for pregnancy and neonatal complications. Specifically, these women should be evaluated for pregnancy induced hypertension during pregnancy than others.

  5. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands

    Science.gov (United States)

    2014-01-01

    Background In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear. Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open. The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. Methods/Design This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information. We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. Discussion The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of

  6. Retrospective evaluation of the pregnancy outcomes of women with epilepsy

    Directory of Open Access Journals (Sweden)

    Mert Kazandı

    2010-09-01

    Full Text Available Objective: The purpose of this study was to investigate obstetric and neonatal outcomes and to discuss benefit effects of preconception counseling of women with epilepsy. Design: Retrospective evaluation of the pregnancy outcomes of women with epilepsy, which it was diagnosed by neurologist at Department of Obstetrics and Gynecology, Ege University School of Medicine, İzmir, between january 2004 and november 2009. Data according to demographic, obstetric and neonatal variables were collected retrospectively from the records of 66 pregnants with epilepsy. We also investigated the pregnancy outcomes related to AED using and preconception counseling. Setting: Department of Obstetrics and Gynecology, Ege University School of Medicine, İzmir Patients: 66 pregnants with epilepsy. Results: The mean maternal age was 28,3±6,3. the median gestational age and fetal weight was 38±0,7 weeks and 3027±341 gr at the time of birth, respectively. Fourteen pregnants (%23,1 were borned before 37. gestational weeks. There were no adverse fetal outcomes and major or minor congenital malformations. The preconception counseling ratio was % 57,57 (n: 38 in study group and all of these used antiepileptic drugs during pregnancy. 28 (%42,43 pregnants with epilepsy didn’t applied preconception counseling that 17 cases of them discontinued their medical terapy during first trimester. Epileptic seizures were commonly developed because of leaving AED. Conclusion: The pregnants with epilepsy have some risk according to disease and medical terapy. A good team work is required by experienced obstetrician and neurologist for management. Then, favorable pregnancy outcomes may be obtained as like as general population.

  7. Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study

    NARCIS (Netherlands)

    C.A. Snijder (Claudia); T. Brand (Teus); V.W.V. Jaddoe (Vincent); A. Hofman (Albert); J.P. Mackenbach (Johan); E.A.P. Steegers (Eric); A. Burdorf (Alex)

    2012-01-01

    textabstractObjectives: Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different

  8. Adherence to medical treatment in relation to pregnancy, birth outcome & breastfeeding behavior among women with Crohn's disease.

    Science.gov (United States)

    Julsgaard, Mette

    2016-07-01

    Crohn's disease (CD) is common among women of fertile age, and it often requires maintenance medical treatment. Adherence to medical treatment among women with CD prior to, during, and after pregnancy has, however, never been examined. Although CD women have increased risk of adverse pregnancy outcomes, little is known about predictors for these outcomes in women with CD. In addition, the impact of breastfeeding on disease activity remains controversial. The aims of this PhD thesis were to determine adherence to treatment and to investigate predictors for and prevalence rates of non-adherence to maintenance medical treatment among women with CD prior to, during, and after pregnancy; to assess pregnancy outcomes among women with CD, taking medical treatment, smoking status, and disease activity into account; to assess breastfeeding rates and the impact of breastfeeding on the risk of relapse. We conducted a population-based prevalence study including 154 women with CD who had given birth within a six-year period. We combined questionnaire data, data from medical records, and medical register data. Among 105 (80%) respondents, more than half reported taking medication with an overall high adherence rate of 69.8%. Counselling, previous pregnancy, and planned pregnancy seemed to decrease the likelihood of non-adherence, whereas smoking seemed to predict non-adherence prior to pregnancy, although our sample size prevented any firm conclusions. During pregnancy, the vast majority (95%) of CD women were in remission. The children's birth weight did not differ in relation to maternal medical treatment, but mean birth weight in children of smokers in medical treatment was 274 g lower than that of children of non-smokers in medical treatment. In our relatively small study CD women in medical treatment were not at increased risk of adverse pregnancy outcomes compared with untreated women with CD. In total, 87.6% of CD women were breastfeeding, and rates did not vary by

  9. Pre-Pregnancy Dating Violence and Birth Outcomes Among Adolescent Mothers in a National Sample.

    Science.gov (United States)

    Madkour, Aubrey Spriggs; Xie, Yiqiong; Harville, Emily W

    2014-07-01

    Although infants born to adolescent mothers are at increased risk of adverse birth outcomes, little is known about contributors to birth outcomes in this group. Given past research linking partner abuse to adverse birth outcomes among adult mothers, we explored associations between pre-pregnancy verbal and physical dating violence and the birth weight and gestational age of infants born to adolescent mothers. Data from the National Longitudinal Study of Adolescent Health Waves I (1995/1996), II (1996), and IV (2007/2008) were analyzed. Girls whose first singleton live births occurred after Wave II interview and before age 20 (N = 558) self-reported infants' birth weight and gestational age at Wave IV. Dating violence victimization (verbal and physical) in the 18 months prior to Wave II interview was self-reported. Controls included Wave I age, parent education, age at pregnancy, time between reporting abuse and birth, and childhood physical and sexual abuse. Weighted multivariable regression models were performed separately by race (Black/non-Black).On average, births occurred 2 years after Wave II interview. Almost one in four mothers reported verbal dating violence victimization (23.6%), and 10.1% reported physical victimization. Birth weight and prevalence of verbal dating violence victimization were significantly lower in Black compared with non-Black teen mothers. In multivariable analyses, negative associations between physical dating abuse and birth outcomes became stronger as time increased for Black mothers. For example, pre-pregnancy physical dating abuse was associated with 0.79 kilograms lower birth weight (pdating abuse was unassociated with birth outcomes among non-Black mothers, and verbal abuse was unassociated with birth outcomes for all mothers. Reducing physical dating violence in adolescent relationships prior to pregnancy may improve Black adolescent mothers' birth outcomes. Intervening on long-term violence may be particularly important.

  10. Physical violence during pregnancy and pregnancy outcomes in Ghana

    NARCIS (Netherlands)

    Pool, Michelle Sharon; Otupiri, Easmon; Owusu-Dabo, Ellis; de Jonge, Ank; Agyemang, Charles

    2014-01-01

    In pregnancy, violence can have serious health consequences that could affect both mother and child. In Ghana there are limited data on this subject. We sought to assess the relationship between physical violence during pregnancy and pregnancy outcomes (early pregnancy loss, perinatal mortality and

  11. Duty hours and pregnancy outcome among residents in obstetrics and gynecology.

    Science.gov (United States)

    Gabbe, Steven G; Morgan, Maria A; Power, Michael L; Schulkin, Jay; Williams, Sterling B

    2003-11-01

    To assess the present status of resident duty hours in obstetrics and gynecology, identify existing policies concerning work schedules during pregnancy, and evaluate pregnancy outcome in female house officers. A questionnaire-based study was administered to residents taking the 2001 Council on Residency Education in Obstetrics and Gynecology examination. More than 90% of the residents reported that their institution had a maternity leave policy. The leave was usually 4-8 weeks long and was paid. Nearly 95% of residents reported that they had to take over the work of residents on maternity leave. Most women residents worked more than 80 hours weekly throughout pregnancy, and few took time off before delivery. Most pregnancies occurred during the fourth year of training and did not seem to be adversely affected by the long work hours. This study, performed before the institution of the new Accreditation Council for Graduate Medical Education resident duty hour policies, demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome. Nevertheless, there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.

  12. 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.

  13. MATERNAL OUTCOME IN PREGNANCY INDUCED HYPERTENSION IN A TEACHING HOSPITAL IN A RURAL AREA IN TELANGANA

    Directory of Open Access Journals (Sweden)

    Kavitha Reddy Kothapally

    2016-09-01

    Full Text Available AIM To analyse the maternal outcome in pregnancy induced hypertension and improve the management strategies. INTRODUCTION Pregnancy induced hypertension is a medical disease peculiar to pregnancy, making pregnancy a high risk condition. Among medical disorders complicating pregnancy, it stands next to anaemia in prevalence. It is responsible for majority of the maternal morbidity and mortality. It also has an adverse perinatal outcome. Hence, early detection and timely intervention of women with pregnancy induced hypertension is important for good maternal and perinatal outcome. MATERIAL & METHODS The present Prospective Observational study was done from April 2015 to February 2016 in the department of obstetrics & gynaecology at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana. A total of 102 pregnant women with pregnancy induced hypertension were enrolled into the study. Demographic details like age, parity, previous obstetric history of pregnancy induced hypertension and diabetes, past history of polycystic ovarian disease, treatment for infertility, gestational age at which hypertension developed in the present pregnancy were noted. Relevant investigations were performed. Gestational age of delivery, mode of delivery and maternal complications were noted. RESULTS The incidence of pregnancy induced hypertension was 4% in the study population. About 59.8% developed pregnancy induced hypertension in the third trimester. Out of this, 64.7% cases were gestational hypertension and 35.3% cases were preeclampsia. Nearly half (41.7% of preeclampsia cases were severe preeclampsia. Postpartum haemorrhage is the commonest complication (13.7%, next being imminent eclampsia (7.8%, abruption (4.9%, eclampsia (3.9% and HELLP syndrome (0.98%. 80% of cases could be delivered beyond 37 weeks of gestational age. 71.57% of cases had lower segment caesarean section for indicated conditions. More than half of pregnancy induced

  14. Medical abortion and the risk of subsequent adverse pregnancy outcomes

    DEFF Research Database (Denmark)

    Virk, Jasveer; Zhang, Jun; Olsen, Jørn

    2007-01-01

    BACKGROUND: The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies. METHODS: We...... identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at ... weight (abortion were compared with risks in women who had had a first-trimester surgical abortion. RESULTS: Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women...

  15. Frequency, Risk Factors, and Adverse Fetomaternal Outcomes of Placenta Previa in Northern Tanzania

    Directory of Open Access Journals (Sweden)

    Elizabeth Eliet Senkoro

    2017-01-01

    Full Text Available Background and Objective. Placenta previa (PP is a potential risk factor for obstetric hemorrhage, which is a major cause of fetomaternal morbidity and mortality in developing countries. This study aimed to determine frequency, risk factors, and adverse fetomaternal outcomes of placenta previa in Northern Tanzania. Methodology. A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre birth registry spanning 2000 to 2015. All women who gave birth to singleton infants were studied. Adjusted odds ratios (ORs with 95% confidence intervals for risk factors and adverse fetomaternal outcomes associated with PP were estimated in multivariable logistic regression models. Result. A total of 47,686 singleton deliveries were analyzed. Of these, the frequency of PP was 0.6%. Notable significant risk factors for PP included gynecological diseases, alcohol consumption during pregnancy, malpresentation, and gravidity ≥5. Adverse maternal outcomes were postpartum haemorrhage, antepartum haemorrhage, and Caesarean delivery. PP increased odds of fetal Malpresentation and early neonatal death. Conclusion. The prevalence of PP was comparable to that found in past research. Multiple independent risk factors were identified. PP was found to have associations with several adverse fetomaternal outcomes. Early identification of women at risk of PP may help clinicians prevent such complications.

  16. Coffee and pregnancy

    DEFF Research Database (Denmark)

    Bech, Bodil Hammer

    Background: Coffee consumption in Denmark is high also among pregnant women and it is presumably their main source of caffeine intake. Coffee or caffeine intake during pregnancy has been linked to adverse pregnancy outcomes such as spontaneous abortion, stillbirth and reduced fetal growth. However...... a review of the literature indicates that further studies are needed to test the hypothesis of an effect of coffee or caffeine on the risk of adverse pregnancy outcomes.The aim of the thesis was to study the relation between coffee and the risk of fetal death and the relation between caffeine intake...

  17. Physically demanding work, fetal growth and the risk of adverse birth outcomes. The Generation R Study

    NARCIS (Netherlands)

    Snijder, Claudia A.; Brand, Teus; Jaddoe, Vincent; Hofman, Albert; Mackenbach, Johan P.; Steegers, Eric A. P.; Burdorf, Alex

    2012-01-01

    Objectives Work-related risk factors, such as long work hours, and physically demanding work have been suggested to adversely influence pregnancy outcome. The authors aimed to examine associations between various aspects of physically demanding work with fetal growth in different trimesters during

  18. [Impact of HIV/HBV infection and HIV/HBV co-infection on outcomes of pregnancy].

    Science.gov (United States)

    Yang, Y; Cheng, W T; Zhou, Y B; Jiang, Q W

    2017-06-10

    Both HIV and HBV infection have become major health problems, of global concern, due to the high prevalence in the past few decades. Data from cumulated epidemiological surveys have shown the links between maternal HIV or HBV infection and adverse outcomes on pregnancy. Maternal HIV or HBV infection may also increase the mother-to-child (MTCT) transmission of the two diseases. However, association between HIV-HBV co-infection and adverse pregnancy is still inconclusive. Does maternal HIV-HBV co-infection have an impact on mother-to-child transmission on either HIV or HBV? Study on effective precautionary measures to promote both maternal and child's health is deemed necessary.

  19. Systemic effects of periodontitis: Lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes

    Science.gov (United States)

    Papapanou, Panos N.

    2015-01-01

    Studies conducted over the past 25 years have focused on the role of periodontitis, an inflammatory condition of microbial etiology that destroys the tooth supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteremias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, while bacteria of oral origin may translocate into the feto-placental unit. Epidemiologic studies largely support an association between periodontitis and ASVD / APOs independent of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarizes key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation. PMID:26388299

  20. Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome.

    Science.gov (United States)

    Sundelin, Heléne E K; Stephansson, Olof; Johansson, Kari; Ludvigsson, Jonas F

    2017-01-01

    An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected. In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes. Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome. Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome. © 2016 Nordic Federation of

  1. Maternal Dietary Patterns and Pregnancy Outcome

    Science.gov (United States)

    Chen, Xuyang; Zhao, Diqi; Mao, Xun; Xia, Yinyin; Baker, Philip N.; Zhang, Hua

    2016-01-01

    Maternal nutritional status during pregnancy will affect the outcomes for the mother and the baby. Many analyses of the relationship between diet and outcome are often based on a single or a few food items or nutrients. However, foods are not consumed in isolation and dietary patterns can be used to assess the whole diet consumed. The use of dietary pattern analysis to understand nutritional intake and pregnancy outcome is becoming more and more popular. Many published studies have showed the association between maternal dietary patterns and pregnancy outcome. This review examined articles about the relationship between maternal dietary patterns and pregnancy outcome. As a modifiable factor, dietary patterns may be more applicable to clinical and pregnant health interventions. PMID:27338455

  2. Maternal Nutritional Status Predicts Adverse Birth Outcomes among HIV-Infected Rural Ugandan Women Receiving Combination Antiretroviral Therapy

    Science.gov (United States)

    Young, Sera; Murray, Katherine; Mwesigwa, Julia; Natureeba, Paul; Osterbauer, Beth; Achan, Jane; Arinaitwe, Emmanuel; Clark, Tamara; Ades, Veronica; Plenty, Albert; Charlebois, Edwin; Ruel, Theodore; Kamya, Moses; Havlir, Diane; Cohan, Deborah

    2012-01-01

    Objective 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. Design Prospective cohort. Methods 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. Results 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 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. Trial Registration Clinicaltrials.gov NCT00993031 PMID:22879899

  3. Co-infection with vaginal Ureaplasma urealyticum and Mycoplasma hominis increases adverse pregnancy outcomes in patients with preterm labor or preterm premature rupture of membranes.

    Science.gov (United States)

    Kwak, Dong-Wook; Hwang, Han-Sung; Kwon, Ja-Young; Park, Yong-Won; Kim, Young-Han

    2014-03-01

    The purpose of this study was to determine the prevalence of Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) in patients with preterm labor or preterm premature rupture of membranes (PPROM) and to determine the effect of these organisms on pregnancy outcomes based on the density of colonization. The study group consisted of 184 women with preterm labor or PPROM. Vaginal cultures for UU and MH were performed for all patients at admission, and the placentas were histologically evaluated after delivery. The prevalence of positive vaginal fluid cultures for genital mycoplasma was 62.5% (112/179). This group included 99 patients carrying only UU and 13 carrying both organisms. No patients were found to carry only MH. Compared to patients only positive for UU, patients with both organisms showed significantly decreased gestational age at birth and birth weight, and significant increases in the incidences of preterm birth, NICU admissions and histologic chorioamnionitis. Vaginal MH tends to be detected with UU, and patients carrying both organisms simultaneously had more severe adverse pregnancy outcomes compared to patients in preterm labor or PPROM who were only positive for UU.

  4. Teenage pregnancy in type 1 diabetes mellitus.

    LENUS (Irish Health Repository)

    Carmody, David

    2010-03-01

    Younger maternal age at delivery has been linked to adverse reproductive outcomes. Pregnancy complicated by type 1 diabetes mellitus (T1DM) is also associated with adverse pregnancy outcomes. Optimising diabetic glycaemic control prior to pregnancy is known to reduce the rate of congenital abnormalities and improve pregnancy outcomes. Teenage pregnancies are not usually planned and little data exist on teenage pregnancy complicated by T1DM. We sought to identify the glycemic control achieved in teenage pregnancy with T1DM and to clarify if there is an associated increase in adverse pregnancy outcomes compared to those seen in older women with T1DM. We compared outcomes in 18 teenagers (TG) with 582 older women with T1DM (CON) from 1995-2007. TG booked to the combined diabetes-obstetrical service at a median gestational age of 11 weeks (range 6-22) compared to 7 weeks in CON (range 4-40, p < 0.02). Glycaemic was worse in TG compared to CON at 13, 26 and 35 weeks gestation, despite higher insulin doses. First trimester miscarriage rate did not differ between groups. Major congenital anomaly rate was 6.2% (1\\/16) compared to 3.2% in CON. This preliminary study has demonstrated that pregnant teenage women with T1DM book later to specialised care and have worse glycaemic control in pregnancy compared to older women with T1DM. This group also appear to be more insulin resistant than older women in early pregnancy. Our data would suggest that teenagers with type 1 diabetes mellitus may constitute a high-risk group for adverse pregnancy outcomes.

  5. Treating periodontal disease for preventing adverse birth outcomes in pregnant women.

    Science.gov (United States)

    Iheozor-Ejiofor, Zipporah; Middleton, Philippa; Esposito, Marco; Glenny, Anne-Marie

    2017-06-12

    Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health. To assess the effects of treating periodontal disease in pregnant women in order to prevent or reduce perinatal and maternal morbidity and mortality. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), Cochrane Pregnancy and Childbirth's Trials Register (to 7 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 6 October 2016). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 6 October 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. We included all randomised controlled trials (RCTs) investigating the effects of periodontal treatment in preventing or reducing perinatal and maternal morbidity and mortality. We excluded studies where obstetric outcomes were not reported. Two review authors independently screened titles and abstracts and extracted data using a prepiloted data extraction form. Missing data were obtained by contacting authors and risk of bias was assessed using Cochrane's 'Risk of bias' tool. Where appropriate

  6. Vaginal microbial flora and outcome of pregnancy.

    Science.gov (United States)

    Donati, Laura; Di Vico, Augusto; Nucci, Marta; Quagliozzi, Lorena; Spagnuolo, Terryann; Labianca, Antonietta; Bracaglia, Marina; Ianniello, Francesca; Caruso, Alessandro; Paradisi, Giancarlo

    2010-04-01

    The vaginal microflora of a healthy asymptomatic woman consists of a wide variety of anaerobic and aerobic bacterial genera and species dominated by the facultative, microaerophilic, anaerobic genus Lactobacillus. The activity of Lactobacillus is essential to protect women from genital infections and to maintain the natural healthy balance of the vaginal flora. Increasing evidence associates abnormalities in vaginal flora during pregnancy with preterm labor and delivery with potential neonatal sequelae due to prematurity and poor perinatal outcome. Although this phenomenon is relatively common, even in populations of women at low risk for adverse events, the pathogenetic mechanism that leads to complications in pregnancy is still poorly understood. This review summarizes the current knowledge and uncertainties in defining alterations of vaginal flora in non-pregnant adult women and during pregnancy, and, in particular, investigates the issue of bacterial vaginosis and aerobic vaginitis. This could help specialists to identify women amenable to treatment during pregnancy leading to the possibility to reduce the preterm birth rate, preterm premature rupture of membranes, chorioamnionitis, neonatal, puerperal and maternal-fetal infectious diseases. Vaginal ecosystem study with the detection of pathogens is a key instrument in the prevention of preterm delivery, pPROM, chorioamnionitis, neonatal, puerperal and maternal-fetal infections.

  7. Rate of teenage pregnancy in Jordan and its impact on maternal and neonatal outcomes.

    Science.gov (United States)

    Khader, Yousef S; Batieha, Anwar; Al Fursan, Rana Kareem; Al-Hader, Rami; Hijazi, Sa'ad S

    2017-07-26

    Objective Research regarding the adverse outcomes of adolescent childbearing has suffered from many limitations such as a small sample size and non-representative samples. This study was conducted to determine the rate of teenage pregnancy among Jordanian adolescents and its associated adverse maternal and neonatal outcomes. Methods The study is a part of a comprehensive national study of perinatal mortality that was conducted between 2011 and 2012 in Jordan. All women who gave birth after 20 weeks of gestation in 18 maternity hospitals in Jordan between 2011 and 2012 were invited to participate in the study. Consenting women were interviewed by the trained midwives in these hospitals using a structured questionnaire prepared for the purpose of this study. Additional information was also collected based on the physical examination by the midwife and the obstetrician at admission and at discharge. Data on the newborn were also collected by the pediatric nurses and the neonatologists in these hospitals. Results The overall rate of teenage pregnancy [95% confidence interval (CI) was 6.2% (5.9%, 6.5%)]. Of the studied maternal and neonatal outcomes, women aged Teenage pregnancy was associated with increased risk of premature delivery, apart from the effects of socioeconomic factors.

  8. Obesity in pregnancy

    DEFF Research Database (Denmark)

    Nøhr, Ellen Aagaard

    Background: The obesity epidemic has led to an increase in obese women of childbearing age. This gives cause for concern because prepregnancy obesity is associated with a number of adverse pregnancy outcomes. The newly established Danish National Birth Cohort (DNBC) has a size that permits......,167), and neonatal mortality in the offspring (n=83,834). Also, the impact of recreational exercise on the risk of preterm birth and obesity-related diseases was considered (n=85,046). Self-reported information about exposures was obtained during pregnancy by means of comprehensive telephone interviews. Pregnancy...... outcomes were obtained from registers and medical records. Cox regression analyses with delayed entry and time-dependent covariates were used to estimate the risk of adverse pregnancy outcomes.Obese women (BMI≥30) faced an increased risk of both late spontaneous abortion and stillbirth compared to normal...

  9. Pregnancy Outcomes Among Patients With Vasculitis

    Science.gov (United States)

    Clowse, Megan E. B.; Richeson, Rachel L.; Pieper, Carl; Merkel, Peter A.

    2015-01-01

    Objective Pregnancy outcomes of patients with vasculitis are unknown, but are of great concern to patients and physicians. Through an online survey, this study assessed pregnancy outcomes among patients with vasculitis. Methods Participants in the Vasculitis Clinical Research Consortium Patient Contact Registry were invited to respond to an anonymous, internet-based survey that included questions about pregnancy outcomes, the timing of pregnancy relative to a diagnosis of vasculitis, and medication use. Results A total of 350 women and 113 men completed the survey. After a diagnosis of vasculitis, 74 pregnancies were reported by women and 18 conceptions were reported by men. The rate of pregnancy loss was higher among women who conceived after a diagnosis of vasculitis compared to those who conceived prior to diagnosis (33.8% versus 22.4%; P = 0.04). Among women, the rate of preterm births increased significantly for pregnancies conceived after a diagnosis of vasculitis relative to those conceived before diagnosis (23.3% versus 11.4%; P = 0.03). Only 18% of women reported worsening of vasculitis during pregnancy, but those who experienced increased vasculitis activity were more likely to deliver preterm. Exposure to cyclophosphamide or prednisone did not appear to impact pregnancy outcomes; however, the number of pregnancies among women taking these medications was small. Among the pregnancies conceived by men with vasculitis, the timing of diagnosis had no significant effect on the rate of pregnancy loss. Conclusion Women who conceived after a diagnosis of vasculitis had a higher rate of pregnancy loss than those who conceived prior to diagnosis. Vasculitis did not worsen during the majority of pregnancies conceived after diagnosis. PMID:23401494

  10. Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes.

    Science.gov (United States)

    Faucett, Allison M; Metz, Torri D; DeWitt, Peter E; Gibbs, Ronald S

    2016-02-01

    Maternal obesity is associated with increased systemic inflammation and an increased risk of preterm premature rupture of membranes. There is an established association between an inflammatory intrauterine environment and adverse neonatal outcomes that is independent of gestational age and mediated by the fetal inflammatory response. It is unknown whether the maternal systemic inflammation that is present in obese women influences the intrauterine environment and predisposes the fetus to adverse neonatal outcomes after preterm premature rupture of membranes. The purpose of this study was to determine whether maternal obesity is associated with adverse neonatal outcomes in pregnancies that are complicated by preterm premature rupture of membranes. This was a secondary analysis of the Maternal-Fetal Medicine Units Network Randomized Clinical Trial on the Beneficial Effects of Antenatal Magnesium Sulfate. Women with singleton pregnancies that were affected by preterm premature rupture of membranes who delivered live-born infants between 24 + 0 and 33 + 6 weeks of gestation were included. An adverse neonatal outcome was defined as a composite outcome of neonatal death, severe necrotizing enterocolitis, respiratory distress syndrome, sepsis, or severe intraventricular hemorrhage. The rates of the composite outcome were compared between obese (body mass index, ≥30 kg/m(2)) and nonobese women. Multivariable logistic regression was used to evaluate the independent effect of obesity on neonatal outcomes. Magnesium sulfate administration, steroid administration, maternal diabetes mellitus, gestational age at delivery, indomethacin exposure, birthweight, and chorioamnionitis were all considered as possible covariates in the multivariable regression models. Three hundred twenty-five of the 1288 women (25.2%) who were included were obese, and 202 of these women (62.2%) had neonates with adverse outcomes. In univariable analysis, maternal prepregnancy obesity was associated

  11. Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study.

    Science.gov (United States)

    Yalcin, Serenat Eris; Yalcin, Yakup; Yavuz, And; Akkurt, Mehmet Ozgur; Sezik, Mekin

    2017-05-24

    To assess whether maternal multiple sclerosis (MS) is associated with adverse pregnancy outcomes by determining the clinical course of disease during pregnancy and postpartum throughout a 10-year-period in a single tertiary center. We conducted a case-control study that included pregnancies with a definitive diagnosis of MS (n=43), matched with 100 healthy pregnant women with similar characteristics. Maternal and perinatal data were retrieved from hospital files. Groups were compared with the Mann-Whitney and χ2 tests. Logistic regression models were constructed to determine independent effects. Maternal demographic and baseline laboratory data were similar across the groups. Rates of preterm delivery, fetal growth restriction, preeclampsia, gestational diabetes, stillbirth, cesarean delivery, congenital malformation, and 5-min Apgar score were comparable (P>0.05 for all). General anesthesia during cesarean delivery (96% vs. 39%, P=0.002), urinary tract infection (UTI) (12% vs. 3%, P=0.04), low 1-min Apgar score (21% vs. 9%, P=0.04), and nonbreastfeeding (33% vs. 2%, P=0.001) were more frequent in women with MS. The low 1-min Apgar score and breastfeeding rates were independent of general anesthesia and UTI in regression models. MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

  12. Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey

    Directory of Open Access Journals (Sweden)

    Nilufer Akgun

    2017-05-01

    Full Text Available Objectives: To determine the effects of pre-pregnancy body mass index (BMI and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry. Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p less than 0.05, and weight gain during pregnancy was associated with parity and increased infant birth weight (p less than 0.05. However, no correlations were observed between mean pregnancy weight gain and maternal complications (p greater than 0.05. The percentage of women who gained the Institute of Medicine (IOM-recommended amount of weight was the highest in the underweight BMI group (54.1% and the lowest in the obese BMI group (24.3%. Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3% and obese (52.5% groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.

  13. 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.

  14. Maternal and fetal outcomes of intimate partner violence associated with pregnancy in the Latin American and Caribbean region.

    Science.gov (United States)

    Han, Alice; Stewart, Donna E

    2014-01-01

    Very high rates of intimate partner violence during pregnancy (IPV-P) are reported in Latin America and the Caribbean (LAC) but data on prevalence and obstetric-related outcomes are limited. To conduct a literature review on risk factors, prevalence, and adverse obstetric-related outcomes of IPV-P in LAC. Systematic review of studies in MEDLINE (1946-2012) and LILACS (1982-2012), and hand searching of reference lists of included studies. Search terms were variations of partner abuse and pregnancy in LAC. Studies were excluded if they did not include IPV-P prevalence or if the perpetrator was not an intimate partner. Study quality was assessed via US Preventive Services Task Force criteria. In the 31 studies included, prevalence rates ranged from 3% to 44%. IPV-P was significantly associated with unintended pregnancies and adverse maternal (depression, pregnancy-related symptom distress, inadequate prenatal care, vaginal bleeding, spontaneous abortion, gestational weight gain, high maternal cortisol, hypertension, pre-eclampsia, STIs) and infant (prematurity, low birth weight, neonatal complications, stillbirth) outcomes (grade II-2 and 3 evidence). IPV-P is highly prevalent in LAC, with poor obstetric-related outcomes. Clinicians must identify women experiencing IPV-P and institute appropriate interventions and referrals to avoid its deleterious consequences. © 2013.

  15. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies.

    Directory of Open Access Journals (Sweden)

    Cathrine Ebbing

    Full Text Available OBJECTIVES: To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies. DESIGN: Population-based registry study. SETTING: Medical Birth Registry of Norway 1999-2009. POPULATION: All births (gestational age >16 weeks to <45 weeks in Norway (623,478 singletons and 11,263 pairs of twins. METHODS: Descriptive statistics and odds ratios (ORs for risk factors and adverse outcomes based on logistic regressions adjusted for confounders. MAIN OUTCOME MEASURES: Velamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU, malformations, birthweight, and perinatal death. RESULTS: The prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1-4.6, and placental abruption (OR = 2.6, (95% CI = 2.1-3.2. The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5-4.3. CONCLUSION: The prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more

  16. Maternal Vitamin D Status and Adverse Birth Outcomes in Children from Rural Western Kenya

    Directory of Open Access Journals (Sweden)

    Eunice N. Toko

    2016-12-01

    Full Text Available Maternal plasma 25-hydroxyvitamin D (25(OHD status and its association with pregnancy outcomes in malaria holoendemic regions of sub-Saharan Africa is poorly defined. We examined this association and any potential interaction with malaria and helminth infections in an ongoing pregnancy cohort study in Kenya. The association of maternal plasma 25(OHD status with pregnancy outcomes and infant anthropometric measurements at birth was determined in a subset of women (n = 63. Binomial and linear regression analyses were used to examine associations between maternal plasma 25(OHD and adverse pregnancy outcomes. Fifty-one percent of the women had insufficient (<75 nmol/L and 21% had deficient (<50 nmol/L plasma 25(OHD concentration at enrollment. At birth, 74.4% of the infants had insufficient and 30% had deficient plasma 25(OHD concentrations, measured in cord blood. Multivariate analysis controlling for maternal age and body mass index (BMI at enrollment and gestational age at delivery found that deficient plasma 25(OHD levels were associated with a four-fold higher risk of stunting in neonates (p = 0.04. These findings add to the existing literature about vitamin D and its association with linear growth in resource-limited settings, though randomized clinical trials are needed to establish causation.

  17. An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks.

    Science.gov (United States)

    Posthumus, A G; Birnie, E; van Veen, M J; Steegers, E A P; Bonsel, G J

    2016-07-01

    in the Netherlands the perinatal mortality rate is high compared to other European countries. Around eighty percent of perinatal mortality cases is preceded by being small for gestational age (SGA), preterm birth and/or having a low Apgar-score at 5 minutes after birth. Current risk detection in pregnancy focusses primarily on medical risks. However, non-medical risk factors may be relevant too. Both non-medical and medical risk factors are incorporated in the Rotterdam Reproductive Risk Reduction (R4U) scorecard. We investigated the associations between R4U risk factors and preterm birth, SGA and a low Apgar score. a prospective cohort study under routine practice conditions. six midwifery practices and two hospitals in Rotterdam, the Netherlands. 836 pregnant women. the R4U scorecard was filled out at the booking visit. after birth, the follow-up data on pregnancy outcomes were collected. Multivariate logistic regression was used to fit models for the prediction of any adverse outcome (preterm birth, SGA and/or a low Apgar score), stratified for ethnicity and socio-economic status (SES). factors predicting any adverse outcome for Western women were smoking during the first trimester and over-the-counter medication. For non-Western women risk factors were teenage pregnancy, advanced maternal age and an obstetric history of SGA. Risk factors for high SES women were low family income, no daily intake of vegetables and a history of preterm birth. For low SES women risk factors appeared to be low family income, non-Western ethnicity, smoking during the first trimester and a history of SGA. the presence of both medical and non-medical risk factors early in pregnancy predict the occurrence of adverse outcomes at birth. Furthermore the risk profiles for adverse outcomes differed according to SES and ethnicity. to optimise effective risk selection, both medical and non-medical risk factors should be taken into account in midwifery and obstetric care at the booking visit

  18. Glycemic Index and Pregnancy: A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Jimmy Chun Yu Louie

    2010-01-01

    Conclusion. There is insufficient evidence to recommend a low-GI diet during normal pregnancy. In pregnancy complicated by GDM, a low-GI diet may reduce the need for insulin without adverse effects on pregnancy outcomes. Until larger-scale intervention trials are completed, a low-GI diet should not replace the current recommended pregnancy diets from government and health agencies. Further research regarding the optimal time to start a low-GI diet for maximum protection against adverse pregnancy outcomes is warranted.

  19. The effects of maternal body mass index on pregnancy outcome.

    LENUS (Irish Health Repository)

    Khashan, A S

    2012-01-31

    The increasing prevalence of obesity is presenting a critical challenge to healthcare services. We examined the effect of Body Mass Index in early pregnancy on adverse pregnancy outcome. We performed a population register-based cohort study using data from the North Western Perinatal survey (N = 99,403 babies born during 2004-2006), based at The University of Manchester, UK. The main outcome measures were Caesarean section delivery, preterm birth, neonatal death, stillbirth, Macrosomia, small for gestational age and large for gestational age. The risk of preterm birth was reduced by almost 10% in overweight (RR = 0.89, [95% CI: 0.83, 0.95]) and obese women (RR = 0.90, [95% CI: 0.84, 0.97]) and was increased in underweight women (RR = 1.33, [95% CI: 1.16, 1.53]). Overweight (RR = 1.17, [95% CI: 1.09, 1.25]), obese (RR = 1.35, [95% CI: 1.25, 1.45]) and morbidly obese (RR = 1.24, [95% CI: 1.02, 1.52]) women had an elevated risk of post-term birth compared to normal women. The risk of fetal macrosomia and operative delivery increased with BMI such that morbidly obese women were at greatest risk of both (RR of macrosomia = 4.78 [95% CI: 3.86, 5.92] and RR of Caesarean section = 1.66 [95% CI: 1.61, 1.71] and a RR of emergency Caesarean section = 1.59 [95% CI: 1.45, 1.75]). Excessive leanness and obesity are associated with different adverse pregnancy outcomes with major maternal and fetal complications. Overweight and obese women have a higher risk of macrosomia and Caesarean delivery and lower risk of preterm delivery. The mechanism underlying this association is unclear and is worthy of further investigation.

  20. Sexually Transmitted Infections and Pregnancy Outcomes in Women without Antenatal Care at Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Pathamaporn Tiengladdawong

    2017-05-01

    Full Text Available Objective: To demonstrate prevalence of sexually transmitted infections (STIs and pregnancy outcomes in Thai pregnant women without antenatal care (ANC who delivered at Siriraj Hospital. Methods: Medical charts of pregnant women without ANC who delivered at Siriraj Hospital during 2010-2014 were reviewed. Data of all deliveries during the same time period were used for the comparison. Results: During 2010-2014, out of 46,486 deliveries, 1,057 had no ANC, ranging from 197 to 229 / year. The average age was 25.5 ± 6.5 years and 85% were married. Prevalence of HIV infection, hepatitis B and other STIs in patients without ANC were 5.9% (62/1,057, 3.3% (35/1,057 and 1.4% (15/1,057, respectively. One third had consumed recreational drugs and urine amphetamine was positive in 20.8% of patients. The frequency of current smokers and current alcohol consumers were 14.6% (154/1,057 and 3.8% (40/1,057. Compared with all deliveries, those without ANC had significantly higher adverse pregnancy outcomes, including preterm birth (39.1% vs 14.0%, RR 2.29, 95%CI 2.10-2.49, birthweight < 2,500 gms (25.9% vs 12.6%, RR 1.84, 95%CI 1.65-2.05 and birthweight < 1,500 gms (4.1% vs 1.3%, RR 3.08, 95%CI 2.28-4.18. Teenage pregnancy significantly increased risk of preterm birth (aOR 1.86, 95%CI 1.36-2.55 and being separate doubled the risk of birthweight < 1,500 gms (aOR 2.13, 95%CI 1.02-4.46 after adjusting for history of recreational drug use, urine amphetamine, smoking, marital status, maternal age and concurrent STIs. Conclusion: STIs and adverse pregnancy outcomes were highly prevalent among deliveries without ANC. Teenage pregnancy and lack of family support appears to increase the risk of poor pregnancy outcomes.

  1. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.

    Science.gov (United States)

    Haider, Batool A; Olofin, Ibironke; Wang, Molin; Spiegelman, Donna; Ezzati, Majid; Fawzi, Wafaie W

    2013-06-21

    To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes; and to evaluate potential exposure-response relations of dose of iron, duration of use, and haemoglobin concentration in prenatal period with pregnancy outcomes. Systematic review and meta-analysis Searches of PubMed and Embase for studies published up to May 2012 and references of review articles. Randomised trials of prenatal iron use and prospective cohort studies of prenatal anaemia; cross sectional and case-control studies were excluded. 48 randomised trials (17 793 women) and 44 cohort studies (1 851 682 women) were included. Iron use increased maternal mean haemoglobin concentration by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59), iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to 0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort studies showed a significantly higher risk of low birth weight (adjusted odds ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in the first or second trimester. Exposure-response analysis indicated that for every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trendtrend=0.005) and risk of low birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg increase in dose/day (P for linear trendtrend=0.002); however, mean haemoglobin was not associated with the risk of low birth weight and preterm birth. No evidence of a significant effect on duration of gestation, small for gestational age births, and birth length was noted. Daily prenatal use of iron substantially improved birth weight in a linear dose-response fashion

  2. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Nucci Luciana Bertoldi

    2001-01-01

    Full Text Available INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI, according to World Health Organization (WHO criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%, overweight 19.2% (18.1%-20.3%, and obesity 5.5% (4.9%-6.2%. Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

  3. Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications.

    Science.gov (United States)

    Berti, C; Cetin, I; Agostoni, C; Desoye, G; Devlieger, R; Emmett, P M; Ensenauer, R; Hauner, H; Herrera, E; Hoesli, I; Krauss-Etschmann, S; Olsen, S F; Schaefer-Graf, U; Schiessl, B; Symonds, M E; Koletzko, B

    2016-01-01

    Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.

  4. Pregnancy outcomes in women with inflammatory bowel disease following exposure to thiopurines and antitumor necrosis factor drugs: a systematic review with meta-analysis.

    Science.gov (United States)

    Mozaffari, S; Abdolghaffari, A H; Nikfar, S; Abdollahi, M

    2015-05-01

    Several studies have indicated the harmful effect of flare-up periods in pregnant women with inflammatory bowel disease (IBD) on their newborns. Therefore, an effective and safe medical treatment during pregnancy is of great concern in IBD patients. The aim of this study was to perform a meta-analysis on the outcomes of thiopurines use and a systematic review of antitumor necrosis factor (anti-TNF) drugs used during pregnancy in women with IBD. The results of cohorts evaluating the safety of anti-TNF drugs during pregnancy up to July 2013 were collected and analyzed. In the meta-analysis, a total of 312 pregnant women with IBD who used thiopurines were compared with 1149 controls (women with IBD who were not treated with any medication and women who were exposed to drugs other than thiopurines) to evaluate the drug effect on different pregnancy outcomes, including prematurity, low birth weight, congenital abnormalities, spontaneous abortion, and neonatal adverse outcomes. Results of statistical analysis demonstrated that congenital abnormalities were increased significantly in thiopurine-exposed group in comparison with control group who did not receive any medicine for IBD treatment. The summary odds ratio was 2.95 with 95% confidence interval = 1.03-8.43 (p = 0.04). We observed no significant differences in occurrence of other adverse pregnancy outcomes between compared groups. The results of cohorts evaluated the safety of anti-TNF drugs during pregnancy demonstrated no increase in occurrence of adverse pregnancy outcomes in comparison with controls except for the significant decrease in gestational age of newborns of drug-exposed mothers in one trial. In conclusion, a benefit-risk ratio should be considered in prescribing or continuing medicinal therapy during pregnancy of IBD patients. © The Author(s) 2014.

  5. The effect of omega-3 supplementation on pregnancy outcomes by smoking status.

    Science.gov (United States)

    Kuper, Spencer G; Abramovici, Adi R; Jauk, Victoria C; Harper, Lorie M; Biggio, Joseph R; Tita, Alan T

    2017-10-01

    Smoking during pregnancy is associated with adverse maternal and neonatal outcomes such as preterm delivery, intrauterine growth restriction, stillbirth, and low birth weight. Because smoking causes oxidative stress, some have suggested using antioxidants to counteract the effects of oxidative stress. Smokers have lower serum levels of omega-3 fatty acids, an important antioxidant, and thus, investigating whether omega-3 supplementation in smokers reduces adverse maternal and neonatal outcomes represents an important area of research. To investigate whether the antioxidant effect of omega-3 fatty acid supplementation on the incidence of adverse pregnancy outcomes differs between smokers and nonsmokers. Secondary analysis of a multicenter randomized controlled trial of omega-3 supplementation for preterm delivery prevention in women with a singleton pregnancy and a history of a previous singleton spontaneous preterm delivery. Subjects were randomized to begin omega-3 or placebo before 22 weeks, which was continued until delivery. All women received 17 alpha-hydroxyprogesterone caproate intramuscularly weekly beginning between 16 and 20 weeks of gestation and continued until 36 weeks of gestation or delivery, whichever occurred first. The primary outcome was spontaneous preterm delivery. Secondary outcomes were indicated preterm delivery, any preterm delivery (spontaneous and indicated), pregnancy-associated hypertension (gestational hypertension and preeclampsia), a neonatal composite (retinopathy of prematurity, intraventricular hemorrhage grade III or IV, patent ductus arteriosus, necrotizing enterocolitis, sepsis, respiratory morbidity, or perinatal death), low birth weight (omega-3 supplementation versus placebo in each subgroup. Zelen tests were performed to test for homogeneity of effect in smokers and nonsmokers. Of 851 subjects included in the analysis, 136 (16%) smoked. Baseline characteristics between omega-3 and placebo groups did not differ in smokers or

  6. Arsenic in drinking water and adverse pregnancy outcome in a arseniasis-endemic area in northeastern Taiwan

    International Nuclear Information System (INIS)

    Yang, C.-Y.; Chang, C.-C.; Tsai, S.-S.; Chuang, H.-Y.; Ho, C.-K.; Wu, T.-N

    2003-01-01

    The well water in Lanyang Basin, which is located in the northeaster portion of Taiwan island, was found to have high levels of arsenic rangin from undetectable levels (<0.15 ppb) to 3.59 ppm. We performed a study to compare the risk of adverse pregnancy outcomes (preterm delivery an birthweight) between an area with historic high well water arsenic level (arsenic-exposed area (AE)) and a comparison area with no historic evidence of arsenic water contamination (non-arsenic-exposed area (NAE)). The mea birth weight in the AEs and NAEs were 3132.6 and 3162.6 g, respectively Babies born in AEs were on average 30 g lighter than those born in NAEs. AE had a higher rate of preterm delivery than NAEs (3.74% vs 3.43%). The result of this study suggest that, after adjustment for potential confounders arsenic exposure from drinking well water was associated, although not significantly, with the risk of preterm delivery, with an odds ratio of 1.1 (0.91-1.33). The estimated reduction in birth weight was 29.05 g (95 CI=13.55-44.55). The findings from this investigation provide evidence for potential role for arsenic exposure through drinking water in increasing th risk of low birthweight

  7. Social adversity in pregnancy and trajectories of women's depressive symptoms: A longitudinal study.

    Science.gov (United States)

    Kingsbury, Ann M; Plotnikova, Maria; Clavarino, Alexandra; Mamun, Abullah; Najman, Jake M

    2018-02-01

    Sound evidence has linked the experience of adversity with depression. Less is known about this association over time. The aim of this study is to determine whether or not social adversity experienced by pregnant women is associated with their patterns of depressive symptoms over their reproductive life course. Data were obtained from a cohort of women collected at their first obstetrical clinic visit of an index pregnancy (time-point 1) and at a further six time-points to 27 years following the birth. Latent Class Growth Modelling was used to estimate trajectories of women's depressive symptoms over this time period. Logistic regression modelling determined the prospective association between measures of adversity in pregnancy and 27-year postpartum depression trajectories, controlling for potential confounders. Experiencing financial problems, housing problems, serious disagreements with partners and with others, and experiencing serious health problems in pregnancy were associated with membership of high and middle depression trajectories over the 27 years. Having someone close die or have a serious illness was associated with the high depression trajectory only. Younger maternal age and low family-income at first clinic visit were also associated with an increased risk of women's membership of both high and middle depression trajectories. Experiencing adversity during pregnancy predicts subsequent patterns of maternal depression over an extended period of women's reproductive life course. It is not clear whether women's experiences of adversity during pregnancy were causally associated with subsequent depression or whether there are other explanations of the observed association. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  8. The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy

    NARCIS (Netherlands)

    Elsinga, Joyce; de Jong-Potjer, Lieke C.; van der Pal-de Bruin, Karin M.; le Cessie, Saskia; Assendelft, Willem J. J.; Buitendijk, Simone E.

    2008-01-01

    BACKGROUND: Recent studies suggest that the basis for adverse pregnancy outcomes is often established early in pregnancy, during organogenesis. It is therefore important to take preventive action as early as possible, preferably before pregnancy. Because most adverse pregnancy outcomes occur in

  9. The Effect of Preconception Counselling on Lifestyle and Other Behaviour Before and During Pregnancy

    NARCIS (Netherlands)

    Elsinga, J.; Jong-Potjer, L.C. de; Pal-de Bruin, K.M. van der; Cessie, S. le; Assendelft, W.J.J.; Buitendijk, S.E.

    2008-01-01

    Background: Recent studies suggest that the basis for adverse pregnancy outcomes is often established early in pregnancy, during organogenesis. It is therefore important to take preventive action as early as possible, preferably before pregnancy. Because most adverse pregnancy outcomes occur in

  10. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview.

    Science.gov (United States)

    Ghazeeri, Ghina S; Nassar, Anwar H; Younes, Zeina; Awwad, Johnny T

    2012-06-01

    This article is a review of the literature assessing pregnancy outcomes and the effect of metformin treatment among women with polycystic ovary syndrome (PCOS). A review of research published in English was undertaken using PubMed and MEDLINE databases. The weight of the available evidence suggests that pregnant women with PCOS are at an increased risk of developing gestational diabetes, hypertensive disorders of pregnancy, preterm birth and early pregnancy loss. Obesity is a contributory factor for the increased risk of gestational diabetes in this group of women and is estimated to affect 5-40% of pregnant women with PCOS. The prevalence of other obstetric complications is estimated at 10-30% for gestational hypertension, 8-15% for pre-eclampsia and 6-15% for preterm birth. The association between PCOS and early pregnancy loss may not be direct, wherein the presence of PCOS-associated hyperinsulinemia, leading to hyperandrogenemia, has been implicated in the pathophysiology of early pregnancy loss. Apart from the role of metformin in improving the metabolic consequences accompanying PCOS, it has been shown to improve pregnancy rates in women with PCOS who are resistant to clomiphene citrate. In conclusion, pregnancy in women with PCOS is associated with adverse obstetric outcomes (multiple adverse obstetric risk). Whether metformin should be administered throughout pregnancy still remains controversial. Further prospective studies that foster a larger number of participants and adjust for all potentially confounding factors are needed. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Frequency of hepatitis C in pregnancy and pregnancy outcome

    International Nuclear Information System (INIS)

    Jaffery, T.; Tariq, N.; Ayub, R.; Yawar, A.

    2005-01-01

    Objective: To determine the frequency of HCV infections in pregnant women, to find out the risk factors of HCV infection in pregnant women and to compare pregnancy outcome of the sero-positive women with sero-negative women. Design: Case-control study. Place and Duration of Study: Shifa International Hospital, Islamabad, from June 2001 to May 2002. Patients and Methods: Study was conducted on 947 booked pregnant women who were screened for HCV antibodies during antenatal consultation and were admitted for delivery in labor room. At the time of admission in labor ward, medical records of all patients were reviewed for anti HCV antibody testing and the presence of risk factors for HCV infection. Previous vaginal deliveries with episiotomy, previous surgeries, blood transfusions, and D and C for abortion or dysfunctional uterine bleeding were taken as independent variables. The obstetric outcome variables studied were: completed weeks of gestation by mother, birth weight and apgar score of newborns. The risk factors under study and the outcome variables were compared among HCV positive and negative women through a case-control study and measures of association calculated. Results: The proportion of HCV sero-positively among pregnant woman in our study was 3.27%. Among all the risk factors under study, previous surgery was found to have a significant association with HCV positive status of women (p=0.001). Other variables did not have significant association with HCV positive status in our study. There was no statistical difference in the mean birth weight of newborns (p=0.94), mean Apgar score of newborns (p=0.73) and mean gestational period among HCV positive cases and controls (p=0.47). Conclusion: Prevalence of hepatitis C in pregnant women was 3.27%. Past history of surgical procedures was the most important factor for transmission of hepatitis C virus infection. No adverse effect on pregnancy outcome was observed in terms of gestational age, Apgar score and baby

  12. Vitamin D deficiency in early pregnancy.

    Directory of Open Access Journals (Sweden)

    Shannon K Flood-Nichols

    Full Text Available Vitamin D deficiency is a common problem in reproductive-aged women in the United States. The effect of vitamin D deficiency in pregnancy is unknown, but has been associated with adverse pregnancy outcomes. The objective of this study was to analyze the relationship between vitamin D deficiency in the first trimester and subsequent clinical outcomes.This is a retrospective cohort study. Plasma was collected in the first trimester from 310 nulliparous women with singleton gestations without significant medical problems. Competitive enzymatic vitamin D assays were performed on banked plasma specimens and pregnancy outcomes were collected after delivery. Logistic regression was performed on patients stratified by plasma vitamin D concentration and the following combined clinical outcomes: preeclampsia, preterm delivery, intrauterine growth restriction, gestational diabetes, and spontaneous abortion.Vitamin D concentrations were obtained from 235 patients (mean age 24.3 years, range 18-40 years. Seventy percent of our study population was vitamin D insufficient with a serum concentration less than 30 ng/mL (mean serum concentration 27.6 ng/mL, range 13-71.6 ng/mL. Logistic regression was performed adjusting for age, race, body mass index, tobacco use, and time of year. Adverse pregnancy outcomes included preeclampsia, growth restriction, preterm delivery, gestational diabetes, and spontaneous abortion. There was no association between vitamin D deficiency and composite adverse pregnancy outcomes with an adjusted odds ratio of 1.01 (p value 0.738, 95% confidence intervals 0.961-1.057.Vitamin D deficiency did not associate with adverse pregnancy outcomes in this study population. However, the high percentage of affected individuals highlights the prevalence of vitamin D deficiency in young, reproductive-aged women.

  13. Toward a bioethical issue: induced multiple pregnancies and neonatal outcomes

    Directory of Open Access Journals (Sweden)

    Scorrano Antonio

    2010-11-01

    Full Text Available Abstract Assisted reproductive technology has made great progress during the last three decades. After the initial enthusiasm, many ethical, legal and social issues related to the application of these procedures began to evolve. Multifetal pregnancy and fetal reduction, embryo cryopreservation, preimplantation genetic diagnosis, risks of birth defects and other adverse outcome associated with assisted reproductive technology are issues that have to be addressed building future collaborative studies and continuing the debate on related ethical issues.

  14. Risks of adverse outcomes in the next birth after a first cesarean delivery.

    Science.gov (United States)

    Kennare, Robyn; Tucker, Graeme; Heard, Adrian; Chan, Annabelle

    2007-02-01

    To estimate the risks of cesarean first birth, compared with vaginal first birth, for adverse obstetric and perinatal outcomes in the second birth. Population-based retrospective cohort study of all singleton, second births in the South Australian perinatal data collection 1998 to 2003 comparing outcomes for 8,725 women who underwent a cesarean delivery for their first birth with 27,313 women who underwent a vaginal first birth. Predictor variables include age, indigenous status, smoking, pregnancy interval, medical and obstetric complications, gestation, patient type, hospital category, and history of ectopic pregnancy, miscarriage, stillbirth or termination of pregnancy. The cesarean delivery cohort had increased risks for malpresentation (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.65-2.06), placenta previa (OR 1.66, 95% CI 1.30-2.11), antepartum hemorrhage (OR 1.23, 95% CI 1.08-1.41), placenta accreta (OR 18.79, 95% CI 2.28-864.6), prolonged labor (OR 5.89, 95% CI 3.91-8.89), emergency cesarean (relative risk 9.37, 95% CI 8.98-9.76) and uterine rupture (OR 84.42, 95% CI 14.64-infinity), preterm birth (OR 1.17, 95% CI 1.04-1.31), low birth weight (OR 1.30, 95% CI 1.14-1.48), small for gestational age (OR 1.12, 95% CI 1.02-1.23), stillbirth (OR 1.56, 95% CI 1.04-2.32), and unexplained stillbirth (OR 2.34, 95% CI 1.26-4.37). The range of the number of primary cesarean deliveries needed to harm included 134 for one additional preterm birth, up to 1,536 for one additional placenta accreta. Cesarean delivery is associated with increased risks for adverse obstetric and perinatal outcomes in the subsequent birth. However, some risks may be due to confounding factors related to the indication for the first cesarean. II.

  15. Comparison of maternal abdominal subcutaneous fat thickness and body mass index as markers for pregnancy outcomes: A stratified cohort study.

    Science.gov (United States)

    Suresh, Ashwin; Liu, Anthony; Poulton, Alison; Quinton, Ann; Amer, Zara; Mongelli, Max; Martin, Andrew; Benzie, Ronald; Peek, Michael; Nanan, Ralph

    2012-10-01

    Obesity in pregnancy is associated with a number of adverse outcomes. The effects of central versus general obesity in pregnancy have not been well established. To compare subcutaneous fat thickness (SFT) with body mass index (BMI) as a marker for pregnancy outcomes. A stratified retrospective cohort study was performed on 1200 pregnancies, selected from a total of 4862 nulliparous, nonsmoking women between 2006 and 2010. SFT was measured on routine ultrasound at 18-22 weeks gestation. BMI and SFT measurements were compared for estimating risks for obesity-related pregnancy outcomes using logistic regression adjusted for maternal age. The median SFT was 18.2 mm (range 6.3-50.9 mm), the median BMI was 23.8 kg/m(2) (range 15.2-52.5), and the correlation between SFT and BMI was 0.53. For every 5 mm increase in SFT and every 5 kg/m(2) increase in BMI, the odds ratios for developing gestational diabetes mellitus were 1.40 (CI 1.22-1.61, P gestational age 1.28 (CI 1.16-1.47, P = 0.001) and 1.10 (CI 0.95-1.28, P = 0.16) and cumulative adverse obesity-related pregnancy outcomes 1.16 (CI 1.10-1.28, P = 0.002) and 1.05 (CI 0.95-1.16, P = 0.45), respectively. SFT at 18-22 weeks gestation is better than BMI as a marker for obesity-related pregnancy outcomes. As SFT is considered a surrogate measure for visceral fat, these results suggest that central obesity is a stronger risk factor than general adiposity in pregnancy. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. Comparison of gestational weight gain-related pregnancy outcomes in American primiparous and multiparous women

    DEFF Research Database (Denmark)

    Lan-Pidhainy, Xiaomiao; Nohr, Ellen A; Rasmussen, Kathleen M

    2013-01-01

    BACKGROUND: In Danish data, the tradeoffs between mother and infant in the risks of adverse pregnancy outcomes were reached at lower gestational weight gain (GWG) among multiparous than among primiparous women. It is unknown whether the same difference exists among American women. OBJECTIVE...... by multiple logistic regression analyses for women in 3 categories of prepregnancy body mass index. RESULTS: Primiparous women gained more weight during pregnancy than did multiparous women (mean ± SD: 15.9 ± 6.9 compared with 13.5 ± 6.2 kg; P

  17. A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

    OpenAIRE

    Kovač Mirjana; Miković Željko; Rakičević Ljiljana; Srzentić Snežana; Mandić Vesna; Đorđević Valentina; Radojković Dragica

    2011-01-01

    Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT) deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the firs...

  18. Chronic Kidney Disease in Pregnancy.

    Science.gov (United States)

    Koratala, Abhilash; Bhattacharya, Deepti; Kazory, Amir

    2017-09-01

    With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase considerably the risk of adverse maternal and fetal outcomes. Moreover, data suggest that a history of recovery from acute kidney injury is associated with adverse pregnancy outcomes. In addition to kidney dysfunction, maternal hypertension and proteinuria predispose women to negative outcomes and are important factors to consider in preconception counseling and the process of risk stratification. In this review, we provide an overview of the physiologic renal changes during pregnancy as well as available data regarding CKD and pregnancy outcomes. We also highlight the important management strategies in women with certain selected renal conditions that are seen commonly during the childbearing years. We call for future research on underexplored areas such as the concept of renal functional reserve to develop a potential clinical tool for prognostication and risk stratification of women at higher risk for complications during pregnancy.

  19. Pregnancy outcome in women with polycystic ovary syndrome

    OpenAIRE

    Nivedhitha V. S.; Sankareswari R.

    2015-01-01

    Background: To compare the pregnancy outcome in polycystic ovary syndrome (PCOS) women with normal women and to study the incidence of pregnancy complications like spontaneous abortions, preterm labour, gestational diabetes, gestational hypertension, preeclampsia, pregnancy and neonatal outcome in women with PCOS. Methods: Prospective comparative study done on 160 pregnant women to compare the pregnancy outcome in PCOS and normal women. All patients were subjected to detailed history, gen...

  20. [Serological survey on Toxoplasma gondii infection in pregnant women with history of adverse pregnancy in Bazhou area, Hebei Province].

    Science.gov (United States)

    Ming-Hui, Zhu; Li-Juan, Xu; Zhen-Wei, Xue

    2016-06-22

    To investigate the Toxoplasma gondii infection status in pregnant women with history of adverse pregnancy and risk factors in Bazhou area, Hebei Province. A total of 302 pregnant women with the history of adverse pregnancy were chosen as respondents (an experimental group) in the hospital from March 2012 to December 2015, and 197 pregnant women without the history of adverse pregnancy as a control group. TOX-IgG and TOX-IgM were detected by using ELISA in two groups. The risk factors of Toxoplasma infection were surveyed by questionnaires. The total positive rate of Toxoplasma antibodies was 28.15% (85/302) in the experimental group, which was significantly higher than that [9.64%(19/197)] in the control group, and the difference was statistically significant ( χ 2 = 24.76, P <0.05). The positive rates of TOX-IgM, TOX-IgG and TOX-IgM + TOX-IgG were 6.95% (21/302), 18.54% (56/302), and 2.65% (8/302) respectively in the experimental group, which were higher than 2.03% (4/197), 7.61% (15/197), and 0% (0/197) respectively in the control group ( χ 2 = 6.07, 11.67, 3.76, all P <0.05). The questionnaire survey showed that the proportions of keeping pets, cutting board regardless, liking to eat hot pot or barbecue, eating raw meat, often eating in the restaurant in the pregnant women with Toxoplasma infection were higher than those in the pregnant women without Toxoplasma infection, and the differences were statistically significant ( χ 2 = 22.57, 3.96, 5.87, 7.40, 4.86, all P <0.05), and therefore, the above unhealthy habits may be important risk factors. Toxoplasma infection could lead to adverse pregnancy outcomes. Therefore, the above-mentioned unhealthy habits should be avoided, especially during pregnancy period.

  1. Cardiovascular outcomes of pregnancy in Marfan's syndrome patients: A literature review.

    Science.gov (United States)

    Kim, So Yeon; Wolfe, Diana S; Taub, Cynthia C

    2018-03-01

    Pregnancy in patients with Marfan's syndrome (MFS) carries an increased risk of cardiovascular complications, resulting in increased maternal and fetal mortality and morbidity. Literature on MFS pregnant patients is relatively sparse, and there has yet to be a concrete consensus on the management of this unique patient population. The purpose of our paper is to provide a literature review of case reports and studies on MFS during pregnancy (published between 2005 and 2015) and to explore cardiovascular outcomes of patients with MFS. Of the 852 women in our review, there were 1112 pregnancies, with an aortic dissection rate of 7.9% and mortality of 1.2%. Data demonstrated a trend that patients whose aortic diameter ≥40 mm had a greater rate of dissection than MFS patients whose aortic diameter pregnancy or currently pregnant should be carefully counseled about the maternal and fetal risks throughout pregnancy. MFS patients whose aortic diameters ≥40 mm should be advised to ideally await pregnancy until prophylactic aortic surgery. As MFS varies in its phenotypic expression, each patient's risk of adverse cardiac events should be assessed individually through a joint Maternal Fetal Medicine and Cardiology Center. © 2017 Wiley Periodicals, Inc.

  2. Pregnancy outcome in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bortoli, A; Pedersen, N; Duricova, D

    2011-01-01

    Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies.......Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies....

  3. The associations between bridal pregnancy and obstetric outcomes among live births in Korea: population-based study.

    Directory of Open Access Journals (Sweden)

    Jung-Yun Lee

    Full Text Available OBJECTIVE: In East Asia the recently increased number of marriages in response to pregnancy is an important social issue. This study evaluated the association of marriage preceded by pregnancy (bridal pregnancy with obstetric outcomes among live births in Korea. METHODS: In this population-based study, 1,152,593 first singleton births were evaluated from data registered in the national birth registration database from 2004 to 2008 in Korea. In the study population, the pregnancy outcomes among live births from the bridal pregnancy group (N = 62,590 were compared with the outcomes of the post-marital pregnancy group (N = 564,749, composed of women who gave birth after 10 months but before 24 months of marriage. The variables preterm birth (PTB; <37 weeks gestation and low birth weight (LBW; <2.5 kg were used to determine the primary outcome. The adjusted odds ratios (aORs and 95% confidence intervals (CIs were calculated after controlling for socio-demographic factors. RESULTS: The socio-demographic factors among the bridal pregnancy group were associated with a social disadvantage and particular risk factors. In the subgroup analyses of maternal age, differences in adverse pregnancy outcomes from bridal pregnancy were identified between women in the following age group: (i ≤19, (ii 20-39, and (iii ≥40 years. After the multivariate analysis, the aORs for each age group were 1.47 (95% CI: 1.15-1.89, 1.76 (1.70-1.83, and 1.13 (0.77-1.66, respectively, for PTB and 0.92 (0.70-1.21, 1.60 (1.53-1.66, and 1.11 (0.71-1.74, respectively, for LBW. In the adjusted logistic regression models, bridal pregnancy was associated with PTB (1.76, 1.69-1.82 and LBW (1.53, 1.48-1.59. CONCLUSION: Pregnancy outcomes among live births from bridal pregnancies are associated with higher risks for PTB and LBW in Korea.

  4. Outcome of pregnancy subsequent to chemotherapy with actinomycin-D in low risk gestational trophoblastic neoplasia

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2017-07-01

    Methods: A retrospective cohort study was conducted on patients with GTN who were referred to Firoozgar and Mirza Koochak Khan teaching hospitals during 10 years, starting from 2004. The inclusion criterion was patients with low-risk persistent GTN after molar pregnancy, EP, and abortion, that treated with single agent chemotherapy actinomycin-D. After following the patients for 12 months, patients with serum βHCG lower than 5 mIU/ml, who intended to have child were allowed to become pregnant. The following items were observed in the study: age, body mass index (BMI, parity, chemotherapy duration, and pregnancy outcomes such as spontaneous abortion or preterm labor, pre-eclampsia, stillbirth, fetal malformation, and repeated molar pregnancy. Results: 74 patients were monitored, 83.78% of them had uncomplicated pregnancy and labor, 4.05% had the abortion, 4.05% had second molar pregnancy, 2.7% had pre-eclampsia, 5.40% had preterm labor. Moreover, stillbirth and malformation did not occur in this study even after chemotherapy treatment. There was not any significant correlation between age, BMI, parity, and chemotherapy duration with pregnancy outcomes. Conclusion: The outcomes of pregnancy after chemotherapy with actinomycin-D is similar to the general population who did not have chemotherapy. The abortion rate and repeated molar pregnancy were similar between population and sample too. Thus, the study shows that the cured patients with low-risk GTN have as much chance of having a normal pregnancy as normal women. In other words, treatment with actinomycin-D does not have any adverse effect in future pregnancies.

  5. Pregnancy outcomes and surgical management of pregnancy complicated by appendicitis: obstetrician view

    OpenAIRE

    Şimşek, Deniz; Turan, Özgür Deniz; Ergenoğlu, Ahmet Mete; Sezer, Taylan Özgür; Şahin, Çağdaş; Demir, Halit Batuhan

    2015-01-01

    Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergenc...

  6. Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

    OpenAIRE

    Deniz Şimşek; Özgür Deniz Turan; Ahmet Mete Ergenoğlu; Halit Batuhan Demir; Taylan Özgür Sezer; Çağdaş Şahin

    2015-01-01

    Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department an...

  7. Impact of noise and air pollution on pregnancy outcomes.

    Science.gov (United States)

    Gehring, Ulrike; Tamburic, Lillian; Sbihi, Hind; Davies, Hugh W; Brauer, Michael

    2014-05-01

    Motorized traffic is an important source of both air pollution and community noise. While there is growing evidence for an adverse effect of ambient air pollution on reproductive health, little is known about the association between traffic noise and pregnancy outcomes. We evaluated the impact of residential noise exposure on small size for gestational age, preterm birth, term birth weight, and low birth weight at term in a population-based cohort study, for which we previously reported associations between air pollution and pregnancy outcomes. We also evaluated potential confounding of air pollution effects by noise and vice versa. Linked administrative health data sets were used to identify 68,238 singleton births (1999-2002) in Vancouver, British Columbia, Canada, with complete covariate data (sex, ethnicity, parity, birth month and year, income, and education) and maternal residential history. We estimated exposure to noise with a deterministic model (CadnaA) and exposure to air pollution using temporally adjusted land-use regression models and inverse distance weighting of stationary monitors for the entire pregnancy. Noise exposure was negatively associated with term birth weight (mean difference = -19 [95% confidence interval = -23 to -15] g per 6 dB(A)). In joint air pollution-noise models, associations between noise and term birth weight remained largely unchanged, whereas associations decreased for all air pollutants. Traffic may affect birth weight through exposure to both air pollution and noise.

  8. Pregnancy Outcomes in Women with Preeclampsia Superimposed on Chronic Hypertension with and without Severe Features.

    Science.gov (United States)

    Moussa, Hind N; Leon, Mateo G; Marti, Ana; Chediak, Alissar; Pedroza, Claudia; Blackwell, Sean C; Sibai, Baha M

    2017-03-01

    Objective  The American Congress of Obstetricians and Gynecologists (ACOG) task force on hypertension in pregnancy introduced a new definition of superimposed preeclampsia (SIP) adding severe features (SF) as new criteria to define severe disease. They also recommended that those with SIP be delivered ≥ 37 weeks, whereas those with SF be delivered ≤ 34 weeks. Our aim was to investigate the validity of this new definition by comparing adverse pregnancy outcomes in SIP with (SIP-SF) and without SF (SIP). Study Design  Women with chronic hypertension (CHTN) enrolled in a multicenter trial were studied. SIP was reclassified according to the new definition to SIP and SIP-SF (persistent systolic blood pressure [BP] > 160 or diastolic BP > 110, platelets  70, creatinine > 1.1, or persistent central nervous system/abdominal symptoms). Composite adverse outcomes including rates of indicated preterm birth, abruptio placentae, postpartum hemorrhage, and maternal death were compared by chi-square. Adjustment was done with a multivariate logistic-regression analysis and all statistical tests were two-sided. Results  A total of 216 women (28%) out of 774 with CHTN developed SIP, 87 (11%) had SIP-SF, and 129 (17%) didn't have SF. Baseline characteristics including maternal age, baseline BP, and assignment to low-dose aspirin were similar between groups. Using univariate analysis, the composite adverse outcome was higher among the SIP-SF group ( p  = 0.04), as well as indicated preterm birth ( p  = 0.02), cesarean section ( p  = 0.02), and SGA ( p  = 0.02). After adjustment, composite adverse outcomes were not significantly different between groups. The rate of SGA, however, was higher among SIP-SF (adjusted odds ratio: 3.12, p  = 0.02). Conclusion  The rate of SIP-SF in this study was 11% of all women with CHTN. Surprisingly, pregnancy outcomes were not significantly different in those with and without SF. We suggest a

  9. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child.

    Science.gov (United States)

    Catalano, Patrick M; Shankar, Kartik

    2017-02-08

    Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L.; Everwijn, S. M. P.; Knapen, M. F. C. M.; Haak, M. C.; Engels, M. A. J.; Manten, G. T. R.; Zondervan, H. A.; Wirjosoekarto, S. A. M.; van Vugt, J. M. G.; Erwich, J. J. H. M.; Bilardo, C. M.; van Pampus, M. G.; de Groot, C. J. M.; Mol, B. W. J.; Pajkrt, E.

    STUDY QUESTION: What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? summary answer: Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and

  11. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

    NARCIS (Netherlands)

    van de Mheen, L; Everwijn, S M P; Knapen, M F C M; Haak, M C; Engels, M A J; Manten, G T R; Zondervan, H A; Wirjosoekarto, S A M; van Vugt, J M G; Erwich, J J H M; Bilardo, C M; van Pampus, M G; de Groot, C J M; Mol, B W J; Pajkrt, E

    STUDY QUESTION: What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? SUMMARY ANSWER: Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and

  12. Agricultural pesticide use and adverse birth outcomes in the San Joaquin Valley of California.

    Science.gov (United States)

    Larsen, Ashley E; Gaines, Steven D; Deschênes, Olivier

    2017-08-29

    Virtually all agricultural communities worldwide are exposed to agricultural pesticides. Yet, the health consequences of such exposure are poorly understood, and the scientific literature remains ambiguous. Using individual birth and demographic characteristics for over 500 000 birth observations between 1997-2011 in the agriculturally dominated San Joaquin Valley, California, we statistically investigate if residential agricultural pesticide exposure during gestation, by trimester, and by toxicity influences birth weight, gestational length, or birth abnormalities. Overall, our analysis indicates that agricultural pesticide exposure increases adverse birth outcomes by 5-9%, but only among the population exposed to very high quantities of pesticides (e.g., top 5th percentile, i.e., ~4200 kg applied over gestation). Thus, policies and interventions targeting the extreme right tail of the pesticide distribution near human habitation could largely eliminate the adverse birth outcomes associated with agricultural pesticide exposure documented in this study.The health consequences of exposure to pesticides are uncertain and subject to much debate. Here, the effect of exposure during pregnancy is investigated in an agriculturally dominated residential area, showing that an increase in adverse birth outcomes is observed with very high levels of pesticide exposure.

  13. Perinatal outcomes in pregnancy with asthma.

    Science.gov (United States)

    Syed, Rashid Zaheer; Zubairi, Ali Bin Sarwar; Zafar, Muhammad Ahsan; Qureshi, Rahat

    2008-09-01

    To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort. A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths. The mean age of asthmatics and nonasthmatics were 28.0 +/- 4.9 years and 27.7 +/- 3.6 years respectively. The average parity among asthmatic women was 2.97 while that in controls was 2.57 (p UTIs and hospital admissions. Asthmatic pregnancies are more likely to result in abortion, premature delivery and low birth weight babies. The asthmatic pregnancies were also linked with higher rates of maternal UTI. Thcrefore a more vigilant monitoring is required in asthmatic pregnancies.

  14. Adverse health events associated with domestic violence during pregnancy among Brazilian women.

    Science.gov (United States)

    Audi, Celene Aparecida Ferrari; Segall-Corrêa, Ana M; Santiago, Silvia M; Pérez-Escamilla, Rafael

    2012-08-01

    domestic violence during pregnancy remains an unsolved and neglected social problem despite the recognised adverse physical and mental health consequences. to examine the association between domestic violence (psychological violence and physical or sexual violence) and health problems self-reported by pregnant women. a cross-sectional analysis from a cohort study of 1,379 pregnant women attending prenatal care in public primary care units in Campinas, São Paulo, Brazil. Data were collected by interviewing women when they enroled for prenatal care. Domestic violence and alcohol abuse were ascertained by validated questionnaires. Referred morbidities, undesirable behaviours and sociodemographic characteristics were also recorded. Univariate analyses were used to estimate prevalence and unadjusted odd ratios. Multivariate logistic regression was used to identify the independent association between psychological violence and physical or sexual violence during pregnancy and women's health outcomes. psychological violence and physical or sexual violence were reported by 19.1% (n=263) and 6.5% (n=89) of the pregnant women, respectively. Psychological violence was significantly associated with obstetric problems [odds ratio (OR) 1.95; 95% confidence interval (CI) 1.39-2.73], premature rupture of membranes (OR 1.64, 95% CI 1.01-2.68), urinary tract infection (OR 1.71, 95% CI 1.19-2.42), headache (OR 1.75, 95% CI 1.25-2.40) and sexual risk behaviours (OR 2.28, 95% CI 1.18-4.41). Physical or sexual violence was significantly associated with: obstetric problems (OR 1.72, 95% CI 1.08-2.75), premature rupture of membranes (OR 2.11, 95% CI 1.14-3.88), urinary tract infection (OR 2.05, 95% CI 1.26-3.34), vaginal bleeding (OR 1.95, 95% CI 1.10-3.43) and lack of sexual desire (OR 3.67, 95% CI 2.23-6.09). domestic violence during pregnancy was associated with adverse clinical and psychological outcomes for women. These results suggest that a well-organised health-care system and

  15. Dietary Patterns in women with Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes: Results from The Norwegian Mother and Child Cohort Study (MoBa).

    Science.gov (United States)

    Myklebust-Hansen, Thea; Aamodt, Geir; Haugen, Margaretha; Brantsæter, Anne Lise; Vatn, Morten H; Bengtson, May-Bente

    2017-12-19

    The aim of the study was to examine dietary patterns and risk of adverse pregnancy outcomes among mothers with inflammatory bowel disease (IBD) in the Norwegian Mother and Child Cohort Study (MoBa). MoBa enrolled participants from all over Norway between 1999 and 2008, and the study comprised 83,988 mothers, of whom there were 183 mothers with Crohn's disease (CD) and 240 with ulcerative colitis (UC). An additional questionnaire was submitted to mothers with IBD in 2013. We extracted three exploratory dietary patterns: a "Prudent," a "Western," and a "Traditional" pattern. We explored the relationship between dietary patterns and IBD and dietary patterns and adverse pregnancy outcomes: small for gestational age (SGA) and preterm delivery (PTD). IBD mothers had a significantly lower adherence to the Traditional dietary pattern [mean score -0.10 (95% CI: - 0.2 - - 0.01)] than non-IBD mothers. In IBD mothers, middle and high adherence to the Traditional dietary pattern was associated with lower risk of SGA [OR tertile 2 vs. tertile 1: 0.44 (95% CI: 0.20 - 0.97) and OR tertile 3 vs. tertile 1: 0.23 (95% CI: 0.08-0.61)] than in IBD and non-IBD mothers with low adherence. In the IBD-subset analyses, similar results were demonstrated for UC mothers [OR tertile 2 vs. tertile 1: 0.21 (95% CI: 0.05 - 0.80) and OR tertile 3 vs. tertile 1: 0.16 (95% CI: 0.04 - 0.60)]. In IBD mothers, higher adherence to a Traditional dietary pattern, characterized by high consumption of lean fish, fish products, potatoes, rice porridge, cooked vegetables, and gravy, was associated with lower risk of SGA. © 2017 Crohn’s & Colitis Foundation of America. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. Selenium deficiency and pregnancy outcome in pregnant women with HIV in Lagos, Nigeria.

    Science.gov (United States)

    Okunade, Kehinde S; Olowoselu, Olusola F; Osanyin, Gbemisola E; John-Olabode, Sarah; Akanmu, Sulaimon A; Anorlu, Rose I

    2018-04-16

    To investigate the prevalence of maternal selenium deficiency and its effects on pregnancy outcomes in pregnant women with HIV in Lagos, Nigeria. The present descriptive cross-sectional study enrolled women aged 15-49 years with HIV who were at 14-26 weeks of a singleton pregnancy and were attending Lagos University Teaching Hospital, Lagos, Nigeria, between August 1, 2016, and April 30, 2017. Participants were selected by consecutive sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure selenium concentrations, and associations between low maternal selenium concentrations (defined as <0.89 μmol/L) and pregnancy outcomes were examined using bivariate and multivariate analysis. The final analysis included 113 patients; selenium deficiency was recorded in 23 (20.4%) patients. Women with selenium deficiency had an approximately eight-fold higher risk of preterm delivery (adjusted odds ratio 7.61, 95% confidence interval 4.37-18.89; P=0.031) and of delivering a term neonate with a low delivery weight (adjusted odds ratio 8.11, 95% confidence interval 3.27-17.22; P=0.012), compared with women with a normal selenium concentration. The prevalence of selenium deficiency among pregnant women with HIV in Lagos was relatively high. The significant associations observed between maternal selenium deficiency and adverse pregnancy outcomes could have implications for the future management of HIV in pregnancy. © 2018 International Federation of Gynecology and Obstetrics.

  17. Occupational Risks and Pregnancy and Infant Health Outcomes in Florida Farmworkers

    Directory of Open Access Journals (Sweden)

    Jennifer Runkle

    2014-08-01

    Full Text Available The agricultural industry has some of the highest incidence rates and numbers of occupational injuries and illnesses in the United States. Injuries and illnesses in agriculture result from accidents, falls, excessive heat, repetitive motion and adverse pesticide exposure. Women working in agriculture are exposed to the same hazards and risks as their male counterparts, but can face additional adverse impacts on their reproductive health. Yet, few occupational risk assessment studies have considered the reproductive health of female farmworkers. The objective of this community-based participatory research study was to conduct a retrospective, cross-sectional survey to collect information on workplace conditions and behaviors and maternal, pregnancy and infant health outcomes among a sample of female nursery and fernery farmworkers in Central Florida. Survey results showed that nursery workers were more likely to report health symptoms during their pregnancy than fernery workers. We also observed a self-reported increased risk of respiratory illness in the first year of life for infants whose mothers worked in ferneries. Our findings confirm that agricultural work presents potential reproductive hazards for women of childbearing age.

  18. Binge drinking in pregnancy

    DEFF Research Database (Denmark)

    Kesmodel, Ulrik Schiøler

    2001-01-01

    Independent of average alcohol intake, the effect of binge drinking on adverse pregnancy outcomes in humans is only sporadically reported, but most studies in humans have found little or no effect of binge drinking on several adverse pregnancy outcomes. In a representative sample of 371 pregnant...... Danish women, the agreement between two different measures of binge drinking during the first half of pregnancy obtained from interviews and questionnaires was assessed, and the frequency and pattern of binge drinking were described. The percentage of agreement between the methods ranged between 81......% and 86%. The proportion of women who reported binge drinking depended on the definition of pregnancy, but the proportion peaked in week 3 measured from the last menstrual period and thereafter declined to approximately 1 percent in week 7. On the basis of this 1998 study, it is suggested that most human...

  19. Nausea, vomiting, and heartburn in pregnancy: a prospective look at risk, treatment, and outcome.

    Science.gov (United States)

    Naumann, Christopher R; Zelig, Craig; Napolitano, Peter G; Ko, Cynthia W

    2012-08-01

    To examine risk factors, treatment, and outcomes for nausea/vomiting (N/V) and heartburn during pregnancy. We included 2731 women from a prospective cohort study of gallbladder disease in pregnancy. Subjects completed questionnaires at enrollment, early third trimester, and 4-6 weeks postpartum. We used logistic regression to examine independent predictors of upper gastrointestinal symptoms. Ninety-five percent of pregnant women experienced either heartburn and/or N/V. Independent predictors for heartburn included prepregnancy heartburn (OR 5.28, 95% CI 3.78-7.37), multigravidity, prepregnancy body mass index, and pregnancy weight gain. Independent predictors for N/V included prepregnancy N/V (OR 2.25, 95% CI 1.52-3.31), other digestive problems prepregnancy, younger age, single gestation, and carrying a female fetus. 11% of women with N/V and 47% of women with heartburn used pharmacologic therapy. Infants born to women with heartburn had significantly higher birth weights (p = 0.03), but gestational age at delivery was not significantly different. N/V was not associated with birth weight or gestational age at delivery. 19.7% of women with heartburn during pregnancy reported postpartum heartburn. Heartburn and N/V are common pregnancy symptoms, particularly among women with a history of such symptoms. Neither condition appears to adversely affect the outcome of pregnancy. Pregnancy-related heartburn predisposes to early postpartum heartburn.

  20. Maternal pre-pregnancy body mass index and circulating microRNAs in pregnancy.

    Science.gov (United States)

    Enquobahrie, Daniel A; Wander, Pandora L; Tadesse, Mahlet G; Qiu, Chunfang; Holzman, Claudia; Williams, Michelle A

    Maternal pre-pregnancy overweight and obese status has been associated with a number of pregnancy complications and adverse offspring outcomes. Mechanisms for observed associations, however, are largely unknown. We investigated associations of pre-pregnancy body mass index with early-mid pregnancy epigenetic biomarkers, circulating microRNAs. Peripheral blood was collected from participants (16-27 weeks gestation) of two multi-racial pregnancy cohorts, the Omega Study and the Pregnancy Outcomes and Community Health Study. Plasma miRNA expression was characterised using epigenome-wide (319 miRNAs) profiling among 20 pregnant women in each cohort. Cohort-specific linear regression models that included the predictor (pre-pregnancy body mass index), the outcome (microRNA expression), and adjustment factors (maternal age, gestational age at blood collection, and race) were fit. Expression of 27 miRNAs was positively associated with pre-pregnancy body mass index in both cohorts (p-values pregnancy body mass index is associated with circulating miRNAs in early-mid pregnancy. Published by Elsevier Ltd.

  1. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian Mother and Child Cohort - a cohort study.

    Science.gov (United States)

    Vikanes, Åse V; Støer, Nathalie C; Magnus, Per; Grjibovski, Andrej M

    2013-09-03

    Hyperemesis gravidarum (HG) characterized by excessive nausea and vomiting in early pregnancy, is reported to be associated with increased risks for low birthweight (LBW), preterm birth (PTB), small-for-gestational-age (SGA) and perinatal death. Conflicting results in previous studies underline the necessity to study HG's potential effect on pregnancy outcomes using large cohorts with valid data on exposure and outcome measures, as well as potential confounders. This study aims to investigate associations between HG and adverse pregnancy outcomes using the Norwegian Mother and Child Cohort Study (MoBa). All singleton pregnancies in MoBa from 1998 to 2008 were included. Multivariable regression was used to estimate relative risks, approximated by odds ratios, for PTB, LBW, SGA and perinatal death. Linear regression was applied to assess differences in birthweight and gestational age for children born to women with and without HG. Potential confounders were adjusted for. Altogether, 814 out of 71,468 women (or 1.1%) had HG. In MoBa HG was not associated with PTB, LBW or SGA. Babies born to women with HG were born on average 1 day earlier than those born to women without HG; (-0.97 day (95% confidence intervals (CI): -1.80 - -0.15). There was no difference in birthweight when maternal weight gain was adjusted for; (23.42 grams (95% CI: -56.71 - 9.86). Babies born by women with HG had lower risk for having Apgar score < 7 after 1 minute (crude odds ratio was 0.64 (95% CI: 0.43 - 0.95)). No differences between the groups for Apgar score < 7 after 5 minutes were observed. Time-point for hospitalisation slightly increased differences in gestational age according to maternal HG status. HG was not associated with adverse pregnancy outcomes. Pregnancies complicated with HG had a slightly shorter gestational length. There was no difference in birth weight according to maternal HG-status. HG was associated with an almost 40% reduced risk for having Apgar score

  2. Physical violence during pregnancy: maternal complications and birth outcomes.

    Science.gov (United States)

    Cokkinides, V E; Coker, A L; Sanderson, M; Addy, C; Bethea, L

    1999-05-01

    To assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes. We used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women's physical violence during pregnancy were based on self-reports of "partner-inflicted physical hurt and being involved in a physical fight." Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes. The prevalence of physical violence was 11.1%. Among women who experienced physical violence, 54% reported having been involved in physical fights only and 46% had been hurt by husbands or partners. In the latter group, 70% also reported having been involved in fighting. Compared with those not reporting physical violence, women who did were more likely to deliver by cesarean and be hospitalized before delivery for maternal complications such as kidney infection, premature labor, and trauma due to falls or blows to the abdomen. Physical violence during the 12 months before delivery is common and is associated with adverse maternal conditions. The findings support the need for research on how to screen for physical violence early in pregnancy and to prevent its consequences.

  3. Sleep disordered breathing in pregnancy

    Directory of Open Access Journals (Sweden)

    Bilgay Izci Balserak

    2015-12-01

    Sleep disordered breathing (SDB is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

  4. Pregnancy complication and outcome in women with history of allergy to medicinal agents.

    Science.gov (United States)

    Ohel, Iris; Levy, Amalia; Zweig, Aya; Holcberg, Gershon; Sheiner, Eyal

    2010-08-01

    Pregnancy outcome in women with a previous history of drug allergy and the role of drug allergies in adverse pregnancy outcomes is unclear. A retrospective cohort study comparing pregnancies of women with and without history of drug allergy was conducted. Data were collected from the computerized perinatal database. A multiple logistic regression model, with background elimination, was constructed to control for confounders. Of 186,443 deliveries, 4.6% (n = 8647) occurred in patients with a history of drug allergy. The following conditions were significantly associated with a history of drug allergy: advanced maternal age, recurrent abortions, fertility treatments, hypertensive disorders, and diabetes mellitus. Using multivariate analysis, with background elimination, history of drug allergy was significantly associated with intrauterine growth restriction (OR = 1.52, CI = 1.3-0.8, P < 0.001) and with preterm delivery (OR = 1.26, CI = 1.14-1.38, P < 0.001). A history of drug allergy is an independent risk factor for intrauterine growth restriction and preterm delivery. Further prospective studies are needed to investigate the nature of this association.

  5. Gestational diabetes mellitus and pregnancy outcomes among Chinese and South Asian women in Canada.

    Science.gov (United States)

    Mukerji, Geetha; Chiu, Maria; Shah, Baiju R

    2013-02-01

    To determine the association between Chinese or South Asian ethnicity and adverse neonatal and maternal outcomes for women with gestational diabetes compared to the general population. A cohort study was conducted using population-based health care databases in Ontario, Canada. All 35,577 women aged 15-49 with gestational diabetes who had live births between April 2002 and March 2011 were identified. Their delivery hospitalization records and the birth records of their neonates were examined to identify adverse neonatal outcomes and adverse maternal outcomes. Compared to infants of mothers from the general population (55.5%), infants of Chinese mothers had a lower risk of an adverse outcome at delivery (42.9%, adjusted odds ratio 0.63, 95% confidence interval 0.58-0.68), whereas infants of South Asian mothers had a higher risk (58.9%, adjusted odds ratio 1.15, 95% confidence interval 1.07-1.23). Chinese women also had a lower risk of adverse maternal outcomes (32.4%, adjusted odds ratio 0.58, 95% confidence interval 0.54-0.63) compared to general population women (41.2%), whereas the risk for South Asian women was not different (39.4%, adjusted odds ratio 0.94, 95% confidence interval 0.88-1.02) from that of general population women. The risk of complications of gestational diabetes differs significantly between Chinese and South Asian patients and the general population in Ontario. Tailored interventions for gestational diabetes management may be required to improve pregnancy outcomes in high-risk ethnic groups.

  6. Effect of hypertensive disorders during pregnancy on neonatal outcomes and umbilical artery flow

    Directory of Open Access Journals (Sweden)

    Dong-mei ZHENG

    2013-09-01

    Full Text Available Objective To observe the effect of hypertensive disorders during pregnancy (HDP on neonatal outcomes and umbilical artery flow. Methods A prospective cohort study method was employed, and 60 pregnant women met the HDP diagnostic criteria (HDP group, aged 31.2±6.0 years, gestation time 251.0±9.0d, hospitalized from Sep. 2011 to May. 2012, and delivered live-born infants and 63 pregnant women with normal blood pressure and without medical or surgical ailments (control group, aged 30.2±2.8 years, gestation time 251.9±7.7d, hospitalized in the the same period, and had live birth were involved in present study. The indexes of umbilical artery blood flow were measured, the adverse neonatal outcomes (neonatal asphyxia, low birth weight babies and premature labor were recorded, and the correlation was analyzed between the adverse neonatal outcomes and the indexes of umbilical artery blood flow. Results The incidence of adverse neonatal outcomes (neonatal asphyxia, low birth weight newborns and premature labor was higher in HDP group (58.3%, 45.0% and 53.3%, respectively than in control group (6.3%, 3.2% and 3.2%, respectively, P<0.05. The results of umbilical artery blood flow indexes, including pulsatility index (PI, resistance index (RI and systolic/diastolic ratio (S/D in HDP group (0.897±0.176, 0.588±0.701 and 2.655±0.346, respectively were significantly higher than in control group (0.741±0.123, 0.525±0.650 and 2.120±0.364, respectively, P<0.05. The indexes of umbilical artery blood flow (PI, RI and S/D in newborns with adverse outcomes were significantly higher than in those newborn without adverse outcomes. Multivariate logistic regression revealed a positive correlation between RI and adverse neonatal outcomes. Conclusions The indexes of umbilical artery blood flow appear to be abnormal in pregnant women with HDP, and adverse neonatal conditions (neonatal asphyxia, low birth weight newborns and premature labor are prone to

  7. Substance abuse during pregnancy: effect on pregnancy outcomes.

    Science.gov (United States)

    Pinto, S M; Dodd, S; Walkinshaw, S A; Siney, C; Kakkar, P; Mousa, H A

    2010-06-01

    To determine the contribution of drug use to maternal and perinatal complications, controlling for social confounders. This is a retrospective cohort study of 247 drug-using women and 741 controls over a 4-year period from 1997 to 2000. Cases were identified from the drug dependency register. Three controls for each woman with substance abuse were selected from the delivery suite records, with calliper matching by year of delivery (any control patient who delivered within 6 months before or after the date of delivery of a drug-using woman was considered as a potential match) and district of residence (post code). The primary outcomes of interest were preterm birth, abruption, pre-eclampsia, intrauterine growth restriction and low birth weight. There were statistically significantly more preterm births amongst drug-using women (relative risk (RR) 2.5, 95% confidence interval (CI) 1.6-3.8), with preterm births complicating 25% of births amongst drug users. The incidence of low birth weight was 30.8% amongst drug-using women compared to 8% in control women (RR 3.6, CI 2.4-5.4), and the incidence of growth restriction was 25%, significantly higher than the control group (RR 3.82, CI 2.4-6.1). The risk of abruption was also higher (RR 2.74, CI 1.1-7.0). Of note is the extremely low incidence of pre-eclampsia among drug users, even after controlling for the confounder effects of parity and smoking. Despite multidisciplinary co-ordinated antenatal care, women with substance abuse during pregnancy are at significant risk of adverse obstetric and perinatal outcome, controlling for social confounders. A limitation of the study is that the sample size was not large enough to clearly assess individual drugs. This is the first study to highlight low incidence of pre-eclampsia among drug users over and above the effect of smoking. Further research is needed to elucidate the underlying biological reason for the lack of pre-eclampsia in women with substance abuse during pregnancy

  8. Pregnancy outcomes after chemotherapy for trophoblastic neoplasia.

    Science.gov (United States)

    Garcia, Mila Trementosa; Lin, Lawrence Hsu; Fushida, Koji; Francisco, Rossana Pulcineli Vieira; Zugaib, Marcelo

    2016-12-01

    The successful development of chemotherapy enabled a fertilitysparing treatment for patients with trophoblastic neoplasia. After disease remission, the outcome of a subsequent pregnancy becomes a great concern for these women. To analyze existing studies in the literature that describe the reproductive outcomes of patients with trophoblastic neoplasia treated with chemotherapy. Systematic review was performed searching for articles on Medline/ Pubmed, Lilacs and Cochrane Library databases, using the terms "gestational trophoblastic disease" and "pregnancy outcome". A total of 18 articles were included. No evidence of decreased fertility after chemotherapy for trophoblastic neoplasia was observed. The abortion rates in patients who conceived within 6 months after chemotherapy was higher compared to those who waited longer. Some studies showed increased rates of stillbirth and repeat hydatidiform moles. Only one work showed increased congenital abnormalities. The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications. However, studies in the literature provide reassuring data about reproductive outcomes of these patients.

  9. Effects of metformin-diet intervention before and throughout pregnancy on obstetric and neonatal outcomes in patients with polycystic ovary syndrome.

    Science.gov (United States)

    Glueck, Charles J; Goldenberg, Naila; Pranikoff, Joel; Khan, Zia; Padda, Jagjit; Wang, Ping

    2013-01-01

    Prospectively assess whether metformin/diet pre-conception and throughout pregnancy would safely reduce first trimester miscarriage and improve pregnancy outcomes in women with polycystic ovary syndrome (PCOS). In 76 PCOS women, first pregnancy miscarriage and live birth were compared before and on metformin/diet, started 6.8 months (median) before conception, continued throughout pregnancy. On metformin 2-2.55 g/day, low glycemic index diet, first pregnancy outcomes in PCOS were compared with 156 community obstetric practice women (controls). Live births, miscarriage, birth metformin-diet, there were 36 miscarriages (47%) and 40 live births vs. 14 (18%) miscarriages and 62 live births on metformin-diet 6.8 months before conception and throughout pregnancy, p = 0.0004, OR 3.99, 95% CI 1.91-8.31. On metformin-diet, PCOS women did not differ (p > 0.08) from controls for birth Metformin-diet before and during pregnancy in PCOS reduces miscarriage and adverse pregnancy outcomes. Study limitation: individual benefits of the diet alone and diet plus metformin could not be assessed separately. Randomized, controlled clinical trials now need to be done with a larger number of patients.

  10. Drinking water and pregnancy outcome in central North Carolina: source, amount, and trihalomethane levels.

    Science.gov (United States)

    Savitz, D A; Andrews, K W; Pastore, L M

    1995-01-01

    In spite of the recognition of potentially toxic chemicals in chlorinated drinking water, few studies have evaluated reproductive health consequences of such exposure. Using data from a case-control study of miscarriage, preterm delivery, and low birth weight in central North Carolina, we evaluated risk associated with water source, amount, and trihalomethane (THM) concentration. Water source was not related to any of those pregnancy outcomes, but an increasing amount of ingested water was associated with decreased risks of all three outcomes (odds ratios around 1.5 for 0 glasses per day relative to 1-3 glasses per day, falling to 0.8 for 4+ glasses per day). THM concentration and dose (concentration x amount) were not related to pregnancy outcome, with the possible exception of an increased risk of miscarriage in the highest sextile of THM concentration (adjusted odds ratio = 2.8, 95% confidence interval = 1.1-2.7), which was not part of an overall dose-response gradient. These data do not indicate a strong association between chlorination by-products and adverse pregnancy outcome, but given the limited quality of our exposure assessment and the increased miscarriage risk in the highest exposure group, more refined evaluation is warranted. PMID:7556013

  11. Bipolar Disorder in Pregnancy: A Review of Pregnancy Outcomes.

    Science.gov (United States)

    Scrandis, Debra A

    2017-11-01

    Women with bipolar disorder may benefit from continuation of their medications during pregnancy, but there may be risks to the fetus associated with some of these medications. This article examines the evidence relating to the effect of bipolar disorder and pharmacologic treatments for bipolar disorder on pregnancy outcomes. MEDLINE, CINAHL, ProQuest Dissertation & Theses, and the Cochrane Database of Systematic Reviews were searched for English-language studies published between 2000 and 2017, excluding case reports and integrative reviews. Twenty articles that met inclusion criteria were included in this review. Women with bipolar disorder have a higher risk for pregnancy complications and congenital abnormalities than do women without bipolar disorder. In addition, illness relapse can occur if psychotropic medications are discontinued. There are limited data to recommend discontinuing lithium, lamotrigine, or carbamazepine during pregnancy. Valproic acid is not recommended during pregnancy due to increased odds of neural tube defects associated with its use. Atypical antipsychotics are used more frequently during pregnancy, with mixed evidence regarding an association between these agents and congenital malformations or preterm birth. The knowledge of benefits and risks of bipolar disorder and its treatment can help women and health care providers make individualized decisions. Prenatal care providers can discuss the evidence about safety of medications used to treat bipolar disorder with women in collaboration with their mental health care providers. In addition, women being treated for bipolar disorder require close monitoring for depressive and manic/hypomanic episodes that impact pregnancy outcomes. © 2017 by the American College of Nurse-Midwives.

  12. The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Maryanne Caruana

    2017-01-01

    Despite the potential adverse effects of maternal CHD on mother and foetus, most pregnancies are uncomplicated and outcomes comparable to those in women without heart disease, particularly if baseline clinical status is good. Based on our findings, it is being proposed that prospective mothers be counselled about the possibility of having smaller infants.

  13. Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes.

    Science.gov (United States)

    Farkash, Evelina; Weintraub, Adi Y; Sergienko, Ruslan; Wiznitzer, Arnon; Zlotnik, Alex; Sheiner, Eyal

    2012-05-01

    To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis. A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders. Out of 219,612 singleton deliveries in 1988-2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, pUTI) (4.2% vs. 0.4%, pUTI (OR 10.3; 95% C.I 4.8-22.1; p<0.001) and younger maternal age (OR 0.96; 95% C.I 0.93-0.99; p=0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7-3.9; p<0.001). Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women.

    LENUS (Irish Health Repository)

    Owens, Lisa A

    2010-03-01

    OBJECTIVE A prospective study of the impact of obesity on pregnancy outcome in glucose-tolerant women. RESEARCH DESIGN AND METHODS The Irish Atlantic Diabetes in Pregnancy network advocates universal screening for gestational diabetes. Women with normoglycemia and a recorded booking BMI were included. Maternal and infant outcomes correlated with booking BMI are reported. RESULTS A total of 2,329 women fulfilled the criteria. Caesarean deliveries increased in overweight (OW) (odds ratio 1.57 [95% CI 1.24-1.98]) and obese (OB) (2.65 [2.03-3.46]) women. Hypertensive disorders increased in OW (2.30 [1.55-3.40]) and OB (3.29 [2.14-5.05]) women. Reported miscarriages increased in OB (1.4 [1.11-1.77]) women. Mean birth weight was 3.46 kg in normal BMI (NBMI), 3.54 kg in OW, and 3.62 kg in OB (P < 0.01) mothers. Macrosomia occurred in 15.5, 21.4, and 27.8% of babies of NBMI, OW, and OB mothers, respectively (P < 0.01). Shoulder dystocia occur in 4% (>4 kg) compared with 0.2% (<4 kg) babies (P < 0.01). Congenital malformation risk increased for OB (2.47 [1.09-5.60]) women. CONCLUSIONS OW and OB glucose-tolerant women have greater adverse pregnancy outcomes.

  15. Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population.

    Science.gov (United States)

    Barcelona de Mendoza, Veronica; Harville, Emily; Theall, Katherine; Buekens, Pierre; Chasan-Taber, Lisa

    2016-06-01

    Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = -0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = -0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.

  16. Major malformation risk, pregnancy outcomes, and neurodevelopmental outcomes associated with metformin use during pregnancy.

    Science.gov (United States)

    Andrade, Chittaranjan

    2016-04-01

    There are several reasons why metformin treatment may be considered for women in neuropsychiatric practice. These include prevention or attenuation of antipsychotic-associated weight gain, prevention or treatment of gestational diabetes mellitus (GDM), treatment of type 2 diabetes mellitus, and improvement of conception chances and pregnancy outcomes in the presence of polycystic ovarian disease (PCOD). This article examines the benefits and risks associated with metformin use during pregnancy. The available data suggest that metformin exposure during the first trimester is not associated with major congenital malformations; that metformin reduces the risk of early pregnancy loss, preeclampsia, preterm delivery, and GDM in women with PCOD; that metformin is associated with at least comparable benefits relative to insulin treatment in women with mild GDM; and that neurodevelopmental outcomes at age 1.5-2.5 years are comparable after gestational exposure to metformin and insulin. Whereas study designs were not always ideal and sample sizes were mostly small to modest, the study findings are more encouraging than discouraging and can guide shared decision-making in women who are receiving or may need metformin during pregnancy. © Copyright 2016 Physicians Postgraduate Press, Inc.

  17. Impact of Different Treatment Approaches on Pregnancy Outcomes in 99 Women Treated for Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    De Sanctis, Vitaliana; Filippone, Francesco Romeo; Alfò, Marco; Muni, Roberta; Cavalieri, Elena; Pulsoni, Alessandro; Annechini, Giorgia; Valeriani, Maurizio; Osti, Mattia Falchetto; Minniti, Giuseppe; Enrici, Riccardo Maurizi

    2012-01-01

    Purpose: The aim of this study was to evaluate the pregnancy outcomes in women with Hodgkin lymphoma (HL) diagnosis, treated between 1972 and 1999 at Department of Radiotherapy and Hematology of University “Sapienza” of Roma. Methods and Materials: We retrospectively studied 99 female patients that conceived after treatment for HL. Fifty-nine (59%) were treated with chemotherapy and radiotherapy, 32 (32%) with radiotherapy alone as supradiaphragmatic or as infradiaphragmatic and 8 (8%) patients with chemotherapy alone. Results: Ninety-nine patients reported 145 pregnancies. We observed 132 deliveries (2 of them twin births) after a median of 55 months (range, 14–278 months) from the end of therapy. Twelve women (12%) experienced 13 miscarriages after a median of 50 months (range, 13–120) from the end of therapy. We recorded 9/132 (7%) premature births and 3/134 babies (2%) were underweight at the time of birth. We recorded 2 cases of congenital malformations. No statistical differences were recorded when adverse pregnancy outcomes were analyzed with respect to chemotherapy alone, radiotherapy alone, or combined therapy. Conclusions: No significant associations between pregnancy outcomes and therapeutic approaches were found. In particular, the infradiaphragmatic radiotherapy showed no statistical association with miscarriages, premature birth, and low birth weight at term when compared with other therapeutic approaches.

  18. "PREVALENCE, MATERNAL COMPLICATIONS AND BIRTH OUTCOME OF PHYSICAL, SEXUAL AND EMOTIONAL DOMESTIC VIOLENCE DURING PREGNANCY"

    Directory of Open Access Journals (Sweden)

    M. Faramarzi

    2005-05-01

    Full Text Available The prevalence of physical violence during pregnancy varies widely in different societies. To assess the incidence of self-reported physical, emotional and sexual violence in pregnancy and describe the association with maternal complication and birth outcomes, 3275 women who gave birth to live-born infants from October 2002 to November 2003 were assessed for self-reported violence in postpartum units of Obstetrics Department of Babol university of Medical Sciences. Outcome data included maternal antenatal hospitalizations, labor and delivery complications and low birth weights and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the association between violence, maternal morbidity and birth outcomes. The prevalence of physical, sexual and emotional domestic violence was respectively 9.1%, 30.8% and 19.2%. Compared with those not reporting physical, sexual and emotional violence, women who did were more likely to deliver by cesarean and to have abnormal progress of labor, premature rupture of membranes, low birth weight, preterm birth and any hospitalization before delivery. Prevalence of physical, emotional or sexual violence during pregnancy was high and was associated with adverse fetal and maternal conditions. These findings support routine screening for physical, emotional and sexual violence in pregnancy and postpartum period to prevent consequences of domestic violence.

  19. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study.

    Science.gov (United States)

    Sharma, S K; Nehra, A; Sinha, S; Soneja, M; Sunesh, K; Sreenivas, V; Vedita, D

    2016-03-01

    Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes. A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis. Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS. Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.

  20. Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes.

    Science.gov (United States)

    Vieira, C L; Coeli, C M; Pinheiro, R S; Brandão, E R; Camargo, K R; Aguiar, F P

    2012-06-01

    The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. Maternal Arterial Murmur in Pregnancy

    DEFF Research Database (Denmark)

    Riknagel, Diana

    2017-01-01

    Alternative methods of assessing the placental function are called for in the attempt to clarify the pathophysiology behind adverse pregnancy outcome as fetal growth restriction. A new concept of using cardiovascular sounds emitted near the uterine arteries in pregnancy is investigated...

  2. Birth outcomes among military personnel after exposure to documented open-air burn pits before and during pregnancy.

    Science.gov (United States)

    Conlin, Ava Marie S; DeScisciolo, Connie; Sevick, Carter J; Bukowinski, Anna T; Phillips, Christopher J; Smith, Tyler C

    2012-06-01

    To examine birth outcomes in military women and men with potential exposure to documented open-air burn pits before and during pregnancy. Electronic data from the Department of Defense Birth and Infant Health Registry and the Defense Manpower Data Center were used to examine the prevalence of birth defects and preterm birth among infants of active-duty women and men who were deployed within a 3-mile radius of a documented open-air burn pit before or during pregnancy. In general, burn pit exposure at various times in relation to pregnancy and for differing durations was not consistently associated with an increase in birth defects or preterm birth in infants of active-duty military personnel. These analyses offer reassurance to service members that burn pit exposure is not consistently associated with these select adverse infant health outcomes.

  3. Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of “Metabolic Memory”

    Directory of Open Access Journals (Sweden)

    Akadiri Yessoufou

    2011-01-01

    Full Text Available The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/or obesity at adulthood. This “fetal programming”, due to intrauterine diabetic milieu, is termed as “metabolic memory”. In gestational diabetes as well as in macrosomia, the complications include metabolic abnormalities, degraded antioxidant status, disrupted immune system and potential metabolic syndrome in adult offspring. Furthermore, there is evidence that maternal obesity may also increase the risk of obesity and diabetes in offspring. However, women with GDM possibly exhibit greater macrosomia than obese women. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require proper management. Management of gestational diabetes mellitus and maternal obesity is essential for maternal and offspring's good health. Increasing physical activity, preventing gestational weight gain, and having some qualitative nutritional habits may be beneficial during both the pregnancy and offspring's future life.

  4. Anaemia of pregnancy, perinatal outcomes and children's developmental vulnerability: a whole-of-population study.

    Science.gov (United States)

    Smithers, Lisa G; Gialamas, Angela; Scheil, Wendy; Brinkman, Sally; Lynch, John W

    2014-09-01

    There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 (n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 (n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index (AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio (IRR) 1.20 [95% CI 1.13, 1.27

  5. Impact of obesity on pregnancy outcome in different ethnic groups: calculating population attributable fractions.

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    Eugene Oteng-Ntim

    Full Text Available OBJECTIVES: To quantify the proportion of adverse pregnancy outcome attributable to maternal obesity. DESIGN: Cross sectional analysis of routine obstetric dataset. SETTING: Guy's and St Thomas's NHS Foundation Trust (GSTFT. POPULATION: 23,668 women who had singleton deliveries at GSTFT between 2004 and 2008. METHODS: Logistic regression was used to estimate the association between BMI and outcome in different ethnic groups. Adjusted odds ratios, and the proportions of obese women, were used to calculate population attributable risk fractions (PAFs. MAIN OUTCOME MEASURES: (I MATERNAL OUTCOMES: diabetes, type of delivery, post-partum haemorrhage, and preterm delivery. (ii Perinatal outcomes: macrosomia, low birth weight, admission to neonatal intensive care/special care baby unit, and perinatal death. RESULTS: The prevalence of maternal obesity was 14%. Increasing BMI was independently associated with increasing risk of adverse obstetric and neonatal outcome. At the individual level, the effect of obesity on diabetes was highest in Asian women compared to white women (p for interaction = 0.03. Calculation of population attributable risk fractions demonstrated that one third of diabetes cases and one in six Caesarean sections could be avoided in this population if all obese women were of normal BMI. At the population level, the contribution of obesity to diabetes was highest for Black women (42%, and lowest for oriental women (8%. Seven percent of neonatal macrosomia in all the population, and 13% in Black mothers, were attributable to obesity. CONCLUSIONS: Preventing obesity prior to pregnancy will substantially reduce the burden of obstetric and neonatal morbidity in this population. This reduction will be higher in Black women.

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

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    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.

  7. Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy.

    Science.gov (United States)

    Jensen, Megan E; Murphy, V E; Gibson, P G; Mattes, J; Camargo, C A

    2018-01-05

    Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants. Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother-infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D D ≥ 75 nmol/L (at one or both time-points). In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26-110) nmol/L at 16 weeks, and 65 (range 32-116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D D ≥ 75 nmol/L at one or both time-points. Maternal 25(OH)D D ≥ 75 nmol/L (71 versus 43%, p = .04). Infant acute-care presentations (45 versus 13%, p = .02) and oral corticosteroid use (26 versus 4%, p = .03) due to "asthma/wheezing" were higher in the maternal group with 25(OH)D D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.

  8. Risk of Adverse Pregnancy Outcome After Paternal Exposure to Methotrexate Within 90 Days Before Pregnancy

    DEFF Research Database (Denmark)

    Eck, Lasse Karlsen; Jensen, Thomas Bo; Mastrogiannis, Dimitrios

    2017-01-01

    OBJECTIVE: To study the association between paternal exposure to methotrexate within the 90-day period before pregnancy and congenital malformations and stillbirth in the offspring. METHODS: We conducted a nationwide register study. Our cohort consisted of all live births in Denmark between 1997...... group and no increased risk of preterm birth (adjusted OR 1.31, 95% CI 0.66-2.59) among the children from exposed fathers. CONCLUSION: We found no association between paternal exposure to methotrexate within 90 days before pregnancy and congenital malformations, stillbirths, or preterm birth. Available...

  9. Pregnancy Outcomes in the Tofacitinib Safety Databases for Rheumatoid Arthritis and Psoriasis.

    Science.gov (United States)

    Clowse, Megan E B; Feldman, Steven R; Isaacs, John D; Kimball, Alexandra B; Strand, Vibeke; Warren, Richard B; Xibillé, Daniel; Chen, Yan; Frazier, Donald; Geier, Jamie; Proulx, James; Marren, Amy

    2016-08-01

    Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), and is being investigated for the treatment of psoriasis. Both conditions can present in women of child-bearing potential, but pregnancy was an exclusion and discontinuation criterion in tofacitinib randomized controlled trials (RCTs) because of the unknown effects of tofacitinib on mother and child. Tofacitinib is a small molecule that has the potential to cross the placenta. The objective was to report outcomes of pregnancy cases identified through April 2014 from tofacitinib RA/psoriasis RCTs, RA post-approval non-interventional studies, and spontaneous adverse-event reporting. Pregnancy outcomes were categorized as follows: healthy newborn, medical termination, fetal death, congenital malformation, spontaneous abortion, or pending/lost to follow-up. Out of 9815 patients, 1821 female patients of child-bearing age were enrolled in the RA/psoriasis RCTs; 47 women became pregnant, including 33 who received tofacitinib monotherapy, 13 who received combination therapy with methotrexate (RA patients only), and one patient whose therapy was still blinded. No fetal deaths were reported. One congenital pulmonary valve stenosis (monotherapy, n = 1), seven spontaneous abortions (monotherapy, n = 4; combination therapy, n = 3), and eight medical terminations (monotherapy, n = 4; combination therapy, n = 3; blinded therapy, n = 1) were identified. Remaining cases reported healthy newborns (n = 25) or were pending/lost to follow-up (n = 6). Forty-four cases of paternal exposure to tofacitinib were reported (monotherapy, n = 43; combination therapy, n = 1), including five spontaneous abortions (monotherapy, n = 4; combination therapy, n = 1), 23 healthy newborns, and 16 pending/lost to follow-up. The pregnancy outcomes reported in this small number of RA/psoriasis patients appear similar to those observed in the general population and in patients treated with

  10. Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital.

    Science.gov (United States)

    Obiechina, Nj; Okolie, Ve; Eleje, Gu; Okechukwu, Zc; Anemeje, Oa

    2011-01-01

    Twin pregnancy is associated with more pregnancy complications and poorer pregnancy outcome than singleton pregnancy. Hence periodic review is necessary to improve on the pregnancy outcome. To determine the incidence and compare pregnancy complications and obstetric outcomes of twin pregnancies and singleton pregnancies. The twin pregnancies (study group) that were delivered at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria from 1st February 2005 to 31st January 2010 were compared with singleton deliveries (control group) that occurred in the same hospital during the same period. A total of 3351 deliveries were conducted during the study period, of which 113 were twin deliveries, giving an incidence of 1:29.6 deliveries. Only 100 case files could be retrieved for analysis. The mean parities for the twins and singletons were 2.7 ± 2.33 weeks and 1.96 ± 1.87 weeks whereas the mean gestational age at delivery for twin and singleton deliveries were 34 ± 5.2 weeks and 38.7 ± 2.4 weeks respectively (P < 0.05). The mean birth weights were 3.14 ± 0.73 kg and 2.3 ± 1.0 kg for singletons and twins respectively (P < 0.05). Hypertensive disorders of pregnancy, cord prolapse, malpresentation, premature rupture of membranes, low Apgar scores, cesarean section rate, and perinatal death were significantly higher in twin pregnancies than in singleton. The incidence of twin pregnancy over the study period was high and was significantly associated with more pregnancy complications and poorer obstetric outcomes. Close antenatal and intrapartum care are needed in order to improve outcome and decrease complications.

  11. A successful outcome of pregnancy in a patient with congenital antithrombin deficiency

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    Kovač Mirjana

    2011-01-01

    Full Text Available Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency.

  12. Effect of melatonin supplementation on pregnancy outcome in Wistar-Kyoto and Sprague-Dawley rats.

    Science.gov (United States)

    Singh, Harbindar Jeet; Saleh, Hisham Ibrahim; Gupalo, Sergey; Omar, Effat

    2013-04-25

    Although melatonin supplementation is known to influence numerous physiological functions, little is however known of its effects on pregnancy outcome. This study investigated the effects of melatonin supplementation on pregnancy outcome in Wistar-Kyoto (WKY) and Sprague-Dawley (SD) rats aged 12-13 weeks. Upon confirmation of proestrus, each female rat was housed overnight with a male of the same strain. On the next morning, following confirmation of mating (vaginal smear), WKY female rats were isolated into individual metabolic cages and given 0, 25, 50 or 100 mg/kg per day of melatonin in drinking water from day 1 of pregnancy to day 21 postpartum. SD females were given 0 or 100 mg/kg per day of melatonin. Maternal weight, duration of pregnancy, litter size, birth weight and body weight of pups up to day 42, and pup mortality were recorded. Data were analyzed using ANOVA for repeated measures. Compared to controls, maternal weight gain during pregnancy was significantly lower in melatonin-supplemented dams (P melatonin-supplemented dams (P melatonin (P melatonin was significantly lower than controls (P melatonin respectively, and all pup deaths occurred after day 21 of weaning. The results suggest that melatonin supplementation during antenatal and postpartum period appears to adversely affect litter size, pup growth and mortality in WKY and SD rats. The precise mechanism causing the death is not clear.

  13. 6. Outcomes and Factors Associated with Adolescent Pregnancies ...

    African Journals Online (AJOL)

    user

    ABSTRACT. Objectives: These were to determine obstetric outcomes associated with adolescent pregnancies and those of older women at the UTH, identify factors associated with and compare the obstetric outcomes between the two age groups with determining the scale of adolescent pregnancy. Materials and methods: ...

  14. Influence of adenomyosis on pregnancy and perinatal outcomes in women with endometriosis.

    Science.gov (United States)

    Scala, Carolina; Leone Roberti Maggiore, Umberto; Racca, Annalisa; Barra, Fabio; Vellone, Valerio Gaetano; Venturini, Pier Luigi; Ferrero, Simone

    2017-12-20

    Several studies investigated the correlation between endometriosis and adverse pregnancy and perinatal outcomes. However, the role of adenomyosis as a risk factor for adverse perinatal outcomes in women with endometriosis has yet to be established. The aim of this study was to explore if fetal and maternal outcomes, in particular the incidence of small for gestational age (SGA) infants, are different in pregnant women with endometriosis (E) and the concomitant presence of diffuse (EDA) and focal ademonyosis (EFA). This is a retrospective analysis of a database collected prospectively during a three-year period. We included 206 pregnant women with endometriosis; 148 (71.8%) with E, 38 (18.4%) with EFA and 20 (9.7%) with EDA. Adenomyosis was diagnosed by ultrasonography, it was classified in focal or diffuse. The study included patients who conceived spontaneously or by assisted reproductive techniques. The three groups were similar in demographic characteristics (age, body mass index, mode of conception). Patients with diffuse adenomyosis compared with those with only endometriosis had significantly lower PAPP-A MoM (0.61 vs 0.88 MoM, p<0.001), higher mean uterine artery pulsatility index (UtA PI) in the 1st (2.23 vs 1.67, p<0.001) and 2nd (1.30 vs 0.94, p<0.001) trimester of pregnancy, and higher incidence of SGA (40% vs 10.8%, p<0.001; respectively). No statistically significant difference was found in patients with focal adenomyosis compared to those with only endometriosis. Logistic regression analysis demonstrated that diffuse adenomyosis (OR=3.744 CI 95%1.158-12.099; p=0.027) was the only independent risk factors for SGA. The presence of diffuse adenomyosis in pregnant women with endometriosis is is strongly associated with SGA infants. Women with diffuse adenomyosis should be treated as being at high risk of placental dysfunction, therefore, these pregnancies might need a closer monitoring. This article is protected by copyright. All rights reserved.

  15. Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort

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    Llopis-González Agustín

    2010-11-01

    Full Text Available Abstract Background Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes. Methods We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption. Results Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small. Conclusion Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.

  16. Pregnancy outcome and complications in women with spina bifida.

    Science.gov (United States)

    Arata, M; Grover, S; Dunne, K; Bryan, D

    2000-09-01

    To describe the antenatal complications, mode of delivery and outcome of pregnancy in women with spina bifida. Case series of women known to have attended the spina bifida clinic at the Royal Children's Hospital. Medical records, postal questionnaire and telephone interview were utilized to collect data on the effect of pregnancy on the health of women and the effect of spina bifida on pregnancy outcome. Of 207 women born between 1945 and 1975, 23 reported having a pregnancy, and 17 who had completed pregnancies agreed to participate. The 17 women had a total of 29 pregnancies, with 23 pregnancies progressing to births. Fourteen of 17 women had antenatal admissions, with wheelchair-dependent women requiring more-frequent and longer admissions. Recurrent urinary infections in pregnancy occurred in women with a prior history of urinary infections; stomal problems occurred but were not serious; mobility was reduced for two women during pregnancy, with full recovery afterwards; and preexisting pressure sores worsened during pregnancy. Vaginal deliveries occurred in one in five pregnancies of women who were wheelchair dependent and in ten of eighteen pregnancies in independently mobile women, including seven of eight pregnancies of independently mobile women without ileal conduits. Cesarean sections were accompanied by postoperative complications in 10 women. Women with spina bifida who become pregnant generally have a positive outcome, with relatively low complication rates.

  17. Pregnancy outcome in type 1 diabetic women with microalbuminuria

    DEFF Research Database (Denmark)

    Ekbom, P; Damm, P; Feldt-Rasmussen, B

    2001-01-01

    To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes.......To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes....

  18. Evaluation of management and surgical outcomes in pregnancies complicated by acute cholecystitis.

    Science.gov (United States)

    El-Messidi, Amira; Alsarraj, Ghazi; Czuzoj-Shulman, Nicholas; Mishkin, Daniel S; Abenhaim, Haim Arie

    2018-01-25

    To evaluate the management of pregnancies complicated by acute cholecystitis (AC) and determine whether pregnant women are more likely to have medical and surgical complications. We carried out a population-based matched cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Pregnant women with AC were age matched to non-pregnant women with AC on a 1:5 ratio. Management and outcomes were compared using descriptive analysis and conditional logistic regression. There were 11,835 pregnant women admitted with AC who were age matched to 59,175 non-pregnant women. As compared to non-pregnant women, women with AC were more commonly managed conservatively, odds ratio (OR) 6.1 (5.8-6.4). As compared to non-pregnant women, pregnant women with AC more commonly developed sepsis [OR 1.4 (1.0-1.9)], developed venous thromboembolism [OR 8.7 (4.3-17.8)] and had bowel obstruction [OR 1.3 (1.1-1.6)]. Among pregnant women with AC, surgical management was associated with a small but significant increased risk of septic shock and bile leak. AC, in the context of pregnancy, is associated with an increased risk of adverse outcomes. Although the literature favors early surgical intervention, pregnancies with AC appear to be more commonly managed conservatively with overall comparable outcomes to surgically managed AC. Conservative management may have a role in select pregnant women with AC.

  19. Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy.

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    Ruben-J Kuon

    Full Text Available Emergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants.Retrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38, ultrasound-indicated (UIC, n = 29 and emergency/ physical examination-indicated (PEIC, n = 33 cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max, neonatal complications (ROP, IVH. Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group.Neonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2. Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM.In our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver.

  20. HBV or HCV Coinfection in HIV-1-Infected Pregnant Women in France: Prevalence and Pregnancy Outcomes.

    Science.gov (United States)

    Benhammou, Valérie; Tubiana, Roland; Matheron, Sophie; Sellier, Pierre; Mandelbrot, Laurent; Chenadec, Jérôme Le; Marel, Emmanuelle; Khoshnood, Babak; Warszawski, Josiane

    2018-04-15

    Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is frequent in HIV-infected persons but their impact on pregnant HIV-infected women is understudied. We explored whether these coinfections are associated with adverse pregnancy outcomes and lower response to antiretroviral therapy (ART). Pregnancies in HIV-1-infected women included in the ANRS French Perinatal Cohort between 2005 and 2013 were analyzed if HBV and HCV infection statuses were available. Among 4236 women, the prevalence of HBV (HBs Ag+) and HCV (RNA+) were 6.2% (95% confidence interval: 5.4 to 6.8) and 1.7% (1.3 to 2.1), respectively. HCV coinfection was strongly associated with a history of drug use; HBV coinfection was 6 times more frequent in women born in Sub-Saharan Africa than in European France. Baseline HIV viral load, CD4 count, and HIV care during pregnancy were similar in coinfected and monoinfected HIV mothers, except that 90% of HBV/HIV women were receiving tenofovir and/or lamivudine or emtricitabine. HCV coinfection was significantly associated with cholestasis [adjusted odds ratio: 4.1 (1.5-10.8), P = 0.005], preterm delivery [3.0 (1.6-5.7), P HIV-infected women, chronic HBV infection, mostly treated using targeted ART, had no major impact on the course of pregnancy. By contrast, chronic HCV infection was associated with a higher risk of obstetrical complications and a poorer immune-virological response to ART. It is yet unknown whether cure of HCV infection before conception can limit these adverse outcomes.

  1. Pregnancy outcome in hyperthyroidism: a case control study.

    Science.gov (United States)

    Aggarawal, Neelam; Suri, Vanita; Singla, Rimpi; Chopra, Seema; Sikka, Pooja; Shah, Viral N; Bhansali, Anil

    2014-01-01

    Data comparing pregnancy outcome in hyperthyroid women with euthyroid women are scarce. Hence, this study was carried out to assess the maternal and fetal outcome in pregnant women with hyperthyroidism to ascertain the effect of disease on pregnancy. This retrospective study was conducted over a period of 28 years. We compared the maternal and fetal outcomes of 208 hyperthyroid women with 403 healthy controls, between women with well-controlled and uncontrolled disease and amongst women diagnosed with hyperthyroidism before and during pregnancy. Maternal outcome: women with hyperthyroidism were at increased risk for preeclampsia (OR = 3.94), intrauterine growth restriction (OR = 2.16), spontaneous preterm labor (OR = 1.73), preterm birth (OR = 1.7), gestational diabetes mellitus (OR = 1.8), and cesarean delivery (OR = 1.47). Hyperthyroid women required induction of labor more frequently (OR = 3.61). Fetal outcome: newborns of hyperthyroid mothers had lower birth weight than normal ones (p = 0.0001). Women with uncontrolled disease had higher odds for still birth (OR = 8.42; 95% CI: 2.01-35.2) and lower birth weight (p = 0.0001). Obstetrical complications were higher in women with hyperthyroidism than normal women. Outcome was worsened by uncontrolled disease. Women with pregestational hyperthyroidism had better outcomes than those diagnosed with it during pregnancy. © 2014 S. Karger AG, Basel.

  2. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

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    Gonzales GF

    2013-10-01

    Full Text Available Gustavo F Gonzales,1–2 Vilma L Tapia,2 Alfredo L Fort,3 Ana Pilar Betran31Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, 2Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; 3Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandAbstract: A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01. The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01. On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01. More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.Keywords: elective cesarean, emergency cesarean, geographical regions, cesarean rates over time, adverse outcomes, developing country

  3. Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

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    Leila Pourali

    2016-05-01

    Full Text Available Introduction: Regarding to the recent advances in assisted reproductive techniques (ART, twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96 and ART group (n=31. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR, postpartum hemorrhage, neonatal outcomes (weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit (NICU admission, mortality, respiratory distress, and icterus were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus. Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.

  4. Impact of excessive pre-pregnancy body mass index and abnormal gestational weight gain on pregnancy outcomes in women with chronic hypertension.

    Science.gov (United States)

    Ornaghi, Sara; Algeri, Paola; Todyrenchuk, Lyudmyla; Vertemati, Emanuela; Vergani, Patrizia

    2018-04-10

    To investigate the effects of excessive pre-pregnancy body mass index (BMI) and abnormal gestational weight gain on adverse outcomes in women with chronic hypertension (CH). A retrospective cohort study of CH women with singleton pregnancy delivered at our Institution in 2002-2013. Women were categorized as normal, overweight, and obese, according to their pre-pregnancy BMI. Further stratification was based on gestational weight gain (insufficient, adequate, and excessive) as defined by 2009 IOM guidelines. Gestational diabetes, hypothyroidism, superimposed preeclampsia, preterm birth gain increased odds of small for gestational age neonate in normal BMI women (aOR, 1.82; 95% CI 1.31-2.07), whereas excessive gain was associated with superimposed preeclampsia in normal BMI patients (aOR, 3.51; 95% CI, 1.16-7.89) and with cesarean delivery in obese women (aOR, 2.96; 95% CI, 1.09-5.81). Excessive pre-conception BMI and abnormal gestational weight gain increase odds of pregnancy complications in CH women. Our results stress the importance of pre-conception counseling for weight normalization in CH women, and support IOM recommendations for adequate weight gain during CH pregnancies. Copyright © 2018 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  5. Sociodemographic factors and pregnancy outcomes associated with prepregnancy obesity: effect modification of parity in the nationwide Epifane birth-cohort.

    Science.gov (United States)

    Boudet-Berquier, Julie; Salanave, Benoit; Desenclos, Jean-Claude; Castetbon, Katia

    2017-08-25

    In light of the adverse outcomes for mothers and offspring related to maternal obesity, identification of subgroups of women at risk of prepregnancy obesity and its related-adverse issues is crucial for optimizing antenatal care. We aimed to identify sociodemographic factors and maternal and neonatal outcomes associated with prepregnancy obesity, and we tested the effect modification of parity on these associations. In 2012, 3368 mothers who had delivered in 136 randomly selected maternity wards were included just after birth in the French birth cohort, Epifane. Maternal height and weight before and at the last month of pregnancy were self-reported. Maternal and neonatal outcomes were collected in medical records. Prepregnancy Body Mass Index (pBMI) was classified into underweight (pregnancy outcomes was stratified on parity (1335 primiparous and 1814 multiparous). Before pregnancy, 7.6% of women were underweight, 64.2% were of normal weight, 18.0% were overweight and 10.2% were obese. Among the primiparous, maternal age of 25-29 years (OR = 2.09 [1.13-3.87]; vs. 30-34 years), high school level (OR = 2.22 [1.33-3.73]; vs. university level), gestational diabetes (OR = 2.80 [1.56-5.01]) and hypertensive complications (OR = 3.80 [1.83-7.89]) were independently associated with prepregnancy obesity. Among the multiparous, primary (OR = 6.30 [2.40-16.57]), junior high (OR = 2.89 [1.81-4.64]) and high school (OR = 1.86 [1.18-2.93]) education levels (vs. university level), no attendance at antenatal classes (OR = 1.77 [1.16-2.72]), excess gestational weight gain (OR = 1.82 [1.20-2.76]), gestational diabetes (OR =5.16 [3.15-8.46]), hypertensive complications (OR = 8.13 [3.97-16.64]), caesarean delivery (OR = 1.80 [1.18-2.77]) and infant birth weight ≥ 4 kg (OR = 1.70 [1.03-2.80]; vs. birth weight between 2.5 kg and 4 kg) were independently associated with prepregnancy obesity. Obesity before pregnancy is associated with a set of

  6. Adverse outcome pathways: opportunities, limitations and open questions

    NARCIS (Netherlands)

    Leist, M.; Ghallab, A.; Graepel, R.; Marchan, R.; Hassan, R.; Bennekou, S.H.; Limonciel, A.; Vinken, M.; Schildknecht, S.; Waldmann, T.; Danen, E.; Ravenzwaay, B. van; Kamp, H.; Gardner, I.; Godoy, P.; Bois, F.Y.; Braeuning, A.; Reif, R.; Oesch, F.; Drasdo, D.; Höhme, S.; Schwarz, M.; Hartung, T.; Braunbeck, T.; Beltman, J.; Vrieling, H.; Sanz, F.; Forsby, A.; Gadaleta, D.; Fisher, C.; Kelm, J.; Fluri, D.; Ecker, G.; Zdrazil, B.; Terron, A.; Jennings, P.; Burg, B. van der; Dooley, S.; Meijer, A.H.; Willighagen, E.; Martens, M.; Evelo, C.; Mombelli, E.; Taboureau, O.; Mantovani, A.; Hardy, B.; Koch, B.; Escher, S.; van Thriel, C.; Cadenas, C.; Kroese, D.; Water, B. van de; Hengstler, J.G.

    2017-01-01

    Adverse outcome pathways (AOPs) are a recent toxicological construct that connects, in a formalized, transparent and quality-controlled way, mechanistic information to apical endpoints for regulatory purposes. AOP links a molecular initiating event (MIE) to the adverse outcome (AO) via key events

  7. Ebstein's anomaly in pregnancy: maternal and neonatal outcomes.

    Science.gov (United States)

    Chopra, Seema; Suri, Vanita; Aggarwal, Neelam; Rohilla, Meenakshi; Vijayvergiya, Rajesh; Keepanasseril, Anish

    2010-04-01

    Ebstein's anomaly is a rare congenital cardiac abnormality, associated with cyanosis and arrhythmia. Patients often reach childbearing age and pregnant women pose a challenge to the treating physician. We describe the course and outcome of pregnancy in women with Ebstein's anomaly and discuss the related management issues. Analysis of pregnancies in four women with Ebstein's anomaly was carried out in a referral institute in northern India. Data of two women were analyzed retrospectively and the other two women were prospectively followed in their pregnancies during the study period. The course of the pregnancy, disease and perinatal outcome in each woman were analyzed. Four women had eight pregnancies all resulting in vaginal deliveries. There were two premature deliveries. The mean birth weight was 2.54 + or - 0.88 kg. Of the eight babies, six did not have any cardiac anomalies; one was an unexplained neonatal death and for another, no data was available. Pregnancy was well tolerated in two patients, while one had right heart failure during early pregnancy, and one had arrhythmia during labor, which was managed medically; one patient had arrhythmia in the postpartum period, which was managed medically. When a woman with Ebstein's anomaly reaches childbearing age, fertility is not affected, even in cyanotic women. Under close supervision by the woman's obstetrician and cardiologist, the pregnancy outcome is usually favorable.

  8. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study

    DEFF Research Database (Denmark)

    Jensen, Dorte; Damm, Peter; Moelsted-Pedersen, Lars

    2004-01-01

    The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.......The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population....

  9. Pregnancy outcomes after chemotherapy for trophoblastic neoplasia

    Directory of Open Access Journals (Sweden)

    MILA TREMENTOSA GARCIA

    Full Text Available SUMMARY Introduction The successful development of chemotherapy enabled a fertilitysparing treatment for patients with trophoblastic neoplasia. After disease remission, the outcome of a subsequent pregnancy becomes a great concern for these women. Objective To analyze existing studies in the literature that describe the reproductive outcomes of patients with trophoblastic neoplasia treated with chemotherapy. Method Systematic review was performed searching for articles on Medline/ Pubmed, Lilacs and Cochrane Library databases, using the terms “gestational trophoblastic disease” and “pregnancy outcome”. Results A total of 18 articles were included. No evidence of decreased fertility after chemotherapy for trophoblastic neoplasia was observed. The abortion rates in patients who conceived within 6 months after chemotherapy was higher compared to those who waited longer. Some studies showed increased rates of stillbirth and repeat hydatidiform moles. Only one work showed increased congenital abnormalities. Conclusion The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications. However, studies in the literature provide reassuring data about reproductive outcomes of these patients.

  10. Hospital-based perinatal outcomes and complications in teenage pregnancy in India.

    Science.gov (United States)

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

    2010-10-01

    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 interviews and by observations using a pretested and predesigned schedule. Results revealed that the teenage mothers had a higher proportion (27.7%) of preterm deliveries compared to 13.1% in the adult mothers and had low-birthweight babies (38.9% vs 30.4% respectively). Stillbirth rate was also significantly higher in teenage deliveries (5.1% vs 0.9% respectively). The teenage mothers developed more adverse perinatal complications, such as preterm births, stillbirths, neonatal deaths, and delivered low-birthweight babies, when compared with those of the adult primigravida mothers. Teenage pregnancy is still a rampant and important public-health problem in India with unfavourable perinatal outcomes and needs to be tackled on a priority basis.

  11. Risk factors of HIV-1 vertical transmission (VT) and the influence of antiretroviral therapy (ART) in pregnancy outcome.

    Science.gov (United States)

    Barral, Maria F M; de Oliveira, Gisele R; Lobato, Rubens C; Mendoza-Sassi, Raul A; Martínez, Ana M B; Gonçalves, Carla V

    2014-01-01

    In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

  12. RISK FACTORS OF HIV-1 VERTICAL TRANSMISSION (VT AND THE INFLUENCE OF ANTIRETROVIRAL THERAPY (ART IN PREGNANCY OUTCOME

    Directory of Open Access Journals (Sweden)

    Maria F.M. Barral

    2014-04-01

    Full Text Available In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

  13. Gestational Weight Gain and Pregnancy Outcomes in Relation to Body Mass Index in Asian Indian Women.

    Science.gov (United States)

    Bhavadharini, Balaji; Anjana, Ranjit Mohan; Deepa, Mohan; Jayashree, Gopal; Nrutya, Subramanyam; Shobana, Mahadevan; Malanda, Belma; Kayal, Arivudainambi; Belton, Anne; Joseph, Kurian; Rekha, Kurian; Uma, Ram; Mohan, Viswanathan

    2017-01-01

    The aim of the study was to compare the weight gain during pregnancy (using Institute of Medicine guidelines) among Asian Indians across different body mass index (BMI) categories (using World Health Organization Asia Pacific BMI cut points) and to compare the pregnancy outcomes in each of the different BMI categories. Retrospective records of 2728 pregnant women attending antenatal clinics and private maternity centers in Chennai, South India, from January 2011 to January 2014 were studied. Pregnancy outcomes were analyzed in relation to BMI and weight gain across different BMI categories. Overweight and obese women who gained more weight during pregnancy were at high risk of delivering macrosomic infants (overweight - odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.1-5.2, P = 0.02 and obese - OR: 1.6, 95% CI: 1.1-2.4, P = 0.01). In addition, obese women who gained more weight were also at high risk of preterm labor (OR: 2.1, 95% CI: 1.1-3.8; P = 0.01), cesarean section (OR: 1.9, 95% CI: 1.4-2.5; P women who gained less weight had a protective effect from cesarean section and macrosomia. Overweight/obese women who gained more weight than recommended are at a high risk of developing adverse pregnancy outcomes. Normal and overweight women who gained weight less than recommended have low risk for cesarean section and macrosomia. However, they have a higher (statistically insignificant) risk for low birth weight and preterm birth. This highlights the need for gaining adequate weight during pregnancy.

  14. Obstetrical complications in dichorionic twin pregnancies in women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Jonsdottir, Fjola; Nilas, Lisbeth; Andreasen, Kirsten R

    2017-01-01

    INTRODUCTION: Both women with polycystic ovary syndrome (PCOS) and women with twin pregnancies have increased risk of adverse pregnancy outcome. The aim of this study was to investigate the impact of PCOS and maternal androgen levels on the outcome of dichorionic twin pregnancy. MATERIAL...

  15. Reported outcomes of 453 pregnancies in patients with Gaucher disease: An analysis from the Gaucher outcome survey.

    Science.gov (United States)

    Lau, Heather; Belmatoug, Nadia; Deegan, Patrick; Goker-Alpan, Ozlem; Schwartz, Ida Vanessa D; Shankar, Suma P; Panahloo, Zoya; Zimran, Ari

    2018-02-01

    Gaucher disease (GD) may worsen during pregnancy, leading to the discussion of continuing treatment during pregnancy. We examined fetal outcomes of pregnancies reported in the Gaucher Outcome Survey, an international GD-specific registry established in 2010. A total of 453 pregnancies were reported. Most pregnancies (336/453, 74.2%) were in women who did not receive GD-specific treatment during pregnancy, while enzyme replacement therapy (ERT) was received during 117/453 (25.8%) pregnancies. No pregnancies exposed to substrate reduction therapy were reported. The percentage of normal outcomes (live birth delivered at term with no congenital abnormalities) was similar in untreated and treated pregnancies (92.9% vs. 91.4%). The percentage of spontaneous abortions in untreated pregnancies was 3.6% (95% CI, 1.9%- 6.2%) compared with 6.9% (95% CI, 3.0%-13.1%) in treated pregnancies (p=0.1866). In women who received velaglucerase alfa <1month prior to conception and/or during pregnancy, 34/36 (94.4%) pregnancies had normal outcomes and 2 (5.6%) ended in spontaneous abortion. Normal outcomes were observed in the 20 pregnancies with velaglucerase alfa exposure starting <1month prior to conception and continuing through all trimesters. These observations, in addition to information in the literature, suggest that continuation of ERT during pregnancy may be appropriate for GD patients. Copyright © 2016 Shire Human Genetic Therapies, Inc. Published by Elsevier Inc. All rights reserved.

  16. Pregnancy, obstetric, and perinatal health outcomes in eating disorders.

    Science.gov (United States)

    Linna, Milla S; Raevuori, Anu; Haukka, Jari; Suvisaari, Jaana M; Suokas, Jaana T; Gissler, Mika

    2014-10-01

    The purpose of this study was to assess pregnancy, obstetric, and perinatal health outcomes and complications in women with lifetime eating disorders. Female patients (n = 2257) who were treated at the Eating Disorder Clinic of Helsinki University Central Hospital from 1995-2010 were compared with unexposed women from the population (n = 9028). Register-based information on pregnancy, obstetric, and perinatal health outcomes and complications were acquired for all singleton births during the follow-up period among women with broad anorexia nervosa (AN; n = 302 births), broad bulimia nervosa (BN; n = 724), binge eating disorder (BED; n = 52), and unexposed women (n = 6319). Women with AN and BN gave birth to babies with lower birthweight compared with unexposed women, but the opposite was observed in women with BED. Maternal AN was related to anemia, slow fetal growth, premature contractions, short duration of the first stage of labor, very premature birth, small for gestational age, low birthweight, and perinatal death. Increased odds of premature contractions, resuscitation of the neonate, and very low Apgar score at 1 minute were observed in mothers with BN. BED was associated positively with maternal hypertension, long duration of the first and second stage of labor, and birth of large-for-gestational-age infants. Eating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring. We recommend close monitoring of pregnant women with either a past or current eating disorder. Attention should be paid to children who are born to these mothers. Copyright © 2014. Published by Elsevier Inc.

  17. Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

    Science.gov (United States)

    Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Braxter, Betty J; Eckhardt, Cara L; Himes, Katherine P; Bodnar, Lisa M

    2018-03-01

    Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes. © 2018 John Wiley & Sons Ltd.

  18. Adverse obstetric outcomes during delivery hospitalizations complicated by suicidal behavior among US pregnant women.

    Science.gov (United States)

    Zhong, Qiu-Yue; Gelaye, Bizu; Smoller, Jordan W; Avillach, Paul; Cai, Tianxi; Williams, Michelle A

    2018-01-01

    The effects of suicidal behavior on obstetric outcomes remain dangerously unquantified. We sought to report on the risk of adverse obstetric outcomes for US women with suicidal behavior at the time of delivery. We performed a cross-sectional analysis of delivery hospitalizations from 2007-2012 National (Nationwide) Inpatient Sample. From the same hospitalization record, International Classification of Diseases codes were used to identify suicidal behavior and adverse obstetric outcomes. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained using logistic regression. Of the 23,507,597 delivery hospitalizations, 2,180 were complicated by suicidal behavior. Women with suicidal behavior were at a heightened risk for outcomes including antepartum hemorrhage (aOR = 2.34; 95% CI: 1.47-3.74), placental abruption (aOR = 2.07; 95% CI: 1.17-3.66), postpartum hemorrhage (aOR = 2.33; 95% CI: 1.61-3.37), premature delivery (aOR = 3.08; 95% CI: 2.43-3.90), stillbirth (aOR = 10.73; 95% CI: 7.41-15.56), poor fetal growth (aOR = 1.70; 95% CI: 1.10-2.62), and fetal anomalies (aOR = 3.72; 95% CI: 2.57-5.40). No significant association was observed for maternal suicidal behavior with cesarean delivery, induction of labor, premature rupture of membranes, excessive fetal growth, and fetal distress. The mean length of stay was longer for women with suicidal behavior. During delivery hospitalization, women with suicidal behavior are at increased risk for many adverse obstetric outcomes, highlighting the importance of screening for and providing appropriate clinical care for women with suicidal behavior during pregnancy.

  19. Increasing Number and Proportion of Adverse Obstetrical Outcomes among Women Living with HIV in the Ottawa Area: A 20-Year Clinical Case Series

    Directory of Open Access Journals (Sweden)

    Sarah Buchan

    2016-01-01

    Full Text Available 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.

  20. Inferring pregnancy episodes and outcomes within a network of observational databases.

    Directory of Open Access Journals (Sweden)

    Amy Matcho

    Full Text Available Administrative claims and electronic health records are valuable resources for evaluating pharmaceutical effects during pregnancy. However, direct measures of gestational age are generally not available. Establishing a reliable approach to infer the duration and outcome of a pregnancy could improve pharmacovigilance activities. We developed and applied an algorithm to define pregnancy episodes in four observational databases: three US-based claims databases: Truven MarketScan® Commercial Claims and Encounters (CCAE, Truven MarketScan® Multi-state Medicaid (MDCD, and the Optum ClinFormatics® (Optum database and one non-US database, the United Kingdom (UK based Clinical Practice Research Datalink (CPRD. Pregnancy outcomes were classified as live births, stillbirths, abortions and ectopic pregnancies. Start dates were estimated using a derived hierarchy of available pregnancy markers, including records such as last menstrual period and nuchal ultrasound dates. Validation included clinical adjudication of 700 electronic Optum and CPRD pregnancy episode profiles to assess the operating characteristics of the algorithm, and a comparison of the algorithm's Optum pregnancy start estimates to starts based on dates of assisted conception procedures. Distributions of pregnancy outcome types were similar across all four data sources and pregnancy episode lengths found were as expected for all outcomes, excepting term lengths in episodes that used amenorrhea and urine pregnancy tests for start estimation. Validation survey results found highest agreement between reviewer chosen and algorithm operating characteristics for questions assessing pregnancy status and accuracy of outcome category with 99-100% agreement for Optum and CPRD. Outcome date agreement within seven days in either direction ranged from 95-100%, while start date agreement within seven days in either direction ranged from 90-97%. In Optum validation sensitivity analysis, a total of 73% of

  1. Inferring pregnancy episodes and outcomes within a network of observational databases

    Science.gov (United States)

    Ryan, Patrick; Fife, Daniel; Gifkins, Dina; Knoll, Chris; Friedman, Andrew

    2018-01-01

    Administrative claims and electronic health records are valuable resources for evaluating pharmaceutical effects during pregnancy. However, direct measures of gestational age are generally not available. Establishing a reliable approach to infer the duration and outcome of a pregnancy could improve pharmacovigilance activities. We developed and applied an algorithm to define pregnancy episodes in four observational databases: three US-based claims databases: Truven MarketScan® Commercial Claims and Encounters (CCAE), Truven MarketScan® Multi-state Medicaid (MDCD), and the Optum ClinFormatics® (Optum) database and one non-US database, the United Kingdom (UK) based Clinical Practice Research Datalink (CPRD). Pregnancy outcomes were classified as live births, stillbirths, abortions and ectopic pregnancies. Start dates were estimated using a derived hierarchy of available pregnancy markers, including records such as last menstrual period and nuchal ultrasound dates. Validation included clinical adjudication of 700 electronic Optum and CPRD pregnancy episode profiles to assess the operating characteristics of the algorithm, and a comparison of the algorithm’s Optum pregnancy start estimates to starts based on dates of assisted conception procedures. Distributions of pregnancy outcome types were similar across all four data sources and pregnancy episode lengths found were as expected for all outcomes, excepting term lengths in episodes that used amenorrhea and urine pregnancy tests for start estimation. Validation survey results found highest agreement between reviewer chosen and algorithm operating characteristics for questions assessing pregnancy status and accuracy of outcome category with 99–100% agreement for Optum and CPRD. Outcome date agreement within seven days in either direction ranged from 95–100%, while start date agreement within seven days in either direction ranged from 90–97%. In Optum validation sensitivity analysis, a total of 73% of

  2. A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes.

    Science.gov (United States)

    Madarshahian, Farah; Hassanabadi, Mohsen

    2012-03-01

    Despite widespread cultural vilification, lactation-pregnancy overlap remains common. Its actual adverse effects remain uncertain. This study compared rates of success in reaching full-term delivery and newborn birth weights between two groups of multiparous pregnant women: those who breast-fed during pregnancy and those who did not. This was a comparative study conducted over 9 months, which examined two groups of women in the maternity units of two hospitals in Birjand, Iran. The first group comprised 80 women who breast-fed for 30 days or more during pregnancy; the second group comprised 240 women who did not. The two groups had similar distributions in terms of maternal age, parity, medical/midwifery problems, and nutritional changes during pregnancy. Two trained nurses used a self-developed questionnaire to collect data. Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group. Results suggest that breastfeeding during normal pregnancy does not increase chance of untoward maternal and newborn outcomes. Nurses and midwives should give expectant mothers appropriate evidence-based guidance and focus attention on promoting proper nutritional intake based on lactation status during pregnancy.

  3. Household air pollution from cooking and risk of adverse health and birth outcomes in Bangladesh: a nationwide population-based study.

    Science.gov (United States)

    Khan, Md Nuruzzaman; B Nurs, Cherri Zhang; Mofizul Islam, M; Islam, Md Rafiqul; Rahman, Md Mizanur

    2017-06-13

    Household air pollution (HAP) from cooking with solid fuels has become a leading cause of death and disability in many developing countries including Bangladesh. We assess the association between HAP and risk of selected adverse birth and maternal health outcomes. Data for this study were extracted from Bangladesh Demographic and Health Survey conducted during 2007-2014. Selected adverse birth outcomes were acute respiratory infection (ARI) among children, stillbirth, low birth weight (LBW), under-five mortality, neonatal mortality and infant mortality. Maternal pregnancy complications and cesarean delivery were considered as the adverse maternal health outcomes. Place of cooking, use of solid fuel within the house boundary and in living room were the exposure variables. To examine the association between exposure and outcome variables, we used a series of multiple logistic regression models accounted for complex survey design. Around 90% of the respondents used solid fuel within the house boundary, 11% of them used solid fuel within the living room. Results of multiple regression indicated that cooking inside the house increased the risk of neonatal mortality (aOR,1.25; 95% CI, 1.02-1.52), infant mortality (aOR, 1.18; 95% CI, 1.00-1.40), ARI (aOR, 1.18; 95% CI, 1.08-1.33), LBW (aOR, 1.25; 95% CI, 1.10-1.43), and cesarean delivery (aOR,1.18; 95% CI, 1.01-1.29). Use of solid fuel, irrespective of cooking places, increased the risk of pregnancy complications (aOR, 1.36; 95% CI, 1.19-1.55). Compared to participants who reported cooking outside the house, the risk of ARI, LBW were significantly high among those who performed cooking within the house, irrespective of type of cooking fuel. Indoor cooking and use of solid fuel in household increase the risk of ARI, LBW, cesarean delivery, and pregnancy complication. These relationships need further investigation using more direct measures of smoke exposure and clinical measures of health outcomes. The use of clean fuels

  4. First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia: A meta-analysis of observational studies.

    Directory of Open Access Journals (Sweden)

    Stephanie Dellicour

    2017-05-01

    .04 (95% CI 0.54-2.01, I2 = 0%, p = 0.910; aHR = 0.73 (95% CI 0.26-2.06, p = 0.551; and aHR = 0.98 (95% CI 0.52-2.04, p = 0.603. The prevalence of major congenital anomalies was similar for first-trimester artemisinin (1.5% [95% CI 0.6%-3.5%] and quinine exposures (1.2% [95% CI 0.6%-2.4%]. Key limitations of the study include the inability to control for confounding by indication in the African studies, the paucity of data on potential confounders, the limited statistical power to detect differences in congenital anomalies, and the lack of assessment of cardiovascular defects in newborns.Compared to quinine, artemisinin treatment in the first trimester was not associated with an increased risk of miscarriage or stillbirth. While the data are limited, they indicate no difference in the prevalence of major congenital anomalies between treatment groups. The benefits of 3-d artemisinin combination therapy regimens to treat malaria in early pregnancy are likely to outweigh the adverse outcomes of partially treated malaria, which can occur with oral quinine because of the known poor adherence to 7-d regimens.PROSPERO CRD42015032371.

  5. Serological prevalence of Coxiella burnetii in dairy goats and ewes diagnosed with adverse pregnancy outcomes in Greece.

    Science.gov (United States)

    Filioussis, George; Theodoridis, Alexandros; Papadopoulos, Dimitrios; Gelasakis, Athanasios I; Vouraki, Sotiria; Bramis, George; Arsenos, Georgios

    2017-12-23

    Coxiella burnetii is an obligatory intracellular bacterial pathogen causing the zoonotic disease Q fever. The most common reservoirs of C. burnetii are wild mammals, birds and ticks. Pregnant domestic ruminants infected with this bacterium are also a major source of human infection. The serological prevalence of C. burnetii in goats and sheep diagnosed with adverse pregnancy outcomes was assessed by undertaking a survey on 800 dairy goats and 800 dairy ewes reared in four different regions of Greece (Macedonia, Thrace, Thessaly, and Peloponnese). A stratified sampling was carried out, taking also as a criterion the age of the animals. Serum antibodies were analyzed by a commercial ELISA according to the manufacturer's recommendations. Generally, there was a statistically significantly higher serological prevalence of C. burnetii (14.4%) in goats compared to sheep (8%). Serological prevalence was higher in adults (15.5% in goats and 8.5% in sheep) compared to yearlings (7.4% in goats and 4.6% in sheep). The prevalence increased significantly with age only in goats. Finally, all animals reared in Peloponnese had a prevalence significantly higher (21% in goats and 18% in sheep) than animals reared in the other three regions. To the best of the authors' knowledge, this is the first report that associates C. burnetii with reproductive disturbances of domestic ruminants in Greece. However, considering the importance of coxiellosis for public health, further investigations are required on its epidemiology regarding abortion, premature delivery, stillbirth and weak offspring in small ruminants, as well as in other domestic and wild animal species.

  6. Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy

    Directory of Open Access Journals (Sweden)

    Ming-Jie Yang

    2015-04-01

    Conclusion: In order to reduce the incidence of pregnancy complication, especially preterm delivery, and to gain good pregnancy outcome, good preparation before conception and good control of the disease during pregnancy are mandatory.

  7. Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.

    Science.gov (United States)

    Peterson, Cora; Grosse, Scott D; Li, Rui; Sharma, Andrea J; Razzaghi, Hilda; Herman, William H; Gilboa, Suzanne M

    2015-01-01

    Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States. Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs. We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost. Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care. Published by Elsevier Inc.

  8. Understanding Pregnancy Anxiety: Concepts, Correlates, and Consequences

    Science.gov (United States)

    Guardino, Christine M.; Schetter, Christine Dunkel

    2014-01-01

    Pregnancy anxiety is a particular emotional state tied to pregnancy-specific concerns, such as worries about the health of the baby and childbirth. A growing body of research demonstrates that pregnancy anxiety is an important risk factor for preterm birth and other adverse birth and child development outcomes. This article defines and describes…

  9. Factors associated with unintended pregnancy, poor birth outcomes and post-partum contraceptive use among HIV-positive female adolescents in Kenya.

    Science.gov (United States)

    Obare, Francis; van der Kwaak, Anke; Birungi, Harriet

    2012-10-06

    Although the experiences of unintended pregnancies and poor birth outcomes among adolescents aged 15-19 years in the general population are well documented, there is limited understanding of the same among those who are living with HIV. This paper examines the factors associated with experiencing unintended pregnancies, poor birth outcomes, and post-partum contraceptive use among HIV-positive female adolescents in Kenya. Data are from a cross-sectional study that captured information on pregnancy histories of HIV-positive female adolescents in four regions of Kenya: Coast, Nairobi, Nyanza and Rift Valley provinces. Study participants were identified through HIV and AIDS programs in the four regions. Out of a total of 797 female participants, 394 had ever been pregnant with 24% of them experiencing multiple pregnancies. Analysis entails the estimation of random-effects logit models. Higher order pregnancies were just as likely to be unintended as lower order ones (odds ratios [OR]: 1.2; 95% confidence interval [CI]: 0.8-2.0) while pregnancies occurring within marital unions were significantly less likely to be unintended compared to those occurring outside such unions (OR: 0.1; 95% CI: 0.1-0.2). Higher order pregnancies were significantly more likely to result in poor outcomes compared to lower order ones (OR: 2.5; 95% CI: 1.6-4.0). In addition, pregnancies occurring within marital unions were significantly less likely to result in poor outcomes compared to those occurring outside such unions (OR: 0.3; 95% CI: 0.1-0.9). However, experiencing unintended pregnancy was not significantly associated with adverse birth outcomes (OR: 1.3; 95% CI: 0.5-3.3). There was also no significant difference in the likelihood of post-partum contraceptive use by whether the pregnancy was unintended (OR: 0.9; 95% CI: 0.5-1.5). The experience of repeat unintended pregnancies among HIV-positive female adolescents in the sample is partly due to inconsistent use of contraception to prevent

  10. Nutrition in pregnancy: Basic principles and recommendations

    Directory of Open Access Journals (Sweden)

    Plećaš Draga

    2014-01-01

    Full Text Available Healthy diet in pregnancy should guarantee proper fetal growth and development, maintain (and promote maternal health and enable lactation. Nutritional counseling and interventions need to be an integral part of antenatal care and continue during pregnancy in order to reduce the risk of maternal, fetal and neonatal complications, as well as the short- and long-term adverse outcomes. Adverse pregnancy outcomes are more common in women who begin the gestation as undernourished or obese in comparison to pregnant women whose weight is within normal ranges. Increased nutritional and energy needs in pregnancy are met through numerous metabolic adaptations; pregnancy is successfully achieved within wide range of variations in energy supply and weight gain. However, if nutrient restriction exceeds the limits of adaptive responses, evidence indicates that fetus will develop the alternative metabolic competence that might emerge as a disease (type 2 diabetes, hypertension, coronary heart disease and stroke in adult life.

  11. Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion.

    Science.gov (United States)

    Frazier, Tyralynn; Hogue, Carol J Rowland; Bonney, Elizabeth A; Yount, Kathryn M; Pearce, Brad D

    2018-06-01

    The Weathering Effect is a theory that links stress exposure, over the life-course, with racial disparities in reproductive outcomes, through the effects of social adversity on a woman's body. The concept of maternal "weathering" captures cumulative somatic and psychological adversities that can exacerbate the effects of aging. Much of the evidence for weathering comes from observational studies linking self-report measures with reproductive outcomes. The purpose of this review is to explore biological mechanisms that underlie these observations. We focus on spontaneous abortion because this event is understudied despite evidence of racial disparities in this outcome. Spontaneous abortion is the most common pregnancy failure, and it happens early in pregnancy. Early pregnancy is a time most susceptible to the harmful effects of immune dysregulation that may, in part, result from adversities experienced before pregnancy begins. In exploring these mechanisms, we draw on well-defined signaling processes observed in the stressor-depression relationship. Pro-inflammatory dysregulation, for example, has particular relevance to immunological control occurring early in pregnancy. Early pregnancy immunologic changes affect the trajectories of pregnancy via control of trophoblastic invasion. Within the first few weeks of pregnancy, uterine derived cytokines operate within cytokine networks and play a critical role in this invasion. Programming for pro-inflammatory dysregulation can occur before conception. This dysregulation, brought into early pregnancy, has implications for viability and success of the index pregnancy. These patterns suggest early pregnancy health is susceptible to stress processing pathways that influence this immunologic control in the first six to eight weeks of pregnancy. In this review, we discuss the known mediating role of immune factors in the stressor-depression relationship. We also discuss how adversity experienced before the index pregnancy, or

  12. Hypercholesterolaemia in pregnancy as a predictor of adverse ...

    African Journals Online (AJOL)

    support the fetus, the placenta, and the yolk sac have yet to be established, and those effects could markedly influence the outcome of pregnancy and long-term .... streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. In- timal accumulation of low density lipoprotein and its.

  13. A Time Interval of More Than 18 Months Between a Pregnancy and a Roux-en-Y Gastric Bypass Increases the Risk of Iron Deficiency and Anaemia in Pregnancy

    DEFF Research Database (Denmark)

    Crusell, Mie Korslund Wiinblad; Nilas, Lisbeth; Svare, Jens

    2016-01-01

    OBJECTIVE: The aim of the study is to explore the impact of time between Roux-en-Y gastric bypass (RYGB) and pregnancy on obstetrical outcome and nutritional derangements. METHODS: In a retrospective cross-sectional study of pregnant women admitted for antenatal care at two tertiary hospitals, we...... examined 153 women with RYGB and a singleton pregnancy of at least 24 weeks. The women were stratified according to a pregnancy nutritional parameters and glycated haemoglobin 1Ac (HbA1c) in second and third trimester...... of adverse pregnancy outcome or birth weight between the two groups. CONCLUSION: A long surgery-to-pregnancy time interval after a RYGB increases the risk of iron deficiency anaemia but not of other nutritional deficits. Time interval does not seem to have an adverse effect on the obstetrical outcome...

  14. Exposure to power-frequency magnetic fields and the risk of infertility and adverse pregnancy outcomes: update on the human evidence and recommendations for future study designs

    Science.gov (United States)

    Lewis, Ryan C.; Hauser, Russ; Maynard, Andrew D.; Neitzel, Richard L.; Wang, Lu; Kavet, Robert; Meeker, John D.

    2016-01-01

    Infertility and adverse pregnancy outcomes are significant public health concerns with global prevalence. Over the past 35 years, research has addressed whether exposure to power-frequency magnetic fields is one of the etiologic factors attributed to these conditions. However, no apparent authoritative reviews on this topic have been published in the peer-reviewed literature for nearly 15 years. This review provides an overview and critical analysis of human studies that were published in the peer-reviewed literature between 2002 and July 2015. Using PubMed, 13 epidemiology studies published during this timeframe that concern exposure to magnetic fields and adverse prenatal (e.g., miscarriage), neonatal (e.g., preterm birth or birth defects), and male fertility (e.g., poor semen quality) outcomes were identified. Some of these studies reported associations whereas others did not, and study design limitations may explain these inconsistencies. Future investigations need to be designed with these limitations in mind to address existing research gaps. In particular, the following issues are discussed: 1) importance of selecting the appropriate study population, 2) need for addressing confounding due to unmeasured physical activity, 3) importance of minimizing information bias from exposure measurement error, 4) consideration of alternative magnetic field exposure metrics, and 5) implications and applications of personal exposure data that is correlated within female-male couples. Further epidemiologic research is needed given the near ubiquitous exposures to power-frequency magnetic fields in the general population. PMID:27030583

  15. NTP Monograph: Developmental Effects and Pregnancy Outcomes Associated With Cancer Chemotherapy Use During Pregnancy.

    Science.gov (United States)

    2013-05-01

    The National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT) conducted an evaluation of the developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy in humans. The final NTP monograph was completed in May 2013 (available at http:// ntp.niehs.nih.gov/go/36495). The incidence of cancer during pregnancy has been reported to occur from 17 to 100 per 100,000 pregnant women. Chemotherapy is a common treatment for cancer; however, most chemotherapy agents are classified as known or suspected human teratogens. Cancer chemotherapy use during pregnancy was selected for evaluation by the NTP because of the: (1) paucity of comprehensive reviews on the pregnancy outcomes following cancer chemotherapy use during pregnancy in humans, including the integration of the developmental animal toxicology literature with the observational studies in humans, and (2) growing public interest in the developmental effects of chemotherapy on offspring exposed to cancer chemotherapy during gestation due to the expected incidence of cancer diagnosed during pregnancy as women delay pregnancy to later ages. Of the approximately 110 cancer chemotherapeutic agents currently in use, the NTP monograph includes data on 56 agents used during 1,261 pregnancies for which pregnancy outcomes were documented. Overall, the NTP evaluation found that treatment with chemotherapy for cancer appeared to be associated with: (1) a higher rate of major malformations following exposure during the first trimester compared to exposure in the second and/or third trimester; (2) an increase the rate of stillbirth following exposure in the second and/ or third trimester; abnormally low levels of amniotic fluid (primarily attributable to Trastuzumab); and (3), also data are insufficient, impaired fetal growth and myelosuppression. Treatment with chemotherapy for cancer during pregnancy did not appear to increase spontaneous preterm birth, or impair

  16. Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

    Science.gov (United States)

    Xiang, Lan; Wei, Zhaolian; Cao, Yunxia

    2014-01-01

    Objective To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes. Methods A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH. Results It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial. Conclusions Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy. PMID:25369062

  17. Remission of eating disorder during pregnancy

    DEFF Research Database (Denmark)

    Madsen, Ida Ringsborg; Hørder, Kirsten; Støving, René Klinkby

    2009-01-01

    Eating disorder during pregnancy is associated with a diversity of adverse outcomes and is of potential danger to both mother and child. There is, however, a tendency for remission of the eating disorder during pregnancy with improvement of symptoms such as restrictive dieting, binging and purgin...

  18. The effect of fertility treatment on adverse perinatal outcomes in women aged at least 40 years.

    Science.gov (United States)

    Harlev, Avi; Walfisch, Asnat; Oran, Eynan; Har-Vardi, Iris; Friger, Michael; Lunenfeld, Eitan; Levitas, Eliahu

    2018-01-01

    To compare perinatal outcomes between spontaneous conception and assisted reproductive technologies (ART) among patients of advanced maternal age. The present retrospective study included data from singleton pregnancies of women aged at least 40 years who delivered between January 1, 1991, and December 31, 2013, at Soroka University Medical Center, Beer Sheva, Israel. Demographic, obstetric, and perinatal data were compared between pregnancies conceived with ART (in vitro fertilization [IVF] or ovulation induction) and those conceived spontaneously. Multiple regression models were used to define independent predictors of adverse outcomes. A total of 8244 singleton pregnancies were included; 229 (2.8%) following IVF, 86 (1.0%) following ovulation induction, and 7929 (96.2%) were spontaneous. Preterm delivery (P<0.001), fetal growth restriction (FGR) (P<0.001), and cesarean delivery (P<0.001) demonstrated linear associations with the conception mode; the highest rates for each were observed for IVF, with decreased rates for ovulation induction and spontaneous conception. The incidence of gestational diabetes and hypertensive disorders were highest among pregnancies following ART. No association was observed between conception mode and perinatal mortality. Multivariate logistic regression demonstrated that IVF was independently associated with increased odds of preterm delivery (P<0.001) and FGR (P=0.027) compared with spontaneous conception. Among patients of advanced maternal age, ART were independently associated with increased FGR and preterm delivery rates compared with spontaneous pregnancies; perinatal mortality was comparable. © 2017 International Federation of Gynecology and Obstetrics.

  19. Poor pregnancy outcome in women with type 2 diabetes

    DEFF Research Database (Denmark)

    Clausen, Tine Dalsgaard; Mathiesen, Elisabeth Reinhardt; Ekbom, Pia

    2005-01-01

    To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001.......To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001....

  20. Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births.

    Science.gov (United States)

    Schneiderman, M; Czuzoj-Shulman, N; Spence, A R; Abenhaim, H A

    2017-10-01

    To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. Population-based retrospective cohort study. All births in the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16-1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08-1.61), have impaired wound healing (OR 4.28, 95% CI 2.55-7.18), develop infections (OR 2.44, 95% CI 1.66-3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15-12.63), require transfusions (OR 6.69, 95% CI 4.69-9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37-7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82-72.96). Congenital anomalies (OR 3.62, 95% CI 2.05-6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15-2.75) were more likely in these pregnancies. Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes. © 2016 Royal College of Obstetricians and Gynaecologists.

  1. HYdroxychloroquine to Improve Pregnancy Outcome in Women with AnTIphospholipid Antibodies (HYPATIA) Protocol: A Multinational Randomized Controlled Trial of Hydroxychloroquine versus Placebo in Addition to Standard Treatment in Pregnant Women with Antiphospholipid Syndrome or Antibodies

    NARCIS (Netherlands)

    Schreiber, Karen; Breen, Karen; Cohen, Hannah; Jacobsen, Soren; Middeldorp, Saskia; Pavord, Sue; Regan, Lesley; Roccatello, Dario; Robinson, Susan E.; Sciascia, Savino; Seed, Paul T.; Watkins, Linda; Hunt, Beverley J.

    2017-01-01

    Women with antiphospholipid antibodies (aPL) are at risk of adverse pregnancy outcomes, including recurrent first-trimester pregnancy loss and late pregnancy complications such as preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, premature delivery,

  2. Antinuclear autoantibodies and pregnancy outcome in women with unexplained recurrent miscarriage.

    Science.gov (United States)

    Ticconi, Carlo; Pietropolli, Adalgisa; Borelli, Barbara; Bruno, Valentina; Piccione, Emilio; Bernardini, Sergio; Di Simone, Nicoletta

    2016-11-01

    To investigate whether antinuclear autoantibodies (ANA) could be related to the outcome of the successive pregnancy in women with unexplained recurrent miscarriage (uRM). Circulating ANA were measured by indirect immunofluorescence in 86 women with uRM before pregnancy, repeated in the first trimester of the successive gestation and correlated with pregnancy outcome. Forty-one women were ANA- and 45 were ANA+ before pregnancy. No relation was found between pre-pregnancy ANA status and the outcome of the successive pregnancy. However, when these women were monitored at 7th week during their pregnancy for ANA, of the 22 ANA+ women who remained ANA+ seven miscarriages (31.8%) were observed, whereas all of the 23 ANA+ women who became ANA- had pregnancies ongoing beyond the 20th week without miscarriage. ANA status could have a role in uRM. Disappearance of ANA in early pregnancy could have a favorable prognostic value in the successive pregnancy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial.

    Science.gov (United States)

    Barakat, Ruben; Pelaez, Mireia; Lopez, Carmina; Lucia, Alejandro; Ruiz, Jonatan R

    2013-07-01

    To examine the effect of regular moderate-intensity exercise (three training sessions/week) on the incidence of gestational diabetes mellitus (GDM, primary outcome). We also examined if the exercise intervention modifies the association between GDM and birth weight and risk of macrosomia, gestational age, risk of caesarean delivery and maternal weight gain (secondary outcomes). We randomly assigned 510 healthy gravida to either an exercise intervention or a usual care (control) group (n=255 each). The exercise programme focused on moderate-intensity resistance and aerobic exercises (three times/week, 50-55 min/session). GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group (IADPSG). The intervention did not reduce the risk of developing GDM (OR 0.84, 95% CI 0.50 to 1.40) when using the WHO criteria. We observed that the intervention reduced by 58% the GDM-related risk (WHO criteria) of having a newborn with macrosomia (OR 1.76, 95% CI 0.04 to 78.90 vs 4.22, 95% CI 1.35 to 13.19) in exercise and control groups, respectively), and by 34% the GDM-related risk of having acute and elective caesarean delivery (OR 1.30, 95% CI 0.44 to 3.84 vs 1.99, 95% CI 0.98 to 4.06 in exercise and control groups, respectively). Gestational age was similar across the treatment groups (control, exercise) and GDM category (GDM or non-GDM), and maternal weight gain was ∼12% lower in the exercise group independent of whether women developed GDM. The results were similar when the IADPSG criteria were used instead. Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes.

  4. Clinical characteristics and pregnancy outcomes of Syrian refugees: a case-control study in a tertiary care hospital in Istanbul, Turkey.

    Science.gov (United States)

    Erenel, Hakan; Aydogan Mathyk, Begum; Sal, Veysel; Ayhan, Isil; Karatas, Suat; Koc Bebek, Arzu

    2017-01-01

    We aimed to compare the clinical characteristics and pregnancy outcomes in women who are Syrian refugees and Turkish women who are non-refugees at a maternity center in Istanbul, Turkey. A total of 600 singleton pregnancies who delivered at Sisli Hamidiye Etfal Training and Research Hospital were included in the study. Demographic data, obstetrical history, clinical findings, obstetrical and neonatal outcomes were compared between 300 Syrian refugees and 300 control patients. The Syrian refugee patients were significantly younger than Turkish patients. The percentage of adolescents aged 12-19 years were significantly higher in the Syrian patients (14.3 vs. 5.3 %, p refugee patients had no antenatal care. However, this ratio was only 7.7 % for the control group (p refugee control patients, refugee women in our study had poor antenatal care but no adverse perinatal outcomes were observed. Further larger multicenter studies may provide more convincing data about obstetric outcomes in the Syrian refugee population as well as adolescent pregnancies in this population.

  5. Pregnancy outcome and ultraviolet radiation; A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Megaw, Lauren, E-mail: lauren.megaw@ed.ac.uk [School of Women' s and Infants Health, University of Western Australia, 35 Crawley Ave, Crawley, Perth, Western Australia (Australia); Edinburgh Tommy' s Centre for Reproductive Health, Queen' s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh (United Kingdom); Clemens, Tom, E-mail: Tom.clemens@ed.ac.uk [School of Geosciences, University of Edinburgh, Drummond St, Edinburgh, Midlothian (United Kingdom); Dibben, Chris, E-mail: Chris.dibben@ed.ac.uk [School of Geosciences, University of Edinburgh, Drummond St, Edinburgh, Midlothian (United Kingdom); Weller, Richard, E-mail: Richard.weller@ed.ac.uk [MRC Centre for Inflammation Research, Queen' s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh (United Kingdom); Stock, Sarah, E-mail: Sarah.stock@ed.ac.uk [School of Women' s and Infants Health, University of Western Australia, 35 Crawley Ave, Crawley, Perth, Western Australia (Australia); Edinburgh Tommy' s Centre for Reproductive Health, Queen' s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh (United Kingdom)

    2017-05-15

    Background: Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy. Objectives: To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications. Methods: We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance. Results: All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods. Discussion: The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question. Conclusions: The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes. - Highlights: • Biologically plausible pathways support an association between ultraviolet radiation (UV) and pregnancy outcomes. • This study is the first systematic review of prevailing literature on the relationship between UV and singleton pregnancy outcomes. • It focuses on both substantive findings and the

  6. Pregnancy outcome and ultraviolet radiation; A systematic review

    International Nuclear Information System (INIS)

    Megaw, Lauren; Clemens, Tom; Dibben, Chris; Weller, Richard; Stock, Sarah

    2017-01-01

    Background: Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy. Objectives: To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications. Methods: We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance. Results: All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods. Discussion: The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question. Conclusions: The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes. - Highlights: • Biologically plausible pathways support an association between ultraviolet radiation (UV) and pregnancy outcomes. • This study is the first systematic review of prevailing literature on the relationship between UV and singleton pregnancy outcomes. • It focuses on both substantive findings and the

  7. Outcome of pregnancy in the Grandmultipara in Enugu, Nigeria ...

    African Journals Online (AJOL)

    Non-use of antenatal services and delay in referral worsen pregnancy outcome. Formal education, campaign against large families, reduction in childhood mortalities and improvement in use of family planning will reduce its incidence while use of hospital services will improve pregnancy outcome. Early referral, team work ...

  8. Pregnancy-Associated Plasma Protein A Levels in Late First Trimester Pregnancies with Small-for-Gestational Age Neonates: A Prospective Case-Control Study.

    Science.gov (United States)

    Agarwal, Rachna; Kumari, Radhika; Mehndiratta, Mohit; Radhakrishnan, Gita; Faridi, M M A; Chandra, Nilesh

    2017-08-01

    We aimed to investigate the association of pregnancy associated plasma protein A (PAPP-A) levels in late first trimester with small for gestational age (SGA) neonates and adverse pregnancy outcomes in a low-income setting. The inclusion criteria were late first trimester (11-13 + 6 weeks) women with singleton and non-anomalous pregnancy. Enrolled participants were sampled for PAPP-A and prospectively followed up for delivery outcome and antenatal complications. A multiple of median (MoM) was calculated and statistically compared between groups. Out of total 284 subjects, 14.54% delivered SGA babies and formed cases (Group A), 66.5% delivered appropriate for gestational age (AGA) neonates with uneventful antenatal period (controls, Group B), and 19.3% were AGA group with adverse pregnancy complications (Group C). The late first trimester median PAPP-A MoM was significantly lower (0.61) in Group A compared to Group B (1.47). Using receiver operating characteristic (ROC) curve for PAPP-A MoM, optimal cutoff value was found at 0.45 MoM, with positive predictive value of 56.2%, specificity of 92.6% and sensitivity of 45%. The median interquartile range (IQR) of PAPP-A MoM value in Group C in comparison with Group B was significantly lower except for abruption. At PAPP-A MoM cutoff value <1, <0.8, <0.6 and <0.4, the odds ratio for adverse pregnancy outcome was 8.30, 7.29, 10.97 and 10.60, respectively, indicating an inverse relationship. With 0.45 MoM cutoff of PAPP-A, the detection rate, specificity and positive predictive value for SGA were 45, 92.6 and 56.2%, respectively. As PAPP-A MoM values decreased, the odds ratio of having adverse pregnancy outcomes increased.

  9. Immunological Adaptations to Pregnancy in Women with Type 1 Diabetes

    NARCIS (Netherlands)

    Groen, Bart; van der Wijk, Anne-Eva; van den Berg, Paul P.; Lefrandt, Joop D.; van den