Quantifying the mediating effect of body mass index in the relationship between a Mediterranean diet and development of maternal pregnancy complications: Australian Longitudinal Study on Women’s Health

NARCIS (Netherlands)

Schoenaker, D.A.J.M.; Soedamah-Muthu, S.S.; Mishra, G.D.

2016-01-01

Background: The contribution of body mass index (BMI) to the observed associations between dietary patterns and risk of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) remains unclear. Objective: The objective of this study was to formally quantify the mediating

Fish and seafood consumption during pregnancy and the risk of asthma and allergic rhinitis in childhood : a pooled analysis of 18 European and US birth cohorts

NARCIS (Netherlands)

Stratakis, Nikos; Roumeliotaki, Theano; Oken, Emily; Ballester, Ferran; Barros, Henrique; Basterrechea, Mikel; Cordier, Sylvaine; de Groot, Renate; den Dekker, Herman T; Duijts, Liesbeth; Eggesbø, Merete; Pia Fantini, Maria; Forastiere, Francesco; Gehring, Ulrike; Gielen, Marij; Gori, Davide; Govarts, Eva; Inskip, Hazel M.; Iszatt, Nina; Jansen, Maria; Kelleher, Cecily; Mehegan, John; Moltó-Puigmartí, Carolina; Mommers, Monique; Oliveira, Andreia; Olsen, Sjurdur F; Pelé, Fabienne; Pizzi, Costanza; Porta, Daniela; Richiardi, Lorenzo; Rifas-Shiman, Sheryl L.; Robinson, Sian M; Schoeters, Greet; Strøm, Marin; Sunyer, Jordi; Thijs, Carel; Vrijheid, Martine; Vrijkotte, Tanja G M; Wijga, Alet H; Kogevinas, Manolis; Zeegers, Maurice P; Chatzi, Leda

2017-01-01

Background: It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess

Maternal smoking during pregnancy and offspring overweight: is there a dose–response relationship? An individual patient data meta-analysis

DEFF Research Database (Denmark)

Morgen, Camilla Schmidt

2018-01-01

A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose–response relationship across number of cigarettes and whether this differs by sex remains unclear. Studies reporting number of cigarettes smoked...... during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using...... a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. Of 26 identified studies, 16 authors provided data on a total of 238,340 mother–child-pairs. A linear positive association...

Maternal smoking during pregnancy and offspring overweight: is there a dose–response relationship? An individual patient data meta-analysis

DEFF Research Database (Denmark)

Morgen, Camilla Schmidt

2018-01-01

A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose–response relationship across number of cigarettes and whether this differs by sex remains unclear. Studies reporting number of cigarettes smoked...... a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. Of 26 identified studies, 16 authors provided data on a total of 238,340 mother–child-pairs. A linear positive association...... during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using...

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.

Association of testosterone and antimüllerian hormone with time to pregnancy and pregnancy loss in fecund women attempting pregnancy.

Science.gov (United States)

Sjaarda, Lindsey A; Mumford, Sunni L; Kuhr, Daniel L; Holland, Tiffany L; Silver, Robert M; Plowden, Torie C; Perkins, Neil J; Schisterman, Enrique F

2018-03-01

To examine whether higher T and/or antimüllerian hormone (AMH) was associated with anovulation, time to pregnancy (TTP), or pregnancy loss risk among healthy, fecund women without diagnosed polycystic ovary syndrome. Prospective cohort study conducted as a secondary analysis from the Effects of Aspirin in Gestation and Reproduction randomized trial. University medical centers. A total of 1,198 healthy, eumenorrheic women aged 18-40 years attempting spontaneous pregnancy with one to two prior pregnancy losses were included. Women were categorized by baseline antimüllerian hormone (AMH), as a surrogate marker of antral follicle count, and T concentrations; the highest quartile for each was "high," and below the top quartile (i.e., lower 75% of values) was "norm," forming four groups: norm T/norm AMH (n = 742), norm T/high AMH (n = 156), high T/norm AMH (n = 157), and high T/high AMH (n = 143). Not applicable. Anovulation, pregnancy incidence, TTP, and pregnancy loss incidence. Women with high T/high AMH had a greater anovulation risk (risk ratio 1.58, 95% confidence interval 1.13-2.22) compared with women with norm T/norm AMH, but with imprecise differences in incidence of pregnancy, TTP, or pregnancy loss. Women with higher T and AMH had more frequent anovulatory cycles but with marginal impacts on TTP or pregnancy loss. A continuum of mild inefficiency in reproductive function may be related to higher T and AMH, including in fecund women with normal menstrual cycles and no clinical diagnosis of polycystic ovary syndrome, but with unclear effects on fecundability and pregnancy loss. NCT00467363. Published by Elsevier Inc.

Unclear-onset intracerebral hemorrhage: Clinical characteristics, hematoma features, and outcomes.

Science.gov (United States)

Inoue, Yasuteru; Miyashita, Fumio; Koga, Masatoshi; Minematsu, Kazuo; Toyoda, Kazunori

2017-12-01

Background and purpose Although unclear-onset ischemic stroke, including wake-up ischemic stroke, is drawing attention as a potential target for reperfusion therapy, acute unclear-onset intracerebral hemorrhage has been understudied. Clinical characteristics, hematoma features, and outcomes of patients who developed intracerebral hemorrhage during sleep or those with intracerebral hemorrhage who were unconscious when witnessed were determined. Methods Consecutive intracerebral hemorrhage patients admitted within 24 hours after onset or last-known normal time were classified into clear-onset intracerebral hemorrhage and unclear-onset intracerebral hemorrhage groups. Outcomes included initial hematoma volume, initial National Institutes of Health Stroke Scale score, hematoma growth on 24-hour follow-up computed tomography, and vital and functional prognoses at 30 days. Results Of 377 studied patients (122 women, 69 ± 11 years old), 147 (39.0%) had unclear-onset intracerebral hemorrhage. Patients with unclear-onset intracerebral hemorrhage had larger hematoma volumes (p = 0.044) and higher National Institutes of Health Stroke Scale scores (p Hematoma growth was similarly common between the two groups (p = 0.176). There were fewer patients with modified Rankin Scale (mRS) scores of 0-2 (p = 0.033) and more patients with mRS scores of 5-6 (p = 0.009) and with fatal outcomes (p = 0.049) in unclear-onset intracerebral hemorrhage group compared with clear-onset intracerebral hemorrhage as crude values, but not after adjustment. Conclusions Patients with unclear-onset intracerebral hemorrhage presented with larger hematomas and higher National Institutes of Health Stroke Scale scores at emergent visits than those with clear-onset intracerebral hemorrhage, independent of underlying characteristics. Unclear-onset intracerebral hemorrhage patients showed poorer 30-day vital and functional outcomes than clear-onset intracerebral hemorrhage patients

The influence of pregnancy on systemic immunity.

Science.gov (United States)

Pazos, Michael; Sperling, Rhoda S; Moran, Thomas M; Kraus, Thomas A

2012-12-01

Adaptations in maternal systemic immunity are presumed to be responsible for observed alterations in disease susceptibility and severity as pregnancy progresses. Epidemiological evidence as well as animal studies have shown that influenza infections are more severe during the second and third trimesters of pregnancy, resulting in greater morbidity and mortality, although the reason for this is still unclear. Our laboratory has taken advantage of 20 years of experience studying the murine immune response to respiratory viruses to address questions of altered immunity during pregnancy. With clinical studies and unique animal model systems, we are working to define the mechanisms responsible for altered immune responses to influenza infection during pregnancy and what roles hormones such as estrogen or progesterone play in these alterations.

Ruptured Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

Valentina Park

2016-09-01

Full Text Available History of present illness: A 21-year-old female presented with sudden onset suprapubic abdominal pain associated with dysuria. The patient also experienced near syncope during bowel movements three times three days ago without falling or losing consciousness. She denied fever, nausea, and vomiting. She stated that she was five weeks pregnant by last menstrual period. She had an ultrasound a few weeks before that showed no intrauterine pregnancy, but she had not followed up for additional testing. Significant findings: The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00. A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10. Discussion: Ectopic pregnancies are a leading cause of maternal morbidity and mortality, as well as decreased fertility.1,2 Differentiating between an ectopic pregnancy and a normal early pregnancy may be difficult, since ultrasound and quantitative beta-hCG may show inconclusive results.3,4 Patients who have used fertility treatment may further complicate the picture because they are at risk for heterotypic pregnancies.5 Ectopic pregnancies most commonly implant in the fallopian tube, but may alternatively implant in the ovary, cervix, abdomen, or uterine cornua.4 Ultrasonography may show an empty uterus, adnexal mass, pelvic free fluid, or an extra-uterine gestational sac, yolk sac, and/or embryo.6 Treatment options for ectopic pregnancy include surgery or methotrexate.2,4 Some patients may be candidates for close outpatient surveillance if the diagnosis is unclear or in very limited cases for early, non-ruptured ectopic pregnancies.2,4

Predictors of Ramadan fasting during pregnancy

NARCIS (Netherlands)

van Bilsen, Lily A.; Savitri, Ary I.; Amelia, Dwirani; Baharuddin, Mohammad; Grobbee, Diederick E.; Uiterwaal, Cuno S P M

2016-01-01

Although the health effects of Ramadan fasting during pregnancy are still unclear, it is important to identify the predictors and motivational factors involved in women's decision to observe the fast. We investigated these factors in a cross sectional study of 187 pregnant Muslim women who attended

Fish and seafood consumption during pregnancy and the risk of asthma and allergic rhinitis in childhood: a pooled analysis of 18 European and US birth cohorts

DEFF Research Database (Denmark)

Stratakis, Nikos; Roumeliotaki, Theano; Oken, Emily

2017-01-01

Background: It has been suggested that prenatal exposure to n-3 long-chain fatty acids protects against asthma and other allergy-related diseases later in childhood. The extent to which fish intake in pregnancy protects against child asthma and rhinitis symptoms remains unclear. We aimed to assess...... whether fish and seafood consumption in pregnancy is associated with childhood wheeze, asthma and allergic rhinitis. Methods: We pooled individual data from 60 774 mother-child pairs participating in 18 European and US birth cohort studies. Information on wheeze, asthma and allergic rhinitis prevalence...... consumption and in sensitivity analyses. Conclusion: We found no evidence supporting a protective association of fish and seafood consumption during pregnancy with offspring symptoms of wheeze, asthma and allergic rhinitis from infancy to mid childhood....

E1. Risk of chronic hypertension in women with a history of hypertensive disorders of pregnancy

DEFF Research Database (Denmark)

Behrens, I; Basit, S; Melbye, M

2016-01-01

BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are known to have an increased risk of hypertension years after their pregnancy. However, how soon after an affected pregnancy the risk of hypertension increases and how/whether this risk evolves over time, is unclear. ...

Cardiac structure and function, and ventricular-arterial interaction 11 years following a pregnancy with preeclampsia.

Science.gov (United States)

Al-Nashi, Maha; Eriksson, Maria J; Östlund, Eva; Bremme, Katarina; Kahan, Thomas

2016-04-01

Preeclampsia (PE) is associated with acute left ventricular dysfunction. Whether these changes eventually resolve remains unclear. This study assessed left and right ventricular structure and function, and ventricular-arterial interaction in 15 women 11 years after a pregnancy with PE and 16 matched control subjects with a normal pregnancy. We found normal left and right ventricular dimensions, systolic function, and global left ventricular strain, with no differences between the groups. In addition, indices of diastolic function, left and right atrial size, and amino-terminal pro-brain natriuretic peptide were normal and did not differ between the groups. Women with a previous PE had impaired night/day ratios for systolic and diastolic ambulatory blood pressure. However, indices of aortic stiffness or ventricular-arterial coupling did not differ between the groups. In conclusion, we could not demonstrate remaining alterations in systolic or diastolic left or right ventricular function, or in ventricular-arterial interaction in women 11 years after PE. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

The right to remain silent: a qualitative study of the medical and social ramifications of pregnancy disclosure for Gambian women.

Science.gov (United States)

Stokes, E; Dumbaya, I; Owens, S; Brabin, L

2008-12-01

Control of infectious diseases in developing countries often requires using drugs that are contraindicated during pregnancy. Avoiding inadvertent exposure to drugs involves women (a) recognising pregnancy early, (b) disclosing the pregnancy to health workers and (c) using medicines in an informed manner. We explored these factors to inform and improve the process by which health workers provide care and treatment to pregnant women. Qualitative study. The Gambia. Rural women and men. We conducted 41 interviews and 16 focus group discussions with women, adolescents, men and traditional birth attendants (TBAs). Pregnancy disclosure. Most women recognised early signs and symptoms of pregnancy and believed other people could easily do so. To avoid gossip, women hid their pregnancies and delayed antenatal care, even though husbands and TBAs insisted on attendance. Women acutely ill in early pregnancy hoped health workers would recognise pregnancy without explicit disclosure. Women said that they knew, and sought to avoid, some contraindicated drugs, but their knowledge was rudimentary. Health workers stressed the benefits, not the risks of prescribed drugs. Despite public health and clinical benefits of preventing and treating pregnancy infections, women were ill informed and pressurised into taking drugs. These ethical issues should be more widely addressed.

Surrogate pregnancy: a guide for Canadian prenatal health care providers

Science.gov (United States)

Reilly, Dan R.

2007-01-01

Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks ofsurrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support. PMID:17296962

Surrogate pregnancy: a guide for Canadian prenatal health care providers.

Science.gov (United States)

Reilly, Dan R

2007-02-13

Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks of surrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support.

The impact of anti-HY responses on outcome in current and subsequent pregnancies of patients with recurrent pregnancy losses

DEFF Research Database (Denmark)

Christiansen, Ole Bjarne; Steffensen, Rudi Nora; Nielsen, Henriette Svarre

2010-01-01

Women pregnant with a male fetus often generate cellular and humoral immune responses against male-specific minor histocompatibility (HY) antigens-however, the importance of these responses for pregnancy outcome is unclear. Epidemiologic studies have shown that the birth of a boy compared...... with a girl prior to a series of miscarriages significantly reduces the chance of a subsequent live birth and pregnancies with boys have an increased risk of placental abruption. This paper aims to review the current knowledge about the impact of anti-HY immunity on pregnancy outcome in terms of miscarriage...... and placental abruption. Our knowledge primarily comes from studies of the impact on pregnancy outcome of HLA class II alleles known to restrict CD4 T cell mediated anti-HY responses among 358 secondary recurrent miscarriage (SRM) patients and 203 of their children born prior to the miscarriages...

Maternal hair testing for the assessment of fetal exposure to drug of abuse during early pregnancy: Comparison with testing in placental and fetal remains.

Science.gov (United States)

Falcon, M; Pichini, S; Joya, J; Pujadas, M; Sanchez, A; Vall, O; García Algar, O; Luna, A; de la Torre, R; Rotolo, M C; Pellegrini, M

2012-05-10

Drug use by pregnant women in the first trimester of pregnancy and subsequent fetal exposure during early gestation can be assessed only by repetitive/systematic maternal blood/urine analysis or segmental hair analysis. No evidence of any relationship between maternal/fetal exposure during this specific period of gestation has been demonstrated to date in a human model. To clarify drugs toxicokinetics and transplacental passage during early pregnancy, the presence of the most widely used recreational drugs of abuse and metabolites was investigated in the proximal 4cm hair segments of women undergoing voluntary termination of pregnancy (n=280) during the 12th week of gestation and the results were compared to those from placenta and fetal tissue samples in order to verify whether maternal hair testing can reflect fetal exposure and, if so, to what extent. Hair, placenta and fetal remains were analyzed by validated gas chromatography mass spectrometry assays. Eighty one positive hair samples were identified: 60 were positive for cannabis (74.1%), 28 for cocaine (34.6%), 7 for opiates (8.6%), 3 for MDMA (3.7%) and 18.5% were positive for more than one drug. The positive hair test results were confirmed in placenta/fetal tissues in 10 cases out of 60 for cannabis (16. 7%); in 7 out of 28 for cocaine (25%); and none for the 6 opiates positive cases and 3 MDMA cases, respectively. Drugs/metabolites in hair of pregnant women can be used as biomarkers of past drug use (repetitive or sporadic), although the use is not always reflected in fetal/placental tissues. There are several possible hypotheses to explain the results: (1) the use occurred before the start of pregnancy, (2) past sporadic consumption which could be measured in hair but not in fetal and placental remains because of the narrow window of drug detection in placental/fetal tissues; (3) the sensitivity of the analytical methods was not high enough for the detection of the minute amount of drugs of abuse and

Valvular Heart Disease and Pregnancy.

Science.gov (United States)

Lau, Emily S; Scott, Nandita S

2018-04-26

With improving reproductive assistive technologies, advancing maternal age, and improved survival of patients with congenital heart disease, valvular heart disease has become an important cause of morbidity and mortality in pregnant women. In general, stenotic lesions, even those in the moderate range, are poorly tolerated in the face of hemodynamic changes of pregnancy. Regurgitant lesions, however, fare better due to the physiologic afterload reduction that occurs. Intervention on regurgitant valve preconception follows the same principles as a non-pregnant population. Prosthetic valves in pregnancy are increasingly commonplace, presenting new management challenges including valve deterioration and valve thrombosis. In particular, anticoagulation during pregnancy is challenging. Pregnancy is a hypercoagulable state and the risks of maternal bleeding and fetal anticoagulant risks need to be balanced. Maternal mortality and complications are lowest with warfarin use throughout pregnancy; however, fetal outcomes are best with low molecular weight heparin use. ACC/AHA guidelines recommend warfarin use, even in the first trimester, if doses are less than 5 mg/day; however, adverse fetal events are not zero at this dose. In addition, it is unclear if better monitoring of low molecular weight heparin with peak and trough anti-Xa levels would lower maternal risks as this has been inconsistently monitored in reported studies. Fortunately, with the emergence of newer data, our understanding of anticoagulant strategies in pregnancy is improving over time which should translate to better pregnancy outcomes in this higher risk population.

The effects of maternal depression and use of antidepressants during pregnancy on risk of a child small for gestational age

DEFF Research Database (Denmark)

Jensen, Hans Mørch; Grøn, Randi; Lidegaard, Ojvind

2013-01-01

Use of antidepressants during pregnancy has been associated with an increased rate of children small for gestational age (SGA), but it is unclear whether this is due to an effect of the underlying depressive disorder.......Use of antidepressants during pregnancy has been associated with an increased rate of children small for gestational age (SGA), but it is unclear whether this is due to an effect of the underlying depressive disorder....

Osteoporosis presenting in pregnancy, puerperium, and lactation.

Science.gov (United States)

Kovacs, Christopher S

2014-12-01

To describe our current state of knowledge about the pathophysiology, incidence, and treatment of osteoporosis that presents during pregnancy, puerperium, and lactation. When vertebral fractures occur in pregnant or lactating women, it is usually unknown whether the skeleton was normal before pregnancy. Maternal adaptations increase bone resorption modestly during pregnancy but markedly during lactation. The net bone loss may occasionally precipitate fractures, especially in women who have underlying low bone mass or skeletal fragility prior to pregnancy. Bone mass and strength are normally restored postweaning. Transient osteoporosis of the hip is a sporadic disorder localized to one or both femoral heads; it is not due to generalized skeletal resorption. Anecdotal reports have used bisphosphonates, strontium ranelate, teriparatide, or vertebroplasty/kyphoplasty to treat postpartum vertebral fractures, but it is unclear whether these therapies had any added benefit over the spontaneous skeletal recovery that normally occurs after weaning. These relatively rare fragility fractures result from multifactorial causes, including skeletal disorders that precede pregnancy, and structural and metabolic stresses that can compromise skeletal strength during pregnancy and lactation. Further study is needed to determine when pharmacological or surgical therapy is warranted instead of conservative or expectant management.

Treatment-related changes in serum lipids and inflammation: clinical relevance remains unclear. Analyses from the Women's Interagency HIV Study

Science.gov (United States)

Parrinello, Christina M; Landay, Alan L; Hodis, Howard N; Gange, Stephen J; Norris, Philip J; Young, Mary; Anastos, Kathryn; Tien, Phyllis C; Xue, Xiaonan; Lazar, Jason; Benning, Lorie; Tracy, Russell P; Kaplan, Robert C

2014-01-01

Summary Among 127 HIV-infected women, the magnitude of HDLc increases after HAART initiation predicted the magnitude of concurrent decreases in inflammation biomarkers. After HAART initiation, changes in LDLc and inflammation were unrelated. In the same population, predicted risk of coronary heart disease based upon levels of standard clinical risk factors was similar before and after HAART treatment. Thus, it remains unknown whether short-term treatment-related changes in standard risk factors may appreciably change risk of CVD. PMID:23435295

Implication of low level inflammation in the insulin resistance of adipose tissue at late pregnancy.

Science.gov (United States)

de Castro, J; Sevillano, J; Marciniak, J; Rodriguez, R; González-Martín, C; Viana, M; Eun-suk, O H; de Mouzon, S Hauguel; Herrera, E; Ramos, M P

2011-11-01

Insulin resistance is a characteristic of late pregnancy, and adipose tissue is one of the tissues that most actively contributes to the reduced maternal insulin sensitivity. There is evidence that pregnancy is a condition of moderate inflammation, although the physiological role of this low-grade inflammation remains unclear. The present study was designed to validate whether low-grade inflammation plays a role in the development of insulin resistance in adipose tissue during late pregnancy. To this end, we analyzed proinflammatory adipokines and kinases in lumbar adipose tissue of nonpregnant and late pregnant rats at d 18 and 20 of gestation. We found that circulating and tissue levels of adipokines, such as IL-1β, plasminogen activator inhibitor-1, and TNF-α, were increased at late pregnancy, which correlated with insulin resistance. The observed increase in adipokines coincided with an enhanced activation of p38 MAPK in adipose tissue. Treatment of pregnant rats with the p38 MAPK inhibitor SB 202190 increased insulin-stimulated tyrosine phosphorylation of the insulin receptor (IR) and IR substrate-1 in adipose tissue, which was paralleled by a reduction of IR substrate-1 serine phosphorylation and an enhancement of the metabolic actions of insulin. These results indicate that activation of p38 MAPK in adipose tissue contributes to adipose tissue insulin resistance at late pregnancy. Furthermore, the results of the present study support the hypothesis that physiological low-grade inflammation in the maternal organism is relevant to the development of pregnancy-associated insulin resistance.

Maternal depressive symptoms during and after pregnancy are associated with attention-deficit/hyperactivity disorder symptoms in their 3- to 6-year-old children.

Science.gov (United States)

Wolford, Elina; Lahti, Marius; Tuovinen, Soile; Lahti, Jari; Lipsanen, Jari; Savolainen, Katri; Heinonen, Kati; Hämäläinen, Esa; Kajantie, Eero; Pesonen, Anu-Katriina; Villa, Pia M; Laivuori, Hannele; Reynolds, Rebecca M; Räikkönen, Katri

2017-01-01

Maternal depressive symptoms during pregnancy have been associated with child behavioural symptoms of attention-deficit/hyperactivity disorder (ADHD) in early childhood. However, it remains unclear if depressive symptoms throughout pregnancy are more harmful to the child than depressive symptoms only during certain times, and if maternal depressive symptoms after pregnancy add to or mediate any prenatal effects. 1,779 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Mothers filled in the Center of Epidemiological Studies Depression Scale biweekly from 12+0-13+6 to 38+0-39+6 weeks+days of gestation or delivery, and the Beck Depression Inventory-II and the Conners' Hyperactivity Index at the child's age of 3 to 6 years (mean 3.8 years, standard deviation [SD] 0.5). Maternal depressive symptoms were highly stable throughout pregnancy, and children of mothers with consistently high depressive symptoms showed higher average levels (mean difference = 0.46 SD units, 95% Confidence Interval [CI] 0.36, 0.56, p maternal depressive symptoms after pregnancy, which both added to and partially mediated the prenatal effects. Maternal depressive symptoms throughout pregnancy are associated with increased ADHD symptomatology in young children. Maternal depressive symptoms after pregnancy add to, but only partially mediate, the prenatal effects. Preventive interventions suited for the pregnancy period may benefit both maternal and offspring mental health.

Genetic Causes of Recurrent Pregnancy Loss.

Science.gov (United States)

Page, Jessica M; Silver, Robert M

2016-09-01

Pregnancy loss is one of the most common obstetric complications, affecting over 30% of conceptions. A considerable proportion of losses are due to genetic abnormalities. Indeed, over 50% of early pregnancy losses have been associated with chromosomal abnormalities. Most are due to de novo nondisjunctional events but balanced parental translocations are responsible for a small but important percentage of genetic abnormalities in couples with recurrent pregnancy loss. In the past, assessment of genetic abnormalities was limited to karyotype performed on placental or fetal tissue. However, advances in molecular genetic technology now provide rich genetic information about additional genetic causes of and risk factors for pregnancy loss. In addition, the use of preimplantation genetic testing in couples undergoing in vitro fertilization has the potential to decrease the risk of pregnancy loss from genetic abnormalities. To date, efficacy is uncertain but considerable potential remains. This chapter will review what is known about genetic causes of recurrent pregnancy loss with a focus on novel causes and potential treatments. Remaining knowledge gaps will be highlighted.

Non-communicating Rudimentary Uterine Horn Pregnancy

Directory of Open Access Journals (Sweden)

I Upadhyaya

2011-12-01

Full Text Available Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confi rmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature. Keywords: Mullerian anomalies, non-communicating rudimentary horn pregnancy, surgical management.

Less-Tight versus Tight Control of Hypertension in Pregnancy

NARCIS (Netherlands)

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

2015-01-01

BACKGROUND The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational

The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies.

Science.gov (United States)

Kovacs, Christopher S

2012-08-21

Maternal adaptations during pregnancy and lactation appear to provide calcium to fetus and neonate without relying on vitamin D or calcitriol. Consequently, the blood calcium, calciotropic hormones, and skeleton appear normal at birth in the offspring of mothers who are severely vitamin D deficient or who lack calcitriol or its receptor. It remains unclear whether skeletal or extraskeletal problems will develop postnatally from exposure to vitamin D deficiency in utero. During the neonatal period, calcitriol-stimulated intestinal calcium absorption becomes the dominant mechanism of calcium delivery. The vitamin D-deficient neonate is at risk to develop hypocalcemia, rickets, and possibly extraskeletal disorders (e.g., type 1 diabetes). Breastfed babies are at higher risk of vitamin D deficiency because normally little vitamin D or 25-hydroxyvitamin D passes into breast milk. Dosing recommendations during pregnancy and lactation should ensure that the baby is born vitamin D sufficient and maintained that way during infancy and beyond.

PREGNANCY LOSS IN MARES

Directory of Open Access Journals (Sweden)

Tibary A

2015-12-01

Full Text Available Pregnancy loss is an important aspect of equine practice due to the economic and emotional loss that it engenders. Pregnancy loss is often divided in two categories: early pregnancy loss (EPL or embryonic death (ED (first 42 days and fetal losses (after 42 days. Diagnosis of the causes of pregnancy loss is often very challenging. Many of the causes of EPL remain poorly documented but studies on embryo development and embryo-uterine interaction have been able to shed some light on predisposing factors. Fetal losses or abortions are dominated by infectious causes and particularly bacterial placentitis. Detailed reviews of pregnancy loss were recently published by the authors (Tibary et al., 2012; Tibary and Pearson, 2012; Tibary et al., 2014. The objective of this paper is to provide an overview of the epidemiology, etiology, diagnosis and prevention of pregnancy loss in the mare.

Circulating Betatrophin Is Strongly Increased in Pregnancy and Gestational Diabetes Mellitus.

Directory of Open Access Journals (Sweden)

Lana Kosi Trebotic

Full Text Available Betatrophin has recently been introduced as a novel hormone and promotor of beta cell proliferation and improved glucose tolerance in mouse models of insulin resistance. In obese and diabetic humans altered levels were reported and a role in pathophysiology of metabolic diseases was therefore hypothesized. However its release and regulation in women with gestational diabetes mellitus (GDM, as well as its associations with markers of obesity, glucose and lipid metabolism during pregnancy still remain unclear.Circulating betatrophin was quantified in 21 women with GDM and 19 pregnant body mass index-matched women with normal glucose tolerance (NGT as well as 10 healthy age-matched non-pregnant women by enzyme-linked immunosorbent assay. Additionally we performed radioimmunassay (RIA to confirm the results.Betatrophin concentrations measured by ELISA were significantly higher in GDM than in NGT (29.3±4.4 ng/ml vs. 18.1±8.7 ng/ml, p<0.001 which was confirmed by RIA. Betatrophin did not correlate with BMI or insulin resistance but showed a weak association with leptin levels in pregnancy and negative relationship with fasting C-peptide levels in all women. Moreover it correlated significantly with lipid parameters including triglycerides and total cholesterol in pregnancy, as well as estrogen, progesteron and birth weight.Circulating betatrophin concentrations are dramatically increased in pregnancy and are significantly higher in GDM versus pregnant NGT. In the light of the previously reported role in lipid metabolism, betatrophin may represent a novel endocrine regulator of lipid alterations in pregnancy. However additional studies are needed to elucidate whether hormonal factors, such as estrogen, control the production of betatrophin and if targeting betatrophin could hold promise in the fight against metabolic disease.

Teen pregnancy: an update.

Science.gov (United States)

McCracken, Katherine A; Loveless, Meredith

2014-10-01

To provide clinicians with a review of recent research and clinically applicable tools regarding teen pregnancy. Teen pregnancy rates have declined but still remain a significant problem in the USA. Teen pregnancy prevention was identified by Centers for Disease Control and Prevention as one of its top six priorities, which is increasing research and intervention data. Long-acting contraceptive methods are acceptable to teens and have been shown to reduce teen birth rates. Pregnant teens need special attention to counseling on pregnancy options and reducing risk during pregnancy with regular prenatal care. Postpartum teens should be encouraged and supported to breastfeed, monitored for depression, and have access to reliable contraception to avoid repeat undesired pregnancy. This review highlights important issues for all providers caring for female adolescents and those who may encounter teen pregnancy. Foremost prevention of teen pregnancy by comprehensive sexual education and access to contraception is the priority. Educating patients and healthcare providers about safety and efficacy of long-acting reversible contraception is a good step to reducing undesired teen pregnancies. Rates of postpartum depression are greater in adolescents than in adults, and adolescent mothers need to be screened and monitored for depression. Strategies to avoid another undesired pregnancy shortly after delivery should be implemented.

Pregnancy Anxiety and Prenatal Cortisol Trajectories

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Kane, Heidi S.; Schetter, Christine Dunkel; Glynn, Laura M.; Hobel, Calvin J.; Sandman, Curt A.

2014-01-01

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 to 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy anxiety over gestation, nor pregnancy anxiety specific to only a particular time in pregnancy predicted cortisol. These findings provide support for one way in which pregnancy anxiety may influence maternal physiology and contribute to a growing literature on the complex biological pathways linking pregnancy anxiety to birth and infant outcomes. PMID:24769094

The Performance of Public Organization: Still Unclear

Directory of Open Access Journals (Sweden)

Bacanu B.

2014-12-01

Full Text Available Nowadays, the present discussions about the organisation’s performance have revealed the fact that the concept is unclear. The use of the concept is more difficult in public organisations. The paper presents the case of Romanian SOE Hidroelectrica and the case of public universities, to pinpoint the fact that ambiguous objectives are the cause of a dilemmatic management. The general opinion is that the results of the public organisations management reflect a poor performance of the latter.

Psychosocial interventions for supporting women to stop smoking in pregnancy

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Chamberlain, Catherine; O’Mara-Eves, Alison; Oliver, Sandy; Caird, Jenny R; Perlen, Susan M; Eades, Sandra J; Thomas, James

2014-01-01

Background Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. Objectives To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. Selection criteria Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. Main results Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy. In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR

Hyperthyroidism in pregnancy.

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Mestman, Jorge H

2012-10-01

Successful outcome in pregnancy hyperthyroidism depends on the cause, interpretation of laboratory tests, and careful use of antithyroid drug (ATD) therapy. Planning of a pregnancy in a woman with active or past history of Graves' hyperthyroidism is mandatory in order to avoid complications. Fetal health may be affected by three factors: poor control of maternal hyperthyroidism, titer of maternal TRAb, and inappropriate use of ATD. Careful assessment of thyroid function through pregnancy and evaluation of fetal development by ultrasonography is the cornerstone for a successful outcome. In a subgroup of women previously treated with ablation therapy, those whose serum TSRAb titers remained elevated, are at risk of having a fetus/neonate with Graves' hyperthyroidism. Use of ATD during lactation is well tolerated, if recommended guidelines are followed. Women during their childbearing age with active Graves' hyperthyroidism should plan their pregnancy. Causes of hyperthyroidism in pregnancy include Graves' disease or autonomous adenoma, and transient gestational thyrotoxicosis as a consequence of excessive production of human chroionic gonadotropin by the placenta. Careful interpretation of thyroid function tests and frequent adjustment of ATD is of utmost importance in the outcome of pregnancy. Graves' hyperthyroidism may relapse early in pregnancy or at the end of the first year postpartum.

Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study.

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Casas, Maribel; Forns, Joan; Martínez, David; Guxens, Mònica; Fernandez-Somoano, Ana; Ibarluzea, Jesus; Lertxundi, Nerea; Murcia, Mario; Rebagliato, Marisa; Tardon, Adonina; Sunyer, Jordi; Vrijheid, Martine

2017-10-01

BackgroundMaternal pre-pregnancy obesity may impair infant neuropsychological development, but it is unclear whether intrauterine or confounding factors drive this association.MethodsWe assessed whether maternal pre-pregnancy obesity was associated with neuropsychological development in 1,827 Spanish children. At 5 years, cognitive and psychomotor development was assessed using McCarthy Scales of Children's Abilities, attention deficit hyperactivity disorder (ADHD) symptoms using the Criteria of Diagnostic and Statistical Manual of Mental Disorders, and autism spectrum disorder symptoms using the Childhood Asperger Syndrome Test. Models were adjusted for sociodemographic factors and maternal intelligence quotient. We used paternal obesity as negative control exposure as it involves the same source of confounding than maternal obesity.ResultsThe percentage of obese mothers and fathers was 8% and 12%, respectively. In unadjusted models, children of obese mothers had lower scores than children of normal weight mothers in all McCarthy subscales. After adjustment, only the verbal subscale remained statistically significantly reduced (β: -2.8; 95% confidence interval: -5.3, -0.2). No associations were observed among obese fathers. Maternal and paternal obesity were associated with an increase in ADHD-related symptoms. Parental obesity was not associated with autism symptoms.ConclusionMaternal pre-pregnancy obesity was associated with a reduction in offspring verbal scores at pre-school age.

Risk of tuberculosis during pregnancy in Mongolia, a high incidence setting with low HIV prevalence.

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Rendell, N L; Batjargal, N; Jadambaa, N; Dobler, C C

2016-12-01

To investigate the epidemiology and the relative risk of tuberculosis (TB) in pregnant women in Mongolia, a high TB incidence setting with a low rate of human immunodeficiency virus co-infection, where active case finding for TB in pregnancy is implemented. We retrospectively collected data on pregnant women diagnosed with TB during 2013. Data were collected through doctors at central TB dispensaries who extracted the relevant information from patients' clinical records. The overall incidence of TB among pregnant women was 228 (95%CI 187276) per 100000 person-years, resulting in an incidence rate ratio of 1.31 (95%CI 1.081.59) in pregnant women compared to the general population. Twelve per cent of the pregnant women with TB chose to have an abortion. In this study, pregnant women had a 1.3-fold higher risk of developing TB than the general population. Based on a moderately increased risk of TB during pregnancy in our study and the potential for adverse health outcomes, TB screening among pregnant women can currently be justified, but the cost-effectiveness of this intervention remains unclear. Patients and doctors need to be educated about the safety of standard TB treatment in pregnancy to reduce the rate of abortions.

Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature.

Science.gov (United States)

Sangsawang, Bussara

2014-07-01

The most common type of urinary incontinence (UI) in pregnant women is stress urinary incontinence (SUI). The number of pregnant women with SUI was variable, the prevalence ranged from 18.6% to 75% and increased with gestational age. It can affect the quality of life (QoL) of approximately 54.3% of all pregnant women in four domains including physical activity, travel, social relationships and emotional health. Pregnancy is one of the main risk factors for the development of SUI in young women. Physiological changes during pregnancy, such as increasing pressure of the growing uterus and fetal weight on the pelvic floor muscle (PFM) throughout pregnancy, together with pregnancy-related hormonal changes such as increased progesterone, decreased relaxin, and decreased collagen levels, may lead to reduced strength and supportive and sphincteric function of the PFM. Pregnancy may associate with the reduction of the PFM strength which can develop the SUI. However, the exact causes of pregnancy-related SUI remain unclear. Multiple factors have been found to be associated with the development of SUI during pregnancy. In genetic risk factors, aging is an important role in SUI development. The other risk factors such as obesity, smoking, constipation, pre-pregnancy SUI, gestational diabetes mellitus (GDM), and pelvic floor muscle exercise (PFME) that utilized preventive strategies can reduce SUI in pregnant women. The purpose of this review is to identify the risk factors for the development of SUI in pregnant women. These understanding can be useful for health professions to inform and counsel the pregnant women to prevent and reduce the risk factors that contribute to the development of SUI during pregnancy and postpartum period. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Pregnancy in pulmonary arterial hypertension

Directory of Open Access Journals (Sweden)

Karen M. Olsson

2016-12-01

Full Text Available Despite advanced therapies, maternal mortality in women with pulmonary arterial hypertension (PAH remains high in pregnancy and is especially high during the post-partum period. However, recent data indicates that morbidity and mortality during pregnancy and after birth have improved for PAH patients. The current European Society of Cardiology/European Respiratory Society guidelines recommend that women with PAH should not become pregnant. Therefore, the risks associated with pregnancy must be emphasised and counselling offered to women at the time of PAH diagnosis and to women with PAH who become pregnant. Early termination should be discussed. Women who choose to continue with their pregnancy should be treated at specialised pulmonary hypertension centres with experience in managing PAH during and after pregnancy.

Pregnancy in pulmonary arterial hypertension.

Science.gov (United States)

Olsson, Karen M; Channick, Richard

2016-12-01

Despite advanced therapies, maternal mortality in women with pulmonary arterial hypertension (PAH) remains high in pregnancy and is especially high during the post-partum period. However, recent data indicates that morbidity and mortality during pregnancy and after birth have improved for PAH patients. The current European Society of Cardiology/European Respiratory Society guidelines recommend that women with PAH should not become pregnant. Therefore, the risks associated with pregnancy must be emphasised and counselling offered to women at the time of PAH diagnosis and to women with PAH who become pregnant. Early termination should be discussed. Women who choose to continue with their pregnancy should be treated at specialised pulmonary hypertension centres with experience in managing PAH during and after pregnancy. Copyright ©ERS 2016.

URINARY TRACT INFECTIONS IN PREGNANCY

Directory of Open Access Journals (Sweden)

N Sivalingam

2007-01-01

Full Text Available Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.

EMMPRIN-Mediated Induction of Uterine and Vascular Matrix Metalloproteinases during Pregnancy and in Response to Estrogen and Progesterone

OpenAIRE

Dang, Yiping; Li, Wei; Tran, Victoria; Khalil, Raouf A.

2013-01-01

Pregnancy is associated with uteroplacental and vascular remodeling in order to adapt for the growing fetus and the hemodynamic changes in the maternal circulation. We have previously shown upregulation of uterine matrix metalloproteinases (MMPs) during pregnancy. Whether pregnancy-associated changes in MMPs are localized to the uterus or are generalized in feto-placental and maternal circulation is unclear. Also, the mechanisms causing the changes in uteroplacental and vascular MMPs during p...

Intimate partner violence and pregnancy: a systematic review of interventions.

Directory of Open Access Journals (Sweden)

An-Sofie Van Parys

Full Text Available BACKGROUND: Intimate partner violence (IPV around the time of pregnancy is a widespread global health problem with many negative consequences. Nevertheless, a lot remains unclear about which interventions are effective and might be adopted in the perinatal care context. OBJECTIVE: The objective is to provide a clear overview of the existing evidence on effectiveness of interventions for IPV around the time of pregnancy. METHODS: Following databases PubMed, Web of Science, CINAHL and the Cochrane Library were systematically searched and expanded by hand search. The search was limited to English peer-reviewed randomized controlled trials published from 2000 to 2013. This review includes all types of interventions aiming to reduce IPV around the time of pregnancy as a primary outcome, and as secondary outcomes to enhance physical and/or mental health, quality of life, safety behavior, help seeking behavior, and/or social support. RESULTS: We found few randomized controlled trials evaluating interventions for IPV around the time of pregnancy. Moreover, the nine studies identified did not produce strong evidence that certain interventions are effective. Nonetheless, home visitation programs and some multifaceted counseling interventions did produce promising results. Five studies reported a statistically significant decrease in physical, sexual and/or psychological partner violence (odds ratios from 0.47 to 0.92. Limited evidence was found for improved mental health, less postnatal depression, improved quality of life, fewer subsequent miscarriages, and less low birth weight/prematurity. None of the studies reported any evidence of a negative or harmful effect of the interventions. CONCLUSIONS AND IMPLICATIONS: Strong evidence of effective interventions for IPV during the perinatal period is lacking, but some interventions show promising results. Additional large-scale, high-quality research is essential to provide further evidence about the effect

Iron homeostasis during pregnancy.

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Fisher, Allison L; Nemeth, Elizabeta

2017-12-01

During pregnancy, iron needs to increase substantially to support fetoplacental development and maternal adaptation to pregnancy. To meet these iron requirements, both dietary iron absorption and the mobilization of iron from stores increase, a mechanism that is in large part dependent on the iron-regulatory hormone hepcidin. In healthy human pregnancies, maternal hepcidin concentrations are suppressed in the second and third trimesters, thereby facilitating an increased supply of iron into the circulation. The mechanism of maternal hepcidin suppression in pregnancy is unknown, but hepcidin regulation by the known stimuli (i.e., iron, erythropoietic activity, and inflammation) appears to be preserved during pregnancy. Inappropriately increased maternal hepcidin during pregnancy can compromise the iron availability for placental transfer and impair the efficacy of iron supplementation. The role of fetal hepcidin in the regulation of placental iron transfer still remains to be characterized. This review summarizes the current understanding and addresses the gaps in knowledge about gestational changes in hematologic and iron variables and regulatory aspects of maternal, fetal, and placental iron homeostasis. © 2017 American Society for Nutrition.

Subhuman Primate Pregnancy Complicated by Streptozotocin-Induced Diabetes Mellitus

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Mintz, Daniel H.; Chez, Ronald A.; Hutchinson, Donald L.

1972-01-01

streptozotocin-treated pregnancies. These data provide evidence that maternal glucose intolerance during pregnancy is associated with enhanced fetal and neonatal pancreatic islet cell responsiveness to glucose and mixed amino acids. Although the specific mechanism(s) that alters both the sensitivity and responsiveness of the normal pancreatic fetal islet to insulinogenic stimuli remains unclear, the data do indicate that insulin-dependent maternal hyperglycemia and hyperaminoacidemia, separately or in combination could contribute to the fetal hyperinsulinemia of pregnancies complicated by diabetes mellitus. Moreover, the overall experiences with these streptozotocin-treated animals suggest that a subhuman primate model may be available to examine directly the antenatal pathophysiology of abnormal carbohydrate metabolism. PMID:4259254

New-Onset Seizures in Pregnancy and Puerperium

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Monton Wongwandee

2016-11-01

Full Text Available Seizures in pregnant women cause several maternal and fetal consequences. Eclampsia is usually diagnosed to be the etiology. However, seizures during pregnancy or puerperium could be caused by pre-existing epilepsy, the initial presentation of a non-pregnancy-related disorder or the new-onset pregnancy-related disorder. Therefore, thorough diagnostic evaluation is essential. Although the pathogenesis of new-onset pregnancy-related neurological disorders remains unknown, physiological changes during pregnancy and puerperium are believed to have a major role. Advanced neuroimaging of the brain and cerebral vessels can help in differentiating the specific causes of seizures in these patients.

Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

NARCIS (Netherlands)

van Beijnum, Janneke; Wilkinson, Tim; Whitaker, Heather J.; van der Bom, Johanna G.; Algra, Ale; Vandertop, W. Peter; van den Berg, René; Brouwer, Patrick A.; Rinkel, Gabriël Je; Kappelle, L. Jaap; Al-Shahi Salman, Rustam; Klijn, Catharina Jm

2017-01-01

Background It is unclear whether the risk of bleeding from brain arteriovenous malformations is higher during pregnancy, delivery, or puerperium. We compared occurrence of brain arteriovenous malformation hemorrhage in women during this period with occurrence of hemorrhage outside this period during

Association of anti-Chlamydia antibodies with ectopic pregnancy in ...

African Journals Online (AJOL)

Background: Ectopic pregnancy remains a major public health problem especially in many developing countries where it is a significant contributor to pregnancy related morbidity and mortality. Objective: To determine the association between prior Chlamydia trachomatis infection and the risk of ectopic pregnancy. Methods: ...

Hypertension in pregnancy

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Andrea Ungar

2007-03-01

Full Text Available Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories: chronic hypertension, pre-eclampsia/eclampsia, pre-eclampsia superimposed on chronic hypertension, and gestational hypertension. A relative paucity of investigative data, as well as the frequent difficulty in making an etiological diagnosis, may lead to problems in its management. This case report analyses current concepts regarding the hypertensive disorders of gestation, focusing on chronic hypertension. Chronic hypertension is defined as blood pressure exceeding 140/90 mmHg before pregnancy or before 20 weeks gestation. Hypertensive disorders in pregnancy may cause maternal and fetal morbidity and remain a leading source of maternal mortality. A prompt diagnosis is needed also because hypertension may be an indicator of pre-eclampsia, a condition which can evolve into serious complications. Maintaining blood pressure below 140/90 mmHg is recommended, although treatment should be determined on an individual basis. Many anti-hypertensive agents appear to be safe for use during pregnancy: methildopa has been the most studied of the anti-hypertensive drugs and has the best safety record. Labetalol, idralazine and nifedipine also have been found to be safe; ACE-inhibitors are absolutely contraindicated, because they are associated with intrauterine growth retardation.

Safety of antimicrobial treatment during pregnancy

DEFF Research Database (Denmark)

Lamont, Harriet F; Blogg, Henrietta J; Lamont, Ronald F

2014-01-01

Introduction: The extent of antibiotic use in pregnancy remains unknown but may occur in > 40% of pregnant women for various indications, at different gestational ages from different sources. Areas covered: Antibiotic resistance, alterations to the neonatal immune system causing allergy, asthma...... in scrutinizing the safety of antibiotic use in pregnancy....

[Licit and illicit substance use during pregnancy].

Science.gov (United States)

Lamy, Sandrine; Delavene, Héloise; Thibaut, Florence

2014-03-01

Licit and illicit substance use during pregnancy is a major public health concern. Alcohol and substance (tobacco, cannabis, cocaine...) use prevalence during pregnancy remains under estimated. Some studies have reported the prevalence of alcohol or substance use in different countries worldwide but most of them were based on the mother's interview. Consumption of one or more psychoactive substances during pregnancy may have serious consequences on the pregnancy and on the child development. However, the type of consequences is still a matter of controversies. The reasons are diverse: different rating scales, potential interactions with environmental and genetic factors. Considering the negative consequences of drug use during pregnancy, preventive campaigns against the use of drugs during pregnancy are strongly recommended.

Data linkage between the National Birth Defects Prevention Study and the Occupational Information Network (O*NET) to assess workplace physical activity, sedentary behaviors, and emotional stressors during pregnancy.

Science.gov (United States)

Lee, Laura J; Symanski, Elaine; Lupo, Philip J; Tinker, Sarah C; Razzaghi, Hilda; Pompeii, Lisa A; Hoyt, Adrienne T; Canfield, Mark A; Chan, Wenyaw

2016-02-01

Knowledge of the prevalence of work-related physical activities, sedentary behaviors, and emotional stressors among pregnant women is limited, and the extent to which these exposures vary by maternal characteristics remains unclear. Data on mothers of 6,817 infants without major birth defects, with estimated delivery during 1997 through 2009 who worked during pregnancy were obtained from the National Birth Defects Prevention Study. Information on multiple domains of occupational exposures was gathered by linking mother's primary job to the Occupational Information Network Version 9.0. The most frequent estimated physical activity associated with jobs during pregnancy was standing. Of 6,337 mothers, 31.0% reported jobs associated with standing for ≥75% of their time. There was significant variability in estimated occupational exposures by maternal age, race/ethnicity, and educational level. Our findings augment existing literature on occupational physical activities, sedentary behaviors, emotional stressors, and occupational health disparities during pregnancy. © 2015 Wiley Periodicals, Inc.

[Thyroid dysfunction during pregnancy].

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Díez, Juan J; Iglesias, Pedro; Donnay, Sergio

2015-10-21

Recent clinical practice guidelines on thyroid dysfunction and pregnancy have changed health care provided to pregnant women, although their recommendations are under constant revision. Trimester- and area-specific reference ranges for serum thyroid-stimulating hormone are required for proper diagnosis of hypothyroidism and hyperthyroidism. There is no doubt on the need of therapy for overt hypothyroidism, while therapy for subclinical hypothyroidism is controversial. Further research is needed to settle adverse effects of isolated hypothyroxinemia and thyroid autoimmunity. Differentiation between hyperthyroidism due to Graves' disease and the usually self-limited gestational transient thyrotoxicosis is critical. It is also important to recognize risk factors for postpartum thyroiditis. Supplementation with iodine is recommended to maintain adequate iodine nutrition during pregnancy and avoid serious consequences in offspring. Controversy remains about universal screening for thyroid disease during pregnancy or case-finding in high-risk women. Opinions of some scientific societies and recent cost-benefit studies favour universal screening. Randomized controlled studies currently under development should reduce the uncertainties that still remain in this area. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy

DEFF Research Database (Denmark)

Nohr, E.A.; Vaeth, M.; Baker, J.L.

2008-01-01

BACKGROUND: Although both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) may affect birth weight, their separate and joint associations with complications of pregnancy and delivery and with postpartum weight retention are unclear. OBJECTIVES: We aimed to investigate...... the combined associations of prepregnancy BMI and GWG with pregnancy outcomes and to evaluate the trade-offs between mother and infant for different weight gains. DESIGN: Data for 60892 term pregnancies in the Danish National Birth Cohort were linked to birth and hospital discharge registers. Self...

Urinary incontinence and weight change during pregnancy and postpartum: a cohort study.

Science.gov (United States)

Wesnes, Stian Langeland; Hunskaar, Steinar; Bo, Kari; Rortveit, Guri

2010-11-01

Weight gain during pregnancy may contribute to increased urinary incontinence (UI) during and after pregnancy, but scientific support is lacking. The effect of weight loss on UI postpartum is unclear. From 1999 to 2006, investigators in the Norwegian Mother and Child Cohort Study recruited pregnant women during pregnancy. This study was based on 12,679 primiparous women who were continent before pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Weight gain greater than the 50th percentile during weeks 0-15 of pregnancy was weakly associated with higher incidence of UI at week 30 compared with weight gain less than or equal to the 50th percentile. Weight gain greater than the 50th percentile during pregnancy was not associated with increased prevalence of UI 6 months postpartum. For each kilogram of weight loss from delivery to 6 months postpartum among women who were incontinent during pregnancy, the relative risk for UI decreased 2.1% (relative risk = 0.98, 95% confidence interval: 0.97, 0.99). Weight gain during pregnancy does not seem to be a risk factor for increased incidence or prevalence of UI during pregnancy or postpartum. However, weight loss postpartum may be important for avoiding incontinence and regaining continence 6 months postpartum.

Maternal fitness at the onset of the second trimester of pregnancy: correlates and relationship with infant birth weight.

Science.gov (United States)

Bisson, M; Alméras, N; Plaisance, J; Rhéaume, C; Bujold, E; Tremblay, A; Marc, I

2013-12-01

What is already known about this subject A healthy life begins in utero and a healthy pregnancy requires a fit and healthy mother. Physical activity during pregnancy provides a stimulation that is essential for promoting optimal body oxygenation and composition as well as metabolic fitness during pregnancy. Although a higher maternal fitness is expected to provide a beneficial fetal environment, it is still unclear whether physical fitness during pregnancy contributes to perinatal health. What this study adds Participation in sports and exercise previously and at the beginning of pregnancy can benefit maternal health by improving cardiorespiratory fitness during pregnancy, irrespective of maternal body mass index. Maternal strength, an indicator of muscular fitness, is an independent determinant of infant fetal growth and can positively influence birth weight. It is still unclear whether maternal physical activity and fitness during pregnancy contributes to perinatal health. The aims of this study were to characterize maternal physical fitness at 16 weeks of pregnancy and to examine its effects on infant birth weight. Maternal anthropometry (body mass index [BMI] and skin-folds), physical activity, cardiorespiratory fitness (VO2 peak) and muscular fitness (handgrip strength) were assessed at 16 weeks of gestation in 65 healthy pregnant women. Offspring birth weight was collected from maternal charts after delivery. A higher VO2 peak was associated with physical activity spent at sports and exercise before and in early pregnancy (P = 0.0005). Maternal BMI was negatively associated with cardiorespiratory fitness (P pregnancy as a new determinant of infant birth weight. © 2012 The Authors. Pediatric Obesity © 2012 International Association for the Study of Obesity.

Retrievable Inferior vena cava filters in pregnancy: Risk versus benefit?

Science.gov (United States)

Crosby, David A; Ryan, Kevin; McEniff, Niall; Dicker, Patrick; Regan, Carmen; Lynch, Caoimhe; Byrne, Bridgette

2018-03-01

Venous thromboembolism remains one of the leading causes of maternal mortality in the developed world. Retrievable inferior vena cava (IVC) filters have a role in the prevention of lethal pulmonary emboli when anticoagulation is contraindicated or has failed [1]. It is unclear whether or not the physiological changes in pregnancy influence efficacy and complications of these devices. The decision to place an IVC filter in pregnancy is complex and there is limited information in terms of benefit and risk to the mother. The objective of this study was to determine the efficacy and safety of these devices in pregnancy and to compare these with rates reported in the general population. The aim of this study was report three recent cases of retrievable IVC filter use in pregnant women in our department and to perform a systematic review of the literature to identify published cases of filters in pregnancy. The efficacy and complication rates of these devices in pregnancy were estimated and compared to rates reported in the general population in a recent review [2]. Fisher's exact test was used for statistical analysis. In addition to our three cases, 16 publications were identified with retrievable IVC filter use in 40 pregnant women resulting in a total of 43 cases. There was no pulmonary embolus in the pregnant group (0/43) compared to 57/6291 (0.9%) in the general population. Thrombosis of the filter (2.3% vs. 0.9%, p = 0.33) and perforation of the IVC (7.0% vs 4.4%, p = 0.44) were more common in pregnancy compared to the general population but the difference was not statistically significant. Failure to retrieve the filter is more likely to occur in pregnancy (26% vs. 11%, p = 0.006) but this did not correlate with the type of device (p = 0.61), duration of insertion (p = 0.58) or mode of delivery (p = 0.37). Data for retrievable IVC filters in pregnancy is limited and there may be a publication bias towards complicated cases. This study

Efficacy and safety of once daily low molecular weight heparin (tinzaparin sodium) in high risk pregnancy.

LENUS (Irish Health Repository)

Ní Ainle, Fionnuala

2008-10-01

Low molecular weight heparin (LMWH) is widely regarded as the anticoagulant treatment of choice for the prevention and treatment of venous thromboembolism during pregnancy. However, previous studies have demonstrated that the pharmacokinetic profiles of LMWH vary significantly with increasing gestation. Consequently, it remains unclear whether LMWH regimens recommended for use in nonpregnant individuals can be safely extrapolated to pregnant women. The aims of this study were to assess the safety and the efficacy of tinzaparin sodium (Innohep) administered only once daily during pregnancy. A systematic retrospective review identified a cohort of 37 high-risk pregnancies which had been managed using tinzaparin 175 IU\\/kg once daily. In 26 cases, the index pregnancy had been complicated by development of an acute venous thromboembolism (17 deep vein thrombosis and nine pulmonary embolism). For each individual, case notes were examined and data extracted using a predetermined questionnaire. No episodes of recurrent venous thromboembolism were identified amongst this cohort of pregnancies managed using once daily LMWH administration. However, two unusual thrombotic complications were observed, including a parietal infarct in one patient, and a postpartum cerebral venous thrombosis in another. Once daily tinzaparin was well tolerated, with no cases of heparin-induced thrombocytopaenia, symptomatic osteoporosis, or foetal malformations. Tinzaparin dose modification based upon peak anti-Xa levels occurred in 45% of the cases examined. The present study is the largest study to have examined the clinical efficacy of once daily LMWH for use in pregnant women at high risk of venous thromboembolism. Our data support the safety and efficacy of antenatal tinzaparin at a dose of 175 IU\\/kg. In order to determine whether this once daily regimen provides equivalent (or indeed greater) thromboprophylaxis to twice daily LMWH regimens during pregnancy will require highly powered

Characterization of the Th profile of the bovine endometrium during the oestrous cycle and early pregnancy.

Directory of Open Access Journals (Sweden)

Lilian J Oliveira

Full Text Available Despite extensive research in the area of cow fertility, the extent to which the maternal immune system is modulated during pregnancy in cattle remains unclear. Therefore, the objective of the current study was to characterize the presence and response profile of B, T-helper (LTh, T- cytotoxic (LTc, gamma delta-T (γδT and natural killer (NK lymphocytes in terms of cell number, distribution and cytokine expression in bovine endometrial tissue to pregnancy. Endometrial tissue samples were collected from beef heifers on Days 5, 7, 13 and 16 of the estrous cycle or pregnancy. Samples were analysed by immunofluorescence to identify the presence and abundance of B-B7 (B-cells, CD4 (LTh, CD8 (LTc, γδT cell receptor (TCR and CD335/NKp46 (NK cells -positive immune cells. Quantitative real time PCR (QPCR was carried out to analyse mRNA relative abundance of FOXP3 (a marker of regulatory T (Treg cells and a panel of immune factors, including MHC-I, LIF, Interleukins 1, 2, 6, 8, 10, 11,12A, IFNa and IFNG. Results indicate that B-B7+ cells are quite populous in bovine endometrial tissue, CD4+ and CD8+ -cells are present in moderate numbers and γδTCR+ and CD335+ cells are present in low numbers. Pregnancy affected the total number and distribution pattern of the NK cell population, with the most significant variation observed on Day 16 of pregnancy. Neither B lymphocytes nor T lymphocyte subsets were regulated temporally during the oestrous cycle or by pregnancy prior to implantation. mRNA transcript abundance of the immune factors LIF, IL1b, IL8 and IL12A, IFNa and IFNG, expression was regulated temporally during the estrous cycle and LIF, IL1b, IL-10, IL11, IL12A were also temporally regulated during pregnancy. In conclusion, the endometrial immune profile of the oestrous cycle favours a Th2 environment in anticipation of pregnancy and the presence of an embryo acts to fine tune this environment.

Serum 25(OH Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes

Directory of Open Access Journals (Sweden)

Piotr Domaracki

2016-09-01

Full Text Available Background: An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM. Moreover, we analyzed an association between maternal serum 25(OHD and the risk of gestational hypertension, preeclampsia and GDM. Material and Methods: The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45, preeclampsia (n = 23 or GDM (n = 103. The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OHD were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OHD concentrations (18.20 vs. 22.10 ng/mL, p = 0.15. Highly significant differences were found in 25(OHD concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021. GDM was not associated with significant differences in 25(OHD concentration. A low level of 25(OHD turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic analysis (AUC = 0.70, p < 0.01. Conclusions: 25(OHD deficiency is common among pregnant Polish women. Low concentrations of 25(OHD may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OHD level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia.

Subsequent pregnancy outcome after previous foetal death

NARCIS (Netherlands)

Nijkamp, J. W.; Korteweg, F. J.; Holm, J. P.; Timmer, A.; Erwich, J. J. H. M.; van Pampus, M. G.

Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to

THE MODEL OF UNCLEAR EXPERT SYSTEM OF PROGNOSTICATION THE CONTENT OF EDUCATION

Directory of Open Access Journals (Sweden)

Ivan M. Tsidylo

2012-12-01

Full Text Available The article deals with the problem of development of the expert system of prognostication of the educational content by means of fuzzy logic. It was the model of making decision by the group of experts in accordance to meaningfulness of the theme in the educational programme on the base of the hierarchical system that combines in itself the use of both unclear and stochastic data. The structure of the unclear system, function and mechanisms of construction of separate blocks of the model are described. The surface of review of the unclear system represents dependence of estimation of the theme meaningfulness on the level of competence of group of experts and size to the point at the permanent value of level’s variation. The testing of the controller on a test selection proves the functional fitness of the developed model.

Implications for the offspring of circulating factors involved in beta cell adaptation in pregnancy

DEFF Research Database (Denmark)

Nalla, Amarnadh; Ringholm, Lene; Søstrup, Birgitte

2014-01-01

is able to stimulate proliferation of rat beta cells. We have identified several circulating factors that may contribute to beta cell adaptation to pregnancy. Further studies are needed to elucidate their possible role in glucose homeostasis in the mother and her offspring.......OBJECTIVE: Several studies have shown an increase in beta cell mass during pregnancy. Somatolactogenic hormones are known to stimulate the proliferation of existing beta cells in rodents whereas the mechanism in humans is still unclear. We hypothesize that in addition to somatolactogenic hormones...... there are other circulating factors involved in beta cell adaptation to pregnancy. This study aimed at screening for potential pregnancy-associated circulating beta cell growth factors. SAMPLES: Serum samples from nonpregnant and pregnant women. METHODS: The effect of serum from pregnant women...

Extracorporeal Pregnancy as a Feminist Issue

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Iskra Krstić

2015-10-01

Full Text Available Extracorporeal pregnancy (ectogenesis presents perhaps the culmination of reproductive technology (NRT. Second wave feminism welcomed the use of NRT (including extracorporeal pregnancy as a means of women’s liberation. Later on, theories belonging to the third wave pointed out the negative implications of NRT and reclaimed the power of unassisted reproduction. This paper will try to point out some remaining productive potentials of NRT and extracorporeal pregnancy. The author wishes to explore the changes in the conceptualisation of the integrity of the individual in the context of the feminist critique of ectogenesis.

Early pregnancy azathioprine use and pregnancy outcomes.

LENUS (Irish Health Repository)

Cleary, Brian J

2012-02-01

BACKGROUND: Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and ventricular\\/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45-6.04). Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93-2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular\\/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness.

Associations between pregnancy-associated glycoproteins and pregnancy outcomes, milk yield, parity, and clinical diseases in high-producing dairy cows.

Science.gov (United States)

Mercadante, P M; Ribeiro, E S; Risco, C; Ealy, A D

2016-04-01

Pregnancy-associated glycoproteins (PAG) are produced by the ruminant placenta and secreted into the maternal circulation throughout pregnancy. The extent to which circulating PAG concentrations predict pregnancy outcomes was examined herein. Also, associations between circulating PAG concentrations and various production parameters and clinical diseases were evaluated. Lactating primiparous and multiparous Holstein cows (n=345) were bred via timed artificial insemination using a standard Ovsynch protocol. Pregnancy was diagnosed by transrectal ultrasonography at d 32, 46, and 74 of gestation. Blood was harvested at d 32 to determine plasma concentrations of PAG and progesterone. Cows pregnant at d 32 that subsequently lost their pregnancy at d 46 and 74 had reduced PAG concentrations. Both artificial insemination service number and parity were associated with plasma PAG concentrations. Concentration of PAG in plasma was greater for cows pregnant from their second or later breeding than those pregnant from the first breeding postpartum, and was increased for primiparous compared with multiparous. In addition, cows with greater milk yield had increased plasma PAG concentrations. No association was detected between body condition score and plasma PAG concentrations. Cows that experienced clinical metritis, metabolic problems, or left displacement abomasum in the early postpartum period preceding breeding had greater plasma PAG concentrations than cows not experiencing these clinical diseases. Also, cows with multiple clinical diseases had increased odds of pregnancy loss when compared with cows not experiencing clinical diseases. Odds ratio testing detected a tendency in the relationship between reduced milk yield and increased pregnancy loss. Collectively, these associations illustrate one feature of the early developing placenta that may predict pregnancy outcomes in dairy cattle. It is unclear if plasma PAG are actively involved with mediating pregnancy outcomes

Evidence-based management of non-tubal ectopic pregnancies.

Science.gov (United States)

Alalade, Aderemi Olaoluwa; Smith, Fredrick John Ennis; Kendall, Charlotte Emma; Odejinmi, Funlayo

2017-11-01

Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.

Maternal depressive symptoms during and after pregnancy are associated with attention-deficit/hyperactivity disorder symptoms in their 3- to 6-year-old children.

Directory of Open Access Journals (Sweden)

Elina Wolford

Full Text Available Maternal depressive symptoms during pregnancy have been associated with child behavioural symptoms of attention-deficit/hyperactivity disorder (ADHD in early childhood. However, it remains unclear if depressive symptoms throughout pregnancy are more harmful to the child than depressive symptoms only during certain times, and if maternal depressive symptoms after pregnancy add to or mediate any prenatal effects. 1,779 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO study. Mothers filled in the Center of Epidemiological Studies Depression Scale biweekly from 12+0-13+6 to 38+0-39+6 weeks+days of gestation or delivery, and the Beck Depression Inventory-II and the Conners' Hyperactivity Index at the child's age of 3 to 6 years (mean 3.8 years, standard deviation [SD] 0.5. Maternal depressive symptoms were highly stable throughout pregnancy, and children of mothers with consistently high depressive symptoms showed higher average levels (mean difference = 0.46 SD units, 95% Confidence Interval [CI] 0.36, 0.56, p < 0.001 compared to the low group, and proportion (32.1% vs. 14.7% and odds (odds ratio = 2.80, 95% CI 2.20, 3.57, p < 0.001 of clinically significant ADHD symptoms. These associations were not explained by the effects of maternal depressive symptoms after pregnancy, which both added to and partially mediated the prenatal effects. Maternal depressive symptoms throughout pregnancy are associated with increased ADHD symptomatology in young children. Maternal depressive symptoms after pregnancy add to, but only partially mediate, the prenatal effects. Preventive interventions suited for the pregnancy period may benefit both maternal and offspring mental health.

Is a vegetarian diet safe to follow during pregnancy? A systematic review and meta-analysis of observational studies.

Science.gov (United States)

Tan, Chang; Zhao, Yudi; Wang, Suqing

2018-04-05

Whether a vegetarian diet is appropriate for pregnancy remains unclear. This study aimed to determine the association between vegetarian diet during pregnancy and various maternal-fetal outcomes. PubMed-Medline, EMBASE, and Cochrane Library databases were searched for relevant articles published by August 30, 2017. Quantitative data were analyzed by a random-effects model with pooled odds ratios or weighted mean difference (WMD) and 95% confidence interval as aggregate estimations. A total of 19 observational studies were identified for each of meta-analysis and narrative review. The overall estimated relation between vegetarian pregnancy and low birth weight (LBW) was marginally significant (1.27 (0.98, 1.65), P = 0.07, I 2 = 0%). Asian (India/Nepal) vegetarian mothers exhibited increased risks to deliver a baby with LBW (1.33 (1.01, 1.76), P = 0.04, I 2 = 0%). However, the WMD of neonatal birth weight in five studies suggested no difference between vegetarians and omnivores. Given the high heterogeneity of the included studies, lack of high-quality evidence, and limited studies included for each category, we failed to reach conclusive results regarding the risks of hypospadias, intrauterine growth retardation, maternal anemia, and gestational diabetes mellitus. Asian vegetarian mothers presented increased risks to deliver babies with LBW than those of omnivores. Large-scale prospective studies focusing on pre- and/or early gestational nutrition will help clarify the correlation between vegetarian diet and various pregnancy outcomes.

Thrombophilia and Pregnancy Complications

Directory of Open Access Journals (Sweden)

Louise E. Simcox

2015-11-01

Full Text Available There is a paucity of strong evidence associated with adverse pregnancy outcomes and thrombophilia in pregnancy. These problems include both early (recurrent miscarriage and late placental vascular-mediated problems (fetal loss, pre-eclampsia, placental abruption and intra-uterine growth restriction. Due to poor quality case-control and cohort study designs, there is often an increase in the relative risk of these complications associated with thrombophilia, particularly recurrent early pregnancy loss, late fetal loss and pre-eclampsia, but the absolute risk remains very small. It appears that low-molecular weight heparin has other benefits on the placental vascular system besides its anticoagulant properties. Its use is in the context of antiphospholipid syndrome and recurrent pregnancy loss and also in women with implantation failure to improve live birth rates. There is currently no role for low-molecular weight heparin to prevent late placental-mediated complications in patients with inherited thrombophilia and this may be due to small patient numbers in the studies involved in summarising the evidence. There is potential for low-molecular weight heparin to improve pregnancy outcomes in women with prior severe vascular complications of pregnancy such as early-onset intra-uterine growth restriction and pre-eclampsia but further high quality randomised controlled trials are required to answer this question.

Blood Clotting and Pregnancy

Medline Plus

Full Text Available ... pregnancy: Be aware of risk factors. Know your family history. Make sure your doctor knows about any ... blood clots or blood clotting disorders in your family. Remain active, with your doctor's approval. Be aware ...

IL-17 producing innate lymphoid cells 3 (ILC3) but not Th17 cells might be the potential danger factor for preeclampsia and other pregnancy associated diseases.

Science.gov (United States)

Barnie, Prince A; Lin, Xin; Liu, Yueqin; Xu, Huaxi; Su, Zhaoliang

2015-01-01

In pregnancy, the immunologic system plays an important role that ensures normal pregnancy development and can as well promote the development of complications. Pregnancy success appears to rely on a discrete balance between the Th cytokines, which are involved in fetal growth and development. Preeclampsia and gestational diabetes are known complications associated with pregnancy. However, the source of the increased IL-17 cytokine in preeclampsia and other pregnancy associated diseases still remains unclear amidst numerous inconsistencies. The recent identification of innate lymphoid cells (ILC) has raised more doubts about the sources of most of the Th associated cytokines. We investigated the source of peripheral IL-17 levels in preeclamptic, gestational diabetics and chronic diabetics compared to healthy pregnancy subjects. To evaluate the source of the increased IL-17 cytokine among preeclampsia, chronic diabetic and gestational diabetic patients we investigated the proportion of Th17 cell populations in peripheral blood mononuclear cells using flow cytometry as well as analyzing levels of IFN-γ, IL-17, IL-1β and HMGB1. This study found that the Th17 cell populations in peripheral blood of preeclamptic, gestational nor chronic diabetes during pregnancy did not correlate with the increased IL-17. We report that the increased IL-17 levels observed in patients with preeclampsia, gestational diabetes and chronic diabetes are associated with innate lymphoid cells 3 (ILC3) and may pose threats to the fetus if disregulated.

Gitelman's syndrome in pregnancy: case report and review of the literature.

LENUS (Irish Health Repository)

McCarthy, Fergus P

2012-01-31

Gitelman\\'s syndrome (GS), a rare renal disorder, results in hypokalaemia, hypomagnesaemia, hypocalciuria and a metabolic alkalosis. It is unclear if an alteration in management is necessary or beneficial during pregnancy. A 32-year-old woman with GS was managed in her second pregnancy. Antenatally, the patient required 39 (principally day case) admissions to the hospital for intravenous (IV) therapy and received a cumulative total of 47 l of IV 0.9% saline solution, 47 doses of 20 mmol magnesium chloride and 46 doses of 80 mmol potassium chloride. She delivered a 2940-g female infant in excellent condition by caesarean section. We would suggest that close attention to maternal weight gain during pregnancy is an easily available clinical tool to assess adequacy of fluid and electrolyte repletion in this condition.

Protective antibodies against placental malaria and poor outcomes during pregnancy, Benin

DEFF Research Database (Denmark)

Ndam, Nicaise Tuikue; Denoeud-Ndam, Lise; Doritchamou, Justin

2015-01-01

Placental malaria is caused by Plasmodium falciparum-infected erythrocytes that bind to placental tissue. Binding is mediated by VAR2CSA, a parasite antigen coded by the var gene, which interacts with chondroitin sulfate A (CSA). Consequences include maternal anemia and fetal growth retardation....... Antibody-mediated immunity to placental malaria is acquired during successive pregnancies, but the target of VAR2CSA-specific protective antibodies is unclear. We assessed VAR2CSA-specific antibodies in pregnant women and analyzed their relationships with protection against placental infection, preterm...... birth, and low birthweight. Antibody responses to the N-terminal region of VAR2CSA during early pregnancy were associated with reduced risks for infections and low birthweight. Among women infected during pregnancy, an increase in CSA binding inhibition was associated with reduced risks for placental...

FACTORS ASSOCIATED WITH PREGNANCY AMONG UNMARRIED WOMEN IN MALAYSIA.

Science.gov (United States)

Zain, Norhasmah Mohd; Low, Wah Yun; Othman, Sajaratulnisah

2015-05-01

Pregnancy among unmarried women may have negative social and health implications in Malaysia. The number of pregnancies among unmarried women has increased in Malaysia, but the socio-demographic profile of these women is unclear. This study aims to evaluate the characteristics of unmarried pregnant women and the factors associated with unmarried pregnancies among young women in Malaysia. We conducted a cross sectional study at six hospitals and six women's shelters in Peninsular Malaysia during 2011-2012. Unmarried pregnant women were compared with married pregnant women. Participants were interviewed using a structured questionnaire asking for socio-demographic data, family background, risky sexual behavior, social support and pregnancy details. A total of 484 women (239 unmarried and 245 married) were included in the study. Most unmarried subjects were adolescents, from urban areas, from a low socioeconomic group, and lived with parents prior to pregnancy. Age (OR=0.67; 95% CI: 0.61-0.74), studying status (OR=17.33; 95% CI: 2.65-113.19), alcohol use (OR=40.46; 95% CI: 2.51-652.38) exposure to pornographic material (OR=13.48; 95% CI: 3.24-56.01), contraceptive use (OR=0.20; 95% CI: 0.08-0.51), and social support (OR=0.90; 95% CI: 0.86-0.94) were all associated with unmarried pregnancy. These factors need to be considered when.designing an intervention program.

Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status

DEFF Research Database (Denmark)

Lambertini, Matteo; Kroman, Niels; Ameye, Lieveke

2018-01-01

Safety of pregnancy in women with history of estrogen receptor (ER)-positive breast cancer remains controversial. In this multicenter case-control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting for guaran......Safety of pregnancy in women with history of estrogen receptor (ER)-positive breast cancer remains controversial. In this multicenter case-control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting...

Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology

International Nuclear Information System (INIS)

Kalawat, Tek Chand; Chittoria, Ravi Kumar; Reddy, Praveen Kumar; Suneetha, Batchu; Narayan, Ravishwar; Ravi, Parthsarthi

2012-01-01

To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb. Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared. In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their

Psychological stress during pregnancy and stillbirth: prospective study

DEFF Research Database (Denmark)

Wisborg, K.; Barklin, A.; Hedegaard, M.

2008-01-01

habits, alcohol and caffeine intake during pregnancy, education and cohabitation failed to change the result. The results remained essentially unchanged after exclusion of preterm deliveries. Exclusion of women with complications during pregnancy such as diabetes, hypertension, vaginal bleeding......OBJECTIVE: To study the association between psychological stress during pregnancy and stillbirth. DESIGN: Prospective follow-up study. SETTING: Aarhus University Hospital, Skejby, Denmark,1989-98. POPULATION: A total of 19 282 singleton pregnancies in women with valid information about...... psychological stress during pregnancy. METHODS: Information about psychological stress during pregnancy was obtained from questionnaires and measured by the 12-item General Health Questionnaires (GHQ). A score was generated by the sum of all the answers, each contributing a value between 0 (low psychological...

Heterotopic pregnancy: Sonographic findings

International Nuclear Information System (INIS)

Kwon, Tae Hee

1999-01-01

To evaluate the sonographic findings of the heterotopic pregnancy which is increasing recently. Thirty-nine cases of heterotopic pregnancy after ovulation induction and IVF-ET (In Vitro Fertilization-Embryo Transfer) during the recent 3 years were analyzed. They were diagnosed by ultrasonography and proved surgically afterwards. Sonographic findings were analyzed focusing on gestational week of intrauterine pregnancy and location of ectopic pregnancy. In particular, adnexal mass was evaluated with regard to size and the characteristic findings such as ectopic gestational sac (echogenic ring). Also, overian cyst and fluid collection in cul-de-sac space were reviewed carefully. Heterotopic pregnancy was proved surgically by salpingectomy in 33 cases and by resection of cornus in six cases. Sonographic diagnosis using transvaginal ultrasound was made from five weeks to nine weeks two days (six weeks and four days in average) from last menstral period in all 39 cases. Ectopic pregnancy was identified in ampullary part in 29 cases, in the isthmic portion of tube in four cases and in the cornus of uterus in six cases. The intrauterine pregnancy was diagnosed by identifying the intrauterine gestational saccontaining a yolk sac in seven cases and the embryo with fetal heart beat in the remaining 32 cases. Adnexal masses of heterotopic pregnancy were less than 3 cm in diameter in 2 cases (57%), 3-4 cm in 11 cases (28%) and more than 4 cm in 6 cases (15%). A characteristic finding of ectopic mass was echogenic ring which was visible in 33 (84.6%) cases by transvaginal ultrasound. Six cases had pelvic hematosalpinx and two had pelvic hematoma. Of 10 cases (26%) which were identified to have ovarian hyperstimulation syndrome, eight (21%) had large amount of fluid collection in cul-de-sac and abdomen. Ultrasonographic identification of the intrauterine pregnancy and the ectopic chorion ring is effective for the early diagnosis of the heterotopic pregnancy.

Acute Kidney Injury in Pregnancy.

Science.gov (United States)

Jim, Belinda; Garovic, Vesna D

2017-07-01

Pregnancy-related acute kidney injury (AKI) has declined in incidence in the last three decades, although it remains an important cause of maternal and fetal morbidity and mortality. Pregnancy-related causes of AKI such as preeclampsia, acute fatty liver of pregnancy, HELLP (Hemolysis, Elevated Liver function tests, Low Platelets) syndrome, and the thrombotic microangiopathies (thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome [HUS]) exhibit overlapping features and often present as diagnostic dilemmas. Differentiating among these conditions may be difficult or impossible based on clinical criteria only. In difficult and rare cases, a renal biopsy may need to be considered for the exact diagnosis and to facilitate appropriate treatment, but the risks and benefits need to be carefully weighed. The use of eculizumab for the treatment of atypical HUS has demonstrated efficacy in early case reports. Non-pregnancy related causes such as volume depletion and pyelonephritis require early and aggressive resuscitative as well as antibiotic measures respectively. We will discuss in this review the various etiologies of AKI in pregnancy, current diagnostic approaches, and the latest treatment strategies. Given the recent trends of increasing maternal age at the time of pregnancy, and the availability of modern reproductive methods increase the risks of AKI in pregnancy in the coming years. Copyright © 2017 Elsevier Inc. All rights reserved.

Limitations of ADAMTS-13 activity level in diagnosing thrombotic thrombocytopenic purpura in pregnancy.

Science.gov (United States)

Ehsanipoor, Robert M; Rajan, Priya; Holcombe, Randall F; Wing, Deborah A

2009-10-01

In pregnancy, it may be difficult to differentiate the syndrome of hemolysis, elevated liver enzymes, and low platelets from thrombotic thrombocytopenia purpura. Severely depressed (present a case of a patient that presented at 20 weeks gestation with elevated liver enzymes and thrombocytopenia. The diagnosis was unclear at the time of presentation. She underwent induction of labor, and during the postpartum course, she was eventually diagnosed with thrombotic thrombocytopenia purpura; however, her activity level of a disintegrin and metalloproteinase with thrombospondin motifs-13 was only moderately depressed at 15% (normal pregnancy value 41%-105%).

[Hypertension during pregnancy: Epidemiology, definition].

Science.gov (United States)

Fauvel, Jean-Pierre

2016-01-01

Hypertension in pregnancy has several forms that differ by their mechanisms and their consequences for mothers and fetus. Chronic hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg before pregnancy or before the 20th week of amenorrhea. Gestational hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg during or after the 20th week of amenorrhea. Preeclampsia is the occurrence of hypertension and proteinuria after 20weeks of amenorrhea. Severe preeclampsia is accompanied by clinical signs and symptoms indicating visceral pain. The HELLP syndrome is a severe preeclampsia accompanied by intravascular hemolysis and hepatic cytolysis. Eclampsia is characterized by seizures of the tonic-clonic type. A chronic hypertension is observed in 1-5% of pregnancies. Gestational hypertension without proteinuria appears in 5-6% of pregnancies. A preeclampsia develops in 1-2% of pregnancies, but much more frequently (up 34%) in the presence of risk factors. High blood pressure during pregnancy remains, by its complications, the leading cause of maternal morbidity and mortality. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Understanding teenage pregnancy in a post-apartheid South African township.

Science.gov (United States)

Mkhwanazi, Nolwazi

2010-05-01

Although South Africa's total fertility rate is one of the lowest in sub-Saharan Africa, high rates of early childbearing remain a concern. Most teenage pregnancies occur among poor black and coloured South Africans. The majority of these pregnancies are said to be unwanted and unplanned and the teenager's relationships, unstable. Becoming a mother during one's teenage years is perceived to be socially, economically and physically deleterious for the teenager and her baby. This paper presents ethnographic data collected over a five-year period in the South African township of Nyanga East in the Western Cape. It draws attention to the circumstances that surround teenage pregnancy and discusses reactions to teenage pregnancies in this community. Findings highlight that despite the negative perception of teenage pregnancy within the township, particular social and cultural circumstances provided fertile ground for its occurrence. Furthermore, the paper argues that in this particular community the management of a teenage pregnancy played a functional and critical role in maintaining and reproducing social norms and ideals regarding intergenerational relationships, which ultimately ensured that the rates of early childbearing remained high.

'NTA', a locally named unclear condition that causes failure to thrive ...

African Journals Online (AJOL)

'NTA', a locally named unclear condition that causes failure to thrive amongst under five children in southeastern Nigeria: An assessment of mothers' and caregivers' perception of its causes and management.

Pregnancy Intention and Post-partum Depressive Affect in Louisiana Pregnancy Risk Assessment Monitoring System.

Science.gov (United States)

Suh, Elizabeth Y; Ma, Ping; Dunaway, Lauren Futrell; Theall, Katherine P

2016-05-01

Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs). Using Louisiana pregnancy risk assessment monitoring system, 2000-2003, a secondary cross-sectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design. In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23-2.53). Furthermore, the association between husbands/partners' who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02-1.69); while among Black women, neither parent's pregnancy intention were associated with mild or severe PPDs. This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.

A prospective-longitudinal study on the association of anxiety disorders prior to pregnancy and pregnancy- and child-related fears.

Science.gov (United States)

Martini, Julia; Asselmann, Eva; Einsle, Franziska; Strehle, Jens; Wittchen, Hans-Ulrich

2016-05-01

This study aimed to investigate the relation between anxiety disorders prior to pregnancy and specific pregnancy- and child-related fears during pregnancy and after delivery. 306 expectant mothers were interviewed regarding anxiety (and depressive) disorders prior to pregnancy and pregnancy- and child-related fears (e.g. fear of labor pain, fear of infant injury) using the Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy- and child-related fears were particularly pronounced in women with multiple anxiety disorders and women with comorbid anxiety and depressive disorders prior to pregnancy. Further analyses revealed associations between particular anxiety disorders and specific pregnancy- and child-related fears. Results remained stable when considering potential confounders such as maternal age, education, marital status, parity, prior abortion and preterm delivery or low birth weight. Our study suggests that especially women with multiple anxiety and/or comorbid depressive disorders may benefit from early targeted interventions to prevent an escalation of anxiety and fears over the peripartum period. Copyright © 2016 Elsevier Ltd. All rights reserved.

Saving face, losing life: obeah pregnancy and reproductive impropriety in Southern Belize.

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Maraesa, Aminata

2012-01-01

References to obeah pregnancy are widespread in southern Belize, where the belief in supernatural forces combines with Catholic teaching to create a conservative reproductive climate in which illegitimate pregnancy, reproductive misfortunes and maternal death are located in a discourse of shame. Obeah pregnancy is said to result when spiritual forces are unleashed through malicious human intent, causing bodily changes that resemble pregnancy. Death of the woman, however, usually occurs before prenatal confirmation; thus it is often unclear if an obeah pregnancy is a viable pregnancy or some other biomedical - or metaphysical - condition. This paper provides a case study of Petrona, whose story is unique in that she does not die from her purported obeah pregnancy; rather, she lives to bear the consequences of her reproductive behaviours that resulted in the stillbirth of a full-term foetus. Petrona was a traditional birth attendant who is trained to uphold biomedical antenatal protocols. Arguing that Petrona was not adequately educated to fulfill her own prenatal obligations, health care personnel sanctioned Petrona's midwifery practice and left her to process her 'shameful' situation. Ultimately, Petrona's story complicates the culturally disengaged narratives of maternal health and highlights the schism between medical knowledge and socioculturally influenced embodied experience.

Attitude and Perception of Adolescents towards Teenage Pregnancy ...

African Journals Online (AJOL)

Teenage pregnancy rates remain on the increase in Makurdi metropolis of Benue State, Nigeria. Therefore, the aim of this study was to assess the attitudes and perceptions of teenagers in Makurdi metropolis regarding teenage pregnancy. A total of two hundred and eighty six adolescents (286) participated in this survey ...

Serum triiodothyronine and free triiodothyronine index in normal pregnancy

International Nuclear Information System (INIS)

Karunanidhi, A.; Charles, S.X.; Kanagasabapathy, A.S.

1981-01-01

The thyroid function at various stages of pregnancy and after delivery was assessed by measuring serum total triiodothyronine (T 3 ), T 3 resin uptake (T 3 RU) and free triiodothyronine index (FT 3 I). In first, second and third trimesters of pregnancy, the mean values of serum total T 3 were significantly elevated (P 3 I remained unaltered. During labour, both serum total T 3 and FT 3 I observed during labour and after delivery may be due to the changes in blood oestrogen levels. This study indicates that serum free T 3 concentrations in pregnancy remained unaltered in the presence of elevated serum total T 3 levels. FT 3 I determination would thus appear to be a reliable in vitro thyroid function test for the assessment of thyroid function throughout pregnancy. Serum total T 3 was measured by radioimmunoassay using radioiodinated T 3 ( 125 I-T 3 ). (author)

Pregnancy after kidney transplantation: high rates of maternal complications

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Cristina Candido

Full Text Available Abstract Introduction: Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. Objective: To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications. Methods: Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. Results: There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001. Conclusion: Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Maternal folate status in early pregnancy and child emotional and behavioral problems: The generation R study

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J.C.J. Steenweg-de Graaff (Jolien); S.J. Roza (Sabine); E.A.P. Steegers (Eric); A. Hofman (Albert); F.C. Verhulst (Frank); V.W.V. Jaddoe (Vincent); H.W. Tiemeier (Henning)

2012-01-01

textabstractBackground: Maternal prenatal folate status has been linked to neurodevelopmental disorders, but the association with child emotional and behavioral problems is unclear. Objectives: We assessed the association of maternal folate status during pregnancy with child emotional and behavioral

Chronic pain management in pregnancy and lactation.

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Coluzzi, F; Valensise, H; Sacco, M; Allegri, M

2014-02-01

During pregnancy most of women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. Few analgesic drugs have been demonstrated to be absolutely contraindicated during pregnancy and breastfeeding, but studies in pregnant women are not available for most of pain medications. The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments. In addition to the conventional classifications from the Food and Drug Administration and the American Academy of Paediatrics, authors analyzed the currently available clinical data from literature.

Ectopic pregnancy: a life-threatening gynecological emergency

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Lawani OL

2013-08-01

Full Text Available Osaheni L Lawani, Okechukwu B Anozie, Paul O Ezeonu Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: The aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at Ebonyi State University Teaching Hospital (EBSUTH in Abakaliki. Methods: This was a retrospective, descriptive study of ectopic pregnancies managed in EBSUTH during the study period (June 1, 2002 to May 31, 2012. The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 4,610 gynecological admissions and 9,828 deliveries, with 215 cases of ectopic pregnancies. A total of 205 cases were suitable for analysis after excluding cases with incomplete records. The relevant data collected were analyzed with SPSS version 15.0 for Windows. Results: Ectopic pregnancy constituted 4.5% of all gynecological admissions, and its incidence was 2.1%. The mean age of the patients was 27 ± 2 years, 196 of 205 (95.6% had ruptured ectopic pregnancies, and the remaining nine (4.4% were unruptured. The commonest (166 of 205, 80.0% clinical presentation was abdominal pain, and the commonest (105 of 205, 51.2% identified risk factor was a previous history of induced abortion. Three deaths were recorded, giving a case-fatality rate of 1.4% (three of 205. Conclusion: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to Nigerian women, as well as a threat to efforts in achieving the UN's Millennium Development Goal 5 in sub-Saharan Africa

Recurrent Pregnancy Loss

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Véronique Piroux

1997-01-01

Full Text Available Antiphospholipid antibodies (APA are associated with thrombosis, thrombocytopenia and fetal loss but they occur in a variety of diseases. Despite many efforts, a correlation between the specificity of particular subgroups of APA and particular clinical situations remains to be established. The antigens at the origin of APA remain to be identified. We discuss here the possible links between cell apoptosis or necrosis, leading to plasma membrane alterations, and the occurrence of APA in response to sustained stimulation. The pathogenic potential of APA is also considered with respect to recurrent pregnancy loss.

Contemporary management of human immunodeficiency virus in pregnancy.

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Donnelly, Meghan; Davies, Jill K

2014-12-01

Contemporary management of HIV in pregnancy remains a moving target. With the development of newer antiretroviral agents with lower side-effect profiles and laboratory methods for detection and monitoring of HIV, considerable progress has been made. This review examines key concepts in the pathophysiology of HIV and pregnancy with emphasis on perinatal transmission and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and for those women with preexisting infection are discussed. Preconception counseling for HIV+ women as well as postpartum issues are addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study

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Menaca, A.; Pell, C.; Manda-Taylor, L.; Chatio, S.; Afrah, N.A.; Were, F.; Hodgson, A.; Ouma, P.; Kalilani, L.; Tagbor, H.; Pool, R.

2013-01-01

Background: In sub-Saharan Africa, the burden of morbidity and mortality linked to malaria during pregnancy (MiP) is significant and compounded by its unclear symptoms and links with other health problems during pregnancy. Mindful of the biomedical and social complexity of MiP, this article explores

Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system.

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Kim, Min Kyoung; Lee, Seung Mi; Bae, Sung-Hee; Kim, Hyun Joo; Lim, Nam Gu; Yoon, Seok-Jun; Lee, Jin Yong; Jo, Min-Woo

2018-01-05

Low socioeconomic status can increase the risk of adverse pregnancy outcomes, but it remains unclear whether this negative association is attributed to inadequate prenatal care. Korea has been adopting a universal healthcare system. All Korean citizens must be enrolled National Health Insurance (NHI) or be recipient of Medical Aid (MA). In addition, Korean government launched a financial support system for antenatal care for all pregnant women in 2008. Therefore, in theory, there is no financial barrier to receive prenatal cares regardless of someone's social class. However, it is still unclear whether adverse pregnancy outcomes observed in low-income women are attributable to low SES or to economic barriers specific to the utilization of medical services. The purpose of this study was to investigate whether socioeconomic status affects pregnancy outcomes after the introduction of this support system, which allows all pregnant women to receive adequate prenatal care regardless of socioeconomic status. Using the National Health Insurance database in Korea, we selected women who gave birth between January 1, 2010 and December 31, 2010. As a proxy indicator reflecting socioeconomic status, we classified subjects as MA recipient ("low" SES) or a NHI beneficiary ("middle/high" SES). In the MA group, 29.4% women received inadequate prenatal care, compared to 11.4% in the NHI group. Mothers in the MA group were more likely to have an abortion (30.1%), rather than deliver a baby, than those in the NHI group (20.7%, P < 0.001). Mothers in the MA group were also more likely to undergo a Caesarean delivery (45.8%; NHI group: 39.6%, P < 0.001), and have preeclampsia (1.5%; NHI group: 0.6%, P < 0.001), obstetric hemorrhage (4.7%; NHI group: 3.9%, P = 0.017), and a preterm delivery (2.1%; NHI group: 1.4%, P < 0.001) than those in the NHI group. Women in the MA group tended to show higher rates of abortion, Caesarean delivery, preeclampsia, preterm delivery

Transient osteoporosis of pregnancy of the bilateral hips in twin gestation: a case series.

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Reese, Maria E; Fitzgerald, Colleen; Hynes, Christina

2015-01-01

Transient osteoporosis of pregnancy has been described as a rare, self-limiting disease of unclear etiology that presents as severe pain, which typically affects pregnant women in their third trimester. We describe 3 cases of primigravid pregnant women with twin gestation who reported unilateral hip pain and who were diagnosed with transient osteoporosis of pregnancy of the hip by magnetic resonance imaging. These women were advised to undergo limited weight bearing and activity modification to minimize the risk of fracture. Each patient was able to proceed through her pregnancy, delivery, and postpartum course without complication, with symptom resolution, and return to unrestricted activity. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Successful Pregnancies Post Renal Transplantation

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Alfi Adnan

2008-01-01

Full Text Available To evaluate the maternal and fetal outcomes in renal transplant female recipients who became pregnant from 1989 to 2005 in our center, we retrospectively studied 20 incident pregnancies in 12 renal transplant recipients; 5 (41.7 % of them from living related, 4 (33.3% from deceased, and 3 (25% from living unrelated donors. The mean age at pregnancy was 30.5 ± 4.5 years and mean interval from transplantation to pregnancy was 21 ± 5.7 months with the interval was < 1 year in one patient. The mean serum creatinine (SCr before pregnancy vs 6 months post delivery was 110 ± 24.3, and 156 ± 190 µmol/ L, respectively, (p = 0.2. All patients were normotensive during the prenatal period except two who were hypertensive, none was markedly proteinuric, and only one acute rejection episode occurred during one pregnancy. Graft loss one year post delivery occurred in 2 patients; one with elevated prenatal SCr > 132 µmol/L, and another with short interval from transplantation to pregnancy < 1 year, while the remaining 10 patients revealed current mean SCr of 105 ± 18.2 µmol/L. Complications during pregnancy inclu-ded pre-eclampsia in (25%, UTI (25%, preterm delivery < 37 weeks (30%, however, none of the pregnancies ended by abortion. Normal vaginal delivery vs cesarean section was 70% vs 30%, respectively. Gestational age at delivery was 36.3 ± 3.9 weeks, and mean fetal birth weight was 2349 ± 574 gm. Apgar score was 9-10 in all of the 20 babies, and none revealed intrauterine growth retardation or congenital anomalies. We conclude that consecutive pregnancies demons-trate long-term maternal and fetal survival and function. The major risk factors are elevated starting serum creatinine, hypertension, and short time interval from transplantation to pregnancy.

Pregnancy, maternal tobacco smoking and early age leukemia in Brazil

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Sergio eKoifman

2012-11-01

Full Text Available Background: Cigarette smoking has been associated with acute myeloid leukemia but hypothesis on the association between maternal smoking during pregnancy and childhood leukemia is unclear. Objectives: To investigate the association between maternal exposure to tobacco smoking during pregnancy and early age (< 2 yr. leukemia (EAL. Methods: A hospital-based multicenter case-control study aiming to explore EAL risk factors was carried out in Brazil during 1999-2007. Data were collected by direct interview with the biological mothers using a standardized questionnaire. The present study included 675 children, being 193 acute lymphoblastic leukemia (ALL, 59 acute myeloid leukemia (AML, and 423 controls, being the latter age frequency matched and paired by area of residence with the cases. Unconditional logistic regression was performed, and odds ratios (OR on the association between tobacco smoking (3 months before pregnancy, during pregnancy, and 3 months after delivery and EAL were ascertained after adjustment for selected variables (maternal age at birth and education, birth weight, infant skin color, and oral contraceptives use during pregnancy.Results: Smoking was reported by 17.5% of case mothers and 20.6% of controls´. Among women who reported to have smoked 20 or more cigarettes during the index pregnancy, an adjusted OR = 5.28 (95% C.I. 1.40-19.95 for ALL was observed. Heavy smoking during breastfeeding yielded an adjusted risk estimate for ALL, OR = 7.78 (95% C.I. 1.33-45.5. No dose-response effect was observed according to smoking exposure during pregnancy and EAL. An association between secondhand smoking during pregnancy or breastfeeding was not observed. Conclusion: An association between maternal smoking and AAL in the offspring was restricted to women who have reported an intense exposure to tobacco smoke during pregnancy and breastfeeding.

Pregnancy In Renal Transplant Recipients

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H. Shahbazian

2006-07-01

Full Text Available Background:Correction of the uremic state by a functioning allograft often restores fertility in women of reproductive age. The rate of fertility significantly differs between industrial countries, developing and middle east countries.On the other hand the results of pregnancy in Kidney Transplantation (KTP patients are significantly better than hemodialysis patients,and pregnancy most often has no side effects on the function of the transplanted kidney.Objectives: The purpose of this study is to investigate the rate of fertility and results of pregnancy among KTP women, and the assessment of the function of transplanted kidneys during pregnancy among those who have received kidneys in Golestan Hospital from 1996 to 2003. Methods: All the transplanted women in child bearing age who were interested in accepting pregnancy were involved in this study. After pregnancy, all the patients were visited twice a month until the 32nd week of pregnancy and their histories were taken and regular clinical examination and necessary paraclinical assessments were carried out. After the 32nd week, they were visited weekly and other necessary assessments were done in addition to previous measures. Taking immunosuppressive drugs was continued with a minor dose reduction and consumption of harmful drugs like some antihypertensives was prohibited. Results: 16 out of 48 women who were at child bearing age and were interested in pregnancy got pregnant and totally 22 cases of pregnancy occurred. Four cases resulted in spontaneous or therapeutic abortion and 3 out of 18 remaining cases had intrauterine fetal death and the others had successful pregnancy. The most common complication was LBW and following that premature labor. Maternal complications were no more than the general population and the function of the transplanted kidney had no decline in most of the cases. Conclusion:Based on what was mentioned,it is concluded that successful KTP can increase the chance of

A Case Report of Ruptured Spontaneous Heterotopic Pregnancy

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F Seidoshohadaei

2008-04-01

Full Text Available ABSTRACT: Introduction & Objective: Heterotopic pregnancy refers to the simultaneous occurrence of pregnancy intrauterine and outside of uterine corpus. It is most often manifested in women who have undergone artificial reproductive technology (ART but rarely occurs spontaneously. Heterotopic pregnancy still remains as a diagnostic and therapeutic challenge to practitioners. In this situation physicians should have high suspicion for diagnosis and intrauterine pregnancy protection. This study reported a case of ruptured spontaneous heterotopic pregnancy. Case: A 32 year-old woman with abdominal pain, nausea, vomiting and hypovolumic shock in 1386 referred to emergency department in Sanandaj hospital. She reported one previous cesarean section. On examination, the patient's abdomen was distended. She had generalized tenderness and rebound tenderness in abdomen. The ultrasonographic examination revealed large amount of fluid in pelvic and abdominal cavity with a large hematoma in right adnex but there was intrauterine pregnancy at 7 weeks with normal fetal heart activity. She underwent laparotomy for heterotopic pregnancy and ruptured tube with tubal pregnancy removed. Intrauterine pregnancy continued without problem and led to birth of a healthy female neonate. Conclusion: Physicians should be quite cautious of heterotopic pregnancy in woman at reproductive age. Any abnormality on physical examination or ultrasonography of a patient with intrauterine pregnancy and abdominal pain should heighten the clinician's suspicion for heterotopic pregnancy

EMMPRIN-mediated induction of uterine and vascular matrix metalloproteinases during pregnancy and in response to estrogen and progesterone.

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Dang, Yiping; Li, Wei; Tran, Victoria; Khalil, Raouf A

2013-09-15

Pregnancy is associated with uteroplacental and vascular remodeling in order to adapt for the growing fetus and the hemodynamic changes in the maternal circulation. We have previously shown upregulation of uterine matrix metalloproteinases (MMPs) during pregnancy. Whether pregnancy-associated changes in MMPs are localized to the uterus or are generalized in feto-placental and maternal circulation is unclear. Also, the mechanisms causing the changes in uteroplacental and vascular MMPs during pregnancy are unclear. MMPs expression, activity and tissue distribution were measured in uterus, placenta and aorta of virgin, mid-pregnant (mid-Preg) and late pregnant (late-Preg) rats. Western blots and gelatin zymography revealed increases in MMP-2 and -9 in uterus and aorta of late-Preg compared with virgin and mid-Preg rats. In contrast, MMP-2 and -9 were decreased in placenta of late-Preg versus mid-Preg rats. Extracellular MMP inducer (EMMPRIN) was increased in uterus and aorta of pregnant rats, but was less in placenta of late-Preg than mid-Preg rats. Prolonged treatment of uterus or aorta of virgin rats with 17β-estradiol and progesterone increased the amount of EMMPRIN, MMP-2 and -9, and the sex hormone-induced increases in MMPs were prevented by EMMPRIN neutralizing antibody. Immunohistochemistry revealed that MMP-2 and -9 and EMMPRIN increased in uterus and aorta of pregnant rats, but decreased in placenta of late-Preg versus mid-Preg rats. Thus pregnancy-associated upregulation of uterine MMPs is paralleled by increased vascular MMPs, and both are mediated by EMMPRIN and induced by estrogen and progesterone, suggesting similar role of MMPs in uterine and vascular tissue remodeling and function during pregnancy. The decreased MMPs and EMMPRIN in placenta of late-Preg rats suggests reduced role of MMPs in feto-placental circulation during late pregnancy. Copyright © 2013 Elsevier Inc. All rights reserved.

Cytomegalovirus infection in pregnancy.

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Kagan, Karl Oliver; Hamprecht, Klaus

2017-07-01

Due to the severe risk of long-term sequelae, prenatal cytomegalovirus infection is of particular importance amongst intrauterine viral infections. This review summarizes the current knowledge about CMV infection in pregnancy. A search of the Medline and Embase database was done for articles about CMV infection in pregnany. We performed a detailed review of the literature in view of diagnosis, epidemiology and management of CMV infection in pregnancy. The maternal course of the infection is predominantly asymptomatic; the infection often remains unrecognized until the actual fetal manifestation. Typical ultrasound signs that should arouse suspicion of intrauterine CMV infection can be distinguished into CNS signs such as ventriculomegaly or microcephaly and extracerebral infection signs such as hepatosplenomegaly or hyperechogenic bowel. Current treatment strategies focus on hygienic measures to prevent a maternal CMV infection during pregnancy, on maternal application of hyperimmunoglobulines to avoid materno-fetal transmission in case of a maternal seroconversion, and on an antiviral therapy in case the materno-fetal transmission have occurred. CMV infection in pregnancy may result in a severe developmental disorder of the newborn. This should be taken into account in the treatment of affected and non-affected pregnant women.

[Large ovarian cyst associated with pregnancy. Case report].

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David, Cristina; Lupaşcu, Ivona; Socolov, Demetra; Vişan, Valeria

2008-01-01

The incidence of adnexal masses in pregnancy is rather low. The diagnosis has become more common with the routine use of ultrasonography in prenatal care. The management of adnexal masses during pregnancy remains controversial. Ultrasonography can characterise correctly the adnexal mass and avoid antepartum surgery. We present the case of a 32 years old gravida, IV gesta, I para, with an ovarian cystic tumour that enlarged during pregnancy from 7 cm to 20 cm. The tumour was correctly characterised by ultrasound exam (Sassone 3) and surgery was not indicated. The pregnancy evoluated well and the patient delivered at term by c. section and ovariectomy was also performed. The postpartum evolution was good.

The MRI diagnosis of extra-uterine pregnancy

International Nuclear Information System (INIS)

Huang Yong; Li Jianping

2002-01-01

Objective: It's an investigation of the finding and diagnostic value of MRI in extrauterine pregnancy. Methods: A retrospective analysis of the MR images and clinical data was made in 4 cases with extra-uterine pregnancy. All cases were confirmed by surgery and pathology. Results: All lesions were found in oviducts. Un-ruptured oviductal pregnancy represented a round hypo-intense area with a lower signaled center on T1WI, and a hyper-intense area on T2WI, while higher signal of the embryo sac wall was revealed on T2WI. In the rest 2 cases, ruptured ectopic pregnancy presented with a complicated intense mass on T1WI, where hyper-intense patches were scattered within lesion. On T2WI, the ruptured oviductal pregnancy was a mixture of iso-intense or hyper-intense components. On T2WI/IR fat suppressing sequence the hyper-intense area remained high signal intensity. A ruptured oviductal pregnancy resulted in a larger mass with hemorrhage found in pelvic cavity. Conclusion: Extra-uterine pregnancy has characteristic MRI manifestations, by which an accurate diagnosis is established with clinical data

Hyperparathyroidism complicating pregnancy: A diagnostic challenge?

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S N Jibhkate

2014-01-01

Full Text Available Primary hyperparathyroidism (PHPT is a rare etiology of hypercalcemia-induced pancreatitis, contributing about 0.4% to 1.5% of cases in the general population and up to 13% of cases during pregnancy. PHPT that occurs during pregnancy is a challenging diagnosis as the physiological changes in calcium homeostasis mask the symptoms of hypercalcemia. PHPT during pregnancy often remains undiagnosed and untreated, and may result in serious clinical implications for the mother and fetus. Most clinicians consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. This article refers to a case of a 24-year married woman in whom PHPT was diagnosed for the first time in postpartum period. She succumbed to complications on Day 20 postpartum. Pathological findings revealed metastatic calcification in lungs, pancreas and uterine vessels, chronic pancreatitis and renal cortical necrosis.

Obesity Disrupts the Rhythmic Profiles of Maternal and Fetal Progesterone in Rat Pregnancy.

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Crew, Rachael C; Mark, Peter J; Clarke, Michael W; Waddell, Brendan J

2016-09-01

Maternal obesity increases the risk of abnormal fetal growth, but the underlying mechanisms remain unclear. Because steroid hormones regulate fetal growth, and both pregnancy and obesity markedly alter circadian biology, we hypothesized that maternal obesity disrupts the normal rhythmic profiles of steroid hormones in rat pregnancy. Obesity was established by cafeteria (CAF) feeding for 8 wk prior to mating and throughout pregnancy. Control (CON) animals had ad libitum access to chow. Daily profiles of plasma corticosterone, 11-dehydrocorticosterone, progesterone, and testosterone were measured at Days 15 and 21 of gestation (term = 23 days) in maternal (both days) and fetal (Day 21) plasma. CAF mothers exhibited increased adiposity relative to CON and showed fetal and placental growth restriction. There was no change, however, in total fetal or placental mass due to slightly larger litter sizes in CAF. Nocturnal declines in progesterone were observed in maternal (39% lower) and fetal (45% lower) plasma in CON animals, but these were absent in CAF animals. CAF mothers were hyperlipidemic at both days of gestation, but this effect was isolated to the dark period at Day 21. CAF maternal testosterone was slightly lower at Day 15 (8%) but increased above CON by Day 21 (16%). Despite elevated maternal testosterone, male fetal testosterone was suppressed by obesity on Day 21. Neither maternal nor fetal glucocorticoid profiles were affected by obesity. In conclusion, obesity disrupts rhythmic profiles of maternal and fetal progesterone, preventing the normal nocturnal decline. Obesity subtly changed testosterone profiles but did not alter maternal and fetal glucocorticoids. © 2016 by the Society for the Study of Reproduction, Inc.

Pregnancy in women with systemic lupus erythematosus.

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Kiss, Emese; Bhattoa, Harjit P; Bettembuk, Peter; Balogh, Adam; Szegedi, Gyula

2002-03-10

Systemic lupus erythematosus (SLE) is an autoimmune disorder which may be affected by hormonal changes, such as those of pregnancy. Women with SLE have increased adverse pregnancy outcomes. A retrospective analysis of the gynecologic and immunologic case history of 140 women with SLE and the outcome of 263 pregnancies in 99 women with SLE. In patients diagnosed with SLE, the proportion of pregnancies ending with live birth at term decreased to one-third compared with three quarters in those without a diagnosis of SLE and the incidence of pre-term deliveries and spontaneous abortions increased by 6.8 and 4.7 times, respectively. When SLE was associated with secondary antiphospholipid (APL) syndrome, and lupus anticoagulant (LA) or beta2-glycoprotein antibodies were present, a further increase in the incidence of pregnancy loss was observed. Pregnancy did not cause a flare-up of SLE in all cases, the disease remained stable in about 30% of the patients. Lupus was mild in the majority of the women who carried out their pregnancy to term. We also observed mothers with active SLE who successfully carried out pregnancies to term. These findings accord with previous literature and should inform rheumatologists, obstetricians and neonatologists who guide patients in their reproductive decisions.

Comparative analysis between endometrial proteomes of pregnant and non-pregnant ewes during the peri-implantation period

OpenAIRE

Zhao, Haichao; Sui, Linlin; Miao, Kai; An, Lei; Wang, Dong; Hou, Zhuocheng; Wang, Rui; Guo, Min; Wang, Zhilong; Xu, Jiqiang; Wu, Zhonghong; Tian, Jianhui

2015-01-01

Background Early pregnancy failure has a profound impact on both human reproductive health and animal production. 2/3 pregnancy failures occur during the peri-implantation period; however, the underlying mechanism(s) remains unclear. Well-organized modification of the endometrium to a receptive state is critical to establish pregnancy. Aberrant endometrial modification during implantation is thought to be largely responsible for early pregnancy loss. Result In this study, using well-managed r...

Maternal Methyl-Group Donor Intake and Global DNA (HydroxyMethylation before and during Pregnancy

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Sara Pauwels

2016-08-01

Full Text Available It is still unclear to which extent methyl-group intake during pregnancy can affect maternal global DNA (hydroxylmethylation. Pregnancy methylation profiling and its link with methyl-group intake in a healthy population could enhance our understanding of the development of pregnancy related disorders. One hundred forty-eight women were enrolled in the MANOE (MAternal Nutrition and Offspring’s Epigenome study. Thiry-four women were enrolled before pregnancy and 116 during the first trimester of pregnancy. Global DNA (hydroxymethylation in blood using LC-MS/MS and dietary methyl-group intake (methionine, folate, betaine, and choline using a food-frequency questionnaire were estimated pre-pregnancy, during each trimester, and at delivery. Global DNA (hydroxymethylation levels were highest pre-pregnancy and at weeks 18–22 of pregnancy. We observed a positive relation between folic acid and global DNA methylation (p = 0.04 and hydroxymethylation (p = 0.04. A high intake of methionine pre-pregnancy and in the first trimester showed lower (hydroxymethylation percentage in weeks 11–13 and weeks 18–22, respectively. Choline and betaine intake in the first weeks was negatively associated with hydroxymethylation. Women with a high intake of these three methyl groups in the second and third trimester showed higher hyrdoxymethylation/methylation levels in the third trimester. To conclude, a time trend in DNA (hydroxymethylation was found and women with higher methyl-group intake showed higher methylation in the third trimester, and not in earlier phases of pregnancy.

SSRI use in pregnancy: Evaluating the risks and benefits | du Toit ...

African Journals Online (AJOL)

Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy. Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant ...

The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management.

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Tabassum, Meher; Atmuri, Kiran

2017-01-01

Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant) in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

Triptan safety during pregnancy: a Norwegian population registry study

International Nuclear Information System (INIS)

Nezvalová-Henriksen, Kateřina; Spigset, Olav; Nordeng, Hedvig

2013-01-01

Knowledge on triptan safety during pregnancy remains limited to their class effect or studies on sumatriptan. Our aim was to evaluate the individual effect of four most frequently used triptans on several pregnancy outcomes. We used the Norwegian prescription database to access information on triptans redeemed by pregnant women living in Norway between 2004 and 2007. This database was linked to the Medical Birth Registry of Norway covering every institutional delivery in Norway and providing information on pregnancy, delivery, maternal and neonatal health. Estimates of associations with pregnancy outcomes were obtained by Generalised Estimation Equations analysis. Of the 181,125 women in our study, 1,465 (0.8 %) redeemed triptans during pregnancy, and 1,095 (0.6 %) redeemed triptans before pregnancy only (disease comparison group). The population comparison group comprised the remaining 178,565 women. Using this group as reference, we found no associations between triptan redemption during pregnancy and congenital malformations. Second trimester redemption was associated with postpartum haemorrhage (adjusted OR 1.57; 95 % CI 1.19–2.07). The disease comparison group had an increased risk of major congenital malformations (adjusted OR 1.48; 95 % CI 1.11–1.97), low birth weight (adjusted OR 1.39; 95 % CI 1.08–1.81), and preterm birth (adjusted OR 1.30; 95 % CI 1.06–1.60). The association of triptans with postpartum hemorrhage could be attributable to decreased platelet agreeability occurring in severe migraine. Likewise, the increased risk of major congenital malformations and other adverse pregnancy outcomes in the disease comparison group might be attributable to migraine severity

Alcohol use disorders in pregnancy.

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DeVido, Jeffrey; Bogunovic, Olivera; Weiss, Roger D

2015-01-01

Alcohol use disorders (AUDs) are less prevalent in pregnant women than in nonpregnant women, but these disorders can create a host of clinical challenges when encountered. Unfortunately, little evidence is available to guide clinical decision making in this population. Drinking alcohol during pregnancy can have negative consequences on both fetus and mother, but it remains controversial as to the volume of alcohol consumption that correlates with these consequences. Likewise, little evidence is available to support the use of particular pharmacologic interventions for AUDs during pregnancy or to guide the management of alcohol detoxification in pregnant women. The use of benzodiazepines (the mainstay of most alcohol detoxification protocols) in pregnant women is controversial. Nevertheless, despite the lack of robust data to guide management of AUDs in pregnancy, clinicians need to make management decisions when confronted with these challenging situations. In that context, this article reviews the epidemiology of AUDs in pregnancy and the pharmacologic management of both AUDs and alcohol withdrawal in pregnant women, with the goal of informing clinicians about what is known about managing these co-occurring conditions.

The acute phase protein ceruloplasmin as a non-invasive marker of pseudopregnancy, pregnancy, and pregnancy loss in the giant panda.

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Erin L Willis

Full Text Available After ovulation, non-pregnant female giant pandas experience pseudopregnancy. During pseudopregnancy, non-pregnant females exhibit physiological and behavioral changes similar to pregnancy. Monitoring hormonal patterns that are usually different in pregnant mammals are not effective at determining pregnancy status in many animals that undergo pseudopregnancy, including the giant panda. Therefore, a physiological test to distinguish between pregnancy and pseudopregnancy in pandas has eluded scientists for decades. We examined other potential markers of pregnancy and found that activity of the acute phase protein ceruloplasmin increases in urine of giant pandas in response to pregnancy. Results indicate that in term pregnancies, levels of active urinary ceruloplasmin were elevated the first week of pregnancy and remain elevated until 20-24 days prior to parturition, while no increase was observed during the luteal phase in known pseudopregnancies. Active ceruloplasmin also increased during ultrasound-confirmed lost pregnancies; however, the pattern was different compared to term pregnancies, particularly during the late luteal phase. In four out of the five additional reproductive cycles included in the current study where females were bred but no birth occurred, active ceruloplasmin in urine increased during the luteal phase. Similar to the known lost pregnancies, the temporal pattern of change in urinary ceruloplasmin during the luteal phase deviated from the term pregnancies suggesting that these cycles may have also been lost pregnancies. Among giant pandas in captivity, it has been presumed that there is a high rate of pregnancy loss and our results are the first to provide evidence supporting this notion.

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

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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.

High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

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Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Moyaki, Mayowa Gabriel; Goon, Daniel Ter; Avramovic, Gordana; Lambert, John

2018-02-27

Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were

Pregnancy-Associated Severe Sepsis: Contemporary State and Future Challenges.

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Oud, Lavi

2014-12-01

Pregnancy is associated with an increased risk of infection related to its associated mechanical and physiological changes. Sepsis remains among the top causes of maternal death worldwide and is associated with substantial maternal morbidity. However, there are sparse data on pregnancy-associated severe sepsis (PASS), related in part to infrequent reports, varying case definitions and methodological approach, small cohort size, and often limited focus on severe sepsis in selected phases of pregnancy outcomes. Available reports vary, but indicate that PASS is a rare but likely increasing complication, and it is more likely to develop with increased maternal age, among minority women, the poor, those lacking health insurance, those with chronic illness or pregnancy-associated complications, and following invasive procedures. Obstetric sites of infection are the most prevalent, but non-obstetric infections often underlie pregnancy-associated severe sepsis, though the source of infection is often not readily apparent during initial care. Women with PASS can have a rapidly fatal course and require heightened clinician vigilance for early diagnosis and timely effective intervention. Nevertheless, available reports raise concerns about prevalent substandard care of these patients, contributing to adverse outcomes. The case fatality of PASS appears lower than that in the general population with severe sepsis, while the long-term outcomes of survivors remain unknown.

Teenage pregnancy and mental health beyond the postpartum period: a systematic review.

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Xavier, Chloé; Benoit, Anita; Brown, Hilary K

2018-02-08

Teenage mothers are at increased risk for adverse social outcomes and short-term health problems, but long-term impacts on mental health are poorly understood. The aims of our systematic review were to determine the association between teenage pregnancy and mental health beyond the postpartum period, critically appraise the literature's quality and guide future research. We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus and Web of Science from inception to June 2017 for peer-reviewed articles written in English or French. Data were collected using a modified Cochrane Data Extraction Form. Study quality was assessed using the Effective Public Health Practice Project critical appraisal tool. Heterogeneity of studies permitted only a qualitative synthesis. Nine quantitative studies comprising the results from analyses of 11 cohorts met our criteria and were rated as strong (n=5), moderate (n=2) or weak (n=2). Three cohorts found a statistically significant association between teenage pregnancy and poor long-term mental health after adjustment, three found a statistically significant association before but not after adjustment and five did not find a statistically significant association. Studies observed varying degrees of attenuation after considering social context. Studies with statistically significant findings tended to comprise earlier cohorts, with outcomes measured at older ages. The association between teenage pregnancy and mental health beyond the postpartum period remains unclear. Future studies should employ age-period-cohort frameworks to disentangle effects of normative patterns and stress accumulation. Social factors are important in determining long-term mental health of teenage mothers and should be prioritised in prevention and intervention strategies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly

Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study.

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Behrens, Ida; Basit, Saima; Melbye, Mads; Lykke, Jacob A; Wohlfahrt, Jan; Bundgaard, Henning; Thilaganathan, Baskaran; Boyd, Heather A

2017-07-12

Objectives  To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time. Design  Nationwide register based cohort study. Setting  Denmark. Populations  482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses). Main outcome measures  10 year cumulative incidences of post-pregnancy hypertension requiring treatment with prescription drugs, and hazard ratios estimated using Cox regression. Results  Of women with a hypertensive disorder of pregnancy in a first pregnancy in their 20s, 14% developed hypertension in the first decade post partum, compared with 4% of women with normotensive first pregnancies in their 20s. The corresponding percentages for women with a first pregnancy in their 40s were 32% and 11%, respectively. In the year after delivery, women with a hypertensive disorder of pregnancy had 12-fold to 25-fold higher rates of hypertension than did women with a normotensive pregnancy. Rates in women with a hypertensive disorder of pregnancy were threefold to 10-fold higher 1-10 years post partum and remained twice as high even 20 or more years later. Conclusions  The risk of hypertension associated with hypertensive disorders of pregnancy is high immediately after an affected pregnancy and persists for more than 20 years. Up to one third of women with a hypertensive disorder of pregnancy may develop hypertension within a decade of an affected pregnancy, indicating that cardiovascular disease prevention in these women should include blood pressure monitoring initiated soon after pregnancy. 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.

Antinuclear autoantibodies and pregnancy outcome in women with unexplained recurrent miscarriage.

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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.

Inflammatory Bowel Disease During Pregnancy.

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Rajapakse, Ramona; Korelitz, Burton I.

2001-06-01

aggressively, as remission remains the greatest investment for a favorable pregnancy outcome.

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

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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.

In vivo immune signatures of healthy human pregnancy: Inherently inflammatory or anti-inflammatory?

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Caroline Graham

Full Text Available Changes in maternal innate immunity during healthy human pregnancy are not well understood. Whether basal immune status in vivo is largely unaffected by pregnancy, is constitutively biased towards an inflammatory phenotype (transiently enhancing host defense or exhibits anti-inflammatory bias (reducing potential responsiveness to the fetus is unclear. Here, in a longitudinal study of healthy women who gave birth to healthy infants following uncomplicated pregnancies within the Canadian Healthy Infant Longitudinal Development (CHILD cohort, we test the hypothesis that a progressively altered bias in resting innate immune status develops. Women were examined during pregnancy and again, one and/or three years postpartum. Most pro-inflammatory cytokine expression, including CCL2, CXCL10, IL-18 and TNFα, was reduced in vivo during pregnancy (20-57%, p<0.0001. Anti-inflammatory biomarkers (sTNF-RI, sTNF-RII, and IL-1Ra were elevated by ~50-100% (p<0.0001. Systemic IL-10 levels were unaltered during vs. post-pregnancy. Kinetic studies demonstrate that while decreased pro-inflammatory biomarker expression (CCL2, CXCL10, IL-18, and TNFα was constant, anti-inflammatory expression increased progressively with increasing gestational age (p<0.0001. We conclude that healthy resting maternal immune status is characterized by an increasingly pronounced bias towards a systemic anti-inflammatory innate phenotype during the last two trimesters of pregnancy. This is resolved by one year postpartum in the absence of repeat pregnancy. The findings provide enhanced understanding of immunological changes that occur in vivo during healthy human pregnancy.

The Unexpected Ovarian Pregnancy at Laparoscopy: A Review of Management

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Meher Tabassum

2017-01-01

Full Text Available Ovarian ectopic pregnancies are a rare occurrence; however the incidence is on the rise. Preoperative diagnosis remains difficult due to nonspecific clinical symptoms and USS findings. Most patients undergo diagnostic laparoscopy with subsequent surgical management. We present the case of a 32-year-old female who presented with vaginal bleeding and an unsited pregnancy, with a BhCG of 24693. Formal USS described unruptured right tubal ectopic with ovarian pregnancy being diagnosed at laparoscopy. A wedge resection was conducted to preserve ovarian function. Postoperative recovery was uneventful and BhCG levels returned to zero (nonpregnant in an outpatient setting. Although laparoscopy remains the gold standard of diagnosis and treatment, in this case report we discuss benefits of early diagnosis for fertility conserving management, including nonsurgical options.

Heartburn and regurgitation in pregnancy: the effect of fat ingestion.

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Dall'Alba, Valesca; Fornari, Fernando; Krahe, Cláudio; Callegari-Jacques, Sidia Maria; Silva de Barros, Sérgio Gabriel

2010-06-01

Reflux symptoms are common in pregnancy, but their association with fat ingestion is unclear. To investigate an association of dietary fats with heartburn and regurgitation in pregnancy. This is a prospective study in which 89 pregnant women (gestational age 34 +/- 4 weeks) attending a low-risk prenatal outpatient clinic were asked to provide information on the frequency they experienced heartburn and regurgitation. Fat ingestion was estimated by means of a 24-h diet record. Symptomatic patients were compared with those with no reflux symptoms (n = 20). Heartburn once a week or more often occurred in 56 of the 89 patients (63%). The ingested amount of polyunsaturated fatty acids was higher in patients with heartburn (11.2 +/- 6.4 vs. 7.7 +/- 3.5 mg; P = 0.022) than in controls after adjusting for age, gain weight during pregnancy, ingestion of caffeine and vitamin C, and total energetic intake. The ingestion of monounsaturated fatty acids was higher in patients with heartburn, but with a borderline statistical significance (16.1 +/- 11 vs. 11.8 +/- 6.5 mg; P = 0.061). No association was observed between the consumption of fats and regurgitation. This study suggests that heartburn in the third trimester of pregnancy is associated with the ingestion of polyunsaturated fatty acids.

Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study

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Menaca, A.; Pell, C.; Manda-Taylor, L.; Chatio, S.; Afrah, N.A.; Were, F.; Hodgson, A.; Ouma, P.; Kalilani, L.; Tagbor, H.; Pool, R.

2013-01-01

Background: In sub-Saharan Africa, the burden of morbidity and mortality linked to malaria during pregnancy (MiP) is significant and compounded by its unclear symptoms and links with other health problems during pregnancy. Mindful of the biomedical and social complexity of MiP, this article explores and compares local understandings of MiP and their links with other pregnancy-related health problems. Methods: A comparative qualitative study was undertaken at four sites in three countries: Gha...

Surrogate pregnancy: a guide for Canadian prenatal health care providers

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Reilly, Dan R.

2007-01-01

Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is l...

Recurrent pregnancy loss: current perspectives

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El Hachem H

2017-05-01

Full Text Available Hady El Hachem,1,2 Vincent Crepaux,3 Pascale May-Panloup,4 Philippe Descamps,3 Guillaume Legendre,3 Pierre-Emmanuel Bouet3 1Department of Reproductive Medicine, Ovo Clinic, Montréal, QC, Canada; 2Department of Obstetrics and Gynecology, University of Montreal, Montréal, QC, Canada; 3Department of Obstetrics and Gynecology, Angers University Hopsital, Angers, France; 4Department of Reproductive Biology, Angers University Hospital, Angers, France Abstract: Recurrent pregnancy loss is an important reproductive health issue, affecting 2%–5% of couples. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Other etiologies have been proposed but are still considered controversial, such as chronic endometritis, inherited thrombophilias, luteal phase deficiency, and high sperm DNA fragmentation levels. Over the years, evidence-based treatments such as surgical correction of uterine anomalies or aspirin and heparin for antiphospholipid syndrome have improved the outcomes for couples with recurrent pregnancy loss. However, almost half of the cases remain unexplained and are empirically treated using progesterone supplementation, anticoagulation, and/or immunomodulatory treatments. Regardless of the cause, the long-term prognosis of couples with recurrent pregnancy loss is good, and most eventually achieve a healthy live birth. However, multiple pregnancy losses can have a significant psychological toll on affected couples, and many efforts are being made to improve treatments and decrease the time needed to achieve a successful pregnancy. This article reviews the established and controversial etiologies, and the recommended therapeutic strategies, with a special focus on unexplained recurrent pregnancy losses and the empiric treatments used nowadays. It also discusses the current role of preimplantation genetic testing in the management of recurrent pregnancy

Antibiotics for asymptomatic bacteriuria in pregnancy.

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Smaill, Fiona M; Vazquez, Juan C

2015-08-07

Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 March 2015) and reference lists of retrieved studies. Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Fourteen studies, involving almost 2000 women, were included. Antibiotic treatment compared with placebo or no treatment reduced the incidence of pyelonephritis (average risk ratio (RR) 0.23, 95% confidence interval (CI) 0.13 to 0.41; 11 studies, 1932 women; very low quality evidence). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; six studies, 1437 babies; low quality evidence) and preterm birth (RR 0.27, 95% CI 0.11 to 0.62; two studies, 242 women; low quality evidence). A reduction in persistent bacteriuria at the time of delivery was seen (average RR 0.30, 95% CI 0.18 to 0.53; four studies; 596 women). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes and maternal adverse effects were rarely described.Overall, all 14 studies were assessed as being at high or unclear risk of bias. While many studies lacked an adequate description of methods and the risk of bias could only be assessed as unclear, in almost all studies there was at least one domain where the risk of bias was judged as high. The three primary outcomes were assessed with

[Relation Between Stress During Pregnancy and Spontaneous Preterm Birth].

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Ortiz Martínez, Roberth Alirio; Castillo, Alejandro

2016-01-01

Preterm birth occurs before 37 completed weeks, its causes are multifactorial and vary according to the gestational age, ethnicity and geographical context. Although several medical/social factors have been clearly identified, over 50% of cases are unknown or unclear; however, psychopathological components emerge as potentially important risk factors. To determine the relationship between the presence of stress during pregnancy and spontaneous preterm birth. Through a study of cases and controls in a level III hospital, with a sample of 360 patients during the period from March to November of 2013, where sociodemographic characteristics were collected. In addition, they were applied scales social adjustment, coping strategies and social support. Logistic regression models were developed; psychological, biological and social. Based on the significant variables in each of these generated a final one. The final model was found that stress during pregnancy increases the odds of spontaneous preterm birth 1.91 times (adjusted OR=2.91; 95%CI, 1.67-5.08; P<.05). Other significant variables were: history of preterm delivery, unplanned pregnancy, no emotional support, rural residence, inadequate prenatal care and non-stable partner. The findings support the hypothesis that stress during pregnancy is associated with spontaneous preterm delivery. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada.

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Kate Salters

Full Text Available Pregnancy incidence rates among women living with HIV (WLWH have increased over time due to longer life expectancy, improved health status, and improved access to and HIV prevention benefits of combination antiretroviral therapy (cART. However, it is unclear whether intended or unintended pregnancies are contributing to observed increases.We analyzed retrospective data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS. Kaplan-Meier methods and GEE Poisson models were used to measure cumulative incidence and incidence rate of pregnancy after HIV diagnosis overall, and by pregnancy intention. We used multivariable logistic regression models to examine independent correlates of unintended pregnancy among the most recent/current pregnancy.Of 1,165 WLWH included in this analysis, 278 (23.9% women reported 492 pregnancies after HIV diagnosis, 60.8% of which were unintended. Unintended pregnancy incidence (24.6 per 1,000 Women-Years (WYs; 95% CI: 21.0, 28.7 was higher than intended pregnancy incidence (16.6 per 1,000 WYs; 95% CI: 13.8, 20.1 (Rate Ratio: 1.5, 95% CI: 1.2-1.8. Pregnancy incidence among WLWH who initiated cART before or during pregnancy (29.1 per 1000 WYs with 95% CI: 25.1, 33.8 was higher than among WLWH not on cART during pregnancy (11.9 per 1000 WYs; 95% CI: 9.5, 14.9 (Rate Ratio: 2.4, 95% CI: 2.0-3.0. Women with current or recent unintended pregnancy (vs. intended pregnancy had higher adjusted odds of being single (AOR: 1.94; 95% CI: 1.10, 3.42, younger at time of conception (AOR: 0.95 per year increase, 95% CI: 0.90, 0.99, and being born in Canada (AOR: 2.76, 95% CI: 1.55, 4.92.Nearly one-quarter of women reported pregnancy after HIV diagnosis, with 61% of all pregnancies reported as unintended. Integrated HIV and reproductive health care programming is required to better support WLWH to optimize pregnancy planning and outcomes and to prevent unintended pregnancy.

Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada.

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Salters, Kate; Loutfy, Mona; de Pokomandy, Alexandra; Money, Deborah; Pick, Neora; Wang, Lu; Jabbari, Shahab; Carter, Allison; Webster, Kath; Conway, Tracey; Dubuc, Daniele; O'Brien, Nadia; Proulx-Boucher, Karene; Kaida, Angela

2017-01-01

Pregnancy incidence rates among women living with HIV (WLWH) have increased over time due to longer life expectancy, improved health status, and improved access to and HIV prevention benefits of combination antiretroviral therapy (cART). However, it is unclear whether intended or unintended pregnancies are contributing to observed increases. We analyzed retrospective data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Kaplan-Meier methods and GEE Poisson models were used to measure cumulative incidence and incidence rate of pregnancy after HIV diagnosis overall, and by pregnancy intention. We used multivariable logistic regression models to examine independent correlates of unintended pregnancy among the most recent/current pregnancy. Of 1,165 WLWH included in this analysis, 278 (23.9%) women reported 492 pregnancies after HIV diagnosis, 60.8% of which were unintended. Unintended pregnancy incidence (24.6 per 1,000 Women-Years (WYs); 95% CI: 21.0, 28.7) was higher than intended pregnancy incidence (16.6 per 1,000 WYs; 95% CI: 13.8, 20.1) (Rate Ratio: 1.5, 95% CI: 1.2-1.8). Pregnancy incidence among WLWH who initiated cART before or during pregnancy (29.1 per 1000 WYs with 95% CI: 25.1, 33.8) was higher than among WLWH not on cART during pregnancy (11.9 per 1000 WYs; 95% CI: 9.5, 14.9) (Rate Ratio: 2.4, 95% CI: 2.0-3.0). Women with current or recent unintended pregnancy (vs. intended pregnancy) had higher adjusted odds of being single (AOR: 1.94; 95% CI: 1.10, 3.42), younger at time of conception (AOR: 0.95 per year increase, 95% CI: 0.90, 0.99), and being born in Canada (AOR: 2.76, 95% CI: 1.55, 4.92). Nearly one-quarter of women reported pregnancy after HIV diagnosis, with 61% of all pregnancies reported as unintended. Integrated HIV and reproductive health care programming is required to better support WLWH to optimize pregnancy planning and outcomes and to prevent unintended pregnancy.

Pregnancy before recurrent pregnancy loss more often complicated by post-term birth and perinatal death.

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Wagner, Marise M; Visser, Jantien; Verburg, Harjo; Hukkelhoven, Chantal W P M; Van Lith, Jan M M; Bloemenkamp, Kitty W M

2018-01-01

The cause of recurrent pregnancy loss often remains unknown. Possibly, pathophysiological pathways are shared with other pregnancy complications. All women with secondary recurrent pregnancy loss (SRPL) visiting Leiden University Medical Center (January 2000-2015) were included in this retrospective cohort to assess whether women with SRPL have a more complicated first pregnancy compared with control women. SRPL was defined as three or more consecutive pregnancy losses before 22 weeks of gestation, with a previous birth. The control group consisted of all Dutch nullipara delivering a singleton (January 2000-2015). Information was obtained from the Dutch Perinatal Registry. Outcomes were preeclampsia, preterm birth, post-term birth, intrauterine growth restriction, breach position, induction of labor, cesarean section, congenital abnormalities, perinatal death and severe hemorrhage in the first ongoing pregnancy. Subgroup analyses were performed for women with idiopathic SRPL and for women ≤35 years. In all, 172 women with SRPL and 1 196 178 control women were included. Women with SRPL were older and had a higher body mass index; 29.7 years vs. 28.8 years and 25.1 kg/m 2 vs. 24.1 kg/m 2 , respectively. Women with SRPL more often had a post-term birth (OR 1.86, 95% CI 1.10-3.17) and more perinatal deaths occurred in women with SRPL compared with the control group (OR 5.03, 95% CI 2.48-10.2). Similar results were found in both subgroup analyses. The first ongoing pregnancy of women with (idiopathic) SRPL is more often complicated by post-term birth and perinatal death. Revealing possible links between SRPL and these pregnancy complications might lead to a better understanding of underlying pathophysiology. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Maternal cerebrovascular accidents in pregnancy: incidence and outcomes.

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Walsh, Jennifer; Murphy, Cliona; Murray, Aoife; O'Laoide, Risteard; McAuliffe, Fionnuala M

2010-12-01

Stroke occurring during pregnancy and the postnatal period is a rare but potentially catastrophic event. The aim of this study was to examine the incidence and outcomes of pregnancies complicated by maternal stroke in a single centre. This is a prospective study of over 35,000 consecutive pregnancies over a four-year period at the National Maternity Hospital in Dublin from 2004 to 2008; in addition we also retrospectively examined all cases of maternal mortality at our institution over a 50-year period from 1959 to 2009. We prospectively identified eight cases of strokes complicating pregnancy and the postnatal period giving an overall incidence of 22.34 per 100,000 pregnancies or 24.74 per 100,000 deliveries. There were no stroke-related mortalities during that time. Retrospective analysis of maternal mortality revealed 102 maternal deaths over a 50-year period, 19 (18.6%) of which were due to cerebrovascular accidents. In conclusion, strokes complicating pregnancy and the puerperium remain a rare event and though there appears to be evidence that the incidence is increasing, the associated maternal mortality appears to be falling.

A Comprehensive Review of Hypertension in Pregnancy

Directory of Open Access Journals (Sweden)

Reem Mustafa

2012-01-01

Full Text Available Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals.

IGF-I during primiparous pregnancy and maternal risk of breast cancer

OpenAIRE

Chen, Tianhui; Lukanova, Annekatrin; Grankvist, Kjell; Zeleniuch-Jacquotte, Anne; Wulff, Marianne; Johansson, Robert; Schock, Helena; Lenner, Per; Hallmans, Goran; Wadell, Goran; Toniolo, Paolo; Lundin, Eva

2009-01-01

Abstract Previously, we reported that insulin-like growth factor (IGF)-I during early pregnancy is positively associated with maternal risk of breast cancer. To further explore this association, we designed a new study limited to women who donated a blood sample during their first pregnancy ending with childbirth. A case?control study was nested within the Northern Sweden Maternity Cohort in which repository since 1975, serum specimens remaining after early pregnancy screening for ...

Management and controversies of classical Hodgkin lymphoma in pregnancy.

Science.gov (United States)

Eyre, Toby A; Lau, I-Jun; Mackillop, Lucy; Collins, Graham P

2015-06-01

The goal of managing classical Hodgkin lymphoma (cHL) in pregnancy is to obtain good long-term outcomes for both the mother and fetus. Given the excellent outcomes outside of pregnancy, the goal of treatment should remain curative. There remains a tension and debate regarding the timing of chemotherapy, the curative nature of such treatment and the timing of delivery. Moreover, the aim during pregnancy should be to minimize fetal toxicity and optimize perinatal outcomes. The management of cHL within pregnancy was covered within the excellent recent British Committee for Standards in Haematology guidelines, but with necessary brevity. By reviewing the literature over the last 30 years, herein we discuss the options for management during each trimester. Critical organogenesis occurs between 2 and 8 weeks post-conception; during which time the immature fetus is vulnerable to cytotoxic exposure. We discuss the evidence for using ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and single agent vinblastine in the first trimester. cHL presenting in pregnancy raises complex and difficult ethical dilemmas that can cause anxiety for patients, families and physicians. Decision-making must be multi-disciplinary and holistic, taking into account the patient's wishes, psycho-social and religious beliefs and personal circumstances. Clear communication between the haemato-oncologist, medical obstetrician, nurse specialists, midwives and neonatologists is paramount to a successful outcome. © 2015 John Wiley & Sons Ltd.

Relationship between maternal immunological response during pregnancy and onset of preeclampsia.

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Martínez-Varea, Alicia; Pellicer, Begoña; Perales-Marín, Alfredo; Pellicer, Antonio

2014-01-01

Maternofetal immune tolerance is essential to maintain pregnancy. The maternal immunological tolerance to the semiallogeneic fetus becomes greater in egg donation pregnancies with unrelated donors as the complete fetal genome is allogeneic to the mother. Instead of being rejected, the allogeneic fetus is tolerated by the pregnant woman in egg donation pregnancies. It has been reported that maternal morbidity during egg donation pregnancies is higher as compared with spontaneous or in vitro fertilization pregnancies. Particularly, egg donation pregnancies are associated with a higher incidence of pregnancy-induced hypertension and placental pathology. Preeclampsia, a pregnancy-specific disease characterized by the development of both hypertension and proteinuria, remains the leading cause of maternal and perinatal mortality and morbidity. The aim of this review is to characterize and relate the maternofetal immunological tolerance phenomenon during pregnancies with a semiallogenic fetus, which are the spontaneously conceived pregnancies and in vitro fertilization pregnancies, and those with an allogeneic fetus or egg donation pregnancies. Maternofetal immune tolerance in uncomplicated pregnancies and pathological pregnancies, such as those with preeclampsia, has also been assessed. Moreover, whether an inadequate maternal immunological response to the allogenic fetus could lead to a higher prevalence of preeclampsia in egg donation pregnancies has been addressed.

Sodium-blood pressure interrelationship in pregnancy.

Science.gov (United States)

Franx, A; Steegers, E A; de Boo, T; Thien, T; Merkus, J M

1999-03-01

In non-pregnant individuals, a strong positive association of sodium intake with blood pressure has been established, but the relationship between sodium intake and blood pressure in human pregnancy remains obscure up to date. The aim of this prospective observational cohort study was to assess the relationship between urinary sodium excretion (as a measure for intake) and blood pressure from the early second trimester onwards throughout pregnancy. The study group consisted of 667 low-risk women with singleton pregnancies, of whom 350 were nulliparous and 317 parous. Blood pressure was measured in a standardised fashion at predetermined intervals from the first antenatal visit prior to 16 weeks gestation until delivery. Urinary sodium excretion was measured in 24-h urine collections on at least four occasions between 16 and 38 weeks gestation. Main outcome measures were the coefficients of correlation between changes in urinary sodium output and changes in blood pressure during six different gestational epochs. No significant correlations were found between changes in urinary sodium output and changes in blood pressure. Correlation coefficients were alike for nulliparous and parous women and for different gestational intervals. Prior to 32 weeks gestation, no differences were observed in sodium excretion between women who remained normotensive and those who developed gestational hypertension. These results suggest that changes in sodium intake are not associated with blood pressure changes in low-risk pregnant women. Blood pressure increases as observed in the second half of normotensive and hypertensive pregnancies are unlikely to be caused by changes in renal sodium handling.

Magnetic resonance imaging detects placental hypoxia and acidosis in mouse models of perturbed pregnancies.

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Gabriele Bobek

Full Text Available Endothelial dysfunction as a result of dysregulation of anti-angiogenic molecules secreted by the placenta leads to the maternal hypertensive response characteristic of the pregnancy complication of preeclampsia. Structural abnormalities in the placenta have been proposed to result in altered placental perfusion, placental oxidative stress, cellular damage and inflammation and the release of anti-angiogenic compounds into the maternal circulation. The exact link between these factors is unclear. Here we show, using Magnetic Resonance Imaging as a tool to examine placental changes in mouse models of perturbed pregnancies, that T 2 contrast between distinct regions of the placenta is abolished at complete loss of blood flow. Alterations in T 2 (spin-spin or transverse relaxation times are explained as a consequence of hypoxia and acidosis within the tissue. Similar changes are observed in perturbed pregnancies, indicating that acidosis as well as hypoxia may be a feature of pregnancy complications such as preeclampsia and may play a prominent role in the signalling pathways that lead to the increased secretion of anti-angiogenic compounds.

Predictors of Ramadan fasting during pregnancy

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Lily A. van Bilsen

2016-12-01

Full Text Available Although the health effects of Ramadan fasting during pregnancy are still unclear, it is important to identify the predictors and motivational factors involved in women’s decision to observe the fast. We investigated these factors in a cross sectional study of 187 pregnant Muslim women who attended antenatal care visits in the Budi Kemuliaan Hospital, Jakarta, Indonesia. The odds of adherence to fasting were reduced by 4% for every week increase in gestational age during Ramadan [odds ratio (OR 0.96; 95% confidence interval (CI 0.92, 1.00; p = 0.06] and increased by 10% for every one unit increase of women’s prepregnancy body mass index (BMI (OR 1.10; 95% CI 0.99, 1.23; p = 0.08. Nonparticipation was associated with opposition from husbands (OR 0.34; 95% CI 0.14, 0.82; p = 0.02 and with women’s fear of possible adverse effects of fasting on their own or the baby’s health (OR 0.47; 95% CI 0.22, 1.01; p = 0.05 and OR 0.43; 95% CI 0.21, 0.89; p = 0.02, respectively, although they were attenuated in multivariable analysis. Neither age, income, education, employment, parity, experience of morning sickness, nor fasting during pregnancy outside of Ramadan determined fasting during pregnancy. Linear regression analysis within women who fasted showed that the number of days fasted were inversely associated with women’s gestational age, fear of possible adverse effects of fasting on their own or the fetal health, and with opposition from husbands. In conclusion, earlier gestational age during Ramadan, husband’s opinion and possibly higher prepregnancy BMI, influence women’s adherence to Ramadan fasting during pregnancy. Fear of adverse health effects of Ramadan fasting is common in both fasting and non-fasting pregnant women.

The kidney in pregnancy: A journey of three decades.

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Prakash, J

2012-05-01

The spectrum of kidney disease occurring during pregnancy includes preeclampsia, hypertensive disorders of pregnancy, urinary tract infection, acute kidney injury, and renal cortical necrosis (RCN). Preeclampsia affects approximately 3-5% of pregnancies. We observed preeclampsia in 5.8% of pregnancies, and 2.38% of our preeclamptic women developed eclampsia. Severe preeclampsia and the eclampsia or hemolysis, elevated liver enzymes levels, and low platelets count (HELLP) syndrome accounted for about 40% of cases of acute kidney injury (AKI) in pregnancy. Preeclampsia/eclampsia was the cause of acute renal failure (ARF) in 38.3% of the cases. Preeclampsia was the most common (91.7%) cause of hypertension during pregnancy, and chronic hypertension was present in 8.3% of patients. We observed urinary tract infection (UTI) in 9% of pregnancies. Sepsis resulting from pyelonephritis can progress to endotoxic shock, disseminated intravascular coagulation, and AKI. The incidence of premature delivery and low birth weight is higher in women with UTI. The incidence of AKI in pregnancy with respect to total ARF cases has decreased over the last 30 years from 25% in 1980s to 5% in 2000s. Septic abortion-related ARF decreased from 9% to 3%. Prevention of unwanted pregnancy and avoidance of septic abortion are key to eliminate abortion-associated ARF in early pregnancy. The two most common causes of ARF in third trimester and postpartum periods were puerperal sepsis and preeclampsia/HELLP syndrome. Pregnancy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome and acute fatty liver of pregnancy were rare causes of ARF. Despite decreasing incidence, AKI remains a serious complication during pregnancy.

[Psychoactive substance use during pregnancy: a review].

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Lamy, S; Thibaut, F

2010-02-01

All around the world, the potential consequences of the increasing use of psychoactive substances during pregnancy are a major public health concern. It is estimated that 20 to 30% of pregnant women use tobacco, 15% use alcohol, 3 to 10% use cannabis and 0.5 to 3% use cocaine. The estimation of tobacco consumption during pregnancy is better known as compared with alcohol and substance use prevalence during pregnancy, which remains under estimated or unknown. For example, in France, the prevalence of cannabis and cocaine use during pregnancy is unknown. In general, the prevalence of drug or alcohol use during pregnancy is estimated by extrapolating data from epidemiological studies conducted in the general population (in France or in other countries). However, drug or alcohol use in the general population may dramatically vary from one country to another. Even if some studies have reported the prevalence of alcohol or substance use in different countries around the world, most of them were based on the mother's interview. In most cases, the mother did not report exactly the amount of drugs or alcohol used. Further studies measuring alcohol or substance use in the mother's blood, hair or in the newborn's meconium are needed. In addition, different methodologies have been used in the literature (different types of interview, with or without biological measurements; different subjects included (in- or out-pregnant women, psychiatric comorbidities or not, different economic status, etc). Despite these methodological biases, the prevalence of drug or alcohol use increases in pregnant women, and in most cases, several drugs are associated. Most of the studies have used structured or semi-structured interviews such as the addiction severity index (ASI) or the alcohol use disorders identification test (AUDIT) to assess alcohol or drug consumption. In addition, the identification of risk factors for substance or alcohol use during pregnancy would allow the early detection of

Monitoring of spine curvatures and posture during pregnancy using surface topography - case study and suggestion of method.

Science.gov (United States)

Michoński, Jakub; Walesiak, Katarzyna; Pakuła, Anna; Glinkowski, Wojciech; Sitnik, Robert

2016-01-01

Low back and pelvic pain is one of the most frequently reported disorders in pregnancy, however etiology and pathology of this problem have not been fully determined. The relationship between back pain experienced during pregnancy and posture remains unclear. It is challenging to measure reliably postural and spinal changes at the time of pregnancy, since most imaging studies cannot be used due to the radiation burden. 3D shape measurement, or surface topography (ST), systems designed for posture evaluation could potentially fill this void. A pilot study was conducted to test the potential of monitoring the change of spine curvatures and posture during pregnancy using surface topography. A single case was studied to test the methodology and preliminarily assess the usefulness of the procedure before performing a randomized trial. The apparatus used in this study was metrologically tested and utilized earlier in scoliosis screening. The subject was measured using a custom-made structured light illumination scanner with accuracy of 0.2 mm. Measurement was taken every 2 weeks, between 17th and 37th week of pregnancy, 11 measurements in total. From the measurement the thoracic kyphosis and lumbar lordosis angles, and vertical balance angle were extracted automatically. Custom-written software was used for analysis. Oswestry Low Back Pain Disability Questionnaire (ODI) was done with every measurement. The values were correctly extracted from the measurement. The results were: 50.9 ± 2.4° for kyphosis angle, 58.1 ± 2.1° for lordosis angle and 4.7 ± 1.7° for vertical balance angle. The registered change was 7.4° in kyphosis angle, 8.4° in lordosis angle and 5.5° in vertical balance angle. The calculated ODI values were between moderate disability and severe disability (22 to 58 %). This case study presents that surface topography may be suitable for monitoring of spinal curvature and posture change in pregnant women. The ionizing radiation studies

Menstrual patterns, fertility and main pregnancy outcomes after allogeneic haematopoietic stem cell transplantation.

Science.gov (United States)

Chiodi, Sandra; Spinelli, Simonetta; Bruzzi, Paolo; Anserini, Paola; Di Grazia, Carmen; Bacigalupo, Andrea

2016-08-01

Two-hundred and sixty-nine females aged ≤42 and undergoing an allogeneic stem cell transplant were retrospectively studied to assess the effect of age, conditioning regimen and chronic graft-versus-host disease (cGVHD) on resumption of stable menstrual cyclicity. Overall, a stable menstrual cyclicity was observed in 22% of cases. The cumulative probability of menses resumption was significantly age and conditioning regimen related. A statistically significant inverse correlation between cGVHD severity and menses resumption was observed only in univariate analysis. In patients with residual ovarian function, infertility was found in 43% and early menopause in 45%. An increased incidence of prematurity and low birth weight (LBW) was observed among the single spontaneous pregnancies. Follicle-stimulating hormone (FSH) and 17 beta-oestradiol levels were found to be inadequate to detect both early signs of menses resumption and menstrual stability. Our study confirms the crucial role of full dose total body irradiation (TBI) and age on menses recovery and fertility after haematopoietic stem cell transplantation (HSCT). The impact of severe cGVHD remains unclear.

Current management of gynecologic cancer in pregnancy.

Science.gov (United States)

Iavazzo, Christos; Minis, Evelyn Eleni; Gkegkes, Ioannis D

2018-04-27

Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbering at an advanced maternal age due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy are comprised of invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell mediated and humoral immunity), increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive, as there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow up of the children from different cancer centres and registries be shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.

Placental Nutrient Transport in Gestational Diabetic Pregnancies

Directory of Open Access Journals (Sweden)

Marisol Castillo-Castrejon

2017-11-01

Full Text Available Maternal obesity during pregnancy is rising and is associated with increased risk of developing gestational diabetes mellitus (GDM, defined as glucose intolerance first diagnosed in pregnancy (1. Fetal growth is determined by the maternal nutrient supply and placental nutrient transfer capacity. GDM-complicated pregnancies are more likely to be complicated by fetal overgrowth or excess adipose deposition in utero. Infants born from GDM mothers have an increased risk of developing cardiovascular and metabolic disorders later in life. Diverse factors, such as ethnicity, age, fetal sex, clinical treatment for glycemic control, gestational weight gain, and body mass index among others, represent a challenge for studying underlying mechanisms in GDM subjects. Determining the individual roles of glucose intolerance, obesity, and other factors on placental function and fetal growth remains a challenge. This review provides an overview of changes in placental macronutrient transport observed in human pregnancies complicated by GDM. Improved knowledge and understanding of the alterations in placenta function that lead to pathological fetal growth will allow for development of new therapeutic interventions and treatments to improve pregnancy outcomes and lifelong health for the mother and her children.

Pregnancy-related changes in center of pressure during gait.

Science.gov (United States)

Bertuit, Jeanne; Leyh, Clara; Rooze, Marcel; Feipe, Véronique

2017-01-01

Physical and hormonal modifications occuring during the pregnancy, can lead to an increase in postural instability and to a higher risk of falls during gait. The first objective was to describe the center of pressure (COP) during late pregnancy at different gait velocity. Comparison of nulliparous women with postpartum women were conducted in order to investigate the effects of pregnancy. The second objective was to analyse COP variability between pregnant and non-pregnant women in order to investigate the effects of pregnancy on gait variability. Fifty-eight pregnant women in the last four months of pregnancy, nine postpartum women and twenty-three healthy non-pregnant women performed gait trials at three different speeds: preferred, slow and fast. In the last four months of pregnancy gait velocity decreased. During the pregnancy, gait velocity decreased by 22%, stopover time increased by 6-12%, COP excursion XY decreased by 5% and COP velocity decreased by 16% and 20% along the anteroposterior and transverse axes, respectively. After delivery, gait velocity increased by 3% but remained a lower compared to non-pregnant women (-12%). Intra-individual variability was greater for non-pregnant than pregnant women. COP parameters were influenced by pregnancy. This suggests that pregnant women establish very specific and individual strategies with the aim of maintaining stability during gait.

Altered drug metabolism during pregnancy: hormonal regulation of drug-metabolizing enzymes.

Science.gov (United States)

Jeong, Hyunyoung

2010-06-01

Medication use during pregnancy is prevalent, but pharmacokinetic information of most drugs used during pregnancy is lacking in spite of known effects of pregnancy on drug disposition. Accurate pharmacokinetic information is essential for optimal drug therapy in mother and fetus. Thus, understanding how pregnancy influences drug disposition is important for better prediction of pharmacokinetic changes of drugs in pregnant women. Pregnancy is known to affect hepatic drug metabolism, but the underlying mechanisms remain unknown. Physiological changes accompanying pregnancy are probably responsible for the reported alteration in drug metabolism during pregnancy. These include elevated concentrations of various hormones such as estrogen, progesterone, placental growth hormones and prolactin. This review covers how these hormones influence expression of drug-metabolizing enzymes (DMEs), thus potentially responsible for altered drug metabolism during pregnancy. The reader will gain a greater understanding of the altered drug metabolism in pregnant women and the regulatory effects of pregnancy hormones on expression of DMEs. In-depth studies in hormonal regulatory mechanisms as well as confirmatory studies in pregnant women are warranted for systematic understanding and prediction of the changes in hepatic drug metabolism during pregnancy.

The clinical approach to the hypertensive disorders of pregnancy

OpenAIRE

YAVUZ, Rahman; YAVUZ, Demet

2012-01-01

Hypertensive disorders in pregnancy remain a major cause of maternal, fetal and neonatal morbidity and mortality not only in developing but also in developed countries. Hypertension in pregnancy can be due to one of several distinct disorders, including gestational hypertension, preexisting chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed upon chronic hypertension. Gebeliğin hipertansif hastalıklarına klinik yaklaşım Gebelikte hipertansif hastalıklar sadece...

Young Women's Lived Experience of Participating in a Positive Youth Development Programme: The "Teens & Toddlers" Pregnancy Prevention Intervention

Science.gov (United States)

Sorhaindo, Annik; Mitchell, Kirstin; Fletcher, Adam; Jessiman, Patricia; Keogh, Peter; Bonell, Chris

2016-01-01

Purpose: Evaluation of the Teens & Toddlers (T&T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to…

Exposure to candesartan during the first trimester of pregnancy in type 1 diabetes: experience from the placebo-controlled diabetic retinopathy candesartan trials

DEFF Research Database (Denmark)

Porta, M; Hainer, J W; Jansson, S-O

2011-01-01

AIMS/HYPOTHESIS: The teratogenic consequences of angiotensin-converting enzyme inhibitors angiotensin receptor blockers (ARBs) during the second and third trimesters of pregnancy are well described. However, the consequences of exposure during the first trimester are unclear, especially in diabet...

Safety of the HPV Bivalent and Quadrivalent Vaccines During Pregnancy.

Science.gov (United States)

Forinash, Alicia B; Yancey, Abigail M; Pitlick, Jamie M; Myles, Thomas D

2011-02-01

To evaluate the safety of the human papillomavirus (HPV) bivalent and quadrivalent vaccines in pregnancy. PubMed (1966-August 2010) was searched using the terms human papillomavirus, human papillomavirus vaccine, and pregnancy. References were reviewed for relevant information. All studies including humans that were published in English with data describing HPV vaccine administration in pregnancy were evaluated. Two combined analyses of 7 Phase 3 efficacy trials have retrospectively evaluated the safety of unintentional administration of either the bivalent (n = 1786) or quadrivalent (n = 2085) HPV vaccine during pregnancy. In addition, postmarketing pregnancy registry surveillance data (prospective, n = 787; retrospective, n = 76) for the quadrivalent HPV vaccine have been published. However, only 279 pregnancies from the studies and 90 pregnancies from the registry occurred within 30 days of receiving the vaccination. Overall, the vaccine does not appear to be associated with an increased risk of spontaneous abortion, fetal malformations, or adverse pregnancy outcomes beyond that found in the general population. Although the data are limited, neither HPV vaccine appears to be associated with an increased risk of adverse pregnancy outcomes. However, limitations of the data include small patient populations, minimal to no adjustments for factors known to influence pregnancy outcomes or malformations, and the majority of the available pregnancy data are from retrospective analysis of Phase 3 efficacy trials. Neither HPV vaccine should be routinely administered during pregnancy. If a pregnancy occurs midseries, the remaining vaccines should be given after pregnancy completion. Further studies are required to determine actual risk. © 2011 SAGE Publications.

Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana.

Science.gov (United States)

Krugu, John Kingsley; Mevissen, Fraukje; Münkel, Meret; Ruiter, Robert

2017-03-01

Globally, an estimated 16 million young women aged 15 to 19 years give birth every year. Most teenage pregnancies are unintended and being pregnant or delivering a baby as a teenager can have serious adverse consequences. Knowledge of the environmental factors and social cognitive determinants influencing young women's failure to protect against unintended pregnancy is necessary to address the high rate of teenage pregnancies. We conducted semi-structured in-depth interviews with 21 young women, who had experience of pregnancy, in Bolgatanga, Ghana. The interview protocol included themes (relationships, sex, pregnancy, family planning) and determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behaviour. Findings show that young women's motivations for sexual relationships are mostly 'beyond love' and seem to focus on economic factors. The main means of sexual protection seems to be condom use. Other forms of contraception were believed to be linked to infertility. Sexuality remains a largely taboo topic for open discussion and sex education in schools seems limited to abstinence-only messages. The need for more open communication on matters of sexuality with young people and the provision of a more comprehensive sexuality education in school to address teenage pregnancies in Ghana, is discussed.

Pregnancy Loss

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... To receive Pregnancy email updates Enter email Submit Pregnancy loss Pregnancy loss is a harsh reality faced ... have successful pregnancies. Expand all | Collapse all Why pregnancy loss happens As many as 10 to 15 ...

Associations of maternal folic acid supplementation and folate concentrations during pregnancy with foetal and child head growth: the Generation R Study

NARCIS (Netherlands)

J.C.J. Steenweg-de Graaff (Jolien); S.J. Roza (Sabine); A.N. Walstra (Alette N.); H. El Marroun (Hanan); E.A.P. Steegers (Eric); V.W.V. Jaddoe (Vincent); A. Hofman (Albert); F.C. Verhulst (Frank); H.W. Tiemeier (Henning); T.J.H. White (Tonya)

2017-01-01

textabstractPurpose: Folic acid supplementation during pregnancy has been associated with a reduced risk of common neurodevelopmental delays in the offspring. However, it is unclear whether low folate status has effects on the developing brain. We evaluated the associations of maternal folic acid

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.

Anaerobes and Bacterial Vaginosis in Pregnancy: Virulence Factors Contributing to Vaginal Colonisation

Directory of Open Access Journals (Sweden)

Charlene W. J. Africa

2014-07-01

Full Text Available The aetiology and pathogenesis of bacterial vaginosis (BV is unclear but it appears to be associated with factors that disrupt the normal acidity of the vagina thus altering the equilibrium between the normal vaginal microbiota. BV has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. This paper reviewed new available information regarding possible factors contributing to the establishment of the BV vaginal biofilm, examined the proposed role of anaerobic microbial species recently detected by new culture-independent methods and discusses developments related to the effects of BV on human pregnancy. The literature search included Pubmed (NLM, LISTA (EBSCO, and Web of Science. Because of the complexity and diversity of population groups, diagnosis and methodology used, no meta-analysis was performed. Several anaerobic microbial species previously missed in the laboratory diagnosis of BV have been revealed while taking cognisance of newly proposed theories of infection, thereby improving our understanding and knowledge of the complex aetiology and pathogenesis of BV and its perceived role in adverse pregnancy outcomes.

Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and suggestion of method

Directory of Open Access Journals (Sweden)

Jakub Michoński

2016-10-01

Full Text Available Abstract Background Low back and pelvic pain is one of the most frequently reported disorders in pregnancy, however etiology and pathology of this problem have not been fully determined. The relationship between back pain experienced during pregnancy and posture remains unclear. It is challenging to measure reliably postural and spinal changes at the time of pregnancy, since most imaging studies cannot be used due to the radiation burden. 3D shape measurement, or surface topography (ST, systems designed for posture evaluation could potentially fill this void. A pilot study was conducted to test the potential of monitoring the change of spine curvatures and posture during pregnancy using surface topography. A single case was studied to test the methodology and preliminarily assess the usefulness of the procedure before performing a randomized trial. The apparatus used in this study was metrologically tested and utilized earlier in scoliosis screening. Case presentation The subject was measured using a custom-made structured light illumination scanner with accuracy of 0.2 mm. Measurement was taken every 2 weeks, between 17th and 37th week of pregnancy, 11 measurements in total. From the measurement the thoracic kyphosis and lumbar lordosis angles, and vertical balance angle were extracted automatically. Custom-written software was used for analysis. Oswestry Low Back Pain Disability Questionnaire (ODI was done with every measurement. The values were correctly extracted from the measurement. The results were: 50.9 ± 2.4° for kyphosis angle, 58.1 ± 2.1° for lordosis angle and 4.7 ± 1.7° for vertical balance angle. The registered change was 7.4° in kyphosis angle, 8.4° in lordosis angle and 5.5° in vertical balance angle. The calculated ODI values were between moderate disability and severe disability (22 to 58 %. Conclusions This case study presents that surface topography may be suitable for monitoring of spinal curvature

Pregnancy across the spectrum of chronic kidney disease.

Science.gov (United States)

Hladunewich, Michelle A; Melamad, Nir; Bramham, Kate

2016-05-01

Management of the pregnant woman with chronic kidney disease is difficult for both nephrologists and obstetricians. Prepregnancy counselling with respect to risk stratification, optimization of maternal health prior to pregnancy, as well as management of the many potential pregnancy-associated complications in this complex patient population remains challenging due to the paucity of large, well-designed clinical studies. Furthermore, the heterogeneity of disease and the relative infrequency of pregnancy, particularly in more advanced stages of chronic kidney disease, leaves many clinicians feeling ill prepared to manage these pregnancies. As such, counselling is imprecise and management varies substantially across centers. All pregnancies in women with chronic kidney disease can benefit from a collaborative multidisciplinary approach with a team that consists of nephrologists experienced in the management of kidney disease in pregnancy, maternal-fetal medicine specialists, high-risk pregnancy nursing staff, dieticians, and pharmacists. Further access to skilled neonatologists and neonatal intensive care unit support is essential given the risks for preterm delivery in this patient population. The goal of this paper is to highlight some of the data that currently exist in the literature, provide management strategies for the practicing nephrologist at all stages of chronic kidney disease, and explore some of the knowledge gaps where future multinational collaborative research efforts should concentrate to improve pregnancy outcomes in women with kidney disease across the globe. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Plasma lactoferrin levels in pregnancy and cystic fibrosis

International Nuclear Information System (INIS)

Sykes, J.A.C.; Thomas, M.J.; Goldie, D.J.; Turner, G.M.

1982-01-01

Plasma lactoferrin levels have been determined by radioimmunoassay for the different weeks of normal pregnancy, in normal healthy adults and in children with and without cystic fibrosis. The lactoferrin levels were higher in pregnancy than in both male and female normal adults and showed a slight progressive increase up to week 29 and thereafter remained high. Five out of seven children with cystic fibrosis had markedly raised plasma lactoferrin levels from six to 16 times higher than the mean of a control group of children. (Auth.)

Periodontal status during pregnancy and postpartum.

Directory of Open Access Journals (Sweden)

Maximino González-Jaranay

Full Text Available Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations.Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline, 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm. Bivariate and multivariate analyses were performed. Type 1 (α error was established at 0.05.Plaque Index increased (p = 0.043 throughout pregnancy (baseline, 42%±0.18; 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13. Gingival Index increased (p3 mm increased (p<0.001 throughout pregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17 and decreased postpartum (21.2%±0.17 but remained significantly (p<0.02 higher than at baseline.Periodontal status deteriorates during gestation but improves postpartum.

Managing Epilepsy in Pregnancy

LENUS (Irish Health Repository)

O Dwyer, V

2017-02-01

Epilepsy is one of the commonest medical conditions affecting women of childbearing age1. In the most recent triennial report into maternal deaths in Ireland and the UK, two thirds of women who died had a medical condition. In this report, 14 maternal deaths during pregnancy and up to 42 days postpartum were attributable to epilepsy or seizures; a rate of 0.4 per 100,000 maternities. In 12 of these women’ the cause was sudden unexplained death in epilepsy. Thus, epilepsy remains a high-risk condition in pregnancy. The gold standard of care is a multidisciplinary approach involving obstetricians, a neurologist and an epilepsy nurse specialist2. Like other units in Ireland this multidisciplinary service is currently provided in the National Maternity Hospital’s maternal medicine clinic, in conjunction with neurology services in Beaumont Hospital.

Factors Associated with Young Adults’ Pregnancy Likelihood

Science.gov (United States)

Kitsantas, Panagiota; Lindley, Lisa L.; Wu, Huichuan

2014-01-01

OBJECTIVES While progress has been made to reduce adolescent pregnancies in the United States, rates of unplanned pregnancy among young adults (18–29 years) remain high. In this study, we assessed factors associated with perceived likelihood of pregnancy (likelihood of getting pregnant/getting partner pregnant in the next year) among sexually experienced young adults who were not trying to get pregnant and had ever used contraceptives. METHODS We conducted a secondary analysis of 660 young adults, 18–29 years old in the United States, from the cross-sectional National Survey of Reproductive and Contraceptive Knowledge. Logistic regression and classification tree analyses were conducted to generate profiles of young adults most likely to report anticipating a pregnancy in the next year. RESULTS Nearly one-third (32%) of young adults indicated they believed they had at least some likelihood of becoming pregnant in the next year. Young adults who believed that avoiding pregnancy was not very important were most likely to report pregnancy likelihood (odds ratio [OR], 5.21; 95% CI, 2.80–9.69), as were young adults for whom avoiding a pregnancy was important but not satisfied with their current contraceptive method (OR, 3.93; 95% CI, 1.67–9.24), attended religious services frequently (OR, 3.0; 95% CI, 1.52–5.94), were uninsured (OR, 2.63; 95% CI, 1.31–5.26), and were likely to have unprotected sex in the next three months (OR, 1.77; 95% CI, 1.04–3.01). DISCUSSION These results may help guide future research and the development of pregnancy prevention interventions targeting sexually experienced young adults. PMID:25782849

Postpartum follow-up in women diagnosed with subclinical hypothyroidism during pregnancy

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K Neelaveni

2017-01-01

Full Text Available Background: Management guidelines about the thyroid disease in pregnancy are silent about the postpartum course of new onset subclinical hypothyroidism (SCH. Hence, we analyzed the 2 years outcome of SCH diagnosed during pregnancy. Materials and Methods: We conducted this retrospective study using the medical records of patients with new onset SCH during pregnancy between 2010 and 2013 (n = 718. Patients who stopped their levothyroxine after delivery with a 2-year follow-up record were included. We excluded patients with known thyroid disorders and continuous use of drugs that affect the thyroid results. The patients were divided into two groups (Group 1 – euthyroid and Group 2 – hypothyroid based on the final outcome after 2 years. The data were analyzed using appropriate statistical methods and a P < 0.05 was considered statically significant. Results: A total of 559 (77.8% women stopped levothyroxine after delivery, and the final follow-up data were available for 467 patients only. At the end of 2 years, 384 (82.2% remained euthyroid, and the remaining 83 (17.8% developed hypothyroidism. SCH and overt hypothyroidism were seen in 22 and 61 patients, respectively. Group 2 patients had higher mean age (25.5 vs. 23.6 years, goiter (51 vs. 2%, initial thyroid stimulating hormone (7.9 vs. 5.1 μIU/mL, and thyroid antibody positivity (76 vs. 13% (P < 0.001. Conclusion: The majority of patients with SCH during pregnancy remain euthyroid after delivery. Advanced age, goiter, positive family history, and thyroid autoimmunity increase the future risk of hypothyroidism in patients with SCH diagnosed during pregnancy.

Dengue vaccination during pregnancy - An overview of clinical trials data.

Science.gov (United States)

Skipetrova, Anna; Wartel, Tram Anh; Gailhardou, Sophia

2018-04-28

The live, attenuated, tetravalent dengue vaccine (CYD-TDV) is licensed in several endemic countries and contraindicated during pregnancy. Inadvertent vaccination during pregnancy may occur during clinical trials that include women of childbearing age. The potential risk associated with dengue vaccination in pregnancy remains unknown. We describe pregnancy outcomes following inadvertent dengue vaccination in pregnancy from CYD-TDV trial data. Data were collected from trials conducted as part of the CYD-TDV clinical development. Women who received CYD-TDV or placebo during the pre-specified pregnancy risk window (from 30 days before the date of their last menstrual period to end of pregnancy) were considered as exposed; pregnancies occurring in non-risk periods during the trials were considered to be non-exposed. Pregnancy losses were defined as abortion (spontaneous or unspecified), death in utero, and stillbirth. 615 pregnancies were reported from 19 CYD-TDV trials: 404 in the CYD-TDV arm, and 211 in the placebo arm. Exposure could not be determined for 7 pregnancies (5, CYD-TDV; 2, placebo). In the CYD-TDV arm, 58 pregnancies were considered as exposed. Most of these (n = 47, 81%) had healthy live births; 6 (10.3%) had pregnancy losses; 3 underwent elective termination and 2 had unknown outcome. In the placebo group, 30 pregnancies were considered exposed. Most of these (n = 25, 83%) had healthy births; 4 (13.3%) had pregnancy losses; and 1 had elective termination. Among non-exposed pregnancies, most resulted in healthy live births; 23/341 (6.7%) in the CYD-TDV group and 17/179 (9.5%) in the placebo group had pregnancy losses. Most reported pregnancy losses were in women considered high-risk for adverse pregnancy outcome, primarily due to young age. In the small dataset assessed, no evidence of increased adverse pregnancy outcomes has been identified from inadvertent immunization of women in early pregnancy with CYD-TDV compared with the control group

Pregnancy after cardiac transplantation. Report of one case and review

Directory of Open Access Journals (Sweden)

Solange Bordignon

2000-12-01

Full Text Available A 14-year-old female patient became pregnant 6 years after heart transplantation. The pregnancy evolved uneventfully, and the newborn infant was healthy. Five months after delivery, the mother was in good condition with preserved ventricular function, and the baby had normal neuro-psychomotor development. Even though the case reported here was a success, pregnancy following cardiac transplantation is considered a high-risk condition and remains contraindicated.

Anaemia in pregnancy is associated with advanced HIV disease.

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Vikesh Nandlal

Full Text Available Anaemia is a common clinical finding in HIV infected women and has been associated with advanced disease. The use of antiretroviral drugs such as Zidovudine (ZDV either for prevention of mother to child transmission (MTCT of HIV or used in combination with other antiretrovirals have been implicated in the development or increased severity of anaemia. We report the prevalence, type, severity and incidence of anaemia in a cohort of HIV infected women who initiated antiretroviral prophylaxis or treatment during pregnancy.This is a retrospective cohort data analysis of 408 HIV infected pregnant women who participated in a breastfeeding intervention study (HPTN 046 Study, ClinicalTrials.gov NCT 00074412 in South Africa. Women initiated zidovudine prophylaxis for PMTCT or triple antiretroviral treatment in pregnancy according to the standard of care. Laboratory and clinical data in pregnancy, <72 hours and 2 weeks postdelivery were extracted from the main database and analysed.The mean Hb concentration was 10.6 g/dL at baseline and 262/408 (64.2% women were diagnosed with anaemia (Hb<11 g/dL in pregnancy, 48/146 (32.9% subsequently developed anaemia intrapartum or postpartum and 89/310 (28.7% of all cases of anaemia remained unresolved by 2 weeks postdelivery. In a univariate analysis, CD4 count and gravidity were significant risk factors for anaemia in pregnancy, RR 1.41; 1.23-1.61 (p<0.001 and 1.10; 1.01-1.18 (p = 0.02 respectively. After adjusting for antiretroviral regimen, age and gravidity in a multivariable analysis, only the CD4 count remains a significant risk factor for anaemia in pregnancy and postdelivery.In conclusion, anaemia was most common among women in the advanced stage of HIV infection (CD4<200 cells/mm3. There was no evidence of an association between ZDV or triple ARVs and anaemia.

Organic Food Consumption during Pregnancy and Hypospadias and Cryptorchidism at Birth: The Norwegian Mother and Child Cohort Study (MoBa).

Science.gov (United States)

Brantsæter, Anne Lise; Torjusen, Hanne; Meltzer, Helle Margrete; Papadopoulou, Eleni; Hoppin, Jane A; Alexander, Jan; Lieblein, Geir; Roos, Gun; Holten, Jon Magne; Swartz, Jackie; Haugen, Margaretha

2016-03-01

The etiologies of the male urogenital anomalies hypospadias and cryptorchidism remain unclear. It has been suggested that maternal diet and environmental contaminants may affect the risk of these anomalies via placental or hormonal disturbances. We examined associations between organic food consumption during pregnancy and prevalence of hypospadias and cryptorchidism at birth. Our study includes 35,107 women participating in the Norwegian Mother and Child Cohort Study (MoBa) who delivered a singleton male infant. Information about use of six groups of organically produced food (vegetables, fruit, bread/cereal, milk/dairy products, eggs, and meat) during pregnancy was collected by a food frequency questionnaire. Women who indicated that they sometimes, often, or mostly consumed organic foods in at least one of the six food groups were classified as organic food consumers in analyses. Hypospadias and cryptorchidism diagnoses were retrieved from the Medical Birth Registry of Norway. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression. Seventy-four male newborns were diagnosed with hypospadias (0.2%), and 151 with cryptorchidism (0.4%). Women who consumed any organic food during pregnancy were less likely to give birth to a boy with hypospadias (OR = 0.42; 95% CI: 0.25, 0.70, based on 21 exposed cases) than women who reported they never or seldom consumed organic food. Associations with specific organic foods were strongest for vegetable (OR = 0.36; 95% CI: 0.15, 0.85; 10 exposed cases) and milk/dairy (OR = 0.43; 95% CI: 0.17, 1.07; 7 exposed cases) consumption. No substantial association was observed for consumption of organic food and cryptorchidism. Consumption of organically produced foods during pregnancy was associated with a lower prevalence of hypospadias in our study population. These findings were based on small numbers of cases and require replication in other study populations.

Industry remains stuck in a transitional mode

International Nuclear Information System (INIS)

Garb, F.A.

1991-01-01

The near future for industry remains foggy for several obvious reasons. The shake-up of the Soviet Union and how the pieces will reform remains unclear. How successful efforts are to privatize government oil company operations around the world has yet to be determined. A long sought peace in the Middle East seems to be inching closer, but will this continue? If it does continue, what impact will it have on world energy policy? Will American companies, which are now transferring their attention to foreign E and P, also maintain an interest in domestic activities? Is the U.S. economy really on the upswing? We are told that the worst of the recession is over, but try telling this to thousands of workers in the oil patch who are being released monthly by the big players in domestic operations. This paper reports that 1992 should be a better year than 1991, if measured in opportunity. There are more exploration and acquisition options available, both domestically and internationally, than there have been in years. Probably more opportunities exist than there are players-certainly more than can be funded with current financial resources

Pregnancy intentions and teenage pregnancy among Latinas: a mediation analysis.

Science.gov (United States)

Rocca, Corinne H; Doherty, Irene; Padian, Nancy S; Hubbard, Alan E; Minnis, Alexandra M

2010-09-01

The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high. Prospective, time-varying data from 2001-2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression. Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low power in a sexual relationship with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%. Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy. Copyright © 2010 by the Guttmacher Institute.

Pregnancy Intentions and Teenage Pregnancy Among Latinas: A Mediation Analysis

Science.gov (United States)

Rocca, Corinne H.; Doherty, Irene; Padian, Nancy S.; Hubbard, Alan E.; Minnis, Alexandra M.

2010-01-01

CONTEXT The extent to which pregnancy intentions mediate the relationship between individual, familial and cultural characteristics and adolescent pregnancy is not well understood. The role of intentions may be particularly important among Latina teenagers, whose attitudes toward pregnancy are more favorable than those of other groups and whose pregnancy rates are high. METHODS Prospective, time-varying data from 2001–2004 were used to investigate whether two measures of pregnancy intentions, wantedness and happiness, mediated associations between risk factors and pregnancy among 213 Latina adolescents in San Francisco. Participants were tested for pregnancy and interviewed about pregnancy intentions, partnerships, family characteristics and activities every six months for two years. Associations and mediation were examined using logistic regression. RESULTS Neither pregnancy intention variable mediated relationships between participant characteristics and pregnancy. After adjustment for other measures, wantedness was strongly associated with pregnancy (odds ratio, 2.6), while happiness was not. Having a strong family orientation was associated with happiness (3.7) but unrelated to pregnancy. Low sexual relationship power with a main partner was associated with an elevated risk of pregnancy (3.3). If the pregnancy intentions of all participants were changed to definitely not wanting pregnancy, the estimated decline in pregnancy risk would be 16%. CONCLUSIONS Pregnancy intentions were important not as mediators but rather as independent risk factors for pregnancy. Differences in pregnancy rates between groups of Latinas may be less a function of intentional choice than of situational factors. Interventions and research should focus on identifying and targeting factors that hinder effective contraceptive use among teenagers who want to avoid pregnancy. PMID:20887287

Comparison of the outcomes between reduced and nonreduced triplet pregnancies achieved by Assisted Reproductive Technology.

Science.gov (United States)

Shiva, Marzieh; Mohammadi Yeganeh, Ladan; Mirzaagha, Elaheh; Chehrazi, Mohammad; Bagheri Lankarani, Narges

2014-10-01

In recent years, the significant increase in multiple pregnancies as a result of assisted reproductive technology (ART) has introduced the concept of multifetal reduction techniques. However, it is still unclear whether there are significant advantages of using this technique. To compare the outcomes of triplet pregnancies achieved by ART managed expectantly with those receiving fetal reduction interventions. In this retrospective study of 115 triplet pregnancies, 57 pregnancies were reduced to twins while 58 were managed expectantly. The fetal loss rate before 24 weeks did not differ between reduced and nonreduced pregnancies (12.3% vs 12.1%). However, the results of those using fetal reduction techniques showed a lower incidence of preterm labour (26.3% vs 50%, P = 0.009), higher mean gestational age at delivery (35.1 ± 2.6 vs 32.4 ± 3.6 weeks, P = 0.002) and higher mean birthweights compared with the control group (2188 ± 547 vs 1674 ± 546 g, P fetal loss. Additionally, there was a lower perinatal mortality, higher live birth rate and lower NICU admission. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Pregnancy Outcome in Cervical Incompetence: Comparison of ...

African Journals Online (AJOL)

Context: Cervical incompetence is a major cause of recurrent mid-trimester pregnancy loss and preterm deliveries; it contributes significantly to fetal loss and neonatal morbidity and mortality. Despite its wide use, the effectiveness of cervical cerclage in its management remains unsettled. Objective: To evaluate the ...

Fecal estrogen, progestagen and glucocorticoid metabolites during the estrous cycle and pregnancy in the giant anteater (Myrmecophaga tridactyla): evidence for delayed implantation.

Science.gov (United States)

Knott, Katrina K; Roberts, Beth M; Maly, Morgan A; Vance, Carrie K; Debeachaump, Jennifer; Majors, Jackie; Riger, Peter; Decaluwe, Heather; Kouba, Andrew J

2013-08-27

Declining numbers of wild giant anteaters highlight the importance of sustainable captive populations. Unfortunately, captive reproductive management is limited by the lack of external physical indicators of female reproductive status and the aggressive behavior of males. We examined the endocrinology of the estrous cycle and pregnancy, and whether delayed implantation is a gestational strategy for giant anteaters as described for other xenarthrans. Feces were collected from seven captive females 3-5 times weekly and mating was recorded. Concentrations of estrogen (estrone-glucuronide, E1, and estradiol-17β, E2), progestagen (20-oxo-progestagens, P4), and glucocorticoid (GC) metabolites were examined in fecal extracts by enzyme immunoassay. Estrous cycles for nulliparous females (6 cycles, n = 2) compared to the multiparous female (6 cycles, n = 1) were shorter (47.3 +/- 4.3 days versus 62.5 +/- 2.6 days) with relatively lower luteal phase concentrations of P4 (49.4 +/- 2.9 ng/g versus 136.8 +/- 1.8 ng/g). The four remaining females had unclear ovarian activity: two females exhibited apparent luteal activity but unclear fluctuations in estrogens, while the other two females had parallel fecal P4 and estrogens concentrations. Pregnancy ranged 171-183 days with females returning to estrus post-partum as early as 60 days (n = 3, 1.8-4 years of age at mating). Delayed implantation was indicated by a biphasic elevation in fecal P4 metabolites: the initial 4-fold increase occurred for 81-105 days and was followed by a 26-fold secondary rise in P4 metabolites lasting 66-94 days prior to parturition. Fecal GC was correlated with fecal estrogens and greatest during estrus, late pregnancy, and six days prior to parturition (estrous cycle GC, 14.4-62.8 ng/g; pregnancy GC, 13.6-232.7 ng/g). Estrous cycles of giant anteaters occurred year-round, but were shorter and more intermittent in younger nulliparous animals compared to a multiparous female. A pronounced

Deciding to Wait: Partnership Status, Economic Conditions, and Pregnancy during the Great Recession

Directory of Open Access Journals (Sweden)

Christine Percheski

2017-02-01

Full Text Available The Great Recession was associated with reduced fertility in the United States. Many questions about the dynamics underlying this reduction remain unanswered, however, including whether reduced fertility rates were driven by decreases in intended or unplanned pregnancies. Using restricted data from the 2006–2010 National Survey of Family Growth (N = 4,630, we exploit variation in state economic indicators to assess the impact of economic conditions on the likelihood of an intended pregnancy, an unplanned pregnancy, or no pregnancy for adult women without a college education. We focus on variations by partnership and marital status. Overall, we find that worse economic conditions were predictive of a lower risk of unplanned pregnancy. Women's odds of intended pregnancy did not, however, respond uniformly to economic conditions but varied by marital status. When economic conditions were poor, married women had lower odds of intended pregnancy, whereas cohabiting women had greater odds of intended pregnancy.

Progression of care among women who use a midwife for prenatal care: Who remains in midwife care?

Science.gov (United States)

Weisband, Yiska Loewenberg; Gallo, Maria F; Klebanoff, Mark A; Shoben, Abigail B; Norris, Alison H

2018-03-01

Prenatal care provided by midwives provides a safe and cost-effective alternative to care provided by physicians. However, no studies have evaluated the frequency of women who leave midwifery care, in a hospital setting. Our study objectives were to measure the frequency of transfers of care to physicians, to describe the sociodemographic and pregnancy-related characteristics of women who transferred to the care of a physician during prenatal care and at delivery, and to assess correlates of these transfers. We used electronic medical records to perform a retrospective cohort study of women who delivered at The Ohio State University Wexner Medical Center (OSUWMC) and had at least one prenatal care visit within OSUWMC's network. We report descriptive findings, using proportions and means with standard deviations. We used logistic regression, with Firth's bias correction as necessary, to assess correlates of transferring to a physician during prenatal care and at delivery. Most women who initiated prenatal care with a midwife remained in midwifery care throughout delivery, with 4.7% transferring to a physician during prenatal care, and an additional 21.4% transferring to a physician during delivery. After adjusting for pregnancy-related factors, the black race was statistically significantly associated with leaving midwifery care during prenatal care (adjusted odds ratio AOR 3.0 [95% CI 1.4-6.6]) and delivery (AOR 2.5 [95% CI 1.5-4.3]). Findings indicate that most women remain in midwifery care throughout pregnancy, but raise important questions with respect to the possible role that race has in pregnancy care. © 2017 Wiley Periodicals, Inc.

Lack of awareness of risk factors for primary toxoplasmosis in pregnancy.

LENUS (Irish Health Repository)

Ferguson, W

2011-12-01

The overall seroprevalence of toxoplasma antibodies in women of childbearing age in Ireland is 25% [1]. Hence, 75% of women remain susceptible to primary toxoplasma infection during pregnancy, which if transmitted to the foetus can cause ocular, neurological and other sequelae. Toxoplasma exposure during pregnancy can be avoided if there is an awareness of the potential sources of infection, mainly contaminated food, water, soil and cat faeces.

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.

Molar Pregnancy

Science.gov (United States)

... weeks of pregnancy Ovarian cysts Anemia Overactive thyroid (hyperthyroidism) Causes A molar pregnancy is caused by an ... have this complication than a partial molar pregnancy. Prevention If you've had a molar pregnancy, talk ...

Biomarkers for Ectopic Pregnancy and Pregnancy of Unknown Location

OpenAIRE

Senapati, Suneeta; Barnhart, Kurt T.

2013-01-01

Early pregnancy failure is the most common complication of pregnancy, and 1–2% of all pregnancies will be ectopic. As one of the leading causes of maternal morbidity and mortality, diagnosing ectopic pregnancy and determining the fate of a pregnancy of unknown location are of great clinical concern. Several serum and plasma biomarkers for ectopic pregnancy have been investigated independently and in combination. The following is a review of the state of biomarker discovery and development for...

Differential relationships between chronic hormone profiles in pregnancy and maternal investment in rhesus monkey mothers with hair loss in the neonatal period.

Science.gov (United States)

Dettmer, Amanda M; Rosenberg, Kendra; Menard, Mark T; El-Mallah, Saif N; Woodward, Ruth A; Suomi, Stephen J; Meyer, Jerrold S

2017-01-01

Hair loss is commonly used as an indicator of well being in primate facilities, yet it has been shown to also occur in otherwise healthy pregnant and postpartum females. There is significant variability in the incidence of hair loss during these important developmental periods, reasons for which remain unclear. We studied female rhesus monkeys (Macaca mulatta, n = 47) with and without hair loss in pregnancy/postpartum. We hypothesized that, similar to previously published reports, pregnancy would result in an increased likelihood of hair loss, and that hair loss would be correlated with higher hair cortisol concentrations (HCCs). We further hypothesized that hair loss among pregnant females is related to differential maternal investment. We studied a subset of monkeys (n = 26) from mid-to-late pregnancy through peak lactation, some of which exhibited hair loss in the perinatal period (n = 15), and some of which did not (n = 11). We examined fetal measurements, infant birth weight, infant growth rate, and milk yield volume (MYV) in the first 30 days as indices of investment. We found that pregnant monkeys showed a greater incidence of hair loss across the study year (χ 2 (2)  = 6.55, P = 0.038), and that mothers with hair loss had significantly higher HCCs in pregnancy than those without (F (2,28)  = 3.8, P = 0.017, η p 2  = 0.21). HCCs in pregnancy were correlated with severity of hair loss in the neonatal period (r (37)  = 0.42, P = 0.008). Moreover, HCCs in pregnancy were positively correlated with infant birth weight (r (12)  = 0.56, P = 0.038), infant growth rate (r (12)  = 0.64, P = 0.014), and MYV (r (11)  = 0.85, P hair loss in some monkeys, especially during the birthing season, may be a signal of greater physiological stress during pregnancy and differential investment by mothers to their offspring. Am. J. Primatol. 79:e22489, 2017. © 2015 Wiley Periodicals, Inc. © 2016 Wiley Periodicals

Wegener's granulomatosis occurring de novo during pregnancy.

Science.gov (United States)

Alfhaily, F; Watts, R; Leather, A

2009-01-01

Wegener's granulomatosis (WG) is rarely diagnosed during the reproductive years and uncommonly manifests for the first time during pregnancy. We report a case of de novo WG presenting at 30 weeks gestation with classical symptoms of WG (ENT, pulmonary). The diagnosis was confirmed by radiological, laboratory, and histological investigations. With a multidisciplinary approach, she had a successful vaginal delivery of a healthy baby. She was treated successfully by a combination of steroids, azathioprine and intravenous immunoglobulin in the active phase of disease for induction of remission and by azathioprine and steroids for maintenance of remission. The significant improvement in her symptoms allowed us to continue her pregnancy to 37 weeks when delivery was electively induced. Transplacental transmission of PR3-ANCA occurred but the neonate remained well. This case of de novo WG during pregnancy highlights the seriousness of this disease and the challenge in management of such patients.

Quantum Dots for Cancer Research: Current Status, Remaining Issues, and Future Perspectives

International Nuclear Information System (INIS)

Fang, Min; Peng, Chun-wei; Pang, Dai-Wen; Li, Yan

2012-01-01

Cancer is a major threat to public health in the 21st century because it is one of the leading causes of death worldwide. The mechanisms of carcinogenesis, cancer invasion, and metastasis remain unclear. Thus, the development of a novel approach for cancer detection is urgent, and real-time monitoring is crucial in revealing its underlying biological mechanisms. With the optical and chemical advantages of quantum dots (QDs), QD-based nanotechnology is helpful in constructing a biomedical imaging platform for cancer behavior study. This review mainly focuses on the application of QD-based nanotechnology in cancer cell imaging and tumor microenvironment studies both in vivo and in vitro, as well as the remaining issues and future perspectives

Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review.

Science.gov (United States)

Seth, Sunaina; Lewis, Andrew J; Galbally, Megan

2016-05-31

Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. A systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. In total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.

A comparison of beliefs about exercise during pregnancy between Chinese and Australian pregnant women

OpenAIRE

Guelfi, Kym J.; Wang, Chen; Dimmock, James A.; Jackson, Ben; Newnham, John P.; Yang, Huixia

2015-01-01

Background Despite the well-established benefits of exercise during pregnancy, many women remain inactive. This may be related, in part, to women?s beliefs about exercise in pregnancy, which are likely influenced by cultural background. Accordingly, the aim of this study was to compare attitudes, subjective norms, and perceived behavioural control toward exercise, together with current levels of exercise participation between Chinese and Australian women during pregnancy. A second aim was to ...

Ambient Air Pollution and Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis

Science.gov (United States)

Hu, Hui; Ha, Sandie; Roth, Jeffrey; Kearney, Greg; Talbott, Evelyn O.; Xu, Xiaohui

2014-01-01

Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and eclampsia) have a substantial public health impact. Maternal exposure to high levels of air pollution may trigger HDP, but this association remains unclear. The objective of our report is to assess and quantify the association between maternal exposures to criteria air pollutants (ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter ≤ 10, 2.5 μm) on HDP risk. PubMed, EMBASE, MEDLINE, Current Contents, Global Health, and Cochrane were searched (last search: September, 2013). After a detailed screening of 270 studies, 10 studies were extracted. We conducted meta-analyses if a pollutant in a specific exposure window was reported by at least four studies. Using fixed- and random-effects models, odds ratios (ORs) and 95% CIs were calculated for each pollutant with specific increment of concentration. Increases in risks of HDP (OR per 10 ppb = 1.16; 95% CI, 1.03-1.30) and preeclampsia (OR per 10 ppb = 1.10; 95% CI, 1.03-1.17) were observed to be associated with exposure to NO2 during the entire pregnancy, and significant associations between HDP and exposure to CO (OR per 1 ppm = 1.79; 95% CI, 1.31-2.45) and O3 (OR per 10 ppb = 1.09; 95% CI, 1.05-1.13) during the first trimester were also observed. Our review suggests an association between ambient air pollution and HDP risk. Although the ORs were relatively low, the population-attributable fractions were not negligible given the ubiquitous nature of air pollution. PMID:25242883

Pre-pregnancy weight status, early pregnancy lipid profile and blood pressure course during pregnancy: The ABCD study

NARCIS (Netherlands)

Oostvogels, Adriëtte J. J. M.; Busschers, Wim B.; Spierings, Eline J. M.; Roseboom, Tessa J.; Gademan, Maaike G. J.; Vrijkotte, Tanja G. M.

2017-01-01

Although pre-pregnancy weight status and early pregnancy lipid profile are known to influence blood pressure course during pregnancy, little is known about how these two factors interact. The association between pre-pregnancy weight status and blood pressure course during pregnancy was assessed in

Increased Sensitivity to Angiotensin II is Present Postpartum in Women with History of Hypertensive Pregnancy

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Saxena, Aditi R.; Karumanchi, S. Ananth; Brown, Nancy J.; Royle, Caroline M.; McElrath, Thomas F.; Seely, Ellen W.

2010-01-01

Pregnancies complicated by new onset hypertension are associated with increased sensitivity to angiotensin II, but it is unclear if this sensitivity persists postpartum. We studied pressor response to infused angiotensin II in 25 normotensive postpartum women in both high and low sodium balance. Ten women had history of hypertensive pregnancy (five with preeclampsia; five with transient hypertension of pregnancy) and 15 women had history of uncomplicated, normotensive pregnancy. Systolic and diastolic blood pressures, aldosterone and soluble fms-like tyrosine kinase 1 (sFlt-1) levels were measured before and after angiotensin II infusion in both dietary phases. In high sodium balance, women with history of hypertensive pregnancy were normotensive but had significantly higher systolic and diastolic blood pressures than controls (115 vs. 104 mmHg and 73 vs. 65 mmHg, respectively, ppregnancy had pressor response to salt loading, demonstrated by increase in systolic blood pressure on high salt diet. They also had greater systolic pressor response (10 vs. 2 mmHg, p=0.03), greater increase in aldosterone (56.8 vs. 30.8 ng/dL, p=0.03) and increase in sFlt-1 levels (11.0 vs. -18.9 pg/mL, p=0.02) after infusion of angiotensin II in low sodium balance, compared with controls. Thus, women with history of hypertensive pregnancy demonstrated salt sensitivity of blood pressure and had increased pressor, adrenal and sFlt-1 responses to infused angiotensin II in low sodium balance. Increased sensitivity to angiotensin II observed during pregnancy in women with hypertensive pregnancy is present postpartum; this feature may contribute to future cardiovascular risk in these women. PMID:20308605

Effectiveness of a Pregnancy Smoking Intervention: The Tennessee Intervention for Pregnant Smokers Program

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Bailey, Beth A.

2015-01-01

Despite the known dangers of pregnancy smoking, rates remain high, especially in the rural, Southern United States. Interventions are effective, but few have been developed and tested in regions with high rates of pregnancy smoking, a culture that normalizes smoking, and a hard-to-reach prenatal population. The goals were to describe a smoking…

How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals.

Directory of Open Access Journals (Sweden)

Judith Stephenson

Full Text Available To determine the extent to which women plan and prepare for pregnancy.Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals.We recruited 1173/1288 (90% women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54-3.54 for taking folic acid and 2.18 (95% CI 1.42-3.36 for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care.Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

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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

Therapeutic drug monitoring in pregnancy.

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Matsui, Doreen M

2012-10-01

Therapeutic drug monitoring (TDM) is commonly recommended to optimize drug dosing regimens of various medications. It has been proposed to guide therapy in pregnant women, in whom physiological changes may lead to altered pharmacokinetics resulting in difficulty in predicting the appropriate drug dosage. Ideally, TDM may play a role in enhancing the effectiveness of treatment while minimizing toxicity of both the mother and fetus. Monitoring of drug levels may also be helpful in assessing adherence to prescribed therapy in selected cases. Limitations exist as therapeutic ranges have only been defined for a limited number of drugs and are based on data obtained in nonpregnant patients. TDM has been suggested for anticonvulsants, antidepressants, and antiretroviral drugs, based on pharmacokinetic studies that have shown reduced drug concentrations. However, there is only relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Further studies are required to determine whether implementation of TDM during pregnancy improves outcome and is associated with any benefit beyond that achieved by clinical judgment alone. The cost effectiveness of TDM programs during pregnancy also remains to be examined.

Review: Alterations in placental glycogen deposition in complicated pregnancies: Current preclinical and clinical evidence.

Science.gov (United States)

Akison, Lisa K; Nitert, Marloes Dekker; Clifton, Vicki L; Moritz, Karen M; Simmons, David G

2017-06-01

Normal placental function is essential for optimal fetal growth. Transport of glucose from mother to fetus is critical for fetal nutrient demands and can be stored in the placenta as glycogen. However, the function of this glycogen deposition remains a matter of debate: It could be a source of fuel for the placenta itself or a storage reservoir for later use by the fetus in times of need. While the significance of placental glycogen remains elusive, mounting evidence indicates that altered glycogen metabolism and/or deposition accompanies many pregnancy complications that adversely affect fetal development. This review will summarize histological, biochemical and molecular evidence that glycogen accumulates in a) placentas from a variety of experimental rodent models of perturbed pregnancy, including maternal alcohol exposure, glucocorticoid exposure, dietary deficiencies and hypoxia and b) placentas from human pregnancies with complications including preeclampsia, gestational diabetes mellitus and intrauterine growth restriction (IUGR). These pregnancies typically result in altered fetal growth, developmental abnormalities and/or disease outcomes in offspring. Collectively, this evidence suggests that changes in placental glycogen deposition is a common feature of pregnancy complications, particularly those associated with altered fetal growth. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

A Review of the Course and Treatment of Non-Infectious Uveitis during Pregnancy.

Science.gov (United States)

Grotting, Lindsay A; Papaliodis, George N

2017-01-01

Inflammatory conditions such as autoimmune uveitis often occur in women of childbearing age. During pregnancy, women may experience exacerbations of their disease in the first trimester. In the later stages of pregnancy, however, the uveitis tends to remain less active. The management of uveitis during pregnancy is a challenging task, forcing the physician to re-evaluate the patient's current therapy and offer alternative options that pose the least risk to the patient and fetus. This article will review treatments widely used for uveitis, including corticosteroid therapy, anti-metabolites, calcineurin inhibitors, and biologic therapy. It will evaluate the use of these medications in pregnancy and the postpartum state.

Teenage pregnancy: a psychopathological risk for mothers and babies?

Science.gov (United States)

Goossens, Gwendoline; Kadji, Caroline; Delvenne, Veronique

2015-09-01

Teen pregnancy remains a public health problem of varying importance in developing and developed countries. There are risks and consequences for teen parents and the child on the medical and socioeconomic level. We conducted a literature search on multiple databases, focusing on the risk and the consequences of teen pregnancy and childbearing. We used different combined keywords as teen pregnancy, teen mother, teenage parents, teenage childbearing, teenage mother depression. Our search included different type of journals to have access on different views (medical, psychological, epidemiologic). The teen mothers are more at risk for postnatal depression, school dropout and bad socioeconomic status. The babies and children are more at risk for prematurity and low birthweight and later for developmental delays and behavior disorders. Pregnancy in adolescence should be supported in an interdisciplinary way (gynecologist, psychologist, child psychiatrist, midwives, pediatrician). We need further studies that allow targeting patients most at risk and personalizing maximum support.

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

11-Year Trends in Pregnancy-Related Health Indicators in Maine, 2000–2010

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David E. Harris

2014-01-01

Full Text Available The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS data from Maine for 2000–2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables and percentages (for categorical variables were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <$20,000/year remained stagnant. Maternal prepregnancy BMI increased. Average pregnancy weight gain decreased but the number of women whose pregnancy weight gain was within the recommended range was unchanged. The rates of smoking and alcohol consumption (before and during pregnancy increased. The Caesarean section rate rose and the fraction of infants born premature (<37 wks gestation or underweight (<2500 gms remained unchanged. The fraction of infants who were breast-fed increased. These results suggest that, despite some positive trends, Maine faces significant challenges in meeting Healthy People 2020 goals.

Analysis of the original causes of placental oxidative stress in normal pregnancy and pre-eclampsia: a hypothesis.

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Yang, Xiang; Guo, Lili; Li, Huaifang; Chen, Xinliang; Tong, Xiaowen

2012-07-01

Pre-eclampsia (PE) and eclampsia remain enigmatic despite intensive research. Growing evidence suggests that placental oxidative stress (OS) is involved in the etiopathogenesis of pre-eclampsia. Reduced perfusion as a result of abnormal placentation was proposed to be responsible for placental OS in PE. However, placental OS was also observed in normal pregnancy. The exact differences and correlation of placental OS in PE and normal pregnancy remain elusive. In this review, we attempted to link both normal pregnancy and PE on the causes of placental OS and proposed a hypothesis that placental OS in normal pregnancy, plus the exploration of other placental and/or maternal factors, could provide a novel explanation of that in PE. We concluded that pregnancy, placental abnormality and preexisting maternal constitutional conditions are three principle factors that could contribute to placental OS in PE. The specific causes in each clinical case could be heterogeneous, which requires individual analysis.

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

Cardiovascular function in pregnancy: effects of posture.

Science.gov (United States)

Del Bene, R; Barletta, G; Mello, G; Lazzeri, C; Mecacci, F; Parretti, E; Martini, E; Vecchiarino, S; Franchi, F; La Villa, G

2001-04-01

To evaluate the cardiovascular response to active postural changes in pregnancy. Prospective study. Outpatient Clinic, Fetal Maternity Unit. Sixteen healthy women referred prior to pregnancy. Heart rate, arterial pressure, echocardiographic end-diastolic and end-systolic left ventricular volumes (Teichholz' s formula) were measured in the three months before pregnancy, at the end of the first and second trimester, at mid third trimester, and six months after delivery in the supine and standing position, in thirteen women (mean age 33, range 25-38 years). Cardiac output (supine position) significantly increased (28%): it reached its maximum at the second trimester, remained steadily elevated in the mid third trimester, and returned to baseline after delivery. Cardiac output increased during pregnancy also in the active orthostatic position, the percentage increase being greater (70%) since the standing pre-conception value was lower. The postural stress induced similar changes in heart rate, arterial pressure and left ventricular ejection fraction before, during and after pregnancy. However, the reduction in cardiac output associated with early standing attenuated significantly at the second trimester and it was absent at mid third trimester (F = 3.13, P = 0.021). This was due to the interplay between the significantly lesser increase in systemic vascular resistance, occurring since the first trimester, and the significantly lesser decrease in left ventricular end-diastolic volume which was observed in the mid third trimester. These data indicate that the elevated cardiac output is adequately maintained in pregnancy during the postural challenge, due to optimisation of the responses of preload and afterload.

Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

Directory of Open Access Journals (Sweden)

A. D. Herrera-Martínez

2015-01-01

Full Text Available Primary hyperparathyroidism (PHPT in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

Ectopic pregnancy: current clinical trends, a fifteen year study.

Science.gov (United States)

Weekes, L R

1981-09-01

trimester. In cases such as this, there can be local excision and hemostasis. Idiopathic thrombocytopenic purpura was another encountered complication. Salpingectomy is inappropriate and even dangerous when used with an ectopic pregnancy. Early diagnosis and prompt surgery can help increase the survival rate. However, conservative surgery which preserves the tube is feasible and practical using salpingotomy and partial salpingectomy. Maternal death resulting from ectopic pregnancy is usually the result of sudden massive hemorrhage. The initiation of therapy prior to rupture is helpful. Ectopic pregnancy rate has remained fairly consistent among the white population but has decreased significantly in the nonwhite population. This is likely tied to an improvement in socioeconomic status, better patient education, and a greater awareness of medical needs. To decrease the maternal mortality rate from ectopic pregnancy, obstetricians and gynecologists must be more aggressive in research and treatment of ectopic pregnancy.

Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy.

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Bruckner, Hannah; Martin, Anne; Bearman, Peter S

2004-01-01

It is often argued that adolescents who become pregnant do not sufficiently appreciate the negative consequences, and that prevention programs should target participants' attitudes toward pregnancy. Data from the first two waves of the National Longitudinal Study of Adolescent Health were used to examine whether 15-19-year-old females' attitudes toward pregnancy influence their contraceptive consistency and their risk of pregnancy. Characteristics and attitudes associated with pregnancy and contraceptive use were assessed using bivariate and multivariate analysis. Twenty percent of female adolescents were defined as having antipregnancy attitudes, 8% as having propregnancy attitudes and 14% as being ambivalent toward pregnancy; the remainder were considered to have mainstream attitudes. Among sexually experienced adolescents, having an attitude toward pregnancy was not associated with risk of pregnancy. However, those who were ambivalent about pregnancy had reduced odds of using contraceptives consistently and inconsistently rather than not practicing contraception at all (odds ratios, 0.5 and 0.4, respectively). Antipregnancy respondents did not differ from proprepregancy respondents in terms of their contraceptive consistency. However, having a positive attitude toward contraception was associated with increased likelihood of inconsistent and consistent contraceptive use compared with nonuse (1.6 and 2.1, respectively). Programs designed to prevent pregnancy need to give young women information about pregnancy and opportunities to discuss the topic so that they form opinions. Furthermore, programs should emphasize positive attitudes toward contraception, because effective contraceptive use is shaped by such attitudes and is strongly associated with reduction of pregnancy risk.

Regulatory T Cells Show Dynamic Behavior During Late Pregnancy, Delivery, and the Postpartum Period.

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Lima, Jorge; Martins, Catarina; Nunes, Glória; Sousa, Maria-José; Branco, Jorge C; Borrego, Luís-Miguel

2017-07-01

Regulatory T cells (Tregs) are critical immunomodulators during early pregnancy by preventing maternal T-cell activation against fetal cells. However, how populations of maternal Tregs vary during and after pregnancy in humans is still unclear. Therefore, we investigated Treg subsets in the peripheral blood of pregnant women from late pregnancy through the postpartum period. To accomplish this, the following circulating Treg subsets were analyzed in 43 healthy pregnant women and 35 nonpregnant women by flow cytometry during the third trimester, on the day of delivery, and postpartum: CD4 Dim CD25 Hi , CD4 + CD25 Hi Foxp3 + , and CD4 + CD25 Hi CD127 -/dim . Additionally, the expression levels of the transcription factor Foxp3 in CD4 Dim CD25 Hi Treg were analyzed. We have found that CD4 Dim CD25 Hi Treg subset significantly decreased in the pregnant women on the day of delivery relative to the third trimester ( P postpartum compared to the third trimester and the day of delivery ( P postpartum compared to the third trimester and the day of delivery ( P postpartum period. Our results offer an explanation for the possible effects of pregnancy on the clinical outcomes of some autoimmune diseases during the postpartum period.

Optimizing anticancer drug treatment in pregnant cancer patients : pharmacokinetic analysis of gestation-induced changes for doxorubicin, epirubicin, docetaxel and paclitaxel

NARCIS (Netherlands)

van Hasselt, J G C; van Calsteren, K; Heyns, L; Han, S; Mhallem Gziri, M; Schellens, J H M; Beijnen, J H; Huitema, A D R; Amant, F

2014-01-01

BACKGROUND: Pregnant patients with cancer are increasingly treated with anticancer drugs, although the specific impact of pregnancy-induced physiological changes on the pharmacokinetics (PK) of anticancer drugs and associated implications for optimal dose regimens remains unclear. Our objectives

To tell or not to tell? Examining the role of discrimination in the pregnancy disclosure process at work.

Science.gov (United States)

Jones, Kristen P

2017-04-01

Despite the rapid entrance of women into the workforce over the past several decades, many workplace experiences unique to women remain poorly understood. One critical, yet understudied, area is the intersection of work and pregnancy. Because pregnancy remains concealable for a substantial amount of time, expectant employees must navigate decisions regarding to whom, when, and how to disclose their pregnant identities at work. In light of evidence that has suggested pregnancy is often stigmatized within the workplace, I employed a retrospective longitudinal design to explore the extent to which women's expectations about discrimination-anticipated discrimination-shape their pregnancy disclosure behaviors, and the extent to which these different behavioral strategies are associated with higher or lower experienced discrimination. I also examined the link between pregnancy disclosure strategies and psychological distress. Taken together, findings suggest that pregnant employees' expectations about pregnancy discrimination play a role in shaping disclosure behaviors at work. Furthermore, certain behavioral strategies for pregnancy disclosure were linked with average reports of experienced discrimination and momentary reports of psychological distress. I also discuss theoretical and practical implications. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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.

Early Pregnancy Losses: Review of Nomenclature, Histopathology, and Possible Etiologies.

Science.gov (United States)

Pinar, M Halit; Gibbins, Karen; He, Mai; Kostadinov, Stefan; Silver, Robert

2018-05-08

Miscarriage is a frequent complication of human pregnancy: ∼50% to 70% of spontaneous conceptions are lost prior to the second trimester. Etiology of miscarriage includes genetic abnormalities, infections, immunological and implantation disorders, uterine and endocrine abnormalities, and lifestyle factors. Given such variability, knowledge regarding causes, pathophysiological mechanisms, and morphologies of primary early pregnancy loss has significant gaps; often, pregnancy losses remain unexplained. Pathologic evaluation of miscarriage tissue is an untapped source of knowledge. Although miscarriage specimens comprise a significant part of pathologists' workload, information reported from these specimens is typically of minimal clinical utility for delineating etiology or predicting recurrence risk. Standardized terminology is available, though not universally used. We reintroduce the terminology and review new information about early pregnancy losses and their morphologies. Current clinical terminology is inconsistent, hampering research progress. This review is a resource for diagnostic pathologists studying this complex problem.

Myasthenia gravis and pregnancy: clinical implications and neonatal outcome

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Estanol Bruno

2004-11-01

Full Text Available Abstract Background The myasthenia gravis is twice as common in women as in men and frequently affects young women in the second and third decades of life, overlapping with the childbearing years. Generally, during pregnancy in one third of patients the disease exacerbates, whereas in two thirds it remains clinically unchanged. Complete remission can occur in some patients. Methods To describe the clinical course, delivery and neonatal outcome of 18 pregnant women with the diagnosis of myasthenia gravis. Retrospective chart review of pregnant patients with myasthenia gravis, followed at the National Institute of Perinatology in Mexico City over an 8-year period. Data was abstracted from the medical records on the clinical course during pregnancy, delivery and neonatal outcome. Results From January 1, 1996 to December 31, 2003 18 patients with myasthenia gravis were identified and included in the study. The mean ± SD maternal age was 27.4 ± 4.0 years. During pregnancy 2 women (11% had an improvement in the clinical symptoms of myasthenia gravis, 7 women (39% had clinical worsening of the condition of 9 other patients (50% remained clinically unchanged. Nine patients delivered vaginally, 8 delivered by cesarean section and 1 pregnancy ended in fetal loss. Seventeen infants were born at mean ± SD gestational age of 37.5 ± 3.0 weeks and a mean birth weight of 2710 ± 73 g. Only one infant presented with transient neonatal myasthenia gravis. No congenital anomalies were identified in any of the newborns. Conclusions The clinical course of myasthenia gravis during pregnancy is variable, with a significant proportion of patients experiencing worsening of the clinical symptoms. However, neonatal transient myasthenia was uncommon in our patient population.

Increased sensitivity to angiotensin II is present postpartum in women with a history of hypertensive pregnancy.

Science.gov (United States)

Saxena, Aditi R; Karumanchi, S Ananth; Brown, Nancy J; Royle, Caroline M; McElrath, Thomas F; Seely, Ellen W

2010-05-01

Pregnancies complicated by new-onset hypertension are associated with increased sensitivity to angiotensin II, but it is unclear whether this sensitivity persists postpartum. We studied pressor response to infused angiotensin II in 25 normotensive postpartum women in both high- and low-sodium balance. Ten women had a history of hypertensive pregnancy (5 with preeclampsia; 5 with transient hypertension of pregnancy), and 15 women had a history of uncomplicated, normotensive pregnancy. Systolic and diastolic blood pressures, aldosterone, and soluble fms-like tyrosine kinase 1 levels were measured before and after angiotensin II infusion in both dietary phases. In high sodium balance, women with a history of hypertensive pregnancy were normotensive but had significantly higher systolic and diastolic blood pressures than controls (115 versus 104 mm Hg and 73 versus 65 mm Hg, respectively; Ppregnancy had a pressor response to salt loading, demonstrated by an increase in systolic blood pressure on a high-salt diet. They also had greater systolic pressor response (10 versus 2 mm Hg; P=0.03), greater increase in aldosterone (56.8 versus 30.8 ng/dL; P=0.03), and increase in soluble fms-like tyrosine kinase 1 levels (11.0 versus -18.9 pg/mL; P=0.02) after infusion of angiotensin II in low-sodium balance compared with controls. Thus, women with a history of hypertensive pregnancy demonstrated salt sensitivity of blood pressure and had increased pressor, adrenal, and soluble fms-like tyrosine kinase 1 responses to infused angiotensin II in low-sodium balance. Increased sensitivity to angiotensin II observed during pregnancy in women with hypertensive pregnancy is present postpartum; this feature may contribute to future cardiovascular risk in these women.

Malaria in pregnancy | Okpere | Nigerian Medical Journal

African Journals Online (AJOL)

Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10,000 maternal deaths and to at least 200,000 newborn deaths annually. Malaria is a contributor ...

[Pharmacokinetic alterations in pregnancy and use of therapeutic drug monitoring].

Science.gov (United States)

Panchaud, Alice; Weisskopf, Etienne; Winterfeld, Ursula; Baud, David; Guidi, Monia; Eap, Chin B; Csajka, Chantal; Widmer, Nicolas

2014-01-01

Following the thalidomide tragedy, pharmacological research in pregnant women focused primarily on drug safety for the unborn child and remains only limited regarding the efficacy and safety of treatment for the mother. Significant physiological changes during pregnancy may yet affect the pharmacokinetics of drugs and thus compromise its efficacy and/or safety. Therapeutic drug monitoring (TDM) would maximize the potential effectiveness of treatments, while minimizing the potential risk of toxicity for the mother and the fetus. At present, because of the lack of concentration-response relationship studies in pregnant women, TDM can rely only on individual assessment (based on an effective concentration before pregnancy) and remains reserved only to unexpected situations such as signs of toxicity or unexplained inefficiency. © 2014 Société Française de Pharmacologie et de Thérapeutique.

Endovascular treatment in pregnancy

International Nuclear Information System (INIS)

Ishii, Akira; Miyamoto, Susumu

2013-01-01

There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient. (author)

Vasculitis and Pregnancy.

Science.gov (United States)

Machen, Leah; Clowse, Megan E B

2017-05-01

Vasculitis is more often a disease of women beyond their reproductive years, leaving the challenges of pregnancy management difficult to study. Pregnancy complications, including pregnancy loss and preterm birth, are higher among women with all forms of vasculitis. It seems that controlling the disease before pregnancy may improve the chances of pregnancy success. Many medications used for vasculitis are considered low risk in pregnancy, including prednisone, colchicine, azathioprine, and tumor necrosis factor inhibitors. Cyclophosphamide, methotrexate, and mycophenolate mofetil should be avoided in pregnancy. Controlling disease with low-risk medications may allow women with vasculitis to have the pregnancies they desire. Copyright © 2017 Elsevier Inc. All rights reserved.

Treatment of Addison's disease during pregnancy.

Science.gov (United States)

Oliveira, Diana; Lages, Adriana; Paiva, Sandra; Carrilho, Francisco

2018-01-01

Addison's disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison's disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison's disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period. An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison's disease.Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental.Monitoring in this period is challenging and remains mainly clinical.The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.

Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

Hulusi B ZEYNELOGLU

2005-09-01

Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

State of the art: Reproduction and pregnancy in rheumatic diseases.

Science.gov (United States)

Østensen, Monika; Andreoli, Laura; Brucato, Antonio; Cetin, Irene; Chambers, Christina; Clowse, Megan E B; Costedoat-Chalumeau, Nathalie; Cutolo, Maurizio; Dolhain, Radboud; Fenstad, M H; Förger, Frauke; Wahren-Herlenius, Marie; Ruiz-Irastorza, Guillermo; Koksvik, Hege; Nelson-Piercy, Catherine; Shoenfeld, Yehuda; Tincani, Angela; Villiger, Peter M; Wallenius, Marianne; von Wolff, Michael

2015-05-01

Throughout the last decade, increasing awareness has been raised on issues related to reproduction in rheumatic diseases including basic research to clarify the important role of estrogens in the etiology and pathophysiology of immune/inflammatory diseases. Sub- or infertility is a heterogeneous condition that can be related to immunological mechanisms, to pregnancy loss, to disease burden, to therapy, and to choices in regard to family size. Progress in reproductive medicine has made it possible for more patients with rheumatic disease to have children. Active disease in women with rheumatoid arthritis (RA) affects their children's birth weight and may have long-term effects on their future health status. Pregnancy complications as preeclampsia and intrauterine growth restriction are still increased in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), however, biomarkers can monitor adverse events, and several new therapies may improve outcomes. Pregnancies in women with APS remain a challenge, and better therapies for the obstetric APS are needed. New prospective studies indicate improved outcomes for pregnancies in women with rare diseases like systemic sclerosis and vasculitis. TNF inhibitors hold promise for maintaining remission in rheumatological patients and may be continued at least in the first half of pregnancy. Pre-conceptional counseling and interdisciplinary management of pregnancies are essential for ensuring optimal pregnancy outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

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

African Journals Online (AJOL)

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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.

The association of daily physical activity and birth outcome: A population-based cohort study

NARCIS (Netherlands)

M.I. Both (Marieke); M.A. Overvest (Mathilde); M.F. Wildhagen (Mark); J. Golding (Jean); H.I.J. Wildschut (Hajo)

2010-01-01

textabstractThe potential relationship between daily physical activity and pregnancy outcome remains unclear because of the wide variation in study designs and physical activity assessment measures. We sought to prospectively quantify the potential effects of the various domains of physical activity

The relationship between urinary tract infection during pregnancy and preeclampsia: causal, confounded or spurious?

Science.gov (United States)

Karmon, Anatte; Sheiner, Eyal

2008-06-01

Preeclampsia is a major cause of maternal morbidity, although its precise etiology remains elusive. A number of studies suggest that urinary tract infection (UTI) during the course of gestation is associated with elevated risk for preeclampsia, while others have failed to prove such an association. In our medical center, pregnant women who were exposed to at least one UTI episode during pregnancy were 1.3 times more likely to have mild preeclampsia and 1.8 times more likely to have severe preeclampsia as compared to unexposed women. Our results are based on univariate analyses and are not adjusted for potential confounders. This editorial aims to discuss the relationship between urinary tract infection and preeclampsia, as well as examine the current problems regarding the interpretation of this association. Although the relationship between UTI and preeclampsia has been demonstrated in studies with various designs, carried-out in a variety of settings, the nature of this association is unclear. By taking into account timeline, dose-response effects, treatment influences, and potential confounders, as well as by neutralizing potential biases, future studies may be able to clarify the relationship between UTI and preeclampsia by determining if it is causal, confounded, or spurious.

Alcohol and pregnancy

Science.gov (United States)

Drinking alcohol during pregnancy; Fetal alcohol syndrome - pregnancy; FAS - fetal alcohol syndrome ... lead to lifelong damage. DANGERS OF ALCOHOL DURING PREGNANCY Drinking a lot of alcohol during pregnancy can ...

Therapeutic apheresis for severe hypertriglyceridemia in pregnancy.

Science.gov (United States)

Basar, Rafet; Uzum, Ayse Kubat; Canbaz, Bulent; Dogansen, Sema Ciftci; Kalayoglu-Besisik, Sevgi; Altay-Dadin, Senem; Aral, Ferihan; Ozbey, Nese Colak

2013-05-01

During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy. We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used. When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.

The developmental origin of adolescent alcohol use: findings from the Mater University Study of Pregnancy and its outcomes.

Science.gov (United States)

Alati, Rosa; Clavarino, Alexandra; Najman, Jake M; O'Callaghan, Michael; Bor, William; Mamun, Abdullah Al; Williams, Gail M

2008-11-01

It is unclear whether fetal alcohol exposure contributes to alcohol use in adolescence. In this study, we examine the association between maternal alcohol use in pregnancy and adolescents' drinking patterns at age 14. The association of maternal alcohol exposure with early drinking was examined in 4363 adolescents taking part to the Mater University Study of Pregnancy (MUSP) and its outcomes, a population based birth cohort study commenced in Brisbane (Australia) in 1981. Mothers and children were followed up at birth, 5 and 14 years after the initial interview. Maternal alcohol use was assessed before and during pregnancy and at the 5 years follow-up. Adolescents' alcohol use was assessed at child age 14. In multivariable analysis those born of mothers who consumed 3+ glasses during pregnancy were at increased risk to report drinking 3+ glasses compared with those whose mothers reported no drinking or drinking up to 2 glasses. Comparisons controlling for drinking before pregnancy and at age 5 found the averaged odds ratio of maternal drinking in pregnancy on risk of reporting alcohol consumption of 3 and more glasses at age 14 was 2.74 (CI 1.70, 4.22). Our study suggests that they maybe a biological origin of early drinking. Further studies are needed to better disentangle the nature of the association and the role of other possible confounding factors.

PP033. High blood pressure in pregnancy: an indicator of future health outcomes.

Science.gov (United States)

Tooher, J; Chiu, C L; Thornton, C; Lupton, S; O'Loughlin, A; Makris, A; Hennessy, A; Lind, J M; Korda, A; Ogle, R; Horvath, J

2012-07-01

Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal and perinatal morbidity and mortality worldwide. In Australia approximately 10% of all pregnancies are affected by HDP. There is growing evidence that endothelial damage caused by HDP remains after pregnancy and has long term consequences on maternal health. The aim of our research was to determine the association between HDP and risk of having high blood pressure in later life. Self-reported data regarding a physician's diagnosis of HDP and of high blood pressure later in life were obtained from women recruited from the 45 and Up Study, Australia. Relative risks (converted from odds ratios) and 99% confidence intervals were estimated using logistic regression, adjusting for demographic and lifestyle characteristics. A total of 82,164 women were included in the study, of which 9,845 reported having HDP. Women who had HDP had a significantly increased risk of having high blood pressure later in life compared to women who did not have HDP (adjusted relative risk of 2.05, 99% CI 1.99-2.11, phigh blood pressure 6.3 years (99% CI 5.85-6.66, phigh blood pressure compared to women who have a healthy pregnancy. Women with HDP should be monitored closely in the years following pregnancy for early identification and intervention of high blood pressure. Copyright © 2010. Published by Elsevier B.V.

Maternal weight and body composition in the first trimester of pregnancy.

LENUS (Irish Health Repository)

Fattah, Chro

2012-02-01

OBJECTIVE: Previous studies on weight gain in pregnancy suggested that maternal weight on average increased by 0.5-2.0 kg in the first trimester of pregnancy. This study examined whether mean maternal weight or body composition changes in the first trimester of pregnancy. DESIGN: Prospective observational study. POPULATION: We studied 1,000 Caucasian women booking for antenatal care in the first trimester of pregnancy. SETTING: Large university teaching hospital. METHODS: Maternal height and weight were measured digitally in a standardized way and Body Mass Index (BMI) was calculated. Maternal body composition was measured using segmental multifrequency Bioelectrical Impedance Analysis (BIA). Sonographic examination confirmed the gestational age and a normal ongoing singleton pregnancy in all subjects. MAIN OUTCOME MEASURES: Maternal weight, maternal body composition. RESULTS: The mean BMI was 25.7 kg\\/m(2) and 19.0% of the women were in the obese category (> or =30.0 kg\\/m(2)). Cross-sectional analysis by gestational age showed that there was no change in mean maternal weight, BMI, total body water, fat mass, fat-free mass or bone mass before 14 weeks gestation. CONCLUSIONS: Contrary to previous reports, mean maternal weight and mean body composition values remain unchanged in the first trimester of pregnancy. This has implications for guidelines on maternal weight gain during pregnancy. We also recommend that calculation of BMI in pregnancy and gestational weight gain should be based on accurate early pregnancy measurements, and not on self-reported or prepregnancy measurements.

Gestational Diabetes Mellitus: Risks and Management during and after Pregnancy

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Buchanan, Thomas A.; Xiang, Anny H.; Page, Kathleen A.

2015-01-01

Gestational diabetes mellitus (GDM) represents glucose levels in the high end of the population distribution during pregnancy. GDM carries a small but potentially important risk of adverse perinatal outcomes and a longer-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements compliment maternal glucose measurements in identifying pregnancies that need such intensification. Glucose testing shortly after pregnancy can stratify the near-term diabetes risk in mothers, Thereafter, annual glucose and HbA1C testing can detect deteriorating glycaemic control, a harbinger of future diabetes, usually type 2. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning allows optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity. PMID:22751341

Undercarboxylated osteocalcin is associated with insulin resistance, but not adiponectin, during pregnancy.

Science.gov (United States)

Srichomkwun, Panudda; Houngngam, Natnicha; Pasatrat, Sophitsachi; Tharavanij, Thipaporn; Wattanachanya, Lalita; Khovidhunkit, Weerapan

2016-07-01

In mice, undercarboxylated osteocalcin (ucOC) improves beta-cell function and insulin sensitivity through adiponectin. In humans, levels of total osteocalcin (OC) and ucOC were negatively correlated with insulin resistance (IR) indices in patients with type 2 diabetes. Whether ucOC plays a role in glucose homeostasis and whether its effect is mediated through adiponectin during pregnancy is unclear. Serum levels of total OC, ucOC, and adiponectin were measured in 130 pregnant women with varying degrees of IR [gestational diabetes mellitus (GDM), n = 74 and non-GDM, n = 56]. In all participants, total OC and ucOC levels were positively correlated with HOMA-IR and HOMA-%B, and negatively correlated with QUICKI. In contrast, adiponectin levels were negatively correlated with HOMA-IR and positively correlated with QUICKI (P insulin secretion and IR indices, but not adiponectin levels, in pregnant women. Changes in OC might be a sensitive response to increased IR during pregnancy, which was not mediated through adiponectin.

Is Generalized Maternal Optimism or Pessimism During Pregnancy Associated with Unplanned Cesarean Section Deliveries in China?

Directory of Open Access Journals (Sweden)

Cheryl A. Moyer

2010-01-01

Full Text Available This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

Normotensive blood pressure in pregnancy: the role of salt and aldosterone.

Science.gov (United States)

Gennari-Moser, Carine; Escher, Geneviève; Kramer, Simea; Dick, Bernhard; Eisele, Nicole; Baumann, Marc; Raio, Luigi; Frey, Felix J; Surbek, Daniel; Mohaupt, Markus G

2014-02-01

A successful pregnancy requires an accommodating environment. Salt and water availability are critical for plasma volume expansion. Any changes in sodium intake would alter aldosterone, a hormone previously described beneficial in pregnancy. To date, it remains ambiguous whether high aldosterone or high salt intake is preferable. We hypothesized that increased aldosterone is a rescue mechanism and appropriate salt availability is equally effective in maintaining a normotensive blood pressure (BP) phenotype in pregnancy. We compared normotensive pregnant women (n=31) throughout pregnancy with young healthy female individuals (n=31-62) and performed salt sensitivity testing within the first trimester. Suppression of urinary tetrahydro-aldosterone levels by salt intake as measured by gas chromatography-mass spectrometry and urinary sodium excretion corrected for creatinine, respectively, was shifted toward a higher salt intake in pregnancy (Ppregnancy, neither high urinary tetrahydro-aldosterone nor sodium excretion was correlated with higher BP. In contrast, in nonpregnant women, systolic BP rose with aldosterone (Ppregnancy without causing aldosterone-induced hypertension. Second, salt seems to aid in BP lowering in pregnancy for reasons incompletely elucidated, yet involving renin suppression and potentially placental sensing mechanisms. Further research should identify susceptible individuals and clarify effector mechanisms.

Teenage pregnancy prevention: the role of young men.

Science.gov (United States)

Vargas, Gabriela; Borus, Joshua; Charlton, Brittany M

2017-08-01

Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregnancy prevention. Young men have varying views on contraception as well as which partner(s) should be responsible for its use. Limited contraception knowledge reduces young men's sexual health communication as well as their contraception use. Healthcare providers play a major role as one of the main sources of sexual health information for young men, but there are gaps in young men's sexual health care so new guidelines have emerged. Recent literature highlights young men's range of views on contraception as well as their low sexual health knowledge and sexual health communication. To address teenage pregnancy and improve young men's overall wellness, healthcare providers should routinely address sexual health. Healthcare providers may use our newly proposed acronym, HIS BESTT, (Hello. Initiate. Sexual health assessment. Both condoms and female dependent methods. Examine genitals. STI screening. Talking to partner(s). Talking to parent(s) or guardians), to incorporate current clinical recommendations.

Pregnancy

DEFF Research Database (Denmark)

Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

2013-01-01

Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and hea...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

Interventions for hyperthyroidism pre-pregnancy and during pregnancy.

Science.gov (United States)

Earl, Rachel; Crowther, Caroline A; Middleton, Philippa

2013-11-19

Women with hyperthyroidism in pregnancy have increased risks of miscarriage, stillbirth, preterm birth, and intrauterine growth restriction; and they can develop severe pre-eclampsia or placental abruption. To identify interventions used in the management of hyperthyroidism pre-pregnancy or during pregnancy and to ascertain the impact of these interventions on important maternal, fetal, neonatal and childhood outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013). We planned to include randomised controlled trials, quasi-randomised controlled trials, and cluster-randomised trials comparing antithyroid interventions for hyperthyroidism pre-pregnancy or during pregnancy with another intervention or no intervention (placebo or no treatment). Two review authors assessed trial eligibility and planned to assess trial quality and extract the data independently. No trials were included in the review. As we did not identify any eligible trials, we are unable to comment on implications for practice, although early identification of hyperthyroidism before pregnancy may allow a woman to choose radioactive iodine therapy or surgery before planning to have a child. Designing and conducting a trial of antithyroid interventions for pregnant women with hyperthyroidism presents formidable challenges. Not only is hyperthyroidism a relatively rare condition, both of the two main drugs used have potential for harm, one for the mother and the other for the child. More observational research is required about the potential harms of methimazole in early pregnancy and about the potential liver damage from propylthiouracil.

Narcolepsy and pregnancy

DEFF Research Database (Denmark)

Maurovich-Horvat, Eszter; Kemlink, David; Högl, Birgit

2013-01-01

In a retrospective cohort study undertaken in 12 European countries, 249 female narcoleptic patients with cataplexy (n = 216) and without cataplexy (n = 33) completed a self-administrated questionnaire regarding pregnancy and childbirth. The cohort was divided further into patients whose symptoms...... of narcolepsy started before or during pregnancy (308 pregnancies) and those in whom the first symptoms of narcolepsy appeared after delivery (106 pregnancies). Patients with narcolepsy during pregnancy were older during their first pregnancy (P ...

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

Science.gov (United States)

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.

Caffeine in Pregnancy

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... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... Nutrition, weight & fitness > Caffeine in pregnancy Caffeine in pregnancy E-mail to a friend Please fill in ...

Primary omental pregnancy

International Nuclear Information System (INIS)

Yildizhan, R.; Kurdoglu, M.; Kolusari, A.; Erten, R.

2008-01-01

Omental pregnancy is a rare form of ectopic pregnancy and can be seen primarily or secondary to a tubal pregnancy. A 25-yeal-old woman presented with abdominal distention with pain and anemia without vaginal bleeding. After a provisional diagnosis of ruptured ectopic pregnancy, laparotomy was performed. On surgical exploration, the bilateral tubes and ovaries were intact, however, an omental pregnancy was detected as the cause of hemoperitoneum. Partial omentectomy was performed. Although most cases are secondary, presented here is an additional case of primary omental pregnancy at 12 weeks according to Studdiford's criteria. Histological evidence of neovascularization into the supporting tissue confirmed our diagnosis. A primary omental pregnancy should always be considered as a possible explanation for severe hemoperitoneum in ectopic pregnancies presenting with acute abdomen and with intact adnexes on surgical exploration. (author)

HIV and Pregnancy

Science.gov (United States)

... Management Education & Events Advocacy For Patients About ACOG HIV and Pregnancy Home For Patients Search FAQs HIV ... HIV and Pregnancy FAQ113, July 2017 PDF Format HIV and Pregnancy Pregnancy What is human immunodeficiency virus ( ...

Listeria and Pregnancy

Science.gov (United States)

... Events Advocacy For Patients About ACOG Listeria and Pregnancy Home For Patients Search FAQs Listeria and Pregnancy ... Pregnancy PFS013, January 2017 PDF Format Listeria and Pregnancy Fact Sheets Food Poisoning in Pregnant Women The ...

Maternal protein intake in pregnancy and offspring metabolic health at age 9-16 y

DEFF Research Database (Denmark)

Maslova, Ekaterina; Hansen, Susanne; Grunnet, Louise Groth

2017-01-01

in free-living populations remains limited. Objective: We examined the association of protein intake in pregnancy with offspring metabolic health at age 9-16 y in a longitudinal cohort that oversampled pregnancies with gestational diabetes mellitus (GDM). Design: Six hundred eight women with an index...... provide little support for an association of maternal protein intake in pregnancy with measures of offspring metabolic health. Further studies in larger cohorts are needed to determine whether low maternal protein intake in pregnancy may improve glucose homeostasis in GDM-exposed and male offspring....... pregnancy affected by gestational diabetes mellitus and 626 controls enrolled in the Danish National Birth Cohort were used for the analysis. Protein (total, animal, vegetable) intake was assessed by using a foodfrequency questionnaire in gestational week 25. The offspring underwent a clinical examination...

Abuse during Pregnancy

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Vaccinations during Pregnancy

Science.gov (United States)

... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Radiation and Pregnancy

Science.gov (United States)

... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Mercury and Pregnancy

Science.gov (United States)

... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Syphilis in pregnancy

Science.gov (United States)

... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis.

Science.gov (United States)

Liu, Youxia; Ma, Xinxin; Zheng, Jie; Liu, Xiangchun; Yan, Tiekun

2017-07-18

Presently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes. We systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model. One thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), lower mean gestational age at delivery (-0.70 week [95% CI -1.21 to -0.19 week]) and lower birth weight (-740 g [95% CI -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%). PR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality.

A 26-Year-Old Retained Demised Abdominal Pregnancy Presenting with Umbilical Fistula

Science.gov (United States)

Daniel, Nnadi; Bashir, Bello; Ibrahim, Ango; Swati, Singh

2014-01-01

This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient's condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day. PMID:24639908

A 26-Year-Old Retained Demised Abdominal Pregnancy Presenting with Umbilical Fistula

Directory of Open Access Journals (Sweden)

Nnadi Daniel

2014-01-01

Full Text Available This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient’s condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day.

Exercise during Pregnancy

Medline Plus

Full Text Available ... Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Sex during Pregnancy

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Sex During Pregnancy KidsHealth / For Parents / Sex During Pregnancy ... satisfying and safe sexual relationship during pregnancy. Is Sex During Pregnancy Safe? Sex is considered safe during ...

Exercise during Pregnancy

Medline Plus

Full Text Available ... Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & birth Postpartum ... Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & birth Postpartum ...

Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

Science.gov (United States)

Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

2008-03-01

Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

Ectopic Pregnancy

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... caused by blood loss) lower back pain What Causes an Ectopic Pregnancy? An ectopic pregnancy usually happens because a fertilized ... protect against sexually transmitted infections (STDs) that can cause PID. If ... about the pregnancy being ectopic, talk to your doctor — it's important ...

Anaemia in pregnancy is associated with advanced HIV disease.

Science.gov (United States)

Nandlal, Vikesh; Moodley, Dhayendre; Grobler, Anneke; Bagratee, Jayanthilall; Maharaj, Niren R; Richardson, Paul

2014-01-01

Anaemia is a common clinical finding in HIV infected women and has been associated with advanced disease. The use of antiretroviral drugs such as Zidovudine (ZDV) either for prevention of mother to child transmission (MTCT) of HIV or used in combination with other antiretrovirals have been implicated in the development or increased severity of anaemia. We report the prevalence, type, severity and incidence of anaemia in a cohort of HIV infected women who initiated antiretroviral prophylaxis or treatment during pregnancy. This is a retrospective cohort data analysis of 408 HIV infected pregnant women who participated in a breastfeeding intervention study (HPTN 046 Study, ClinicalTrials.gov NCT 00074412) in South Africa. Women initiated zidovudine prophylaxis for PMTCT or triple antiretroviral treatment in pregnancy according to the standard of care. Laboratory and clinical data in pregnancy, anaemia (Hbpregnancy, 48/146 (32.9%) subsequently developed anaemia intrapartum or postpartum and 89/310 (28.7%) of all cases of anaemia remained unresolved by 2 weeks postdelivery. In a univariate analysis, CD4 count and gravidity were significant risk factors for anaemia in pregnancy, RR 1.41; 1.23-1.61 (panaemia in pregnancy and postdelivery. In conclusion, anaemia was most common among women in the advanced stage of HIV infection (CD4anaemia.

Metformin treatment for Type 2 diabetes in pregnancy?

Science.gov (United States)

Simmons, David

2010-08-01

Metformin lowers blood glucose by reducing hepatic glucose output, increasing insulin sensitivity and enhancing peripheral glucose uptake. Metformin is widely used in women with Type 2 diabetes of child-bearing age, many of whom become pregnant. Studies to date in Type 2 diabetes in pregnancy, gestational diabetes and polycystic ovarian syndrome are reassuring. Metformin is not considered teratogenic. There is sufficient evidence that metformin is safe used throughout pregnancy, with no worsening of obstetric or perinatal outcomes. Women may benefit from the lesser weight gain. The long-term risks to the offspring remain inadequately researched, with no evidence of harm up to 2 years, and no suggestions of later complications in countries using metformin for many years. Metformin is recommended for use in pregnancies complicated by Type 2 diabetes, but women should be informed of the evidence regarding its associated risks and benefits to enable an informed choice over its use. 2010 Elsevier Ltd. All rights reserved.

Exercise during Pregnancy

Medline Plus

Full Text Available ... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Exercise during Pregnancy

Medline Plus

Full Text Available ... Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & birth Postpartum care Baby ... Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & birth Postpartum care Baby ...

Management of systemic lupus erythematosus during pregnancy: challenges and solutions

Directory of Open Access Journals (Sweden)

Knight CL

2017-03-01

Full Text Available Caroline L Knight, Catherine Nelson-Piercy Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, St Thomas’ Hospital, London, UK Abstract: Systemic lupus erythematosus (SLE is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal–neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy. In pregnancy, early referral for hospital-coordinated care, involvement of obstetricians and rheumatologists (and other specialists as required, an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus. A cesarean section may be required in certain obstetric contexts (such as urgent preterm delivery for maternal and/or fetal well-being, but vaginal birth should be the aim for the majority of women. Postnatally, an ongoing individual management plan remains important, with neonatal management where necessary and rheumatology follow-up. This article explores the challenges at each stage of pregnancy, discusses the effect of SLE on pregnancy and

Reproductive and relational trajectories leading to pregnancy: Differences between adolescents and adult women who had an abortion.

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Pereira, Joana I F; Pires, Raquel S A; Araújo-Pedrosa, Anabela F; Canavarro, Maria Cristina C S P

2018-05-01

The literature has been conceptualizing pregnancy occurrence as a multiphase event. However, the different combinations of decisions and behaviors leading to pregnancy that end in abortion remain unexplored in the literature. The aims of the study were to describe the reproductive and relational trajectories leading to pregnancy in women who decide to abort and to explore the differences in this process according to women's age [adolescents (leading to pregnancy were identified. The most frequent trajectory (30.8%) included women who 1) were involved in a long-term romantic relationship, 2) did not plan the pregnancy, 3) were using contraception, and 4) did not identify the contraceptive failure that led to pregnancy. Although this was the most frequent trajectory for both age groups, the remaining trajectories showed a different distribution. Compared to adolescents, adult women's trajectories more frequently included casual relationships with non-use of contraception, or contraceptive use with no contraceptive failure identification. Our study highlights the need to recognize the multiplicity of reproductive and relational trajectories leading to pregnancies that end in abortion and their specificities according to women's age. These findings have important implications for abortion counselling and for the development of age-appropriate guidelines for preventive interventions, by drawing attention to prioritization of different contexts of intervention according women's age. Copyright © 2018 Elsevier B.V. All rights reserved.

Iron deficiency anaemia in pregnancy: The role of parenteral iron.

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Esen, Umo I

2017-01-01

Maternal and perinatal morbidity and mortality remain major challenges in the delivery of safe maternity care worldwide. Anaemia in pregnancy is an important contributor to this dismal picture, especially where blood transfusion services are poorly developed. An early diagnosis and treatment of iron deficiency anaemia in pregnancy using the new generation dextran-free parenteral iron preparations can save lives and reduce morbidity in selected pregnancies. It is time to cast aside the fears associated with the use of the old parenteral iron preparations which were associated a high incidence of anaphylaxis, and embrace the use of new parenteral iron products which have better side effect profiles and can deliver total dose infusions without the need for test dosing. In selected women, the benefits of this treatment far outweigh any disadvantages.

Bleeding during Pregnancy

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... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

Pregnancy at 65, risks and complications

Directory of Open Access Journals (Sweden)

Shailja Verma

2016-01-01

Full Text Available A 65-year-old postmenopausal pregnant woman was referred with antepartum hemorrhage at 29 weeks of gestation. Postadmission diagnosed with chronic hypertension, gestational diabetes mellitus, valvular heart disease, and placenta previa. Her pregnancy was terminated by cesarean delivery at 32 weeks as she had a bout of bleeding per vaginum. Most of the placenta was adherent with no plane of cleavage; therefore, cesarean hysterectomy was performed. Baby birth weight was 1650 g and was shifted to nursery for observation and mother needed Intensive Care Unit care postcesarean. On the 15th day, both healthy mother and baby were discharged. Although pregnancy is possible in postmenopausal women with hormone support but the incidence of complications remain very high. It raises a need for developing well-laid guidelines for performing in vitro fertilization in older age group women.

Liver disease in pregnancy

Institute of Scientific and Technical Information of China (English)

Noel M Lee; Carla W Brady

2009-01-01

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.

[Characteristics of miscarriage and women's rights after pregnancy loss].

Science.gov (United States)

Lewicka, Magdalena; Sulima, Magdalena; Pyć, Maria; Stawarz, Barbara

2013-01-01

The term "miscarriage" refers to the end of pregnancy before the 22nd week of gestation, or taking into account the criterion of foetal weight (less than 500 g). Approximately 15-20% of recognized pregnancies and miscarriage involve spontaneous expulsion of the blastocyst from the uterine cavity. This constitutes about 80% of miscarriages in the first 12 weeks of gestation. The literature lists a number of factors which cause the loss of pregnancies. The most frequently cited causes of abortion are: genetic, anatomical, immunological and hormonal factors, and infections. A large number of miscarriages remain unexplained (idiopathic miscarriages). Clinical signs of miscarriage include bleeding and pain. Bleeding or spotting is the earliest sign of miscarriage. Data from the patient's history, physical examination, ultrasound examination and tests for hCG level can enable diagnosis of bleeding in early pregnancy, help to assess the degree of risk, and implement an appropriate treatment regimen and care for pregnant women adapted to their needs. Loss of pregnancy is an interdisciplinary problem involving obstetrics, epidemiology, public health, psychology, and other specialities. The role of medical personnel in the care of women after the loss of a child, regardless of the week and therapeutic procedures, as well as for giving adequate information regarding the rights of women after pregnancy loss. The obligation to inform women of their rights concerns medical staff, and it is important to promote knowledge in this field among doctors, nurses and midwives who care for women after miscarriage.

Plasma YKL-40 during pregnancy and gestational diabetes mellitus.

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Rinnov, Anders R; Rathcke, Camilla N; Bonde, Lisbeth; Vilsbøll, Tina; Knop, Filip K

2015-11-01

Gestational diabetes mellitus (GDM) is characterised by hyperglycaemia during pregnancy. The clinical circumstances involved in the development of GDM leaves the patient at a high risk of the subsequent development of type 2 diabetes. Plasma levels of the inflammation marker YKL-40 are elevated in type 2 diabetes and correlate with fasting plasma glucose levels and insulin resistance in patients with type 2 diabetes. With the present study we aimed to determine if pregnancy (and associated insulin resistance) with or without GDM affects plasma YKL-40 levels. Plasma from women diagnosed with GDM and healthy normal glucose-tolerant pregnant women (non-GDM) was obtained at the third trimester of pregnancy and again 3-4 months following delivery, and levels of YKL-40 and interleukin 6 (IL-6; known to regulate YKL-40) were measured. Plasma YKL-40 levels were similarly low during pregnancy in both groups and increased significantly after delivery, but remained lower in the GDM group compared with the non-GDM group postpartum. In contrast, plasma IL-6 levels were not affected by pregnancy or diagnosis of GDM, Nevertheless, YKL-40 levels were associated with IL-6 levels in the non-GDM group (but not in the GDM group). Pregnancy seems to be associated with a temporary reduction in circulating YKL-40, which increases after delivery, but to a much lesser extent in women with GDM than in non-GDM women. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Pregnancy & Motherhood >

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Smoking when pregnant; Pregnancy and smoking; Smoking during pregnancy; Pregnant women smoking; Smoking when pregnant effects; Pregnancy and smoking effects; Pregnant quit smoking; Pregnant stop smoking; How to quit smoking when pregnant; Smoking and fertility; Smoking and infertility; Mom smoking; Smoking around children; Second hand smoke and children

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

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

Sympathetic activation during early pregnancy in humans

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Jarvis, Sara S; Shibata, Shigeki; Bivens, Tiffany B; Okada, Yoshiyuki; Casey, Brian M; Levine, Benjamin D; Fu, Qi

2012-01-01

Sympathetic activity has been reported to increase in normotensive pregnant women, and to be even greater in women with gestational hypertension and preeclampsia at term. Whether sympathetic overactivity develops early during pregnancy, remaining high throughout gestation, or whether it only occurs at term providing the substrate for hypertensive disorders is unknown. We tested the hypothesis that sympathetic activation occurs early during pregnancy in humans. Eleven healthy women (29 ± 3 (SD) years) without prior hypertensive pregnancies were tested during the mid-luteal phase (PRE) and early pregnancy (EARLY; 6.2 ± 1.2 weeks of gestation). Muscle sympathetic nerve activity (MSNA) and haemodynamics were measured supine, at 30 deg and 60 deg upright tilt for 5 min each. Blood samples were drawn for catecholamines, direct renin, and aldosterone. MSNA was significantly greater during EARLY than PRE (supine: 25 ± 8 vs. 14 ± 8 bursts min−1, 60 deg tilt: 49 ± 14 vs. 40 ± 10 bursts min−1; main effect, P < 0.05). Resting diastolic pressure trended lower (P = 0.09), heart rate was similar, total peripheral resistance decreased (2172 ± 364 vs. 2543 ± 352 dyne s cm−5; P < 0.05), sympathetic vascular transduction was blunted (0.10 ± 0.05 vs. 0.36 ± 0.47 units a.u.−1 min−1; P < 0.01), and both renin (supine: 27.9 ± 6.2 vs. 14.2 ± 8.7 pg ml−1, P < 0.01) and aldosterone (supine: 16.7 ± 14.1 vs. 7.7 ± 6.8 ng ml−1, P = 0.05) were higher during EARLY than PRE. These results suggest that sympathetic activation is a common characteristic of early pregnancy in humans despite reduced diastolic pressure and total peripheral resistance. These observations challenge conventional thinking about blood pressure regulation during pregnancy, showing marked sympathetic activation occurring within the first few weeks of conception, and may provide the substrate for pregnancy induced cardiovascular complications. PMID:22687610

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.

Recurrent pregnancy loss

DEFF Research Database (Denmark)

Egerup, P; Kolte, A M; Larsen, E C

2016-01-01

STUDY QUESTION: Is there a different prognostic impact for consecutive and non-consecutive early pregnancy losses in women with secondary recurrent pregnancy loss (RPL)? SUMMARY ANSWER: Only consecutive early pregnancy losses after the last birth have a statistically significant negative prognostic...... impact in women with secondary RPL. WHAT IS KNOWN ALREADY: The risk of a new pregnancy loss increases with the number of previous pregnancy losses in patients with RPL. Second trimester losses seem to exhibit a stronger negative impact than early losses. It is unknown whether the sequence of pregnancy...... losses plays a role for the prognosis in patients with a prior birth. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study of pregnancy outcome in patients with unexplained secondary RPL included in three previously published, Danish double-blinded placebo-controlled trials of intravenous...

Postural equilibrium during pregnancy: decreased stability with an increased reliance on visual cues.

Science.gov (United States)

Butler, Erin E; Colón, Iris; Druzin, Maurice L; Rose, Jessica

2006-10-01

The purpose of this study was to determine whether there are changes in postural equilibrium during pregnancy and to examine whether the incidence of falls increases during pregnancy. Static postural balance measures were collected from 12 pregnant women at 11 to 14, 19 to 22, and 36 to 39 weeks gestation and at 6 to 8 weeks after delivery and from 12 nulligravid control subjects who were matched for age, height, weight, and body mass index. Subjects were asked to stand quietly on a stable force platform for 30 seconds with eyes open and closed. Path length and average radial displacement were computed on the basis of the average of 3 trials for each condition. The women were asked at each session if they had sustained a fall in the previous 3 months. Postural stability remained relatively stable during the first trimester; however, second and third trimester and postpartum values for path length and average radial displacement with eyes open and closed were increased significantly compared with the control subjects, which indicates diminished postural balance. The difference between the eyes open and closed values of path length increased as pregnancy progressed. Although 25% of pregnant women sustained falls, none of the control subjects had fallen in the past year. These data suggest that postural stability declines during pregnancy and remains diminished at 6 to 8 weeks after delivery. The study also indicates that there is an increased reliance on visual cues to maintain balance during pregnancy.

Insulin Use in Pregnancy: An Update

OpenAIRE

Blum, Alyson K.

2016-01-01

IN BRIEF Insulin remains the standard of care for the treatment of type 1 diabetes, type 2 diabetes, and uncontrolled gestational diabetes. Tight control maintained in the first trimester and throughout pregnancy plays a vital role in decreasing poor fetal outcomes, including structural anomalies, macrosomia, hypoglycemia of the newborn, adolescent and adult obesity, and diabetes. Understanding new insulin formulations and strengths is important in assessing risks, since no data on their use ...

A role for ethanol-induced oxidative stress in controlling lineage commitment of mesenchymal stromal cells through inhibition of wnt/beta-catenin signaling

Science.gov (United States)

The mechanisms by which chronic ethanol intake induces bone loss remain unclear. In females, the skeletal response to ethanol varies depending on physiologic status (viz. cycling, pregnancy, lactation). Ethanol-induced oxidative stress appears to be a key event leading to skeletal toxicity. In the c...

Maternal employment during pregnancy and birth outcomes: evidence from Danish siblings.

Science.gov (United States)

Wüst, Miriam

2015-06-01

I use Danish survey and administrative data to examine the impact of maternal employment during pregnancy on birth outcomes. As healthier mothers are more likely to work and health shocks to mothers may impact employment and birth outcomes, I combine two strategies: First, I control extensively for time-varying factors that may correlate with employment and birth outcomes, such as pre-pregnancy family income and maternal occupation, pregnancy-related health shocks, maternal sick listing, and health behaviors (smoking and alcohol consumption). Second, to account for remaining time-invariant heterogeneity between mothers, I compare outcomes of mothers' consecutive children. Mothers who work during the first pregnancy trimester have a lower risk of preterm birth. I find no effect on the probability of having a baby of small size for gestational age. To rule out that health selection of mothers between pregnancies drives the results, I focus on mothers whose change in employment status is likely not to be driven by underlying health (mothers who are students in one of their pregnancies and mothers with closely spaced births). Given generous welfare benefits and strict workplace regulations in Denmark, my findings support a residual explanation, namely, that exclusion from employment may stress mothers in countries with high-female employment rates. Copyright © 2014 John Wiley & Sons, Ltd.

Demographic factors associated with smoking cessation during pregnancy in New South Wales, Australia, 2000-2011.

Science.gov (United States)

Passmore, Erin; McGuire, Rhydwyn; Correll, Patricia; Bentley, Jason

2015-04-18

Smoking during pregnancy increases the risk of adverse health outcomes for both the mother and the child. Rates of smoking during pregnancy, and rates of smoking cessation during pregnancy, vary between demographic groups. This study describes demographic factors associated with smoking cessation during pregnancy in New South Wales, Australia, and describes trends in smoking cessation in demographic subgroups over the period 2000 - 2011. Data were obtained from the New South Wales Perinatal Data Collection, a population-based surveillance system covering all births in New South Wales. Multivariate logistic regression was used to explore associations between smoking cessation during pregnancy and demographic factors. Between 2000 and 2011, rates of smoking cessation in pregnancy increased from 4.0% to 25.2%. Demographic characteristics associated with lower rates of smoking cessation during pregnancy included being a teenage mother, being an Aboriginal person, and having a higher number of previous pregnancies. Between 2000 and 2011, rates of smoking cessation during pregnancy increased dramatically across all demographic groups. However, specific demographic groups remain significantly less likely to quit smoking, suggesting a need for targeted efforts to promote smoking cessation in these groups.

The association between smoking and ectopic pregnancy: why nicotine is BAD for your fallopian tube.

Directory of Open Access Journals (Sweden)

Andrew W Horne

Full Text Available Epidemiological studies have shown that cigarette smoking is a major risk factor for tubal ectopic pregnancy but the reason for this remains unclear. Here, we set out to determine the effect of smoking on Fallopian tube gene expression. An oviductal epithelial cell line (OE-E6/E7 and explants of human Fallopian tubes from non-pregnant women (n = 6 were exposed to physiologically relevant concentrations of cotinine, the principle metabolite of nicotine, and changes in gene expression analyzed using the Illumina Human HT-12 array. Cotinine sensitive genes identified through this process were then localized and quantified in Fallopian tube biopsies from non-pregnant smokers (n = 10 and non-smokers (n = 11 using immunohistochemistry and TaqMan RT-PCR. The principle cotinine induced change in gene expression detected by the array analysis in both explants and the cell line was significant down regulation (P<0.05 of the pro-apoptotic gene BAD. We therefore assessed the effect of smoking on cell turnover in retrospectively collected human samples. Consistent with the array data, smoking was associated with decreased levels of BAD transcript (P<0.01 and increased levels of BCL2 transcript (P<0.05 in Fallopian tube biopsies. BAD and BCL2 specific immunolabelling was localized to Fallopian tube epithelium. Although no other significant differences in levels of apoptosis or cell cycle associated proteins were observed, smoking was associated with significant changes in the morphology of the Fallopian tube epithelium (P<0.05. These results suggest that smoking may alter tubal epithelial cell turnover and is associated with structural, as well as functional, changes that may contribute to the development of ectopic pregnancy.

[Quebec Pregnancy Cohort: prevalence of medication use during gestation and pregnancy outcomes].

Science.gov (United States)

Bérard, Anick; Sheehy, Odile

2014-01-01

Many women are exposed to medications during pregnancy. The Quebec Pregnancy Cohort (QPC) is a prospective population-based cohort which includes all data on pregnancies and children between January 1997 and December 2008. We linked four administrative databases in Quebec, Canada: RAMQ (medical and pharmaceutical), MED-ECHO (hospitalizations), ISQ (births/deaths), and MELS (Ministry of Education). Pregnancies included were covered by the Quebec prescription drug insurance plan (36% of women aged 15-45 years) from 12 months prior until the end of pregnancy. We analyzed 97,680 pregnancies. Prevalence of medication use was 74% pre-pregnancy, 56% during pregnancy, and 80% post-pregnancy. Most frequently used medications during pregnancy were antibiotics (47%), antiemetic drugs (23%), and non-steroïdal anti-inflammatory drugs (NSAIDs) [17%]. Medication users were more likely to have spontaneous abortions, preterm births, children with congenital malformations and postpartum depression than non-users (ppregnancy. The QPC is a powerful tool for perinatal pharmacoepidemiological research. © 2014 Société Française de Pharmacologie et de Thérapeutique.

Ultrasound pregnancy

Science.gov (United States)

Pregnancy sonogram; Obstetric ultrasonography; Obstetric sonogram; Ultrasound - pregnancy; IUGR - ultrasound; Intrauterine growth - ultrasound; Polyhydramnios - ultrasound; Oligohydramnios - ultrasound; ...

HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015.

Science.gov (United States)

Patel, Monita; Tedaldi, Ellen; Armon, Carl; Nesheim, Steven; Lampe, Margaret; Palella, Frank; Novak, Richard; Sutton, Madeline; Buchacz, Kate

2018-01-01

To examine HIV viral suppression during/after pregnancy. Prospective observational cohort. We identified pregnancies from 1996 to 2015. We examined HIV RNA viral load (VL), VL suppression (≤500 copies/mL), and antiretroviral therapy (ART) status at pregnancy start, end, and 6 months postpartum. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for VL nonsuppression. Among 253 pregnancies analyzed, 34.8% of women exhibited VL suppression at pregnancy start, 60.1% at pregnancy end, and 42.7% at 6 months postpartum. Median VL (log 10 copies/mL) was 2.80 (interquartile range [IQR]: 1.40-3.85) at pregnancy start, 1.70 (IQR: 1.40-2.82) at pregnancy end, and 2.30 (IQR: 1.40-3.86) at postpartum. Risk of postpartum VL nonsuppression was also lower among women on ART and with VL suppression at pregnancy end (versus those not; adjusted RR = 0.30, 95% CI: 0.17-0.53). Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.

Lung cancer during pregnancy: A narrative review

Directory of Open Access Journals (Sweden)

Sotirios Mitrou

2016-07-01

Full Text Available Lung cancer, the leading cause of cancer deaths in males for decades, has recently become one of commonest causes for women too. As women delay the start of their family, the co-existence of cancer and pregnancy is increasingly observed. Nevertheless, lung cancer during pregnancy remains a rather uncommon condition with less than 70 cases published in recent years. Non-small cell lung carcinoma is the commonest type accounting for about 85% of all cases. Overall survival rates are low. Chemotherapy and/or targeted treatment have been used with poor outcomes. The disease has been also found to affect the products of conception with no short- or long-term consequences for the neonate. This article is referring to a narrative review of lung cancers diagnosed in pregnant women around the world.

[Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances].

Science.gov (United States)

Hung, Hsuan-Man; Chiang, Hsiao-Ching

2017-02-01

Most women experience the worse sleep quality of their life during pregnancy and the early postpartum period. Although pregnancy typically accounts for a relatively short part of a woman's life, the related sleep disturbances may have a significant and negative impact on her long-term health. Approximately 78-80% of pregnant women experience sleep disturbances, including interruptions in deep sleep, decreased total sleep time, poor subjective sleep quality, frequent night waking, and reduced sleep efficacy. Sleep disturbances during pregnancy start during the first trimester and become prevalent during the third trimester. Related factors include physiological and psychosocial changes and an unhealthy lifestyle. As non-pharmacological interventions have the potential to improve sleep quality in 70% to 80% of patients with insomnia, this is the main approached that is currently used to treat pregnancy-related sleep disturbances. Examples of these non-pharmacological interventions include music therapy, aerobic exercise, massage, progressive muscle relaxation, multi-modal interventions, and the use of a maternity support belt. The efficacy and safety of other related non-pharmacological interventions such as auricular acupressure, cognitive therapy, tai chi, and aromatherapy remain uncertain, with more empirical research required. Additionally, non-pharmacological interventions do not effectively treat sleep disturbances in all pregnant women.

Spontaneous adrenal hemorrhage during pregnancy: a case with horseshoe kidney

Directory of Open Access Journals (Sweden)

Mohadeseh Amini

2017-11-01

Full Text Available Spontaneous adrenal hemorrhage is an acute hemorrhage during pregnancy, which can be tragic for the mother and the baby. We report a unique spontaneous hemorrhage during pregnancy in a case with horseshoe kidney with separated adrenal, presented for the first time in the world. Computed tomography scan showed a horseshoe kidney fused with left normal kidney. Interestingly the adrenal gland was remained in right flank and separated from the horseshoe kidney, which prepares a probable physical stress for the hemorrhage. Diagnosis and surgery were done successfully and the case was fully recovered after several days.

Is pregnancy planning associated with background characteristics and pregnancy-planning behavior?

DEFF Research Database (Denmark)

Stern, Jenny; Salih Joelsson, Lana; Tydén, Tanja

2016-01-01

household income, to be currently working (≥50%) and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information-seeking and intake of folic acid, but without a reduction in alcohol consumption. One......-third of all women took folic acid 1 month prior to conception, 17% used tobacco daily and 11% used alcohol weekly 3 months before conception. Conclusions A majority rated their pregnancy as very or fairly planned, with socio-economic factors as explanatory variables. The level of pregnancy planning should......Introduction Prevalence of planned pregnancies varies between countries but is often measured in a dichotomous manner. The aim of this study was to investigate to what level pregnant women had planned their pregnancies and whether pregnancy planning was associated with background characteristics...

Loratadine and Pregnancy

Science.gov (United States)

... loratadine more frequently during pregnancy. Can taking loratadine cause other pregnancy problems? Loratadine is not expected to cause other pregnancy problems. A study of 161 women taking loratadine ...

Exacerbation of pre-existing diabetes insipidus during pregnancy, mechanisms and management.

Science.gov (United States)

Tack, Lloyd J W; T'Sjoen, Guy; Lapauw, Bruno

2017-06-01

During pregnancy, physiological changes in osmotic homeostasis cause water retention. If excessive, this can cause gestational diabetes insipidus (DI), particularly in patients with already impaired vasopressin secretion. We present the case of a 34-year-old patient with pre-existing hypopituitarism who experienced a transient exacerbation of her DI during a twin pregnancy. In contrast to typical gestational DI, polyuria and polydipsia occurred during the first trimester and remained stable thereafter. This case highlights a challenging clinical entity of which pathophysiology, diagnostic approach and treatment will be discussed.

Peripheral microcirculation during pregnancy and in women with pregnancy induced hypertension.

Science.gov (United States)

Ohlmann, P; Jung, F; Mrowietz, C; Alt, T; Alt, S; Schmidt, W

2001-01-01

During pregnancy the cardiovascular system undergoes several changes so as to adapt the maternal organism to the strains of pregnancy. These adaptations can assume a pathological development in persons with a previous history of cardiovascular problems. On the other hand the absence of these adaptations may lead to a pathological course of pregnancy. Pregnancy induced hypertension (PIH) may be such a pathological development due to maladaptation. The causes are for the most part unknown. For some time it has been assumed that it is due to microcirculatory disorders. Using periungual capillary microscopy the present study prospectively investigated the changes in peripheral microcirculation during pregnancy focussing on pregnancy induced hypertension. Sixty-seven women with a normal course of pregnancy and 28 women with pregnancy induced hypertension were evaluated. Throughout the prospective study 3 examinations were performed during pregnancy and one during childbed. The women who developed a PIH were registered during the third trimester. Erythrocyte velocity at rest and vascular reagibility of capillaries following a 3 minute ischaemia were evaluated. In the course of pregnancy a significant increase of approximately 30% in erythrocyte velocity could be observed. Interpolation to obtain the best strait line result demonstrates that it is a continuous increase. Erythrocyte velocity returns to normal in the course of 14 weeks post partum. Due to a physiological vasodilatation during pregnancy, vascular reaction to ischaemic stress significantly decreases. During childbed these changes return to normal. Examinations on women with pregnancy induced hypertension not only showed a significant reduction of microcirculation under resting conditions but also a different pattern of reaction to ischaemic stress. Erythrocyte velocity under resting conditions lies 36% below normal values. Furthermore the distinctly shortened hyperaemic period indicates a hightened

76 FR 23732 - Margin Requirements for Uncleared Swaps for Swap Dealers and Major Swap Participants

Science.gov (United States)

2011-04-28

... the currency in which payment obligations under the swap are required to be settled; Any obligation... RIN 3038--AC97 Margin Requirements for Uncleared Swaps for Swap Dealers and Major Swap Participants... the Commission to adopt capital and initial and variation margin requirements for certain swap dealers...

IDIOPATHIC ERYTHEMA NODOSUM AND PREGNANCY: DESCRIPTION OF A CASE

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B S Belov

2009-01-01

Full Text Available Erythema nodosum (EN is a dermatosis of unclear etiology, which is characterized by vascular lesion of the skin; it shows itself as hard painful nodes occurring in the derma or subcutaneous fat on the shins and thighs. EN has been described in many chronic infectious processes with some features of its clinical course. In most cases, the disease is regarded as a nonspecific immunoinflammatory response to a wide spectrum of etiological factors, including that in gestation, which presents certain problems in curing the patient. The example given below supports the need for timely testing for infectious markers in pregnancy and, in case of evolving EN, for using not only nonsteroidal anti-inflammatory drugs, but also pathogenetic treatment.

Frequency of maternal mortality and morbidity in pregnancy-induced hypertension

International Nuclear Information System (INIS)

Riaz, S.; Jabeen, A.

2011-01-01

Background: Pregnancy-induced hypertension (PIH) is defines as hypertension in pregnancy, and is sustained blood pressure >140 mm Hg systolic or 90 mm Hg diastolic. Objective of this study was to see the maternal outcome in terms of morbidity and mortality in PIH. Methods: This descriptive study was conducted in Obstetrics and Gynaecology Unit of Fauji Foundation Hospital, Rawalpindi from January to December 2010. Both booked and un-booked cases were selected after fulfilling inclusion criteria. A detailed history and clinical examination was recorded and relevant investigations were performed. Patients were monitored for rise in blood pressure, development of complications related to hypertensions in pregnancy as well as maternal and perinatal outcome. Results: During this period, 100 patients were admitted with pregnancy-induced hypertension. Majority were un-booked. Primigravida were 60 (60%), and were in age group 21-30 year, remaining were above 30 year. Four patients had placental abruption, 2 pulmonary oedema, 5 HELLP syndrome, 2 severe renal impairment, 20 elevated liver enzyme, 23 uncontrolled blood pressure, 20 server preeclampsia, 10 thrombocytopenia, 3 eclampsia, 10 had impaired coagulation profile, and 1 had maternal death. Conclusion: Pregnancy induced hypertension is a major cause of maternal mortality and morbidity. In Pakistan, its incidence and related mortality are high due to lack of adequate antenatal care. (author)

Human Immunodeficiency Virus Infection in Pregnancy

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Yasemin Arikan

1998-01-01

Full Text Available The incidence and prevalence of human immunodeficiency virus (HIV infection in women of child-bearing age continue to increase both internationally and in Canada. The care of HIV-infected pregnant women is complex, and multiple issues must be addressed, including the current and future health of the woman, minimization of the risk of maternal-infant HIV transmission, and maintenance of the well-being of the fetus and neonate. Vertical transmission of HIV can occur in utero, intrapartum and postpartum, but current evidence suggests that the majority of transmission occurs toward end of term, or during labour and delivery. Several maternal and obstetrical factors influence transmission rates, which can be reduced by optimal medical and obstetrical care. Zidovudine therapy has been demonstrated to reduce maternal-infant transmission significantly, but several issues, including the short and long term safety of antiretrovirals and the optimal use of combination antiretroviral therapy in pregnancy, remain to be defined. It is essential that health care workers providing care to these women fully understand the natural history of HIV disease in pregnancy, the factors that affect vertical transmission and the management issues during pregnancy. Close collaboration among a multidisciplinary team of knowledgeable health professionals and, most importantly, the woman herself can improve both maternal and infant outcomes.

A Rare Cause of Low Back Pain in Pregnancy: Pregnancy Associated Osteoporosis

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Alparslan Yetişgin

2016-12-01

Full Text Available Pregnancy associated osteoporosis is a rare entity seen at the third trimester of first pregnancy or early postpartum period. It does not recur frequently in the subsequent pregnancies; however, it might lead to various complications unless it is treated. In this paper, we presented a woman diagnosed with pregnancy-associated osteoporosis with back pain at the 6th month of the pregnancy in order to discuss the points to be taken into consideration in the diagnosis/differential diagnosis and treatment options of pregnancy associated osteoporosis.

Adolescent Pregnancy Guidelines.

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Fleming, Nathalie; O'Driscoll, Teresa; Becker, Gisela; Spitzer, Rachel F

2015-08-01

on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).

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

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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.

Effects of Intrauterine Growth Restriction During Late Pregnancy on the Development of the Ovine Fetal Thymus and the T-Lymphocyte Subpopulation.

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Liu, Yingchun; He, Shan; Zhang, Yuan; Xia, Wei; Li, Ming; Zhang, Chongzhi; Gao, Feng

2015-07-01

The retarded development of fetal thymus in intrauterine growth restriction (IUGR) from maternal undernutrition during late pregnancy destroys the tridimensional structure and modifies the development of fetal T lymphocytes. The mechanisms, however, remain unclear. The objective of this study was to investigate the effect of IUGR during late pregnancy on the development of the ovine fetal thymus and the T-lymphocyte subpopulation. Eighteen time-mated ewes with singleton fetuses were allocated to three groups at day 90 of pregnancy: restricted group 1 (RG1, 0.18 MJ ME/BW(0.75) /day, n = 6), restricted group 2 (RG2, 0.33 MJ ME/BW(0.75) /day, n = 6) and a control group (CG, ad libitum, 0.67 MJ ME/BW(0.75) /day, n = 6). Fetuses were recovered at slaughter on day 140. Fetuses in RG1 exhibited decreased (P restricted groups. In addition, there was reduced mRNA expression (P < 0.05) of T-cell receptor, apoptosis antigen 1 ligand, and RAG2 in the RG1 group. In contrast, increases in glutathione peroxidase, malondialdehyde, caspase-3, Cytochrome c, and CD4(+) T cells were observed (P < 0.05), and higher mRNA expressions (P < 0.05) of protein 53, Bcl-2 associated X protein (Bax), and apoptosis antigen 1 (Fas) were found in RG1 fetuses; and thymuses of RG2 fetuses had increased caspase-3, and expression of Fas and Bax (P < 0.05), relative to control fetuses. These results indicate that reduced cell proliferation, oxidative stress, and increased cell apoptosis were the potential mechanisms for impaired development and microenvironment of IUGR fetal thymus, and for modifying the maturation of CD4(+) CD8(+) thymocytes underlying their reduced numbers . © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Early Pregnancy Loss

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... go on to have successful pregnancies. Repeated pregnancy losses are rare. Testing and evaluation can be done ... find a cause if you have several pregnancy losses. Even if no cause is found, most couples ...

Planning a pregnancy

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... on Twitter Facebook Pinterest Email Print Planning a pregnancy Lupus Foundation of America September 27, 2017 Resource ... History or presence of antiphospholipid antibodies Planning Your Pregnancy Although many lupus pregnancies will have no complications, ...

Medicine and Pregnancy

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... Consumer Information by Audience For Women Medicine and Pregnancy Share Tweet Linkedin Pin it More sharing options ... reporting problems to FDA . Sign Up for a Pregnancy Registry Pregnancy Exposure Registries are research studies that ...

Cancer in pregnancy

DEFF Research Database (Denmark)

Han, Sileny N; Kesic, Vesna I; Van Calsteren, Kristel

2013-01-01

OBJECTIVE: To evaluate physicians' attitudes and knowledge regarding the treatment possibilities for patients with cancer in pregnancy. STUDY DESIGN: A 30-item questionnaire was mailed electronically to physicians across Europe, who were potentially involved in care of pregnant patients and....../or cancer, using the membership directories of different professional societies. RESULTS: 142 surveys were eligible for analysis. A median of 2 (range 0-100) patients with cancer in pregnancy were treated per center in 2010. The vast majority of respondents (94%) agreed that management of pregnant patients...... with cancer should be decided by a multidisciplinary team. When cancer is diagnosed in the first or early second trimester of pregnancy, 44% of respondents prefer termination of pregnancy: if the patient wishes to preserve the pregnancy, 77% consider deliberate delay and treatment later in pregnancy. When...

Melanoma during pregnancy

DEFF Research Database (Denmark)

de Haan, Jorine; Lok, Christianne A; de Groot, Christianne J M

2017-01-01

The management of melanoma during pregnancy is challenging as maternal benefits and fetal risks need to be balanced. Here, we present an overview of the incidence, the demographic and clinical characteristics and the treatment modalities used. After analysis of obstetric, fetal and maternal outcome......, recommendations for clinical practice are provided. From the 'International Network on Cancer, Infertility and Pregnancy' database, pregnant patients with melanoma were identified and analysed. Sixty pregnancies were eligible for analysis. Fifty percent of the patients presented with advanced melanoma during...... pregnancy (14 stage III and 16 stage IV), and 27% were diagnosed with recurrent melanoma. Surgery was the main therapeutic strategy during pregnancy. Only four patients with advanced melanoma were treated during pregnancy with systemic therapy (n=1) or radiotherapy (n=3). Premature delivery was observed...

Pregnancy and Eye

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Anubhav Chauhan

2016-03-01

Full Text Available Visual obscurations are common during pregnancy. The ocular effects of pregnancy may be physiological,pathological or may be modifications of pre-existing conditions. While most of the described changes are transient in nature, others extend beyond delivery and may lead to permanent visual impairment. Also, pregnancy can affect vision through systemic disease that are either specific to the pregnancy itself or systemic diseases that occur more frequently in relation to pregnancy. Neuro-ophthalmological disorders should be kept in mind in pregnant women presenting with visual acuity or field loss. Therefore, it is important to be aware of the ocular changes in pregnancy in order to counsel and advice women who currently are, or are planning to become pregnant. [Archives Medical Review Journal 2016; 25(1.000: 1-13

Exercise After Pregnancy

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... 2 days a week. When can I start exercising after pregnancy? If you had a healthy pregnancy ... some guidelines I can follow when I begin exercising after pregnancy? Aim to stay active for 20– ...

Pregnancy-associated severe sepsis.

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Oud, Lavi

2016-04-01

This article examines the contemporary knowledge and uncertainties about the burden of pregnancy-associated severe sepsis (PASS), and its manifestations, management, and outcomes. There are relatively sparse data on PASS, related in part to infrequent reports and varying use of terminology and case definitions. PASS remains rare, although its incidence appears to be rapidly rising in some high-resource countries, affecting especially women with limited resources, minorities, and those with chronic illness. High level of clinician vigilance and rapid initiation of appropriate antimicrobial therapy, coupled with effective systemic support for organ dysfunction and correction of occult and overt hypoperfusion are the keys to limit adverse outcomes. However, timely diagnosis and provision of effective care remain a challenge, with reported prevalent delay in recognition and delivery of time-sensitive care interventions among maternal decedents. The mortality rate of PASS has been rising and its case fatality, although relatively low, has remained unchanged, in contrast to the outcome gains in the general population. The long-term sequelae of PASS remain unknown. The relatively limited contemporary data on PASS suggest a rising public health hazard in the obstetric population in high-resource countries, with ongoing challenges in assuring consistent provision of time-sensitive care.

Vanishing twin syndrome among ART singletons and pregnancy outcomes.

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Magnus, Maria C; Ghaderi, Sara; Morken, Nils-Halvdan; Magnus, Per; Bente Romundstad, Liv; Skjærven, Rolv; Wilcox, Allen J; Eldevik Håberg, Siri

2017-11-01

Among babies born by ART, do singleton survivors of a vanishing twin have lower birth weight than other singletons? Vanishing twin syndrome (VTS) was associated with lower birth weight among ART singletons; a sibship analysis indicated that the association was not confounded by maternal characteristics that remain stable between deliveries. Previous studies indicate that ART singletons with VTS have increased risk of adverse pregnancy outcomes, compared with other ART singletons. The potential contribution of unmeasured maternal background characteristics has been unclear. This was a Norwegian population-based registry study, including 17 368 mothers with 20 410 ART singleton deliveries between January 1984 and December 2013. The study population included 17 291 ART singletons without VTS, 638 ART singletons with VTS and 2418 ART singletons with uncertain vanishing twin status. We estimated differences in birth weight and gestational age comparing ART singletons with VTS first to all ART singletons without VTS, and subsequently to their ART siblings without VTS, using random- and fixed-effects linear regression, respectively. The corresponding comparisons for the associations with preterm birth and small for gestational age (SGA) were conducted using random-and fixed-effects logistic regression. The sibling analysis of preterm birth included 587 discordant siblings, while the sibling analysis of SGA included 674 discordant siblings. ART singletons with VTS had lower birth weight when compared to all ART singletons without VTS, with an adjusted mean difference (95% CI) of -116 g (-165, -67). When we compared ART singletons with VTS to their ART singletons sibling without VTS, the adjusted mean difference was -112 g (-209, -15). ART singletons with VTS also had increased risk of being born SGA, with an adjusted odds ratio (OR) (95% CI) of 1.48 (1.07, 2.03) compared to all ART singletons without VTS, and 2.79 (1.12, 6.91) in the sibship analyses. ART singletons with

An appraisal of the management of ectopic pregnancy in a nigerian tertiary hospital.

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Igwegbe, Ao; Eleje, Gu; Okpala, Bc

2013-04-01

Ectopic pregnancy has remained a significant cause of maternal morbidity and mortality especially in the sub Saharan Africa. A periodic appraisal of its management is paramount. To determine the incidence and associated risk factors, for ectopic pregnancy, review available treatment modalities and suggest interventions to reduce its prevalence, morbidity and mortality. A cross sectional study with retrolective data collection of all cases of ectopic pregnancy managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria between 1(st) January, 2002 and 31(st) December, 2011 was undertaken. Analysis was carried out using Epi-info 2008 version 3.5.1. During the study period, there were a total 98 cases of ectopic pregnancies out of 8,811 deliveries and 1884 gynecological admissions, giving an incidence of 0.9% of all attendants or 1 in 90 deliveries and 5.2% of all gynecological admissions. Only 94.9% (93/98) case files were retrieved and were used in the final analysis. The mean age of the patients was 30.1 (0.7) years while the mean gestational age at presentations was 7.4 weeks. Previous induced abortion, 37.5% (36/93) was the commonest associated risk factor, followed by pelvic infections, 35.5% (33/93). The recurrence rate was 6.5% (6/93). Majority, 80.6% (75/93) presented with abdominal pain and 35.8% (33/93) presented with vaginal bleeding. Up to 88.2% (82/93) had salpingectomy while only 2.5% (2/93) were successfully managed medically with methotrexate therapy following diagnosis with transvaginal ultrasound Missed diagnosis of ectopic pregnancy occurred in 16.1% (15/93). There was no maternal death. Ectopic pregnancy has remained an important gynecological condition in our center. The common identifiable risk factors were induced abortion and pelvic infection. Early first trimester transvaginal ultrasound should be offered to all women for early diagnosis.

Factors Associated with Pregnancy among Married Adolescents in Nepal: Secondary Analysis of the National Demographic and Health Surveys from 2001 to 2011

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Rina Pradhan

2018-01-01

Full Text Available Pregnancy-related morbidity and mortality are much more prevalent among adolescents than adults, particularly in low-income settings. Little is known about risk factors for pregnancy among adolescents in Nepal, but setting-specific evidence is needed to inform interventions. This study aimed to describe the prevalence, and identify factors associated with pregnancy among adolescents in Nepal between 2001 and 2011. Secondary analyses of Nepal Demographic Health Surveys (NDHS data from 2001, 2006, and 2011 were completed. The outcome was any pregnancy or birth among married adolescents; prevalence was calculated for each survey year. Although the rate of marriage among adolescent women in Nepal decreased significantly from 2001 to 2011, prevalence of pregnancy and birth among married adolescent women in Nepal remains high (average 56% in Nepal, and increased significantly between 2001 and 2011. Regression analyses of this outcome indicate higher risk was associated with living in the least resourced region, early sexual debut, and older husband. Despite national efforts to reduce pregnancies among married adolescent women in Nepal, prevalence remains high. Integrated, cross-sectoral prevention efforts are required. Poverty reduction and infrastructure improvements may lead to lower rates of adolescent pregnancy.

Syphilis during pregnancy: a preventable threat to maternal-fetal health.

Science.gov (United States)

Rac, Martha W F; Revell, Paula A; Eppes, Catherine S

2017-04-01

Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin appropriate for their stage of syphilis. The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies. We recommend all viable pregnancies receive the first

Spontaneous Pregnancy and Partial Recovery of Pituitary Function in a Patient with Sheehan's Syndrome

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Ting-Ting See

2005-04-01

Full Text Available Sheehan's syndrome is caused by pregnancy-related hemorrhage leading to ischemic necrosis of the anterior pituitary gland and hypopituitarism. Spontaneous pregnancy in Sheehan's syndrome is very rare. We report the case of a patient with Sheehan's syndrome who suffered from anterior pituitary insufficiency, but with sparing of gonadotropic function. The patient became pregnant spontaneously and, after her second delivery, thyrotropic function recovered. However, the patient's growth hormone and cortisol levels remained unresponsive to an insulin-tolerance test. This case demonstrates that pituitary function may recover from less extensive pituitary ischemia. We emphasize the importance of early identification of pregnancy in such cases. It is crucial to institute adequate hormone-replacement therapy during pregnancy, since hypopituitarism is associated with high fetal and maternal morbidity and mortality.

PP144. Profile of lupus pregnancy in internal medecine practice.

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Haddad, T; Hakem, D; Berrah, A

2012-07-01

The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome 'APLS' is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. it's a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21-41), SLE evolve with an average of 2.5years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient's. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive

Pregnancy and Reproductive Issues

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... Health Pregnancy Share this page Facebook Twitter Email Pregnancy and Reproductive Issues Tahirah Diagnosed in 2003 Pregnancy ... in control groups without the disease. Effects of pregnancy on MS Before 1950, most women with MS ...

Weight Gain during Pregnancy

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... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal ... fitness > Weight gain during pregnancy Weight gain during pregnancy E-mail to a friend Please fill in ...

Acute Pancreatitis and Pregnancy

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... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

Putting pregnancy in its place: conceiving pregnancy as carework in the workplace.

Science.gov (United States)

Gatrell, Caroline

2011-03-01

This paper contributes to understandings of the relationship between pregnancy, health and place by exploring how health advice on pregnancy may be implemented, in practice, 'at work'. The paper first defines the following of health advice on pregnancy as a form of informal 'carework' which obliges pregnant women to implement caring practices comprising emotional and embodied labour. It then observes how health advice on pregnancy carework pays little regard to the impact of place. Drawing upon in-depth interviews with 15 professionally employed mothers/expectant mothers; the paper suggests that the performance of pregnancy carework may be incompatible with workplace settings. The tensions are highlighted between medical representations of pregnancy as a 'condition' and the treatment of pregnancy, within professional workplaces, as 'not an illness'. The question is raised as to whether insufficient reference to place within health advice reflects underlying gendered expectations that pregnancy carework ought to be performed within the home. Copyright © 2009 Elsevier Ltd. All rights reserved.

Exercise during Pregnancy

Medline Plus

Full Text Available ... Global Map Premature Birth Report Cards Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & ... Caring for your baby Feeding your baby Family health & safety Complications & Loss Pregnancy complications Preterm labor & premature ...

Planning for Pregnancy

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... Before Pregnancy Home Overview Planning for Pregnancy Women Men Image Library Women Who Want to Become Pregnant Women Who Do Not Want to Become Pregnant Hugging Nutrition Physical Activity Visiting the Doctor Planning for Pregnancy Language: English ( ...

Teen Pregnancy and Childbearing

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... Pregnancy has sub items, Reproductive Health & Teen Pregnancy Contraceptive Use STDs Teen Pregnancy & Childbearing Teen Pregnancy Prevention Program Trends Negative Impacts Strategies & Approaches for Prevention Engaging Adolescent Males in Prevention Tips for Parents of Teens ...

Back Pain During Pregnancy

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... Advocacy For Patients About ACOG Back Pain During Pregnancy Home For Patients Search FAQs Back Pain During ... FAQ115, January 2016 PDF Format Back Pain During Pregnancy Pregnancy What causes back pain during pregnancy? How ...

Associations of adolescent hopelessness and self-worth with pregnancy attempts and pregnancy desire.

Science.gov (United States)

Fedorowicz, Anna R; Hellerstedt, Wendy L; Schreiner, Pamela J; Bolland, John M

2014-08-01

We examined the associations of pregnancy desire (ambivalence or happiness about a pregnancy in the next year) and recent pregnancy attempts with hopelessness and self-worth among low-income adolescents. To evaluate independent associations among the study variables, we conducted gender-stratified multivariable logistic regression analyses with data derived from 2285 sexually experienced 9- to 18-year-old participants in the Mobile Youth Survey between 2006 and 2009. Fifty-seven percent of youths reported a desire for pregnancy and 9% reported pregnancy attempts. In multivariable analyses, hopelessness was positively associated and self-worth was negatively associated with pregnancy attempts among both female and male youths. Hopelessness was weakly associated (P = .05) with pregnancy desire among female youths. The negative association of self-worth and the positive association of hopelessness with pregnancy attempts among young men as well as young women and the association of hopelessness with pregnancy desire among young women raise questions about why pregnancy is apparently valued by youths who rate their social and cognitive competence as low and who live in an environment with few options for material success.

Gestational Diabetes and Pregnancy

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... Pregnant Avoiding Pregnancy Zika and Pregnancy Articles Gestational Diabetes and Pregnancy Language: English (US) Español (Spanish) Recommend ... diabetes must also take insulin. Problems of Gestational Diabetes in Pregnancy Blood sugar that is not well ...

Pregnancy week by week

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Cystic Fibrosis and Pregnancy

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy After Age 35

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy Complications: Bacterial Vaginosis

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Your Checkup Before Pregnancy

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy Complications: HELLP Syndrome

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Common Discomforts of Pregnancy

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy Complications: Placenta Previa

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Getting Ready for Pregnancy

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... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

Pregnancy and Rheumatic Disease

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... with Rheumatic Disease Pregnancy & Rheumatic Disease Pregnancy and Rheumatic Disease Fast Facts Diseases with the potential to affect ... control. What are the effects of pregnancy on rheumatic disease? The effects of pregnancy on rheumatic diseases vary ...

Safety of low-molecular-weight heparin in pregnancy: a systematic review

NARCIS (Netherlands)

Sanson, B. J.; Lensing, A. W.; Prins, M. H.; Ginsberg, J. S.; Barkagan, Z. S.; Lavenne-Pardonge, E.; Brenner, B.; Dulitzky, M.; Nielsen, J. D.; Boda, Z.; Turi, S.; Mac Gillavry, M. R.; Hamulyák, K.; Theunissen, I. M.; Hunt, B. J.; Büller, H. R.

1999-01-01

Unfractionated heparin (UFH) remains the anticoagulant of choice during pregnancy. Low-molecular-weight heparins (LMWH) are an attractive alternative to UFH due to their logistic advantages and their association with a lower incidence of osteoporosis and HIT. We reviewed all published clinical

Advances in interspecific pregnancy

Institute of Scientific and Technical Information of China (English)

无

2001-01-01

Interspecific pregnancy in which the conceptus and female carrying the pregnancy are of different species is a key step to interspecific cloning. Cloning endangered animals by interspecific pregnancy is such a highlight catching people's eyes nowadays. In this article, the history of interspecific pregnancy, the methods for establishment of interspecific pregnancy, the corresponding theories, barriers and applied prospects are reviewed.``

Exercise in Pregnancy.

Science.gov (United States)

Gregg, Vanessa H; Ferguson, James E

2017-10-01

Routine exercise should be recommended to healthy pregnant women after consultation with an obstetric provider. Even pregnant women who have not been exercising regularly can gradually increase their exercise during pregnancy. Regular exercise during pregnancy promotes overall wellness and helps maintain appropriate gestational weight gain and appropriate fetal weight gain. Exercise in pregnancy may also reduce hypertensive disorders of pregnancy and gestational diabetes, and may be associated with shorter first stage of labor and decreased risk for cesarean section. Exercise in pregnancy is safe for pregnant women and their fetuses and can have multiple health benefits. Copyright © 2017 Elsevier Inc. All rights reserved.

[Secondary osteoporosis UPDATE. Bone metabolic change and osteoporosis during pregnancy and lactation].

Science.gov (United States)

Kurabayashi, Takumi; Tamura, Ryo; Hata, Yuki; Nishijima, Shota; Tsuneki, Ikunosuke; Tamura, Masaki; Yanase, Toru

2010-05-01

Calcium transfer from the mother to the infant during pregnancy and lactation plays an extremely important role in the bone health of the mother and neonate. Calcium aids in bone health through all ages but is especially crucial during pregnancy and lactation. Changes in the structure and metabolism of bone during pregnancy and the early stage of postpartum are evaluated by investigating bone mineral density (BMD), bone histomorphometry and bone markers of human or animal models. The bone resorption increased at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. Puerperal BMD remained static over the subsequent 5-10 years. If the women have a low BMD at this stage of their reproductive life, it tends not to improve over this time. Perhaps identification of this at-risk group may lead to effective interventions to reduce fracture risk in later life.

Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996-2010.

Science.gov (United States)

Feig, Denice S; Hwee, Jeremiah; Shah, Baiju R; Booth, Giliian L; Bierman, Arlene S; Lipscombe, Lorraine L

2014-06-01

Women with diabetes in pregnancy have high rates of pregnancy complications. Our aims were to explore trends in the incidence of diabetes in pregnancy and examine whether the risk of serious perinatal outcomes has changed. We performed a population-based cohort study of 1,109,605 women who delivered in Ontario, Canada, between 1 April 1996 and 31 March 2010. We categorized women as gestational diabetes (GDM) (n = 45,384), pregestational diabetes (pre-GDM) (n = 13,278), or no diabetes (n = 1,050,943). The annual age-adjusted rates of diabetes in pregnancy were calculated, and rates of serious perinatal outcomes were compared between groups and by year using Poisson regression. The age-adjusted rate of both GDM (2.7-5.6%, P women with no diabetes, women with pre-GDM and GDM faced an increased risk of congenital anomalies (relative risk 1.86 [95% CI 1.49-2.33] and 1.26 [1.09-1.45], respectively), and perinatal mortality remained elevated in women with pre-GDM (2.33 [1.59-3.43]). The incidence of both GDM and pre-GDM in pregnancy has doubled over the last 14 years, and the overall burden of diabetes in pregnancy on society is growing. Although congenital anomaly rates have declined in women with diabetes, perinatal mortality rates remain unchanged, and the risk of both remains significantly elevated compared with nondiabetic women. Increased efforts are needed to reduce these adverse outcomes. © 2014 by the American Diabetes Association.

Exercise during Pregnancy

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Full Text Available ... Global Map Premature Birth Report Cards Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? ... Feeding your baby Family health & safety Complications & Loss Pregnancy complications Preterm labor & premature birth The newborn intensive ...

Invited Commentary: Induced Abortion and the Risk of Preeclampsia in a Subsequent Pregnancy.

Science.gov (United States)

Basso, Olga

2015-10-15

Although it is well established that a having a pregnancy that ends in a birth protects against subsequent preeclampsia, it is unclear whether a pregnancy ending in miscarriage or induced abortion confers any protection. In this issue of the Journal, Parker et al. (Am J Epidemiol. 2015;182(8):663-669) examine whether, in nulliparous women, a history of induced abortion is associated with a lower risk of preeclampsia in a later pregnancy, focusing on the hypothesis that endometrial injury facilitates later implantation. The authors take advantage of data obtained by linking several Finnish population-based registries that include detailed data on induced abortions, although information on miscarriages was of lower quality. Parker et al. found a modest reduction in risk among women with a history of induced abortion. However, there was little evidence that risk differed between women who had medical abortions and those who had surgical abortions (the latter of which is presumably associated with a higher degree of injury). History of miscarriage was not associated with preeclampsia risk. Although the study by Parker et al. adds to the evidence that suggests that women with a history of induced abortion have a lower risk of preeclampsia, it is difficult to evaluate whether the observed association is due to having had a previous pregnancy (however short) versus none, to confounding, or to an actual effect of induced abortion. © The Author 2015. 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.

The Effect of Ramadan Fasting On Neonatal Weight In Different Trimesters Of Pregnancy

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nahid sarafraz

2015-09-01

Full Text Available Background and Objectives: several investigations have been done to evaluate the effect of Ramadan fasting on fetal and maternal health, which have all led to controversial results. The role of Ramadan fasting time in birth weight is still unclear. This study evaluated the effect of fasting at different periods of pregnancy on birth weight. Methods: 250 pregnant women fasting at least one day during Ramadan participated in this retrospective cohort study. Subjects were categorized into 3 groups, namely first trimester (n=112, second trimester (n=68 and third trimester (n=70 of pregnancy. Demographic and anthropometric data, obstetric history and history of Ramadan fasting were recorded. After delivery, neonatal birth weight was measured. The mean of weight and frequency of low birth weight in each group were calculated. Probable related factors of low birth weight of neonates with fasting mothers were evaluated. Results: The mean of birth weight in different groups of Ramadan fasting time in first, second and third trimester of pregnancy were 3411.52±529.88, 3214.57±463.56 and 3336.86±444.89 gr respectively, which had a statistically significant difference (p=0.03. Frequencies of low birth weight in different groups of Ramadan fasting time in first trimester was 8.9%, in second trimester 8.8% and in third trimester it was 7.1%, which had no statistically significant difference (p=0.9. Among all evaluated factors, only neonatal sex was related to low birth weight. Conclusion: Time of Ramadan fasting during pregnancy does not affect birth weight.

Uneventful octreotide LAR therapy throughout three pregnancies, with favorable delivery and anthropometric measures for each newborn: a case report

Directory of Open Access Journals (Sweden)

Naccache Deeb

2011-08-01

Full Text Available Abstract Introduction The safety of octreotide use, in its short-acting preparation, in pregnancy is still unclear. This report provides the first documentation of uneventful octreotide LAR use during three pregnancies in a woman with bronchial carcinoid-associated adrenocorticotropic hormone-dependent Cushing's syndrome. Case presentation A 25-year-old Arabic woman presented to our emergency department with rapid onset of headache, flaring acne and hirsutism, facial puffiness, weight gain and paroxysmal myopathy, and paranoiac thoughts of rape and sexual intimidation. After undergoing surgical removal of a mass by left lower lung lobectomy, her residual lung disease medical therapy failed. Chronic octreotide LAR injections were initiated as indicated by a positive octreoscan. Follow-up revealed a long-lasting positive response to octreotide. Avidity of octreotide to somatostatin receptor sub-type 2 was later confirmed by a positive somatostatin receptor sub-type 2 in the resected tumor specimen. Against our instructions, the patient had three spontaneous pregnancies leading to delivery of three full-term healthy children while her octreotide LAR therapy continued. Conclusion This case adds more data supporting the potential for the safe use of octreotide and the feasibility of octreotide LAR use during pregnancy, making compliance with the patient's preference not to withdraw octreotide therapy as soon as her pregnancy is confirmed a thoughtful option.

Anesthesia in pregnancy with heart disease

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Ankur Luthra

2017-01-01

Full Text Available Management of pregnant women with heart disease remains challenging due to the advancement of innovations in cardiac surgery and correction of complex cardiac anomalies, and more recently, with the successful performance of heart transplants, cardiac diseases are not only likely to coexist with pregnancy, but will also increase in frequency over the years to come. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death. Since many of these deaths occur during or immediately following parturition, heart disease is of special importance to the anesthesiologist. This importance arises from the fact that drugs used for preventing or relieving pain during labor and delivery exert a major influence – for better or for worse – on the prognosis of the mother and newborn. Properly administered anesthesia and analgesia can contribute to the reduction of maternal and neonatal mortality and morbidity.

A Rare Cause of Low Back Pain in Pregnancy: Pregnancy Associated Osteoporosis

OpenAIRE

Alparslan Yetişgin; Dilek Şen Dokumacı; Mehmet Ali Eren; Hamza Karabağ

2016-01-01

Pregnancy associated osteoporosis is a rare entity seen at the third trimester of first pregnancy or early postpartum period. It does not recur frequently in the subsequent pregnancies; however, it might lead to various complications unless it is treated. In this paper, we presented a woman diagnosed with pregnancy-associated osteoporosis with back pain at the 6th month of the pregnancy in order to discuss the points to be taken into consideration in the diagnosis/differential diagnosis and t...

Single blastocyst transfer: The key to reduce multiple pregnancy rates without compromising the live birth rate

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Uma M Sundhararaj

2017-01-01

Full Text Available Background: Historically, to achieve higher pregnancy rates, multiple embryos were transferred after an in-vitro fertilisation (IVF. However, this practice is being reassessed, because it leads to multiple pregnancies that is known to cause adverse maternal and fetal outcomes. Aim: To compare the pregnancy outcomes in fresh IVF or intracytoplasmic sperm injection (ICSI cycles among women undergoing elective single blastocyst transfer (eSBT vs. those undergoing double blastocyst transfer (DBT. Settings and Design: It is a retrospective data analysis of 582 patients undergoing fresh IVF/ICSI cycles performed from January 2012 to June 2015. Materials and Methods: Patients, who underwent IVF/ICSI and developed more than one blastocyst, were included in the study. Donor cycles were excluded from the study. All the embryos were cultured to blastocyst stage in sequential media followed by transfer of two blastocysts (DBT or eSBT and cryopreservation of the remaining. Statistical Analysis: Statistical analysis was performed using chi square test. Results: Out of 582 patients, in 149 patients one blastocyst was transferred and in 433 patients two blastocysts were transferred. There was no statistical difference in the biochemical pregnancy rate, clinical pregnancy rate and live birth rate in both the groups. Statistics demonstrated a significant drop in miscarriage rate in eSBT group. There was no incidence of twins in eSBT group, whereas twin birth rate per clinical pregnancy was 29.02% in DBT group. Conclusion: Single blastocyst transfer is an effective method to reduce the risk of multiple births without compromising the pregnancy outcomes. Given the promising potential of vitrification; the remaining blastocyst can be cryopreserved.

Is pregnancy associated with biochemical and haematological changes in HIV-infected Nigerian women?

Directory of Open Access Journals (Sweden)

L O Omo-Aghoja

2010-04-01

Full Text Available Background.\tWhile there is evidence that HIV affects the course and outcome of pregnancy, reports on the effects of pregnancy on HIV infection remain conflicting, especially in low-resource settings. Methodology. A prospective study of two demographically similar cohorts of HIV-seropositive women, 154 pregnant and 151 non-pregnant, was conducted in a hospital setting in Nigeria. Results. Cases and controls were matched for age, but parity in controls was significantly higher than in cases (p

Suspected ectopic pregnancy.

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Seeber, Beata E; Barnhart, Kurt T

2006-02-01

Women who present with pain and bleeding in the first trimester are at risk for ectopic pregnancy, a life-threatening condition. Conditions that predispose a woman to ectopic pregnancy are damaged fallopian tubes from prior tubal surgery or previous pelvic infection, smoking, and conception using assisted reproduction. Many women without risk factors can develop an ectopic pregnancy. A diagnostic algorithm that includes the use of transvaginal ultrasonography, human chorionic gonadotropin (hCG) concentrations, and, sometimes, uterine curettage can definitively diagnose women at risk in a timely manner. The absence of an intrauterine pregnancy above an established cut point of hCG is consistent with an abnormal pregnancy but does not distinguish a miscarriage from an ectopic pregnancy. When the initial hCG value is low, serial hCG values can be used to determine whether a gestation is potentially viable or spontaneously resolving. The minimal rise in hCG for a viable pregnancy is 53% in 2 days. The minimal decline of a spontaneous abortion is 21-35% in 2 days, depending on the initial level. A rise or fall in serial hCG values that is slower than this is suggestive of an ectopic pregnancy. Women diagnosed with an unruptured ectopic pregnancy are potential candidates for medical management with methotrexate. Intramuscular injection with methotrexate can be used to safely treat an ectopic pregnancy with success rates, tubal patency rates, and future fertility that are similar to those obtained with conservative surgery. Success rates using methotrexate are inversely rated to baseline hCG values and are higher using "multidose" compared with "single-dose" regimens. Surgical treatment may be conservative or definitive and should be attempted in most cases via laparoscopy.

Time from cervical conization to pregnancy and preterm birth.

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Himes, Katherine P; Simhan, Hyagriv N

2007-02-01

To estimate whether the time interval between cervical conization and subsequent pregnancy is associated with risk of preterm birth. Our study is a case control study nested in a retrospective cohort. Women who underwent colposcopic biopsy or conization with loop electrosurgical excision procedure, large loop excision of the transformation zone, or cold knife cone and subsequently delivered at our hospital were identified with electronic databases. Variables considered as possible confounders included maternal race, age, marital status, payor status, years of education, self-reported tobacco use, history of preterm delivery, and dimensions of cone specimen. Conization was not associated with preterm birth or any subtypes of preterm birth. Among women who underwent conization, those with a subsequent preterm birth had a shorter conization-to-pregnancy interval (337 days) than women with a subsequent term birth (581 days) (P=.004). The association between short conization-to-pregnancy interval and preterm birth remained significant when controlling for confounders including race and cone dimensions. The effect of short conization-to-pregnancy interval on subsequent preterm birth was more persistent among African Americans when compared with white women. Women with a short conization-to-pregnancy interval are at increased risk for preterm birth. Women of reproductive age who must have a conization procedure can be counseled that conceiving within 2 to 3 months of the procedure may be associated with an increased risk of preterm birth. II.

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.

[Sodium intake during pregnancy].

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Delemarre, F M; Franx, A; Knuist, M; Steegers, E A

1999-10-23

International studies have yielded contradictory results on efficacy of a sodium-restricted diet during pregnancy in preventing and curing hypertension of pregnancy. In the Netherlands three studies have been performed to investigate the value of dietary sodium restriction in pregnancy; they concerned epidemiology, prevention and treatment. Midwives often prescribed this dietary intervention. Urinary sodium excretion was not related to blood pressure changes in pregnancy. Dietary sodium restriction from the third month of pregnancy onwards did not reduce the incidence of pregnancy-induced hypertension. Maternal side effects were a decreased intake of nutrients, decreased maternal weight gain, lowered plasma volume and stimulation of the renin-angiotensin-aldosterone system. A dietary sodium restriction in women with early symptoms of pregnancy-induced hypertension showed no therapeutic effect on blood pressure. There is no place for dietary sodium restriction in the prevention or treatment of hypertension in pregnancy.

Validity of a food frequency questionnaire to estimate long-chain polyunsaturated fatty acid intake among Japanese women in early and late pregnancy.

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Kobayashi, Minatsu; Jwa, Seung Chik; Ogawa, Kohei; Morisaki, Naho; Fujiwara, Takeo

2017-01-01

The relative validity of food frequency questionnaires for estimating long-chain polyunsaturated fatty acid (LC-PUFA) intake among pregnant Japanese women is currently unclear. The aim of this study was to verify the external validity of a food frequency questionnaire, originally developed for non-pregnant adults, to assess the dietary intake of LC-PUFA using dietary records and serum phospholipid levels among Japanese women in early and late pregnancy. A validation study involving 188 participants in early pregnancy and 169 participants in late pregnancy was conducted. Intake LC-PUFA was estimated using a food frequency questionnaire and evaluated using a 3-day dietary record and serum phospholipid concentrations in both early and late pregnancy. The food frequency questionnaire provided estimates of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake with higher precision than dietary records in both early and late pregnancy. Significant correlations were observed for LC-PUFA intake estimated using dietary records in both early and late pregnancy, particularly for EPA and DHA (correlation coefficients ranged from 0.34 to 0.40, p food frequency questionnaire, which was originally designed for non-pregnant adults and was evaluated in this study against dietary records and biological markers, has good validity for assessing LC-PUFA intake, especially EPA and DHA intake, among Japanese women in early and late pregnancy. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Unintentional exposure to radiation during pregnancy from nuclear medical diagnostic procedures

International Nuclear Information System (INIS)

Moka, D.

2005-01-01

The administration of radiopharmaceuticals during pregnancy is contraindicated due to a lack of vital indications. However, if prenatal exposure to radiation should occur in the framework of a nuclear medical diagnostic procedure then fortunately no longterm side-effects would normally be expected. Radiation damage in the preimplantation phase leads to early abortion. However, if the further course of pregnancy remains uncomplicated then no subsequent side-effects need be expected. On a conservative estimate, it would require doses exceeding 50 mGy to cause radiation damage within the uterus after the preimplantation phase. However, the standard radioactivities applied for diagnostic purposes in nuclear medicine, can be obtained with doses of less than 20 mGy. On the basis of current knowledge, therefore, there is no reason to terminate pregnancy on medical grounds after diagnostic exposure to radiopharmaceuticals. (orig.)

Unmet need for contraception and its association with unintended pregnancy in Bangladesh.

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Bishwajit, Ghose; Tang, Shangfeng; Yaya, Sanni; Feng, Zhanchun

2017-06-12

Unmet need for contraception and unintended pregnancy are important public health concerns both in developing and developed countries. Previous researches have attempted to study the factors that influence unintended pregnancy. However, the association between unmet need for contraception and unwanted pregnancy is not studied adequately. The aim of the present study was to measure the prevalence of unmet need for contraception and unwanted pregnancy, and to explore the association between these two in a nationally representative sample in Bangladesh. Data for the present study were collected from Bangladesh demographic and health survey conducted in 2011. Participants were 7338 mothers ageing between 13 and 49 years selected from both rural and urban residencies. Planning status of last pregnancy was the main outcome variable and unmet need for contraception was the explanatory variable of primary interest. Cross tabulation, chi-square tests and logistic regression (Generalised estimating equations) methods were used for data analysis. Mean age of the sample population was 25.6 years (SD 6.4). Prevalence of unmet need for contraception was 13.5%, and about 30% of the women described their last pregnancy as unintended. In the adjusted model, the odds of unintended pregnancy were about 16 fold among women who reported facing unmet need for contraception compared to those who did not (95% CI = 11.63-23.79). National rates of unintended pregnancy and of unmet need for contraception remain considerably high and warrant increased policy attention. Findings suggests that programs targeting to reduce unmet need for contraception could contribute to a lower rate of unintended pregnancy in Bangladesh. More in-depth and qualitative studies on the underlying sociocultural causes of unmet need can help develop context specific solutions to unintended pregnancies.

[Pregnancy-specific beta-glycoprotein in the serum of women with a complicated early pregnancy].

Science.gov (United States)

Radikov, N

1989-01-01

The author determined pregnancy specific beta 1-glycoprotein in 109 women with threatened early pregnancy as 32 of the women suffered from abortus imminens with several unsuccessful pregnancies in the past as well as 67 women with abortus incipiens with bleeding ex utero. The author established that 87% of women with abortus imminens and preserved pregnancies had values of beta 1-glycoprotein close to those of normal pregnancy for the respective gestational week. 93% of women with abortus incipiens preserved pregnancies till term, but the specific glycoprotein was with in normal ranges. Spontaneous abortion occurred in 7% of women with low values under the 10th percentile. The present study show that examination of pregnancy specific beta 1-glycoprotein in women with threatened early pregnancy is of prognostic significance for the outcome of pregnancy.

Bipolar Disorder in Pregnancy: A Review of Pregnancy Outcomes.

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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.

Periodontal status during pregnancy and postpartum.

Science.gov (United States)

González-Jaranay, Maximino; Téllez, Luís; Roa-López, Antonio; Gómez-Moreno, Gerardo; Moreu, Gerardo

2017-01-01

Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations. Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline), 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05. Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13). Gingival Index increased (ppregnancy (baseline, 56.7%±0.20; 21-23 weeks, 66.36%±0.17; 34-36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (ppregnancy (baseline, 2.51±0.05; 21-23 weeks, 2.63±0.053; 34-36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (ppregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (pPeriodontal status deteriorates during gestation but improves postpartum.

Eight years' experience with an IVF surrogate gestational pregnancy programme.

Science.gov (United States)

Raziel, Arieh; Schachter, Morey; Strassburger, Deborah; Komarovsky, Dafna; Ron-El, Raphael; Friedler, Shevach

2005-08-01

The aim of this study was to retrospectively audit eight years' experience of an IVF surrogate gestational programme and to compare the outcome of surrogacy due to absence of the uterus with surrogacy indicated for repeated IVF failure and recurrent abortions. A total of 60 cycles of IVF surrogate pregnancy were initiated in 19 treated couples. Absence of the uterus was the indication for surrogacy in 10 cases: Rokitansky syndrome (eight cases) and post-hysterectomy (two cases) designated as group A. The indications in the remaining nine patients (group B) were: IVF implantation failure (three cases), habitual abortions (four cases) and deteriorating maternal diseases (two cases). IVF performance and subsequent pregnancy outcome of groups A and B were compared. There was no difference in ovarian stimulation parameters and in IVF performance between the groups A and B. The overall pregnancy rate per transfer was 10/60 (17%). The pregnancy rates per patient and per transfer were 7/10 (70%) and 7/35 (20%) in group A compared with 3/9 (33%) and 3/25 (12%) in group B. A median number of three treatment cycles were needed to achieve pregnancy. In conclusion, the existence or absence of the uterus in the commissioning mothers is irrelevant for their IVF performance and conception rates. In patients who conceived after more than three IVF cycles, an additional 'oocyte factor' might be present.

78 FR 66621 - Protection of Collateral of Counterparties to Uncleared Swaps; Treatment of Securities in a...

Science.gov (United States)

2013-11-06

... or MSP may not have that information. \\45\\ Several commenters highlighted the importance of have the... Swaps Customer Account constitute ``customer property''; and owners of such account constitute ``customers.'' DATES: Effective date: This rule is effective January 6, 2014. Compliance dates: For uncleared...

[Sexuality and pregnancy].

Science.gov (United States)

Sueiro, E; Gayoso, P; Perdiz, C; Doval, J L

1998-10-15

We intend to describe the sexual behaviour of pregnancies women. Family Planning Center Nóvoa Santos, of Galician Health Service (SERGAS), of Ourense (SPAIN). 206 pregnancies women that are attended in a obstetric psychoprophylaxis's programme, during two years (January/93-January/95). We analysed the social economic, of reproduction, of medical attention and psycho-sexual variables. We use the PRESTA and SPSS statistics programmes. The average age is 28 years old, is married, has elementary studies and this is the first pregnancy. Her pregnancy is desire and normally developed. Her sexual desire and intercourse frequency is the same (1-2 per week); the intercourse is pleasant and the more habitual position is she over. Some times, the couple has relations without coitus and she practises the masturbation, and she enjoy of this practice. The pregnancies women have different sexual behaviours. They are satisfied with all them. The health' professional should favour the complete enjoy of the sexuality during the pregnancy.

[Thyroid and pregnancy].

Science.gov (United States)

Iwen, K A; Lehnert, H

2018-05-17

During pregnancy thyroid hormones have profound effects on embryonal/fetal development and maternal health. Therefore, thyroid gland disorders should be immediately diagnosed and adequately treated. Pregnancy-specific physiological alterations during pregnancy cause changes in the reference interval for thyroid-stimulating hormone levels and trimester-specific thresholds must be taken into account. This article summarizes the most important diagnostic and therapeutic aspects before, during and after pregnancy. With reference to the period prior to pregnancy, the article discusses iodide supplementation, preconceptional examination of thyroid gland metabolism and the importance of thyroid gland functional disorders for fertility and fulfilling the desire to have children. With a view to the period during pregnancy, the effect of hypothyroxinemia, hypothyroidism, and hyperthyroidism as well as the effects of their treatment on the development of the child are explained. Finally, a description is given of what must be paid attention to in the breast-feeding period and in postpartum thyroiditis.

Trajectories of anxiety and health related quality of life during pregnancy.

Directory of Open Access Journals (Sweden)

K Oliver Schubert

Full Text Available Anxiety and health related Quality of Life (HRQoL have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI- and Short Form (36 Health Survey (SF-36 scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma, on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.

Outdoor Activity and High Altitude Exposure During Pregnancy: A Survey of 459 Pregnancies.

Science.gov (United States)

Keyes, Linda E; Hackett, Peter H; Luks, Andrew M

2016-06-01

To evaluate whether women engage in outdoor activities and high altitude travel during pregnancy; the health care advice received regarding high altitude during pregnancy; and the association between high altitude exposure and self-reported pregnancy complications. An online survey of women with at least 1 pregnancy distributed on websites and e-mail lists targeting mothers and/or mountain activities. Outcome measures were outdoor activities during pregnancy, high altitude (>2440 m) exposure during pregnancy, and pregnancy and perinatal complications. Hiking, running, and swimming were the most common activities performed during pregnancy. Women traveled to high altitude in over half of the pregnancies (244/459), and most did not receive counseling regarding altitude (355, 77%), although a small proportion (14, 3%) were told not to go above 2440 m. Rates of miscarriage and most other complications were similar between pregnancies with and without travel above 2440 m. Pregnancies with high altitude exposure were more likely to have preterm labor (odds ratio [OR] 2.3; 95% CI 0.97-5.4; P = .05). Babies born to women who went to high altitude during pregnancy were more likely to need oxygen at birth (OR 2.34; 95% CI 1.04-5.26; P sports and travel to high altitude have a low rate of complications. Given the limitations of our data, further research is necessary on the risks associated with high altitude travel and physical activity and how these apply to the general population. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy.

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Shin, Dayeon; Lee, Kyung Won; Song, Won O

2016-03-11

Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003-2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2-11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2-11.7, AOR 5.4; 95% CI 2.0-14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those

Ectopic ovarian pregnancy

International Nuclear Information System (INIS)

Sachdev, P.S.; Jatoi, N.; Memon, R.A.; Sachdev, C.S.

2003-01-01

A case of ectopic ovarian pregnancy is presented occurring in a 24 years old woman after natural conception. The clinical diagnosis was ruptured tubal pregnancy. Gross findings were suggestive of ruptured corpus luteum cyst on exploration. The histopathological examination of specimen brought forward the diagnosis of ovarian pregnancy. (author)

Teenage pregnancy

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... or family member, your partner, or your labor coach with you. Stay Healthy During Your Pregnancy You ... Pregnancy Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

Ectopic Pregnancy

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... woman is pregnant. If you have an ectopic pregnancy, the fertilized egg grows in the wrong place, ... tubes. The result is usually a miscarriage. Ectopic pregnancy can be a medical emergency if it ruptures. ...

Salivary buffer effect in relation to late pregnancy and postpartum.

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Laine, M; Pienihäkkinen, K

2000-02-01

We studied the salivary pH, buffer effect (BE), and flow rates of unstimulated and paraffin-stimulated saliva of 8 women in their late pregnancy and postpartum. Salivary samples were collected about 1 month prior to and about 2 months after delivery. In non-pregnant control women, two paraffin-stimulated salivary samples were collected 1 month apart. The salivary BE increased significantly from late pregnancy to postpartum without exception. The increase was 2.04 +/- 1.17 pH units (P pH) to 6.82 +/- 1.01 (final pH). This change was not due to variation in salivary flow rates, since both unstimulated and paraffin-stimulated flow rates remained unchanged. In control women the difference between the 2 BE measurements was only 0.13 +/- 0.47 pH units on average. We concluded that women with high postpartum BE values may have moderate or even low BE values in late pregnancy. In control women, individual variation was found to be low in all variables studied.

Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

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Raed Alroughani

2016-01-01

Full Text Available The burden of multiple sclerosis (MS in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs, which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.

Mean blood velocities and flow impedance in the fetal descending thoracic aortic and common carotid artery in normal pregnancy.

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Bilardo, C M; Campbell, S; Nicolaides, K H

1988-12-01

A linear array pulsed Doppler duplex scanner was used to establish reference ranges for mean blood velocities and flow impedance (Pulsatility Index = PI) in the descending thoracic aorta and in the common carotid artery from 70 fetuses in normal pregnancies at 17-42 weeks' gestation. The aortic velocity increased with gestation up to 32 weeks, then remained constant until term, when it decreased. In contrast, the velocity in the common carotid artery increased throughout pregnancy. The PI in the aorta remained constant throughout pregnancy, while in the common carotid artery it fell steeply after 32 weeks. These results suggest that with advancing gestation there is a redistribution of the fetal circulation with decreased impedance to flow to the fetal brain, presumably to compensate for the progressive decrease in fetal blood PO2.

Forced freedom. Part 6. The large-scale consumer. Natural gas trade laborious en unclear

International Nuclear Information System (INIS)

Kop, L.

2001-01-01

Many organisations are busy taking care of their natural gas purchase. Data are compiled, profiles studied, and possibilities for peak shaving examined. Because of the unknown subject, many companies consult specialised advisers. All in all a lot of work, the more so while much is still unclear. One good advice is to ask the VEMW, a Dutch association for the industrial users of energy, environment and water. VEMW has insight into market prices and related conditions

Diabetes insipidus and pregnancy.

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Chanson, Philippe; Salenave, Sylvie

2016-06-01

Diabetes insipidus (DI) is a rare complication of pregnancy. It is usually transient, being due to increased placental production of vasopressinase that inactivates circulating vasopressin. Gestational, transient DI occurs late in pregnancy and disappears few days after delivery. Acquired central DI can also occur during pregnancy, for example in a patient with hypophysitis or neuroinfundibulitis during late pregnancy or postpartum. Finally, pre-existing central or nephrogenic DI may occasionally be unmasked by pregnancy. Treatment with dDAVP (desmopressin, Minirin(®)) is very effective on transient DI of pregnancy and also on pre-existing or acquired central DI. Contrary to vasopressin, dDAVP is not degraded by vasopressinase. Nephrogenic DI is insensitive to dDAVP and is therefore more difficult to treat during pregnancy if fluid intake needs to be restricted. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Anaemia in pregnancy.

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Goonewardene, Malik; Shehata, Mishkat; Hamad, Asma

2012-02-01

Anaemia in pregnancy, defined as a haemoglobin concentration (Hb) anaemia in pregnancy, nutritional iron deficiency anaemia (IDA) being the commonest. Underlying inflammatory conditions, physiological haemodilution and several factors affecting Hb and iron status in pregnancy lead to difficulties in establishing a definitive diagnosis. IDA is associated with increased maternal and perinatal morbidity and mortality, and long-term adverse effects in the new born. Strategies to prevent anaemia in pregnancy and its adverse effects include treatment of underlying conditions, iron and folate supplementation given weekly for all menstruating women including adolescents and daily for women during pregnancy and the post partum period, and delayed clamping of the umbilical cord at delivery. Oral iron is preferable to intravenous therapy for treatment of IDA. B12 and folate deficiencies in pregnancy are rare and may be due to inadequate dietary intake with the latter being more common. These vitamins play an important role in embryo genesis and hence any relative deficiencies may result in congenital abnormalities. Finding the underlying cause are crucial to the management of these deficiencies. Haemolytic anaemias rare also rare in pregnancy, but may have life-threatening complications if the diagnosis is not made in good time and acted upon appropriately. Copyright © 2011 Elsevier Ltd. All rights reserved.

Achieving pregnancy safely for HIV-serodiscordant couples: a social ecological approach.

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Saleem, Haneefa T; Narasimhan, Manjulaa; Denison, Julie A; Kennedy, Caitlin E

2017-03-08

The recognition and fulfilment of the sexual and reproductive health and rights (SRHR) of all individuals and couples affected by HIV, including HIV-serodiscordant couples, requires intervention strategies aimed at achieving safe and healthy pregnancies and preventing undesired pregnancies. Reducing risk of horizontal and vertical transmission and addressing HIV-related infertility are key components of such interventions. In this commentary, we present challenges and opportunities for achieving safe pregnancies for serodiscordant couples through a social ecological lens. At the individual level, knowledge (e.g. of HIV status, assisted reproductive technologies) and skills (e.g. adhering to antiretroviral therapy or pre-exposure prophylaxis) are important. At the couple level, communication between partners around HIV status disclosure, fertility desires and safer pregnancy is required. Within the structural domain, social norms, stigma and discrimination from families, community and social networks influence individual and couple experiences. The availability and quality of safer conception and fertility support services within the healthcare system remains essential, including training for healthcare providers and strengthening integration of SRHR and HIV services. Policies, legislation and funding can improve access to SRHR services. A social ecological framework allows us to examine interactions between levels and how interventions at multiple levels can better support HIV-serodiscordant couples to achieve safe pregnancies. Strategies to achieve safer pregnancies should consider interrelated challenges at different levels of a social ecological framework. Interventions across multiple levels, implemented concurrently, have the potential to maximize impact and ensure the full SRHR of HIV-serodiscordant couples.

Indication of prenatal diagnosis in pregnancies complicated by undetectable second-trimester maternal serum estriol levels.

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Minsart, Anne-Frédérique; Van Onderbergen, Anne; Jacques, Francotte; Kurt, Crener; Gillerot, Yves

2008-07-01

Undetectable maternal serum unconjugated estriol levels in the second-trimester screening test have been associated with congenital pathology and an adverse pregnancy outcome. We reviewed outcomes of pregnancies with undetectable levels of estriol (threatened fetal abortion, one case of multiple congenital anomalies and one case of isolated adrenocorticotropin hormone deficiency. There were 6 women remaining with unexplained undetectable estriol. Undetectable maternal estriol values may indicate a severe fetal pathology and should lead to further investigations.

Physical activity patterns during pregnancy through postpartum

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Evenson Kelly R

2009-11-01

Full Text Available Abstract Background Realizing the importance of regular physical activity, particularly in the prevention of chronic diseases and unhealthy weight gain, it is important to study how physical activity changes during and after pregnancy using prospective study designs. The aim of this study was to describe the mode, duration, intensity, and changes in physical activity during pregnancy through one year postpartum among a cohort of women. Methods This study was part of the third Pregnancy, Infection and Nutrition Postpartum Study at the University of North Carolina Hospitals. A cohort of 471 women was followed at 17-22 and 27-30 weeks' gestation and at 3 and 12 months postpartum. The participants reported the mode, frequency, duration, and intensity of all physical activities that increased their breathing and heart rate in the past week. Results Overall physical activity for the cohort decreased from 17-22 weeks to 27-30 weeks of gestation, but rebounded up at 3 months postpartum and remained stable at 12 months postpartum. The mean MET h/wk values for each time point were 24.7 (standard deviation, SD 26.8, 19.1 (SD 18.9, 25.7 (SD 29.3, and 26.7 (SD 31.5. In postpartum, women reported more care-giving and recreational activity and less indoor household activity, as compared to their activity level during pregnancy. Conclusion For health benefits and weight management, health care professionals are encouraged to provide pregnant and postpartum women with information on recommendations of physical activity, particularly regarding the minimum duration and intensity level.

The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients.

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Lambertini, Matteo; Anserini, Paola; Fontana, Valeria; Poggio, Francesca; Iacono, Giuseppina; Abate, Annalisa; Levaggi, Alessia; Miglietta, Loredana; Bighin, Claudia; Giraudi, Sara; D'Alonzo, Alessia; Blondeaux, Eva; Buffi, Davide; Campone, Francesco; Merlo, Domenico F; Del Mastro, Lucia

2017-05-19

Fertility and pregnancy issues are of key importance for young breast cancer patients. Despite several advances in the field, there are still multiple unmet needs and barriers in discussing and dealing with these concerns. To address the significant challenges related to fertility and pregnancy issues, the PREgnancy and FERtility (PREFER) study was developed as a national comprehensive program aiming to optimize care and improve knowledge around these topics. The PREFER study is a prospective cohort study conducted across several Italian institution affiliated with the Gruppo Italiano Mammella (GIM) group evaluating patterns of care and clinical outcomes of young breast cancer patients dealing with fertility and pregnancy issues. It is composed of two distinctive studies: PREFER-FERTILITY and PREFER-PREGNANCY. The PREFER-FERTILITY study is enrolling premenopausal patients aged 18-45 years, diagnosed with non-metastatic breast cancer, who are candidates to (neo)adjuvant chemotherapy and not previously exposed to anticancer therapies. The primary objective is to obtain and centralize data about patients' preferences and choices towards the available fertility preserving procedures. The success and safety of these strategies and the hormonal changes during chemotherapy and study follow-up are secondary objectives. The PREFER-PREGNANCY study is enrolling survivors achieving a pregnancy after prior history of breast cancer and patients diagnosed with pregnancy-associated breast cancer (PABC). The primary objectives are to obtain and centralize data about the management and clinical outcomes of these women. Patients' survival outcomes, and the fetal, obstetrical and paediatric care of their children are secondary objectives. For both studies, the initial planned recruitment period is 5 years and patients will remain in active follow-up for up to 15 years. The PREFER-FERTILITY study was first activated in November 2012, and the PREFER-PREGNANCY study in May 2013

PREGNANCY AND THYROID

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Simona Gaberšček

2004-01-01

Full Text Available Background. In conditions with appropriate iodine intake, thyroid gland adapts to changes during pregnancy without any consequences. Fetal need for thyroid hormones in the first trimester is directly connected with transplacental transport of thyroid hormones. Fetal synthesis of thyroid hormones depends on availability of iodine in the feto-placental unit. Hypo- and hyperthyroidism during pregnancy are risk factors for pregnant woman and for normal development of fetus and child.Conclusions. Pregnant women with appropriately treated thyroid diseases have the same outcome of pregnancy as healthy women, and neuroendocrinological development of children is not impaired. If the disease is unrecognized or untreated, complications of pregnancy and delivery occur more frequently. Therefore, timely recognition and treatment of the diseases with appropriate drugs during pregnancy and, also, after delivery is very important.

Predicting the outcome of pregnancy in threatened abortion using ultrasound in detecting the viability of foetus.

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Gabriel, R

1992-06-01

Between December 1990 and May 1991 in Malaysia, clinicians at the Sultanah Aminah Hospital in Johor Bahru screened 200 women with a diagnosis of threatened miscarriage with ultrasound to determine whether ultrasound could evaluate the viability of the fetus and thus the outcome of pregnancy in cases of threatened abortion. A fetal heartbeat was absent in 65% of cases with the remaining 35% of cases having a fetal heartbeat. Nonviability of the fetus or an abnormal or very early pregnancy may have accounted for an absent fetal heartbeat. The pregnancy of 46% of cases continued while 41% experienced spontaneous abortion. Just 6.2% of cases with a fetal heartbeat suffered from spontaneous abortion compared with 69.7% of those without a fetal heartbeat. 93.8% of cases with a fetal heartbeat continued their pregnancies compared with 30.3% of those without a fetal heartbeat. Inability of ultrasound to detect fetal heartbeats during early pregnancy probably accounted for the somewhat high percentage of those without a fetal heartbeat who continued their pregnancies. Among patients with a fetal heartbeat, the number of pregnancies that continued. Ultrasound detected 13% abnormal pregnancies (i.e., molar pregnancy or ectopic pregnancy). Surgery on these cases confirmed the ultrasound findings. These results showed that ultrasound should be used in every case of threatened miscarriage and that a fetal heartbeat does indicate the viability of the fetus.

US findings of tubal pregnancy

International Nuclear Information System (INIS)

Lee, Hwa Sung; Kim, Hyun Hee; Jee, Mi Hyun; Kweon, Young Hwa; Oh, Yoon Jin; Hong, Ju Hee; Kim, Soon Yong; Kim, Sang Young

1994-01-01

Early diagnosis of ruptured and unruptured tubal pregnancy became more accurate with the introduction of transvaginal sonographic equipment. The management principle of tubal pregnancy might be changed according to the sonographic findings. The purposes of this study were to define the sonographic findings of tubal pregnancy and to determine whether it is possible to differentiate the unruptured tubal pregnancies from the ruptured ones depending on the sonographic findings. The authors investigated the sonographic findings of the surgically confirmed 25 tubal pregnancy patients. There were 22(88%) unruptured and 3(12%) ruptured tubal pregnancies. Unruptured pregnancies showed tubal ring in 8, well defined hematosalpinx in 11, and poorly defined hematosalpinxin 2 patients. Ruptured pregnancies showed tubal sac with irregular margin in 2, and ill-defined hematosalpinx in one patient. In summary, well marginated tubal ring and hematosalpinx suggested unruptured tubal pregnancy, while tubal sac with irregular margin suggested ruptured pregnancy. However, it was difficult to differentiate the unruptured tubal pregnancy from the ruptured one when hematosalpinx was ill-defined

Hypothyroidism incidence in and around pregnancy: a Danish nationwide study.

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Andersen, S L; Carlé, A; Olsen, J; Laurberg, P

2016-11-01

Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. Population-based cohort study using Danish nationwide registers. All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997-2010 and the IR in three-month intervals before, during and after the woman's first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66-1.19), second trimester: 0.71 (0.52-0.97), third trimester: 0.29 (0.19-0.45)) and increased after birth with the highest level at 4-6 months postpartum (IRR 3.62 (2.85-4.60)). These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase. © 2016 European Society of Endocrinology.

Association between maternal nutritional status in pregnancy and offspring cognitive function during childhood and adolescence; a systematic review.

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Veena, Sargoor R; Gale, Catharine R; Krishnaveni, Ghattu V; Kehoe, Sarah H; Srinivasan, Krishnamachari; Fall, Caroline Hd

2016-08-12

The mother is the only source of nutrition for fetal growth including brain development. Maternal nutritional status (anthropometry, macro- and micro-nutrients) before and/or during pregnancy is therefore a potential predictor of offspring cognitive function. The relationship of maternal nutrition to offspring cognitive function is unclear. This review aims to assess existing evidence linking maternal nutritional status with offspring cognitive function. Exposures considered were maternal BMI, height and weight, micronutrient status (vitamins D, B12, folate and iron) and macronutrient intakes (carbohydrate, protein and fat). The outcome was any measure of cognitive function in children aged nutritional status during pregnancy as defined by BMI, single micronutrient studies, or macronutrient intakes influences offspring cognitive function is inconclusive. There is a need for more trials especially in populations with high rates of maternal undernutrition. Registered in PROSPERO CRD42013005702 .

Juvenile Dermatomyositis in Pregnancy

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Anthony Emeka Madu

2013-01-01

Full Text Available Juvenile dermatomyositis has variable clinical presentations both in and outside of pregnancy. A literature review indicated that optimal maternal and fetal outcomes can be anticipated when the pregnancy is undertaken while the disease is in remission. Poorer outcomes are associated with flare-up of the disease in early pregnancy compared with exacerbation in the second or third trimester, when fetal prognosis is usually good. We present a case of JDM in pregnancy with disease exacerbation late in pregnancy and review of the relevant literature.

Pregnancy-induced thrombocytopenia and TTP, and the risk of fetal death, in Upshaw-Schulman syndrome: a series of 15 pregnancies in 9 genotyped patients.

Science.gov (United States)

Fujimura, Yoshihiro; Matsumoto, Masanori; Kokame, Koichi; Isonishi, Ayami; Soejima, Kenji; Akiyama, Nobu; Tomiyama, Junji; Natori, Kazuhiko; Kuranishi, Yasunobu; Imamura, Yutaka; Inoue, Nobumasa; Higasa, Satoshi; Seike, Masako; Kozuka, Teruhiko; Hara, Masamichi; Wada, Hideo; Murata, Mitsuru; Ikeda, Yasuo; Miyata, Toshiyuki; George, James N

2009-03-01

Upshaw-Schulman syndrome (USS) is a congenital thrombotic thrombocytopenic purpura (TTP) due to mutations in the gene that encodes for ADAMTS13 (ADAMTS13), but its clinical signs may be mild or absent during childhood. We have identified 37 patients with USS (24 females, 13 males) belonging to 32 families. The nine women from six families who were diagnosed during their first pregnancy are the focus of this report. Six of the nine women had episodes of thrombocytopenia during childhood misdiagnosed as idiopathic thrombocytopenic purpura. Thrombocytopenia occurred during the second-third trimesters in each of their 15 pregnancies, with 16 babies (one twin pregnancy), often followed by TTP. Of 15 pregnancies, eight babies were stillborn or died soon after birth, and the remaining seven were all premature except one, who was born naturally following plasma infusions to the mother that had started at 8 weeks' gestation. All nine USS women had severely deficient ADAMTS13 activity. ADAMTS13 analyses demonstrated that eight women were compound heterozygotes of Y304C/G525D (2 siblings), R125VfsX6/Q1302X (2 siblings), R193W/R349C (2 siblings), I178T/Q929X, and R193W/A606P; one woman was homozygous for R193W. Only the R193W mutation has been previously reported. These observations emphasize the importance of measuring ADAMTS13 activity in the evaluation of thrombocytopenia during childhood and pregnancy.

Nevi and pregnancy.

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Bieber, Amy Kalowitz; Martires, Kathryn J; Driscoll, Marcia S; Grant-Kels, Jane M; Pomeranz, Miriam Keltz; Stein, Jennifer A

2016-10-01

Changes in the moles of pregnant women are frequently attributed to pregnancy, but recent studies suggest that pregnancy does not induce significant physiologic changes in nevi. It is common for nevi on the breasts and abdomen to grow with normal skin expansion, but studies that have examined melanocytic nevi on the backs or lower extremities have found no significant changes in size during pregnancy. Several studies have also investigated the belief that moles darken during pregnancy and have found insufficient evidence to support this idea. Dermoscopically, transient changes have been identified, but none are suggestive of melanoma. Results vary in terms of histologic changes seen in samples taken from pregnant women, but all authors agree that any histopathologic features consistent with melanoma should be viewed as melanoma and not attributed to pregnancy. Biopsy specimens should be obtained promptly from any changing mole that would raise concern for malignancy in a nonpregnant patient. Such procedures can be performed safely during pregnancy. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives

NARCIS (Netherlands)

Widyawati, W.; Jans, S.M.P.J.; Utomo, S.; Dillen, J. van; Janssen, A.L.

2015-01-01

BACKGROUND: Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with

Vaccines in pregnancy: The dual benefit for pregnant women and infants.

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Marshall, H; McMillan, M; Andrews, R M; Macartney, K; Edwards, K

2016-04-02

Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.

Do assisted-reproduction twin pregnancies require additional antenatal care?

Science.gov (United States)

Jauniaux, E; Ben-Ami, I; Maymon, R

2013-02-01

Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are

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.

Unintended pregnancy and intimate partner violence around pregnancy in a population-based study.

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Martin-de-las-Heras, Stella; Velasco, Casilda; Luna, Juan de Dios; Martin, Aurelia

2015-06-01

Intimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. However, the relationship between IPV and women's ability to control their fertility has not been adequately explored. To investigate the association between unintended pregnancy and emotional or physical violence perpetrated by partners around pregnancy. A population-based study was undertaken, recruiting women (n=779) at the hospital obstetric departments and gathering social and family data. IPV was diagnosed by using the Index of Spouse Abuse (ISA). Data were gathered by trained midwives in 15 public hospitals in southern Spain and multivariate logistic regression analysis was performed. The pregnancy was reported to be unintended by 118 (15.1%) of the study population. Unintended pregnancy was significantly associated with: physical and/or emotional IPV around pregnancy, age, marital status, cohabitation, educational level, and employment status. After adjusting for socio-demographic characteristics, emotional IPV around pregnancy was significantly associated with an unintended pregnancy (AOR=2.5; 95% CI=1.5-4.3). Being in a non-committed relationship was a risk factor (AOR=3.5; 95% CI=1.8-6.1) and being in employment a protective factor (AOR=0.4; 95% CI=0.2-0.8) for an unintended pregnancy. Women who report an unintended pregnancy may be experiencing emotional IPV. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. A better understanding of the relationship between unintended pregnancy and violence can aid midwives about potential reproductive health risk factors associated with abuse. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Carnitine Deficiency and Pregnancy

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Anouk de Bruyn

2015-01-01

Full Text Available We present two cases of carnitine deficiency in pregnancy. In our first case, systematic screening revealed L-carnitine deficiency in the first born of an asymptomatic mother. In the course of her second pregnancy, maternal carnitine levels showed a deficiency as well. In a second case, a mother known with carnitine deficiency under supplementation was followed throughout her pregnancy. Both pregnancies had an uneventful outcome. Because carnitine deficiency can have serious complications, supplementation with carnitine is advised. This supplementation should be continued throughout pregnancy according to plasma concentrations.

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

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Kathrin F Stanger-Hall

Full Text Available The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005 from all U.S. states with information on sex education laws or policies (N = 48, we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S

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Stanger-Hall, Kathrin F.; Hall, David W.

2011-01-01

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future. PMID:22022362

Understanding Conceptualizations of Pregnancy and Planning for Pregnancy Among Adolescent Girls and Young Women in Harare, Zimbabwe.

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Tinago, Chiwoneso B; Ingram, Lucy Annang; Frongillo, Edward A; Blake, Christine E; Engelsmann, Barbara; Simmons, David

2018-07-01

Zimbabwe has one of the highest rates of maternal mortality, yet little is understood about adolescent girls' and young women's perspectives on pregnancy or planning for pregnancy. The research study took an emic approach to understand and describe how adolescent girls and young women (14-24 years) in Harare, Zimbabwe, conceptualize pregnancy and planning for pregnancy and how these conceptualizations inform pregnancy decisions. Semi-structured, in-depth, qualitative interviews were conducted with adolescent girls and young women ( N = 48) and data were analyzed thematically using NVivo 10. Pregnancy was conceptualized across nine themes: carrying a child and oneself, growing a family, motherhood, the best time for pregnancy, pregnancy decision makers, who is responsible for the pregnancy, pregnancy burden, pregnancy dangers, and increase in social status with pregnancy. Planning for pregnancy was conceptualized during the prepregnancy, pregnancy, and postpregnancy phases. Findings emphasize considering sociocultural views concerning pregnancy and including social networks in maternal health efforts.

Teenage Pregnancy.

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McClellan, Mary C.

1987-01-01

Reviews the problems of teenage pregnancy, including the costs to society, the challenge to educators, and the types of preventive programs developing across the country. Programs dealing strictly with reproduction and contraception are the least effective deterrents to teenage pregnancy. (MD)

Zika Virus and Pregnancy

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Full Text Available ... Guidance & Publications Practice Management Education & Events Advocacy For Patients About ACOG Zika Virus and Pregnancy Home For Patients Zika Virus and Pregnancy Page Navigation ▼ ACOG Pregnancy ...

Subacute Thyroiditis During Pregnancy

Directory of Open Access Journals (Sweden)

CANAN YILDIZ

2017-03-01

Full Text Available In this article, we present a case of subacute thyroiditis occurring in the first trimester of pregnancy in a 33-years-old pregnant patient. Thyrotoxicosis during pregnancy is a rare condition and occurs in 0.1 to 0.4% of all pregnancies. Graves' Disease and transient gestational thyrotoxicosis constitute the majority of emerging thyrotoxicosis during pregnancy. Subacute thyroiditis may also cause temporary thyrotoxicosis. Although the majority of the patients recover without treatment, complications in the pregnancy should be considered and each patient must be evaluated individually. As a result, differential diagnosis of thyrotoxicosis in pregnancy and treatment plan should be done well and subacute thyroiditis should be considered in differential diagnosis. [J Contemp Med 2017; 7(1.000: 1-1

Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture.

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Sanz-Salvador, Lucía; García-Pérez, Miguel Ángel; Tarín, Juan J; Cano, Antonio

2015-02-01

Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use. © 2015 European Society of Endocrinology.

Diabetes insipidus during pregnancy.

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Ananthakrishnan, Sonia

2016-03-01

Diabetes insipidus (DI) in pregnancy is a heterogeneous syndrome, most classically presenting with polyuria and polydipsia that can complicate approximately 1 in 30,000 pregnancies. The presentation can involve exacerbation of central or nephrogenic DI during pregnancy, which may have been either overt or subclinical prior to pregnancy. Women without preexisting DI can also be affected by the actions of placental vasopressinase which increases in activity between the 4th and 38th weeks of gestation, leading to accelerated metabolism of AVP and causing a transient form of DI of pregnancy. This type of DI may be associated with certain complications during pregnancy and delivery, such as preeclampsia. Management of DI of pregnancy depends on the pathophysiology of the disease; forms of DI that lack AVP can be treated with desmopressin (DDAVP), while forms of DI that involve resistance to AVP require evaluation of the underlying causes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pregnancy: an immune challenge

Directory of Open Access Journals (Sweden)

Maria Angelica Ehara Watanabe

2014-12-01

Full Text Available Several studies demonstrate the importance of immunological aspects of pregnancy. During pregnancy, the embryo is implanted in the womb, where it will develop until the end of pregnancy. Amongst the immune aspects, the importance of the modulation of T lymphocytes, natural killers (NK cells and many cytokines in maternal organism can be mentioned. The maternal tolerance to the fetus appears to be mediated by specific maternal hormones and by the expression of human leukocyte antigen G (HLA-G - characteristic in pregnancy. Other studies suggest that fetal rejection and complications during pregnancy may occur because of the presence of minor histocompatibility antigens (mHAg, acquired by blood sharing of the mother with the fetus, and because of the presence of maternal antibodies against the sperm and against the fetus. The purpose of this review is to describe the immunological aspects that allow maternal tolerance to the fetus during pregnancy, as well as possible causes for rejection of the embryo and complications during pregnancy.

Smoking during pregnancy and risk of abnormal glucose tolerance: a prospective cohort study

Directory of Open Access Journals (Sweden)

Haskins Amy E

2010-09-01

Full Text Available Abstract Background Disturbances in glucose metabolism during pregnancy are associated with negative sequalae for both mother and infant. The association between smoking and abnormal glucose tolerance (AGT remains controversial. Therefore, the aim of this study was to examine the relationship between smoking prior to and during pregnancy and risk of AGT. Methods We utilized data from a prospective cohort of 1,006 Hispanic (predominantly Puerto Rican prenatal care patients in Western Massachusetts. Women reported pre- and early pregnancy smoking at recruitment (mean = 15 weeks and mid pregnancy smoking at a second interview (mean = 28 weeks. AGT was defined as > 135 mg/dL on the routine 1-hour glucose tolerance test (1-hr OGTT. We used multivariable regression to assess the effect of pre, early, and mid-pregnancy smoking on risk of AGT and screening plasma glucose value from the 1-hr OGTT. Results In age-adjusted models, women who smoked > 0-9 cigarettes/day in pre-pregnancy had an increased risk of AGT (OR = 1.90; 95% CI 1.02-3.55 compared to non-smokers; this was attenuated in multivariable models. Smoking in early (OR = 0.48; 95% CI 0.21-1.10 and mid pregnancy (OR = 0.38; 95% CI 0.13-1.11 were not associated with AGT in multivariable models. Smoking during early and mid pregnancy were independently associated with lower glucose screening values, while smoking in pre-pregnancy was not. Conclusions In this prospective cohort of Hispanic women, we did not observe an association between smoking prior to or during pregnancy and risk of AGT. Findings from this study, although based on small numbers of cases, extend prior research to the Hispanic population.

Putting pregnancy in its place: conceiving pregnancy as carework in the workplace

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Gatrell, C J

2011-01-01

This paper contributes to understandings of the relationship between pregnancy, health and place by exploring how health advice on pregnancy may be implemented, in practice, ‘at work’. The paper first defines the following of health advice on pregnancy as a form of informal ‘carework’ which obliges pregnant women to implement caring practices comprising emotional and embodied labour. It then observes how health advice on pregnancy carework pays little regard to the impact of place. Drawing up...

Relationships between pregnancy outcomes, biochemical markers and pre-pregnancy body mass index.

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Han, Y S; Ha, E H; Park, H S; Kim, Y J; Lee, S S

2011-04-01

We examined the relationships between pre-pregnancy maternal body mass index (BMI), pregnancy outcomes and biochemical markers. This study was conducted as a cross-sectional analysis. Korean women in their second and third trimesters of pregnancy were recruited at two hospitals in the metropolitan Seoul area. Pre-pregnancy BMI was categorized in four groups according to the Asia-Pacific standard. Fasting blood samples were obtained and analyzed for serum levels of homocysteine, folate and high-sensitivity C-reactive protein (hs-CRP). Concentrations of fetal fibronectin were assessed in the cervix and vagina, and cervical length was measured. Obese subjects had a lower education level and a lower income level than subjects of normal weight. The level of maternal stress was positively associated with pre-pregnancy BMI. Normal weight subjects were more likely to eat breakfast and consume meals of appropriate size than the rest of our sample. In overweight and obese subjects, weight gain during pregnancy was significantly lower than in the underweight and normal subjects. High pre-pregnancy maternal BMI increased the risks of preterm delivery (odds ratio (OR)=2.85, confidence interval (CI)=1.20-6.74), low-birth-weight (LBW) infants (overweight subjects: OR=5.07, CI=1.76-14.63; obese subjects: OR=4.49, CI=1.54-13.13) and macrosomia. In obese subjects, the average serum folate level was significantly lower than in the underweight subjects. In obese subjects, the average serum hs-CRP level was significantly higher than in the rest of our sample. Pregnancy outcomes are influenced by pre-pregnancy BMI. These findings suggest that women can minimize their risks of preterm delivery, LBW and macrosomia by maintaining normal pre-pregnancy BMI.

Glucose screening tests during pregnancy

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Oral glucose tolerance test - pregnancy; OGTT - pregnancy; Glucose challenge test - pregnancy; Gestational diabetes - glucose screening ... screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if you ...

Oral Health Knowledge of Pregnant Women on Pregnancy Gingivitis and Children's Oral Health.

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Zhong, C; Ma, K N; Wong, Y S; So, Y; Lee, P C; Yang, Y

2015-01-01

Pregnancy gingivitis and early childhood caries remain prevalent in Hong Kong. The aim of this study was to assess pregnant women's knowledge and beliefs related to pregnancy gingivitis and children's oral health. An outreach survey was carried out in a clinic that provided antenatal examination. A written oral health questionnaire related to pregnancy gingivitis and early childhood caries was administered to pregnant women. Of the 106 pregnant women who enrolled in the study, 100 completed the questionnaires. Among the 100 subjects, only 39% correctly identified that hormonal changes contribute to pregnancy gingivitis. Only 36% identified red and swollen gums as signs of gingivitis. Furthermore, 53% of the surveyed pregnant women were not sure about the amount of toothpaste to administer to a child aged 18 months to 5 years. Almost 50% assumed that a replanted avulsed tooth would probably not survive within a short extra-alveolar period of less than 60 minutes. Prenatal women generally lack knowledge of a common oral disease that occurs during pregnancy and of what constitutes adequate oral health care for children. Oral health care education should be implemented as part of a prenatal care program.

AUTOIMMUNE DISEASE DURING PREGNANCY AND THE MICROCHIMERISM LEGACY OF PREGNANCY

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Adams Waldorf, Kristina M.; Nelson, J. Lee

2009-01-01

Pregnancy has both short-term effects and long-term consequences. For women who have an autoimmune disease and subsequently become pregnant, pregnancy can induce amelioration of the mother’s disease, such as in rheumatoid arthritis, while exacerbating or having no effect on other autoimmune diseases like systemic lupus erythematosus. That pregnancy also leaves a long-term legacy has recently become apparent by the discovery that bi-directional cell trafficking results in persistence of fetal cells in the mother and of maternal cells in her offspring for decades after birth. The long-term persistence of a small number of cells (or DNA) from a genetically disparate individual is referred to as microchimerism. While microchimerism is common in healthy individuals and is likely to have health benefits, microchimerism has been implicated in some autoimmune diseases such as systemic sclerosis. In this paper, we will first discuss short-term effects of pregnancy on women with autoimmune disease. Pregnancy-associated changes will be reviewed for selected autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus and autoimmune thyroid disease. The pregnancy-induced amelioration of rheumatoid arthritis presents a window of opportunity for insights into both immunological mechanisms of fetal-maternal tolerance and pathogenic mechanisms in autoimmunity. A mechanistic hypothesis for the pregnancy-induced amelioration of rheumatoid arthritis will be described. We will then discuss the legacy of maternal-fetal cell transfer from the perspective of autoimmune diseases. Fetal and maternal microchimerism will be reviewed with a focus on systemic sclerosis (scleroderma), autoimmune thyroid disease, neonatal lupus and type I diabetes mellitus. PMID:18716941

Hypopituitarism and successful pregnancy

OpenAIRE

Du, Xue; Yuan, Qing; Yao, Yanni; Li, Zengyan; Zhang, Huiying

2014-01-01

Hypopituitarism is a disorder characterized by the deficiency of one or more of the hormones secreted by the pituitary gland. Hypopituitarism patients may present the symptoms of amenorrhea, poor pregnancy potential, infertility, and no production of milk after delivery. Successful pregnancy in hypopituitarism patient is rare because hypopituitarism is associated with an increased risk of pregnancy complications, such as abortion, anemia, pregnancy-induced hypertension, placental abruption, p...

Differences in clinical presentation and pregnancy outcomes in antepartum preeclampsia and new-onset postpartum preeclampsia: Are these the same disorder?

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Vilchez, Gustavo; Hoyos, Luis R; Leon-Peters, Jocelyn; Lagos, Moraima; Argoti, Pedro

2016-11-01

New-onset postpartum preeclampsia is a poorly defined condition that accounts for a significant percentage of eclampsia cases. It is unclear whether new-onset postpartum preeclampsia is a different disorder from or belongs to the same spectrum of classic antepartum preeclampsia. The objective of this study was to compare the clinical presentation and pregnancy outcomes of antepartum preeclampsia and new-onset postpartum preeclampsia. A retrospective study including 92 patients with antepartum preeclampsia and 92 patients with new-onset postpartum preeclampsia was performed. Clinical presentation and pregnancy outcomes were compared. Chi-square test was used to analyze categorical variables, and independent t -test and Mann-Whitney U -test for numerical variables. P -values of presentation, laboratory markers and pregnancy outcomes. New-onset postpartum preeclampsia has a distinct patient profile and clinical presentation than antepartum preeclampsia, suggesting they may represent different disorders. Characterization of a patient profile with increased risk of developing this condition will help clinicians to identify patients at risk and provide early and targeted interventions to decrease the morbidity associated with this condition.

Unmet social needs and teenage pregnancy in Ogbomosho, South-western Nigeria.

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Salami, Kabiru K; Ayegboyin, Matthew; Adedeji, Isaac A

2014-12-01

Consistent high teenage pregnancy rates in South-western Nigeria are characteristically underpinned by the unmet social needs of the teenagers. To elicit intergenerational views on the influence of unmet social needs on teenage pregnancy. Through a descriptive and cross-sectional design, a total of 174 respondents who were either pregnant teenagers, teenage mothers during the survey or had been pregnant as teenagers, were interviewed, using questionnaire supplemented with 12 key informant interviews. With the mean age of 16.5 years, and educational status range of between primary and below (25.8%) and tertiary (9.8%) levels, only 39.7% respondents were married, about half (47.7%) remained single while others were separated (12.6%). Less than half (44.9%) of the respondents were engaged in occupational activities. The unmet material and financial supports expected from parents (43.1%), the lack of free education from government up till secondary school level (51.2%), the lack of sex education and knowledge needs for signs of maturity (53.4%) and discouragement from friends not to have boyfriend (66.1%) prone teenagers to unplanned pregnancy. Promotion of sexual education and parental care is encouraged as strategy against unplanned pregnancy among teenagers.

Assessment of renal function during various stages of pregnancy in women

International Nuclear Information System (INIS)

Iqbal, S.A.; Ansari, A.K.; Akhtar, M.S.

2003-01-01

A study was conducted to investigate changes in renal functions during different trimesters of pregnancy in Pakistani women. For this purpose, 26 non-pregnant women (Group 1) and 63 women in different stages of pregnancy (18 in first trimester, Group II; 22 in the second trimester, Group III and 23 in the third trimester, Group IV), were selected. Blood samples were taken from all subjects for determination of serum glucose, albumin, creatinine, urea and uric acid. Similarly, urine samples were analysed for creatinine and other urinary parameters including GFR (glomerular filtration rate). Significant increase (P<0.05) was observed in urinary level of creatinine in Group 1only, while differences among women of other groups were non-significant. There was a significant rise in the rate of GFR in pregnant as compared to non-pregnant women as determined on the basis of endogenous creatinine clearance. Urine volume also increased significantly as pregnancy progressed. Serum urea decreased significantly in Groups II and IV, while creatinine remained unchanged. Serum uric acid also showed significant decrease in the first trimester but returned to control level in the 3rd trimester. Serum glucose level increased, while serum albumin decreased during pregnancy. (author)

Progression of major depression during pregnancy and postpartum: a preliminary study.

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Shivakumar, Geetha; Johnson, Neysa L; McIntire, Donald D; Leveno, Kenneth

2014-04-01

The purpose of this pilot study was to investigate major depressive symptoms among a high-risk group of pregnant women managed at a tertiary care setting. The study prospectively evaluated pregnant women who met DSM-IV criteria for a major depressive episode (MDE). Psychiatric measures for depression, anxiety and social impairment were administered at monthly intervals during pregnancy and immediate postpartum period. Twenty-four women provided longitudinal data from mid pregnancy to 2 months of postpartum period. 86% of women were clinically symptomatic at the beginning of study during pregnancy and only 32% remained clinically symptomatic at 2 months following delivery reaching. This difference reached a statistical significance level p depression, comorbid anxiety disorder, histories of domestic violence, and those with uninvolved spouse or partners were more at-risk to be clinically symptomatic in the immediate postpartum period. In a group consisting of largely Latina women at a tertiary care setting, progression of major depression when treated with antidepressant medication(s) is that of an improvement from pregnancy to immediate postpartum period. Further longitudinal studies are needed to assess impact of clinical characteristics and treatment on major depression in larger diverse obstetric group.

Hiding or hospitalising? On dilemmas of pregnancy management in East Cameroon.

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van der Sijpt, Erica

2013-01-01

Current international debates and policies on safe motherhood mainly propose biomedical interventions to reduce the risks during pregnancy and delivery. Yet, the conceptualisations of risk that underlie this framework may not correspond with local perceptions of reproductive dangers; consequently, hospital services may remain underutilised. Inspired by a growing body of anthropological literature exploring local fertility-related fears, and drawing on 15 months of fieldwork, this paper describes ideas about risky reproduction and practices of pregnancy protection in a Cameroonian village. It shows that social and supernatural threats to fertility are deemed more significant than the physical threats of fertility stressed at the (inter)national level. To protect their pregnancies from those social and supernatural influences, however, women take very physical measures. It is in this respect that biomedical interventions, physical in their very nature, do connect to local methods of pregnancy management. Furthermore, some pregnant women purposefully deploy hospital care in an attempt to reduce relational uncertainties. Explicit attention to the intersections of the social and the physical, and of the supernatural and the biomedical, furthers anthropological knowledge on fertility management and offers a starting point for more culturally sensitive safe motherhood interventions.

Pregnancy-Associated Changes in Pharmacokinetics: A Systematic Review

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Leibson, Tom; Carls, Alexandra; Ito, Shinya; Koren, Gideon

2016-01-01

Background Women are commonly prescribed a variety of medications during pregnancy. As most organ systems are affected by the substantial anatomical and physiological changes that occur during pregnancy, it is expected that pharmacokinetics (PK) (absorption, distribution, metabolism, and excretion of drugs) would also be affected in ways that may necessitate changes in dosing schedules. The objective of this study was to systematically identify existing clinically relevant evidence on PK changes during pregnancy. Methods and Findings Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science (Thomson Reuters), from database inception to August 31, 2015. An update of the search from September 1, 2015, to May 20, 2016, was performed, and relevant data were added to the present review. No language or date restrictions were applied. All publications of clinical PK studies involving a group of pregnant women with a comparison to nonpregnant participants or nonpregnant population data were eligible to be included in this review. A total of 198 studies involving 121 different medications fulfilled the inclusion criteria. In these studies, commonly investigated drug classes included antiretrovirals (54 studies), antiepileptic drugs (27 studies), antibiotics (23 studies), antimalarial drugs (22 studies), and cardiovascular drugs (17 studies). Overall, pregnancy-associated changes in PK parameters were often observed as consistent findings among many studies, particularly enhanced drug elimination and decreased exposure to total drugs (bound and unbound to plasma proteins) at a given dose. However, associated alterations in clinical responses and outcomes, or lack thereof, remain largely unknown. Conclusion This systematic review of pregnancy-associated PK changes identifies a significant gap between the accumulating knowledge of PK changes in pregnant women and our understanding of their

Tests Related to Pregnancy

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... to learn. Search form Search Tests related to pregnancy You are here Home Testing & Services Testing for ... to Genetic Counseling . What Are Tests Related to Pregnancy? Pregnancy related testing is done before or during ...

Asthma Medications and Pregnancy

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... Asthma Associated Conditions Asthma & Pregnancy Asthma & Pregnancy: Medications Asthma & Pregnancy: Medications Make an Appointment Refer a Patient ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

The Role of Headache in the Classification and Management of Hypertensive Disorders in Pregnancy.

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Sperling, Jeffrey D; Dahlke, Joshua D; Huber, Warren J; Sibai, Baha M

2015-08-01

Hypertensive disorders of pregnancy remain among the leading causes of maternal morbidity and mortality. The onset of headaches in patients with hypertensive disorders of pregnancy has been considered as a premonitory symptom for eclampsia and other adverse maternal outcomes. Headaches are very common symptoms during pregnancy and the postpartum period with a reported incidence of 39%; however, headache is absent in 30-50% of women before the onset of eclampsia and is a poor predictor of eclampsia and adverse maternal outcomes. If included in the definition of cerebral or visual disturbances, headache may be considered a symptom of preeclampsia, a diagnostic feature of preeclampsia with severe features, a premonitory symptom of eclampsia, and an indication for delivery. Inclusion of this nonspecific symptom in the diagnosis and management of hypertensive disorders of pregnancy in the absence of an evidence basis may lead to unintended consequences including excessive testing, visits to outpatient offices or emergency departments, additional hospitalization, and iatrogenic preterm delivery without proven benefit. If a cerebral disturbance such as severe or persistent headache presents for the first time during pregnancy or postpartum, an evaluation should be performed that considers a broad differential diagnosis, including but not limited to hypertensive disorders of pregnancy, and the diagnostic evaluation is similar to that in nonpregnant adults. This commentary draws attention to the implications of considering the cerebral disturbance of headache as a symptom that portends adverse pregnancy outcome in the current recommendations for diagnosing and managing hypertensive disorders of pregnancy.

Provision of no-cost, long-acting contraception and teenage pregnancy.

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Secura, Gina M; Madden, Tessa; McNicholas, Colleen; Mullersman, Jennifer; Buckel, Christina M; Zhao, Qiuhong; Peipert, Jeffrey F

2014-10-02

The rate of teenage pregnancy in the United States is higher than in other developed nations. Teenage births result in substantial costs, including public assistance, health care costs, and income losses due to lower educational attainment and reduced earning potential. The Contraceptive CHOICE Project was a large prospective cohort study designed to promote the use of long-acting, reversible contraceptive (LARC) methods to reduce unintended pregnancy in the St. Louis region. Participants were educated about reversible contraception, with an emphasis on the benefits of LARC methods, were provided with their choice of reversible contraception at no cost, and were followed for 2 to 3 years. We analyzed pregnancy, birth, and induced-abortion rates among teenage girls and women 15 to 19 years of age in this cohort and compared them with those observed nationally among U.S. teens in the same age group. Of the 1404 teenage girls and women enrolled in CHOICE, 72% chose an intrauterine device or implant (LARC methods); the remaining 28% chose another method. During the 2008-2013 period, the mean annual rates of pregnancy, birth, and abortion among CHOICE participants were 34.0, 19.4, and 9.7 per 1000 teens, respectively. In comparison, rates of pregnancy, birth, and abortion among sexually experienced U.S. teens in 2008 were 158.5, 94.0, and 41.5 per 1000, respectively. Teenage girls and women who were provided contraception at no cost and educated about reversible contraception and the benefits of LARC methods had rates of pregnancy, birth, and abortion that were much lower than the national rates for sexually experienced teens. (Funded by the Susan Thompson Buffett Foundation and others.).

Pregnancy course and outcome in women traveling to developing countries.

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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.

Etiology, clinical features and outcome of fulminant hepatic failure in pregnancy.

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Brohi, Zahida Parveen; Sadaf, Aneela; Perveen, Uzma

2013-09-01

To determine the etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. An observational hospital based study was conducted at Isra University hospital Hyderabad from 1st March 2009 to 28th February 2010. Total 1192 obstetric patients were admitted in obstetrics & gynaecology department during this period, of whom 52 were with Fulminant hepatic failure in pregnancy and were included in this study. A pre-designed structured proforma was used. All patients had clinical history and underwent a physical examination. Routine laboratory tests, liver function tests and viral serology were performed in all cases. All results were analyzed on statistical software SPSS version 11. Frequencies and percentages were calculated, the final outcome was recorded. Out of 52, 6 (11.5%) presented in the first trimester, 4 (7.6%) in the second trimester and 42 (80.7%) were in their 3rd trimester of pregnancy. Etiology of the disease was Hepatitis E in 28 (53.8%), Hepatitis B in 9 (17.3%), Hepatitis C in 7 (13.5%) HELLP syndrome in 7 (13.5%) and acute fatty liver of pregnancy in 1 (3.57%) case. Maternal mortality was 15 (28.8%) and foetal mortality was 40 (77%). Only 12 (23.1%) new born remained alive. Fulminant hepatic failure in pregnancy has very high foetal and maternal mortality which is mostly due to viral hepatitis E.

Parent-offspring conflict and the persistence of pregnancy-induced hypertension in modern humans

DEFF Research Database (Denmark)

Hartsteen, Birgitte Hollegaard; Byars, Sean Geoffrey; Lykke, Jacob

2013-01-01

Preeclampsia is a major cause of perinatal mortality and disease affecting 5-10% of all pregnancies worldwide, but its etiology remains poorly understood despite considerable research effort. Parent-offspring conflict theory suggests that such hypertensive disorders of pregnancy may have evolved...... towards the end of pregnancy in order to explain why these disorders have not been removed by natural selection in our hunter-gatherer ancestors. We analyzed >750,000 live births in the Danish National Patient Registry and all registered medical diagnoses for up to 30 years after birth. We show...... that early PIH leading to improved postpartum survival and health represents a balanced compromise between the reproductive interests of parents and offspring, whereas later onset of PIH may reflect an unbalanced parent-offspring conflict at the detriment of maternal and offspring health....

Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy

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Tanvir Samra

2015-01-01

Full Text Available Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.

Pregnancy and melanoma.

Science.gov (United States)

Driscoll, Marcia S; Martires, Kathryn; Bieber, Amy Kalowitz; Pomeranz, Miriam Keltz; Grant-Kels, Jane M; Stein, Jennifer A

2016-10-01

Malignant melanoma is the most common malignancy during pregnancy, and is diagnosed during childbearing age in approximately one-third of women diagnosed with melanoma. The impact of hormonal changes during pregnancy and from iatrogenic hormones on melanoma is controversial. Women undergo immunologic changes during pregnancy that may decrease tumor surveillance. In addition, hormone receptors are found on some melanomas. In spite of these observations, the preponderance of evidence does not support a poorer prognosis for pregnancy-associated melanomas. There is also a lack of evidence that oral contraceptives or hormone replacement therapy worsens melanoma prognosis. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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 ...