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

Science.gov (United States)

Harris, Nathaniel; Eudy, Amanda; Clowse, Megan

2018-06-15

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

The adverse effects of hypothyroidism and hyperthyroidism during pregnancy

Directory of Open Access Journals (Sweden)

Mahnaz Boroumand Rezazadeh

2015-06-01

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

The oral microbiome and adverse pregnancy outcomes

Directory of Open Access Journals (Sweden)

Cobb CM

2017-08-01

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

Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy.

Science.gov (United States)

Forbes, Shareen; Barr, Sarah M; Reynolds, Rebecca M; Semple, Scott; Gray, Calum; Andrew, Ruth; Denison, Fiona C; Walker, Brian R; Norman, Jane E

2015-11-01

Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies. We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group). Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04). Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.

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

Science.gov (United States)

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

2009-02-25

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

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

Directory of Open Access Journals (Sweden)

Algert Charles S

2009-02-01

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

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

Science.gov (United States)

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

2013-10-01

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

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

Science.gov (United States)

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

2018-04-23

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

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

Science.gov (United States)

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

2015-07-01

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

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

OpenAIRE

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

2005-01-01

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

Association of maternal periodontal health with adverse pregnancy outcome.

Science.gov (United States)

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

2013-01-01

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

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

OpenAIRE

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

2005-01-01

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

Maternal Periodontitis, Preeclampsia and Adverse Pregnancy Outcomes

Directory of Open Access Journals (Sweden)

Pourandokht Afshari

2013-07-01

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

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

NARCIS (Netherlands)

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

2015-01-01

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2015-12-01

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

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

Science.gov (United States)

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

2018-01-01

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

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

DEFF Research Database (Denmark)

Thanh Nguyen Hoang; Toan Ngo Van; Gammeltoft, Tine

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Yong Zhang

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

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Xing Ge

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

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

Directory of Open Access Journals (Sweden)

Deepti Verma

2016-06-01

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

Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes.

Science.gov (United States)

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

2012-06-01

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

Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events

DEFF Research Database (Denmark)

Khashan, Ali; Abel, Kathryn; McNamee, R.

2008-01-01

CONTEXT: Most societies believe that a mother's psychological state can influence her unborn baby. Severe adverse life events during pregnancy have been consistently associated with an elevated risk of low birth weight and prematurity. Such events during the first trimester have also been...... associated with risk of congenital malformations. OBJECTIVE: To assess the effect in offspring of antenatal maternal exposure to an objective measure of stress on risk of adverse neurodevelopment, specifically schizophrenia. We hypothesized that the strongest relationship would be to maternal exposures...... not linked with a higher risk of schizophrenia. CONCLUSIONS: Our population-based study suggests that severe stress to a mother during the first trimester may alter the risk of schizophrenia in offspring. This finding is consistent with ecological evidence from whole populations exposed to severe stressors...

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

Science.gov (United States)

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

2017-08-01

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

Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

Directory of Open Access Journals (Sweden)

Lauren A V Orenstein

Full Text Available Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa.We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM, low birth weight (LBW, prematurity, and major congenital malformations (MCM in Sub-Saharan African countries were also performed.Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3 per 1,000 total births, and the most common causes were hemorrhage (34%, dystocia (22%, and severe hypertensive disorders of pregnancy (22%. Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4 or premature (median 15.4%, IQR: 10.6-19.1 were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6, with the musculoskeletal system comprising 30%.Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

Directory of Open Access Journals (Sweden)

Natasha Gupta

2014-01-01

Full Text Available Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.

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

Science.gov (United States)

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

2018-03-01

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

Severe heparin osteoporosis in pregnancy.

OpenAIRE

Griffiths, H. T.; Liu, D. T.

1984-01-01

A case of severe osteoporosis following administration of low dose subcutaneous heparin in pregnancy is reported. Possible reasons for the condition are suggested which caution against the indiscriminate use of subcutaneous heparin in pregnancy.

Starvation Ketoacidosis: A Cause of Severe Anion Gap Metabolic Acidosis in Pregnancy

Directory of Open Access Journals (Sweden)

Nupur Sinha

2014-01-01

Full Text Available Pregnancy is a diabetogenic state characterized by relative insulin resistance, enhanced lipolysis, elevated free fatty acids and increased ketogenesis. In this setting, short period of starvation can precipitate ketoacidosis. This sequence of events is recognized as “accelerated starvation.” Metabolic acidosis during pregnancy may have adverse impact on fetal neural development including impaired intelligence and fetal demise. Short periods of starvation during pregnancy may present as severe anion gap metabolic acidosis (AGMA. We present a 41-year-old female in her 32nd week of pregnancy, admitted with severe AGMA with pH 7.16, anion gap 31, and bicarbonate of 5 mg/dL with normal lactate levels. She was intubated and accepted to medical intensive care unit. Urine and serum acetone were positive. Evaluation for all causes of AGMA was negative. The diagnosis of starvation ketoacidosis was established in absence of other causes of AGMA. Intravenous fluids, dextrose, thiamine, and folic acid were administered with resolution of acidosis, early extubation, and subsequent normal delivery of a healthy baby at full term. Rapid reversal of acidosis and favorable outcome are achieved with early administration of dextrose containing fluids.

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

Science.gov (United States)

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

2015-11-01

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

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

Science.gov (United States)

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

2018-01-16

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

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

Science.gov (United States)

Krejci, Charlene B; Bissada, Nabil F

2012-01-01

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

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

Science.gov (United States)

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

2018-01-01

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

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies.

Science.gov (United States)

Corbella, Stefano; Taschieri, Silvio; Francetti, Luca; De Siena, Francesca; Del Fabbro, Massimo

2012-07-01

Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case-control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case-control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case-control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.

Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

OpenAIRE

Gupta, Natasha; Ahmed, Seema; Shaffer, Lemuel; Cavens, Paula; Blankstein, Josef

2014-01-01

Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term an...

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

NARCIS (Netherlands)

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

2014-01-01

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

Does Uterine Fibroid Adversely Affect Obstetric Outcome of Pregnancy?

Directory of Open Access Journals (Sweden)

Hend S. Saleh

2018-01-01

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

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

Science.gov (United States)

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

2014-09-01

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

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

Directory of Open Access Journals (Sweden)

Grace Stephen

2018-01-01

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

Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy

Directory of Open Access Journals (Sweden)

Bro SP

2015-01-01

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

Association of severe thrombocytopenia and poor prognosis in pregnancies with aplastic anemia.

Directory of Open Access Journals (Sweden)

Jae Eun Shin

Full Text Available PURPOSE: We sought to estimate the risks of adverse obstetric outcomes and disease outcomes associated with severe thrombocytopenia in pregnant women with aplastic anemia (AA. METHODS: In a retrospective study, we compared demographics, clinical characteristics, laboratory results, and outcomes between severe thrombocytopenia (ST and non-severe thrombocytopenia (non-ST groups comprising pregnant women with AA. RESULTS: Of 61 AA patients, 43 (70% were diagnosed as AA before pregnancy and 18 (30% were AA during pregnancy. The ST group exhibited lower gestational age at nadir of platelet count (26.0 versus 37.0 weeks, p<0.001 and at delivery (37.3 versus 39.1 weeks, p = 0.008, and a higher rate of bleeding gums (33.8 versus 7.7%, p = 0.015 than the non-ST group. In addition, the ST group exhibited more transfusions during pregnancy (72.7 versus 15.4%, p<0.001 and postpartum period (45.0 versus 2.7%, p<0.001, and more bone marrow transplant after delivery (25.0 versus 0.0%, p<0.001 than the non-ST group. The ST group had a higher odds ratio of composite disease complications (OR, 9.63; 95% CI, 2.82-32.9; p<0.001 and composite obstetric complications (OR, 6.78; 95% CI, 2.11-21.8; p = 0.001 than the non-ST group. CONCLUSIONS: Severe thrombocytopenia is more associated with obstetric and disease complications than is non-severe thrombocytopenia in pregnant women with AA.

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

Science.gov (United States)

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Chulyong Park

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

Pregnancy-associated severe sepsis.

Science.gov (United States)

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.

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

Science.gov (United States)

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

2014-05-01

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

A thick placenta: a predictor of adverse pregnancy outcomes.

Science.gov (United States)

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

2014-01-01

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

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

Directory of Open Access Journals (Sweden)

Aurélie Di Bartolomeo

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

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

Science.gov (United States)

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

2017-01-01

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

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

Science.gov (United States)

Ide, Mark; Papapanou, Panos N

2013-04-01

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

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

Science.gov (United States)

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

2016-06-01

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

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

DEFF Research Database (Denmark)

Pihl, Kasper; Larsen, Torben; Laursen, Inga

2009-01-01

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

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

OpenAIRE

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

2015-01-01

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

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

Science.gov (United States)

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

2012-12-01

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

The relationship between salivary bacterial flora and adverse pregnancy outcomes

Directory of Open Access Journals (Sweden)

Sadeghi R

2011-04-01

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

Role of perinatal adversities on tic severity and symptoms of attention deficit/hyperactivity disorder in children and adolescents with a tic disorder.

Science.gov (United States)

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

2010-01-01

To investigate the role of perinatal adversities with regard to tic severity and comorbid attention deficit/hyperactivity disorder (ADHD) symptoms in children with a tic disorder. In 75 children and adolescents with a tic disorder, we retrospectively assessed presence of pregnancy, delivery, and postnatal complications and of prenatal exposure to smoking and alcohol. Children with and without these perinatal adversities were compared regarding tic and ADHD symptom severity. Furthermore, through linear regressions, we investigated whether perinatal adversities would interact with presence in first-degree relatives of tic or any mental disorders with the tic or ADHD measure as outcome. Presence of delivery complications was related to tic severity and prenatal smoking exposure to severity of comorbid ADHD symptoms. The relationship between smoking exposure in utero and ADHD symptom severity appeared to be more pronounced in children with a positive family history of mental disorders. This study provides evidence of a role for perinatal adversities in the etiology of tic disorders. Children with perinatal adversities may be vulnerable to develop more severe tics or comorbid ADHD symptoms in the presence of a positive family history of mental disorders, suggesting a role for gene-environment interactions.

Periodontal treatment for preventing adverse pregnancy outcomes

DEFF Research Database (Denmark)

Schwendicke, Falk; Karimbux, Nadeem; Allareddy, Veerasathpurush

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Bari O

2017-05-01

Full Text Available Omar Bari,1 Philip R Cohen2 1School of Medicine, University of California San Diego, La Jolla, CA, USA; 2Department of Dermatology, University of California San Diego, La Jolla, CA, USA Abstract: Hereditary hemorrhagic telangiectasia (HHT is an autosomal dominant condition with a prevalence of ~1 in 5,000 individuals. The pathophysiology of this condition centers on the lack of capillary beds between arterioles and venules, leading to direct contact between these vessels. This results in telangiectases on characteristic locations such as the face, fingers, mouth, and nasal mucosa. Visceral arteriovenous malformations (AVMs are also observed in many patients, and these are most commonly seen in the brain, gastrointestinal tract, and lungs. Liver AVMs are present in many patients with HHT, though these individuals are usually asymptomatic; however, liver AVMs may lead to serious complications, such as high output cardiac failure. Diagnosis of HHT hinges upon fulfilling three out of four criteria: family history of the condition, mucocutaneous telangiectases, spontaneous and recurrent episodes of epistaxis, and visceral AVMs. Management is guided by international consensus guidelines and targets patients’ specific AVMs. Prognosis is good, though severe complications including hemorrhage and paradoxical emboli are possible. Novel therapeutics are being explored in clinical trials; bevacizumab and pazopanib inhibit angiogenesis, while thalidomide bolsters blood vessel maturation. Pregnancy in patients with HHT is considered high risk. While the majority of pregnancies proceed normally, severe complications have been reported in some women with HHT; these include heart failure, intracranial hemorrhage, pulmonary hemorrhage, and stroke. Such complications occur most often in the second and third trimesters when maternal changes such as peripheral vasodilation and increased cardiac output are at their maximum. Awareness of the diagnosis of HHT has

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

Directory of Open Access Journals (Sweden)

Barbara Torlinska

2018-03-01

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

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

Science.gov (United States)

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

2017-03-01

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

Acute severe asthma presenting in late pregnancy.

Science.gov (United States)

Holland, S M; Thomson, K D

2006-01-01

Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

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

Directory of Open Access Journals (Sweden)

Mojgan Barati

2014-01-01

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

Health Behaviours during Pregnancy in Women with Very Severe Obesity

Directory of Open Access Journals (Sweden)

Nor A. Mohd-Shukri

2015-10-01

Full Text Available The health behaviours of pregnant women with very severe obesity are not known, though these women are at high risk of pregnancy complications. We carried out a prospective case-control study including 148 very severely obese (BMI >40 kg/m2 and 93 lean (BMI <25 kg/m2 pregnant women. Diet, physical activity, smoking, alcohol and folic acid consumption were assessed by questionnaire in early and late (16 and 28 weeks gestation pregnancy. Circulating levels of iron, vitamin B12 and folate and other essential trace elements and minerals were measured in a subset at each time point. The findings biochemically confirmed that very severely obese women consumed diets that were energy-rich but poor in essential micronutrients. A third of all women met physical activity recommendations for pregnancy. A third of very severely obese women and two thirds of lean women took folic acid supplements prior to pregnancy. Very severely obese women were more likely to smoke but less likely to drink alcohol than lean women (all p < 0.05. Women with very severe obesity have low self-reported intakes and circulating levels of essential micronutrients in pregnancy and few follow current recommendations for pregnancy nutrition and lifestyle. These high-risk women represent a group to target for education about health behaviours prior to and during pregnancy.

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

Science.gov (United States)

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

2017-06-10

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

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

Science.gov (United States)

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

2017-09-01

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

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

Science.gov (United States)

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

2018-05-05

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

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.

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

LENUS (Irish Health Repository)

Murphy, Deirdre J

2013-09-01

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

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

NARCIS (Netherlands)

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

2007-01-01

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

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

Science.gov (United States)

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

2017-12-01

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

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

Science.gov (United States)

Meeker, John D.; Benedict, Merle D.

2013-01-01

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

Binge drinking in pregnancy

DEFF Research Database (Denmark)

Kesmodel, Ulrik Schiøler

2001-01-01

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

Severe Anaemia during Late Pregnancy

Directory of Open Access Journals (Sweden)

Mahenaz Akhtar

2012-01-01

Full Text Available Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

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.

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

Science.gov (United States)

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

2016-02-01

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

[Causes and management of severe acute liver damage during pregnancy].

Science.gov (United States)

Sepulveda-Martinez, Alvaro; Romero, Carlos; Juarez, Guido; Hasbun, Jorge; Parra-Cordero, Mauro

2015-05-01

Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.

Thyroid dysfunction and pregnancy outcomes

Directory of Open Access Journals (Sweden)

Sima Nazarpour

2015-07-01

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

APCR, factor V gene known and novel SNPs and adverse pregnancy outcomes in an Irish cohort of pregnant women

LENUS (Irish Health Repository)

Sedano-Balbas, Sara

2010-03-10

Abstract Background Activated Protein C Resistance (APCR), a poor anticoagulant response of APC in haemostasis, is the commonest heritable thrombophilia. Adverse outcomes during pregnancy have been linked to APCR. This study determined the frequency of APCR, factor V gene known and novel SNPs and adverse outcomes in a group of pregnant women. Methods Blood samples collected from 907 pregnant women were tested using the Coatest® Classic and Modified functional haematological tests to establish the frequency of APCR. PCR-Restriction Enzyme Analysis (PCR-REA), PCR-DNA probe hybridisation analysis and DNA sequencing were used for molecular screening of known mutations in the factor V gene in subjects determined to have APCR based on the Coatest® Classic and\\/or Modified functional haematological tests. Glycosylase Mediated Polymorphism Detection (GMPD), a SNP screening technique and DNA sequencing, were used to identify SNPs in the factor V gene of 5 APCR subjects. Results Sixteen percent of the study group had an APCR phenotype. Factor V Leiden (FVL), FV Cambridge, and haplotype (H) R2 alleles were identified in this group. Thirty-three SNPs; 9 silent SNPs and 24 missense SNPs, of which 20 SNPs were novel, were identified in the 5 APCR subjects. Adverse pregnancy outcomes were found at a frequency of 35% in the group with APCR based on Classic Coatest® test only and at 45% in the group with APCR based on the Modified Coatest® test. Forty-eight percent of subjects with FVL had adverse outcomes while in the group of subjects with no FVL, adverse outcomes occurred at a frequency of 37%. Conclusions Known mutations and novel SNPs in the factor V gene were identified in the study cohort determined to have APCR in pregnancy. Further studies are required to investigate the contribution of these novel SNPs to the APCR phenotype. Adverse outcomes including early pregnancy loss (EPL), preeclampsia (PET) and intrauterine growth restriction (IGUR) were not significantly more

Sleep disordered breathing in pregnancy

Directory of Open Access Journals (Sweden)

Bilgay Izci Balserak

2015-12-01

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

Asking women about mental health and social adversity in pregnancy: results of an Australian population-based survey.

Science.gov (United States)

Yelland, Jane; Brown, Stephanie J

2014-03-01

Social adversity undermines health in pregnancy. The objective of this study was to examine the extent to which pregnant women were asked about their mental health and life circumstances in pregnancy checkups. Population-based postal survey of recent mothers in two Australian states. Around half of the 4,366 participants reported being asked about depression (45.9%) and whether they were anxious or worried about things happening in their life (49.6%); fewer reported being asked about relationship issues (29.6%), financial problems (16.6%), or family violence (14.1%). One in five women (18%) reported significant social adversity. These women were more likely to recall being asked about their mental health and broader social health issues. Far higher levels of inquiry were reported by women in the public maternity system with midwives more likely than doctors to ask about mental health, family violence, and other social hardships. Routine pregnancy visits afford a window of opportunity for identifying and supporting women experiencing mental health problems and social adversity. Changing practice to take advantage of this opportunity will require concerted and coordinated efforts by practitioners and policy makers to build systems to support public health approaches to antenatal care. © 2014, Copyright the Authors Journal compilation © 2014, Wiley Periodicals, Inc.

Anaemia in pregnancy.

Science.gov (United States)

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.

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

DEFF Research Database (Denmark)

Pihl, Kasper; Larsen, Torben; Rasmussen, Steen

2009-01-01

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

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

Science.gov (United States)

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

2016-06-22

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

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

Science.gov (United States)

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

2017-07-18

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

Advanced abdominal pregnancy, with live fetus and severe preeclampsia, case report.

Science.gov (United States)

Hailu, Fekade Getachew; Yihunie, Getnet Tesfaye; Essa, Ahmed Amdihun; Tsega, Walelign Kindie

2017-07-26

Abdominal pregnancy may account for up to 1.4% of all ectopic pregnancies. The incidence of abdominal pregnancy differs in various literatures and ranges between 1:10,000 pregnancies to 1:30, 000 pregnancies. The clinical symptoms of an uncomplicated abdominal pregnancy are unspecific. There are reports of maternal and fetal survival from advanced abdominal pregnancies. Our case was a 26 years old gravida 4, para 3 (2 alive, one early neonatal death) woman. She presented to Felegehiwot Referal Hospital with a principal complaint of vomiting, epigastric pain, headache, and blurring of vision. Emergency cesarean delivery was decided with the impression of bicornuate uterus with intrauterine pregnancy, intrauterine growth restriction and sever preeclampsia.it was found to be advanced abdominal pregnancy. Placenta was removed and pack was used to control bleeding. Both the mother and neonate were discharged in a good condition. Abdominal pregnancy with live fetus is an extremely rare condition and requires a high index of suspicion. Endometrial cavity may not be required for development of severe preeclampsia and packing is effective in controlling bleeding in selected cases.

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

DEFF Research Database (Denmark)

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

2013-01-01

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

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

Science.gov (United States)

Berger, Katherine E; Masterson, James; Mascardo, Joy; Grapa, Jayvee; Appanaitis, Inger; Temengil, Everlynn; Watson, Berry Moon; Cash, Haley L

2016-08-01

The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.

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

Science.gov (United States)

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

2015-08-25

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

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

Science.gov (United States)

Hashim, Raghad; Akbar, Madiha

2014-12-01

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

Association Between Maternal Smoking During Pregnancy and Severe Mental Illness in Offspring.

Science.gov (United States)

Quinn, Patrick D; Rickert, Martin E; Weibull, Caroline E; Johansson, Anna L V; Lichtenstein, Paul; Almqvist, Catarina; Larsson, Henrik; Iliadou, Anastasia N; D'Onofrio, Brian M

2017-06-01

Several recent population-based studies have linked exposure to maternal smoking during pregnancy to increased risk of severe mental illness in offspring (eg, bipolar disorder, schizophrenia). It is not yet clear, however, whether this association results from causal teratogenic effects or from confounding influences shared by smoking and severe mental illness. To examine the association between smoking during pregnancy and severe mental illness in offspring, adjusting for measured covariates and unmeasured confounding using family-based designs. This study analyzed population register data through December 31, 2013, for a cohort of 1 680 219 individuals born in Sweden from January 1, 1983, to December 31, 2001. Associations between smoking during pregnancy and severe mental illness in offspring were estimated with adjustment for measured covariates. Cousins and siblings who were discordant on smoking during pregnancy and severe mental illness were then compared, which helped to account for unmeasured genetic and environmental confounding by design. Maternal self-reported smoking during pregnancy, obtained from antenatal visits. Severe mental illness, with clinical diagnosis obtained from inpatient and outpatient visits and defined using International Classification of Diseases codes for bipolar disorder and schizophrenia spectrum disorders. Of the 1 680 219 offspring included in the analysis, 816 775 (48.61%) were female. At the population level, offspring exposed to moderate and high levels of smoking during pregnancy had greater severe mental illness rates than did unexposed offspring (moderate smoking during pregnancy: hazard ratio [HR], 1.25; 95% CI, 1.19-1.30; high smoking during pregnancy: HR, 1.51; 95% CI, 1.44-1.59). These associations decreased in strength with increasing statistical and methodologic controls for familial confounding. In sibling comparisons with within-family covariates, associations were substantially weaker and nonsignificant (moderate

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

DEFF Research Database (Denmark)

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

2009-01-01

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

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

NARCIS (Netherlands)

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

2016-01-01

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

Relationship of Heme Oxygenase-1 (HO-1 Level with Onset and Severity in Normotensive Pregnancy and Severe Preeclampsia

Directory of Open Access Journals (Sweden)

John Johannes Wantania

2016-08-01

Full Text Available Background: Preeclampsia still becomes a major problem in pregnancies. Various evidences showed that heme oxygenase-1 (HO-1 is very important in pregnancy. This study aims to understand the relationship of heme oxygenase-1 level with onset and severity in normotensive pregnancy and severe preeclampsia. Methods: This is a cross sectional analytic comparative study, the subjects consisted of 26 patients with normotensive pregnancies and 26 patients with severe preeclampsia. Blood samples from women with < 34 / ≥ 34 weeks’ normotensive pregnancies and women with severe preeclampsia were taken. HO-1 ELISA kit used to quantitate heme oxygenase-1 level in samples. Results: The level of heme oxygenase-1 in normotensive pregnant women < 34 weeks lower than severe preeclampsia pregnant women < 34 weeks (3.28 ± 0.46 ng/mL vs 4.20 ± 0.64 ng/mL, p=0.003, respectively. The median level of heme oxygenase-1 in normotensive pregnant women ≥ 34 weeks was 2.96 (2.41–4.39 ng/mL, while severe preeclampsia pregnant women ≥ 34 weeks was 3.52 (2.88–5.43 ng/mL, (p=0.040. The median level of heme oxygenase-1 in normotensive pregnant women was 3.04 (2.41–4.39 ng/mL, while severe preeclampsia pregnant women was 3.68 (2.88–5.67 ng/mL, (p=0.001. Conclusions: There is correlation between the incidence of severe preeclampsia with heme oxygenase-1 level in < 34 and ≥ 34 weeks of pregnancy. There is a significant difference between the level of heme oxygenase-1 in pregnant women with severe preeclampsia and in women with normotensive pregnancy. 

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

Science.gov (United States)

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

2017-07-01

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

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

Science.gov (United States)

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

2017-09-01

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

Efficacy and safety of electroconvulsive therapy in the first trimester of pregnancy: a case of severe manic catatonia.

Science.gov (United States)

Pinna, Martina; Manchia, Mirko; Pillai, Gianluca; Salis, Piergiorgio; Minnai, Gian Paolo

2015-08-01

Electroconvulsive therapy (ECT) is an appropriate, albeit often neglected, option for managing severe or life-threatening psychiatric symptoms during pregnancy. We report on the rapid effectiveness and safety of ECT during the first trimester of pregnancy in a 28-year-old woman with severe catatonia. Catatonic symptoms were assessed using the Catatonia Rating Scale (CRS). The patient was treated with unilateral ECT using left anterior right temporal (LART) placement. Seizure quality and duration were monitored by a two-lead electroencephalograph (EEG) and by one-lead electromyography (EMG). During each ECT session, the fetal heart rate was monitored with electrocardiogram (ECG). After the second ECT treatment (day 13 of hospitalization), we observed remission of the catatonic symptoms, as shown by the drop in the CRS score from 22 to 0. No cognitive abnormalities were reported and no gynecological complications were detected (e.g. vaginal bleeding, abdominal pain, or uterine contraction). The patient delivered at term a healthy male neonate who presented normal growth as well as normal psychomotor development. This case highlights the effectiveness of ECT in treating severe catatonic mania during the first 3 months of pregnancy. In addition, ECT proved to be a safe therapeutic option, since neither mother nor infant experienced any adverse event. We suggest that ECT might be considered as a valid and safe option in the therapeutic decision-making process when catatonic symptoms manifest during pregnancy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

Directory of Open Access Journals (Sweden)

Florian Kurth

Full Text Available BACKGROUND: Sub-Saharan Africa has the highest rates of maternal and neonatal mortality worldwide. Young maternal age at delivery has been proposed as risk factor for adverse pregnancy outcome, yet there is insufficient data from Sub-Saharan Africa. The present study aimed to investigate the influence of maternal adolescence on pregnancy outcomes in the Central African country Gabon. METHODOLOGY AND PRINCIPAL FINDINGS: Data on maternal age, parity, birth weight, gestational age, maternal Plasmodium falciparum infection, use of bednets, and intake of intermittent preventive treatment of malaria in pregnancy were collected in a cross-sectional survey in 775 women giving birth in three mother-child health centers in Gabon. Adolescent women (≤16 years of age had a significantly increased risk to deliver a baby with low birth weight in univariable analysis (22.8%, 13/57, vs. 9.3%, 67/718, OR: 2.9, 95% CI: 1.5-5.6 and young maternal age showed a statistically significant association with the risk for low birth weight in multivariable regression analysis after correction for established risk factors (OR: 2.7; 95% CI: 1.1-6.5. In further analysis adolescent women were shown to attend significantly less antenatal care visits than adult mothers (3.3±1.9 versus 4.4±1.9 mean visits, p<0.01, n = 356 and this difference accounted at least for part of the excess risk for low birth weight in adolescents. CONCLUSION: Our data demonstrate the importance of adolescent age as risk factor for adverse pregnancy outcome. Antenatal care programs specifically tailored for the needs of adolescents may be necessary to improve the frequency of antenatal care visits and pregnancy outcomes in this risk group in Central Africa.

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

Directory of Open Access Journals (Sweden)

Jessica S. A. de Araujo

2016-06-01

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

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

International Nuclear Information System (INIS)

Munim, S.; Maheen, H.

2012-01-01

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

Treatments for iron-deficiency anaemia in pregnancy.

Science.gov (United States)

Reveiz, Ludovic; Gyte, Gillian Ml; Cuervo, Luis Gabriel; Casasbuenas, Alexandra

2011-10-05

Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm. To assess the effects of different treatments for anaemia in pregnancy attributed to iron deficiency (defined as haemoglobin less than 11 g/dL or other equivalent parameters) on maternal and neonatal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2011), CENTRAL (2011, Issue 5), PubMed (1966 to June 2011), the International Clinical Trials Registry Platform (ICTRP) (2 May 2011), Health Technology Assessment Program (HTA) (2 May 2011) and LATINREC (Colombia) (2 May 2011). Randomised controlled trials comparing treatments for anaemia in pregnancy attributed to iron deficiency. We identified 23 trials, involving 3.198 women. We assessed their risk of bias. Three further studies identified are awaiting classification. Many of the trials were from low-income countries; they were generally small and frequently methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (risk ratio 0.38, 95% confidence interval 0.26 to 0.55, one trial, 125 women) and better haematological indices than placebo (two trials). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. Most trials reported no clinically relevant outcomes nor adverse effects. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions

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

Science.gov (United States)

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

2010-01-01

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

Management of Severe Hypertriglyceridemia with Plasmapheresis During Pregnancy

Directory of Open Access Journals (Sweden)

Gokhan Boyraz

2016-01-01

Full Text Available Although severe hypertriglyceridemia is rarely seen in pregnancy, it may result in acute pancreatitis leading to increased morbidity in both mother and fetus. Restriction of dietary lipid and lipid-lowering medications are the cornerstones of the treatment. Experiences with plasmapheresis are limited. Herein, a pregnant woman with hypertriglyceridemia who was given preconceptional counseling and medical therapy and kept under close observation since the early weeks of gestation, succesfully managed with dietary lipid restriction and especially with serial plasmapheresis is discussed. Her previous pregnancy was remarkable with fetal demise due to acute pancreatitis at 24th weeks of gestation. It is important that the clinicians have a clear understanding of the normal lipid profile during pregnancy, the clinical picture, the potential complications, available treatment options of hypertriglyceridemia particularly during pregnancy.

β-Blocker treatment during pregnancy and adverse pregnancy outcomes

DEFF Research Database (Denmark)

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

2012-01-01

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

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

Science.gov (United States)

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

2018-04-01

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

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

DEFF Research Database (Denmark)

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

2006-01-01

BACKGROUND: Laboratory work may constitute a possible health hazard for workers as well as for their offspring, and involves a wide range of exposures, such as organic solvents, carcinogenic agents, ionizing radiation, and/or microbiological agents. Adverse pregnancy outcomes in the offspring...... exposed, and of non-laboratory employees unexposed (n = 1,909). Exposure data were obtained by questionnaires to research group leaders. Logistic regression analysis estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Paternal laboratory work in general showed no statistically...

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

Directory of Open Access Journals (Sweden)

Louise C Kenny

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

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

Directory of Open Access Journals (Sweden)

Puneet Singh Talwar

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Jing Yang

2017-01-01

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

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

Science.gov (United States)

Catalano, Patrick M; Shankar, Kartik

2017-02-08

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

Tobacco smoking during pregnancy and risk of adverse behaviour in offspring

DEFF Research Database (Denmark)

Dürr, Dorte Wiwe; Høyer, Birgit Bjerre; Christensen, Line Høgenhof

2015-01-01

pregnant women. Whenthe children were from five to nine years of age, the parents assessed the child’s behaviour using theStrength and Difficulties Questionnaire (SDQ).Results: Overall, smoking in pregnancy was not associated with a higher probability of adverse behaviourassessed by the total SDQ score....... However, in the crude analysis smoking was associated with a highermean difference of SDQ-total score. In Greenland the SDQ-total mean difference (MD) was (MD (95%CI) = 1.31 points (0.42; 2.19)) and in Ukraine (MD (95% CI) = 0.18 points (−1.2; 0.91)), whereas the adjustedmean differences were...

Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children.

Science.gov (United States)

Mina, T H; Lahti, M; Drake, A J; Räikkönen, K; Minnis, H; Denison, F C; Norman, J E; Reynolds, R M

2017-01-01

Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress. We evaluated neuropsychiatric symptoms in 112 children aged 3-5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5-25 kg/m2). The mothers completed the Conners' Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively. Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners' Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and

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

Science.gov (United States)

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

2004-07-01

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

ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and foetal outcomes in glucose tolerant women classified using International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria

LENUS (Irish Health Repository)

Dennedy, MC

2011-09-15

Background and aims: Raised maternal body mass index (BMI), in association with hyperglycaemia is associated with adverse pregnancy outcome. Whether BMI has an independent effect on adverse pregnancy outcome is not clear. We aimed to investigate the effects of raised maternal BMI on pregnancy outcome in glucose tolerant women, classified using the IADPSG criteria.\\r\

Long-term outcome of pregnancy complicating with severe aplastic anemia under supportive care.

Science.gov (United States)

Chen, Kuan-Ju; Chang, Yao-Lung; Chang, Horng; Su, Shen-Yuan; Peng, Hsiu-Huei; Chang, Shuenn-Dyh; Chao, An-Shine

2017-10-01

Pregnancy associated with aplastic anemia (AA) is a rare and heterogeneous disorder. We aimed to identify and evaluate the maternal and pregnant outcomes of pregnancy-associated severe AA treated with supportive care. A 25-year retrospective study was conducted at in a single center between 1990 and 2014 with pregnancy associated severe AA. In addition, relevant published cases of antenatally diagnosed pregnancy-associated severe AA after 1990 were identified by PubMed. The main goal was to determine the impact of various risk factors on maternal and fetal outcomes. 15 women with 18 pregnancies were enrolled. With addition of the published reports in literature, a total of 36 cases were included for reference review. Univariate analysis showed that low platelet counts (<2.0 × 10 9 /L), bone marrow hypocellularity (<25%), and late diagnosis during pregnancy were predictors of poor maternal outcomes (P < 0.05). The complication rate of pregnancy outcomes was 53.3%, including preterm delivery, small gestational age (SGA), preterm premature ruptured of membranes (PPROM) and preeclampsia. This study identified the risk factors of mortality and morbidity in pregnant women with severe AA, as well as the obstetrical complications associated with neonatal outcome. Copyright © 2017. Published by Elsevier B.V.

Pregnancy and autoimmune connective tissue diseases

Science.gov (United States)

Marder, Wendy; Littlejohn, Emily A

2016-01-01

The autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before and during pregnancy and the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy. PMID:27421217

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

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

Brannon, Patsy M

2012-05-01

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

Risk of adverse pregnancy outcome in women exposed to livestock

DEFF Research Database (Denmark)

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

2013-01-01

outcome in women with self-reported occupational or domestic contact with livestock compared to pregnant women without such contact. The Danish National Birth Cohort collected information on pregnancy outcome from 100 418 pregnant women (1996-2002) from which three study populations with occupational and....../or domestic exposure to livestock and a reference group of women with no animal contact was sampled. Outcome measures were miscarriage, very preterm birth (before gestational week 32), preterm birth (before 37 gestational weeks), small for gestational age (SGA), and perinatal death. Adverse reproductive...... outcomes were assessed in four different exposure groups of women with occupational or domestic exposure to livestock with no association found between exposure to livestock and miscarriage, preterm birth, SGA or perinatal death. These findings should diminish general occupational health concerns...

Severe adverse events related to tattooing: An retrospective analysis of 11 years

Directory of Open Access Journals (Sweden)

Uwe Wollina

2012-01-01

Full Text Available Background: The incidence of tattoos has been increased markedly during the last 20 years. Aims: To analyze the patient files for severe adverse medical reactions related to tattooing. Settings: Academic Teaching Hospital in South-East Germany. Materials and Methods: Retrospective investigation from March 2001 to May 2012. Results: The incidence of severe adverse medical reactions has been estimated as 0.02%. Infectious and non-infectious severe reactions have been observed. The consequences were medical drug therapies and surgery. Conclusions: Tattooing may be associated with severe adverse medical reactions with significant morbidity. Regulations, education and at least hygienic controls are tools to increase consumer safety.

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

Science.gov (United States)

Njim, Tsi; Agbor, Valirie Ndip

2017-06-26

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

Pre-existing diabetes mellitus and adverse pregnancy outcomes

Directory of Open Access Journals (Sweden)

Wahabi Hayfaa A

2012-09-01

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

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

NARCIS (Netherlands)

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

2017-01-01

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

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

Science.gov (United States)

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

2015-10-01

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

Maternal obesity in early pregnancy and risk of adverse outcomes.

Science.gov (United States)

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

2013-01-01

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

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

Science.gov (United States)

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

2015-07-01

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

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

Science.gov (United States)

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

2013-01-01

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

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

Science.gov (United States)

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

2012-08-01

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

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

Science.gov (United States)

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

2017-12-19

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

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

Science.gov (United States)

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

2016-09-01

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

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

Science.gov (United States)

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

2011-01-06

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

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

DEFF Research Database (Denmark)

Jensen, Dorte; Lauridsen, Lars Korsholm; Ovesen, Per Glud

2008-01-01

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

Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors.

Science.gov (United States)

Solans-Domènech, Maite; Sánchez, Emília; Espuña-Pons, Montserrat

2010-03-01

To estimate frequency and severity and to identify risk factors of urinary incontinence (UI) and anal incontinence during pregnancy and after delivery in previously continent nulliparous women. We designed a cohort study of healthy, continent, nulliparous pregnant women attending public health care services. The field work was conducted during the control visits of the three trimesters of pregnancy, at the time of delivery, and postpartum. A self-administered questionnaire was used to assess UI (validated and adapted) and anal incontinence. Frequency of UI and anal incontinence and their confidence intervals (95% CIs) were calculated. The correlations between the severity of UI and the degree of effect on daily life were also estimated. Multivariable Cox models were applied to estimate hazard ratios for both incontinences (urinary/anal) during pregnancy and postpartum. The cumulative incidence rate during pregnancy was 39.1% (95% CI 36.3-41.9) for UI and 10.3% (95% CI 8.3-12.3) for anal incontinence. The correlation between severity of UI and effect on daily life was moderate. Age, baseline body mass index, and family history of UI were significantly associated with the occurrence of UI during pregnancy, while age and excess weight gain during pregnancy were associated with the occurrence of anal incontinence during pregnancy. Postpartum, the identified risk factors for both incontinences were incontinence during pregnancy and vaginal delivery. The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence. Some risk factors for both incontinences during pregnancy and postpartum are related to lifestyles and obstetric practices.

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

OpenAIRE

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

2013-01-01

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

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

African Journals Online (AJOL)

owner

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

Fecal Calprotectin during Pregnancy in Women with Moderate-Severe Inflammatory Bowel Disease

DEFF Research Database (Denmark)

Kammerlander, Heidi; Nielsen, Jan; Kjeldsen, Jens

2018-01-01

Background Fecal calprotectin (FC) is a biomarker used for assessing disease activity among IBD patients. Sparse knowledge exists as to whether FC correlates with clinical disease activity during pregnancy. Our aim was to assess FC and selected biomarkers in women with moderate-severe IBD...... and correlate them with clinical disease activity scores in pregnant women. Methods We identified a nationwide cohort of 219 singleton pregnancies in women with moderate-severe disease (all treated with anti-tumor recrosis factor-α [anti-TNF-α] therapy during pregnancy), and we reviewed the medical records....../kg in women with clinically inactive, mild, and moderate-severe disease activity, respectively, and were significantly higher among the women with clinical disease activity. ROC curves for disease activity were computed according to the preconception period: 0.81 (95% confidence interval [CI], 0...

Maternal anxiety from pregnancy to 2 years postpartum: transactional patterns of maternal early adversity and child temperament.

Science.gov (United States)

Agrati, Daniella; Browne, Dillon; Jonas, Wibke; Meaney, Michael; Atkinson, Leslie; Steiner, Meir; Fleming, Alison S

2015-10-01

The aims of this study were to examine the anxiety trajectories of women from pregnancy to 2 years postpartum and to assess the influence of their early life experiences and the temperament of the child on these trajectories. We evaluated state anxiety (State-Trait Anxiety Inventory) at pregnancy and 3, 6, 12, 18, and 24 months postpartum and determined its course as a function of self-reported early adverse experiences (Childhood Trauma Questionnaire) and the temperament of the child at 18 months (Early Child Behavior Questionnaire). Based on growth curve modeling, we found that anxiety followed a general U-shape pattern from gestation to 2 years postpartum, which was modified by early life experience of women. Greater early adversity was associated with higher gestational anxiety, followed by a marked decrease once the baby was born, and subsequent increase during the later postpartum period. The temperament of the child also modulated anxiety trajectories. Thus, mothers of children high in negative affectivity and who also experienced greater early adversity had elevated and flat anxiety trajectories, while child extraversion was associated with increasing anxiety courses approaching 2 years postpartum. These results show that maternal anxiety dynamically changes through the postpartum period with a course that is affected by previous and current experiences.

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

Science.gov (United States)

Baud, David; Regan, Lesley; Greub, Gilbert

2008-02-01

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

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

Science.gov (United States)

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

2008-05-01

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

Baking soda pica associated with rhabdomyolysis and cardiomyopathy in pregnancy.

Science.gov (United States)

Scolari Childress, Katherine M; Myles, Thomas

2013-08-01

Pica is a commonly underappreciated disorder in pregnancy that can lead to several complications, including severe metabolic derangements and other adverse outcomes. We report a case of baking soda pica in pregnancy associated with both rhabdomyolysis and cardiomyopathy. A multigravid woman at 37 weeks of gestation presented with weakness and severe hypokalemia. She subsequently had development of rhabdomyolysis and presumed peripartum cardiomyopathy. After delivery, it was discovered that the patient had a long history of consumption of large quantities of baking soda. Her condition improved with cessation of the pica. Clinicians must have a high index of suspicion for pica in pregnancy because it can lead to complex diagnostic challenges and pregnancy complications. The diagnosis should be considered in a patient with unexplained metabolic abnormalities.

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

International Nuclear Information System (INIS)

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

2015-01-01

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

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

Science.gov (United States)

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

2016-06-01

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

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

International Nuclear Information System (INIS)

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

2006-01-01

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

Periodontal disease and adverse pregnancy outcomes.

Science.gov (United States)

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

2006-09-01

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

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

Directory of Open Access Journals (Sweden)

Valentina Giudici

2014-01-01

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

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

Science.gov (United States)

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.

Does physical activity during pregnancy adversely influence markers of the metabolic syndrome in adult offspring? A prospective study over two decades.

Science.gov (United States)

Danielsen, Inge; Granström, Charlotta; Rytter, Dorte; Hammer Bech, Bodil; Brink Henriksen, Tine; Vaag, Allan Arthur; Olsen, Sjurdur Frodi

2013-08-01

It is unknown whether physical activity during pregnancy (PA) has long-term impact on the metabolic profile of the offspring. We investigated associations of PA with markers of the metabolic syndrome (MS) in 20y old offspring. Longitudinal study where 965 pregnant women during 1988-1989 had four dimensions of PA assessed by questionnaires in gestation week 30: PA at work; leisure time PA, daily amount of walking-biking and sport participation. The following MS markers were assessed in the offspring (n=439): body mass index (BMI), waist circumference, blood pressure, homeostasis model assessment insulin resistance as well as fasting plasma glucose, triglycerides, cholesterol (high-density lipoprotein (HDL), low-density lipoprotein and total cholesterol), insulin and leptin levels. Walking-biking PA in pregnancy is associated with unchanged or subtle, adverse changes of distinct MS markers among offspring including lower levels of HDL cholesterol (ratio 0.95 (95% CI 0.92 to 0.98) per 1 h increment in walking-biking), a higher diastolic blood pressure (difference 1.12 (95% CI 0.03 to 2.20) mm Hg/1 h increment) and a higher BMI (ratio 1.03 (95% CI 1.01 to 1.05) per 1 h increment). In separate analyses in males, these associations persisted and additional adverse associations were found for triglycerides, systolic blood pressure, waist circumference and leptin. No associations were detected with other measures of PA. The study did not substantiate any protective effects of PA in pregnancy. In contrast, data suggested that high amounts of daily walking-biking in pregnancy may have adverse effects on levels of HDL cholesterol, diastolic blood pressure and BMI in young adult offspring.

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

Science.gov (United States)

Menon, Ramkumar; Papaconstantinou, John

2016-01-01

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

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

Science.gov (United States)

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

2016-07-01

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

Severe hypoglycaemia during pregnancy in women with type 1 diabetes: possible role of renin-angiotensin system activity?

DEFF Research Database (Denmark)

Nielsen, L Ringholm; Pedersen-Bjergaard, U; Thorsteinsson, B

2009-01-01

AIMS: To investigate whether increased risk of severe hypoglycaemia in early pregnancy is related to pregnancy-induced changes in renin-angiotensin system (RAS) activity in women with type 1 diabetes (T1DM). METHODS: Severe hypoglycaemic events the year preceding pregnancy were recorded...... retrospectively in 107 consecutive pregnant women with T1DM. Events during pregnancy were recorded prospectively. Measurements of ACE, renin and angiotensinogen were determined at 8, 14, 21, 27 and 33 weeks and postpartum. RESULTS: The rate of severe hypoglycaemia was 1.1 and 5.3 events/patient-year the year...... preceding pregnancy and postpartum ACE activity (relative rate of severe hypoglycaemia above versus below median ACE activity: 4.4 (CI: 1.7-11.9), p=0.003). No association was found between severe hypoglycaemia during pregnancy and renin angiotensin system activity at 8 weeks. CONCLUSIONS: In early...

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

Science.gov (United States)

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

2013-12-20

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

A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures.

Science.gov (United States)

Ofluoglu, Onder; Ofluoglu, Demet

2008-12-01

Osteoporosis associated with pregnancy and lactation is a rare condition. The prevalence, etiology and its pathogenesis is unknown. It causes one or more vertebral fractures with severe, prolonged back pain and height loss in affected women. Majority of the cases are seen in the third trimester or just after delivery in primagravid women. In this case report, a 30-year-old woman who had severe pregnancy-induced osteoporosis with 8 vertebral fractures was presented. During last month of her first pregnancy she had moderate back pain. After delivery, the back pain has gotten worse. The radiological examinations have shown that there was 50% in T6, T8 and T10; 30% in L2; 20% in L1 height loss and biconcave vertebral images in L3-5. In the bone mineral density, L2-4 T score was -4.7 and total femoral T score was -3.1. There was no abnormality in the laboratory findings except mild elevation in alkaline phosphates. Although pregnancy-associated osteoporosis is a rare condition, when pain occurs in the last trimester or early postpartum period, it should be considered in differential diagnosis.

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.

Severe Acute Pancreatitis in Pregnancy

Directory of Open Access Journals (Sweden)

Bahiyah Abdullah

2015-01-01

Full Text Available This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

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

Science.gov (United States)

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

2014-03-01

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

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

Science.gov (United States)

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

2017-03-01

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

Maternal obesity in early pregnancy and risk of adverse outcomes.

Directory of Open Access Journals (Sweden)

Inmaculada Bautista-Castaño

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

Prophylactic treatment of hereditary severe factor VII deficiency in pregnancy.

Science.gov (United States)

Pfrepper, Christian; Siegemund, Annelie; Hildebrandt, Sven; Kronberg, Juliane; Scholz, Ute; Niederwieser, Dietger

2017-09-01

: Severe hereditary factor VII deficiency is a rare bleeding disorder and may be associated with a severe bleeding phenotype. We describe a pregnancy in a 33-year-old woman with compound heterozygous factor VII deficiency and a history of severe menorrhagia and mucocutaneous bleedings. After discontinuation of contraceptives, menstruation was covered with recombinant activated factor VII (rFVIIa), and during pregnancy, rFVIIa had to be administered in first trimester in doses ranging from 15 to 90 μg/kg per day because of recurrent retroplacental hematomas and vaginal bleedings. Thrombin generation was measured in first trimester at different doses of rFVIIa and showed an increase in lag time when doses of less than 30 μg/kg/day were administered, whereas time to thrombin peak and peak thrombin were not influenced. A low-dose rFVIIa prophylactic treatment of 15 μg/kg every other day in the late second and in the third trimester was sufficient to allow a successful childbirth in this patient with severe factor VII deficiency.

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

Science.gov (United States)

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

2002-06-13

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

Coffee and pregnancy

DEFF Research Database (Denmark)

Bech, Bodil Hammer

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

Studies on the relationship between leptin secretion and several pregnancy-related hormones during pregnancy in the golden hamster

International Nuclear Information System (INIS)

Wang Chen; Yang Liguo; Gen Watanabe; Kazuyoshi Taya

2003-01-01

Objective: To determine the relationships between leptin secretion and several pregnancy related hormones, the body weight as well as food intaken in the golden hamster during pregnancy and early lactation. Methods: 100 golden hamsters were mated and divided into 16 groups. Blood specimens were taken at 11:00 daily and were determined for plasma leptin, growth hormone (GH), follicular stimulating hormone (FSH), luteinizing hormone (LH), progesterone estradiol and inhibin with RIA. Relationships between leptin level and food intake as well as material body weight were also noted. Results: A plasma leptin peak level occurred on day 12 of the pregnancy. Leptin levels were significantly correlated with levels of gonadal hormones but not with pituitary hormones. Food intake and material total body weight (including the fetus) bore no significant correlationship with plasma leptin throughout the whole pregnancy stage. However, if the fetus weight was subtracted, the net maternal body weight would be significantly correlated with the leptin concentration. Conclusion: These results suggest that leptin-resistance may exits in the golden hamster during pregnancy. Some pregnancy-related hormones, especially gonadal hormones, have regulatory effect on the secretion of leptin. Positive correlation between leptin and net maternal body weight suggests that leptin is still a signal of the body weight to the central nerves system during pregnancy

Pregnancy shortly after an acute episode of severe acquired thrombotic thrombocytopenic purpura.

Science.gov (United States)

Panaitescu, Anca M; Stoia, Razvan; Ciobanu, Anca M; Demetrian, Mihaela; Peltecu, Gheorghe

2016-12-01

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal condition. In women with a previous history of TTP there is increased risk of recurrence during pregnancy and the puerperium. There is some evidence that the risk of relapse during pregnancy is increased if the interval between the event and conception is short. We present a case in which pregnancy was achieved a few days after full recovery from an acute episode of severe acquired TTP (ADAMTS13 activity <0.1%) which was successfully treated with four courses of plasma exchange. There was no relapse of TTP during pregnancy and a healthy baby was delivered at term; the puerperium was uneventful. Copyright © 2016 Elsevier Ltd. All rights reserved.

Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections.

Science.gov (United States)

Swinney, Caitlyn M; Bau, Karen; Burton, Karen L Oakley; O'Flaherty, Stephen J; Bear, Natasha L; Paget, Simon P

2018-05-01

To determine the incidence of common adverse events after botulinum toxin A (BoNT-A) injections in children with cerebral palsy (CP) and to identify whether the severity of CP influences the incidence of adverse events. This was an observational study of patients attending a BoNT-A clinic at a tertiary paediatric hospital (2010-2014). Data examined included procedural adverse events at the time of injection and at follow-up. Systemic adverse events were defined as lower respiratory tract illnesses, generalized weakness, dysphagia, and death. Severity of CP was categorized by the Gross Motor Function Classification System (GMFCS). The relationships between GMFCS and adverse events were analysed using negative binomial regression models. In total, 591 children underwent 2219 injection episodes. Adverse events were reported during the procedure (130 [6%] injection episodes) and at follow-up (492 [22%] injection episodes). There were significantly increased rates of systemic adverse events in injection episodes involving children in GMFCS level IV (incidence rate ratio [IRR] 3.92 [95% confidence interval] 1.45-10.57]) and GMFCS level V (IRR 7.37 [95% confidence interval 2.90-18.73]; p<0.001). Adverse events after BoNT-A injections are common but mostly mild and self-limiting. Children in GMFCS levels IV and V are at increased risk of systemic adverse events. The relationship between CP severity and BoNT-A adverse events is complex and further research is required to better understand this relationship. Adverse events reported at the time of botulinum toxin A injection occurred in 6% of injection episodes. Adverse events were reported at follow-up in 22% of injection episodes. Children in Gross Motor Function Classification System (GMFCS) levels IV and V have increased rates of systemic adverse events. Children in GMFCS levels IV and V report less local weakness and pain. © 2018 Mac Keith Press.

Teenage pregnancy in type 1 diabetes mellitus.

Science.gov (United States)

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

2010-03-01

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

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

Science.gov (United States)

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

2016-04-01

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

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

DEFF Research Database (Denmark)

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

2009-01-01

score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe...

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

Science.gov (United States)

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

2011-01-01

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

Therapeutic management of type 1 diabetes before and during pregnancy

DEFF Research Database (Denmark)

Mathiesen, Elisabeth R; Damm, Peter; Nielsen, Lene Ringholm

2011-01-01

before and during pregnancy is crucial and the prevalence of severe hypoglycemia during pregnancy needs to be reduced. Rapid-acting insulin analogues are regarded as safe to use in pregnancy and studies on long-acting insulin analogues are in the pipeline. Supplementation with folic acid may reduce......Introduction: Pregnancy increases the risks of adverse outcomes for mother and infant in women with type 1 diabetes. Obtaining and maintaining adequate glycemic control during pregnancy is crucial for optimizing outcomes. Areas covered: The importance of prepregnancy planning and treatment during...... pregnancy is reviewed. The use of insulin analogues and antihypertensive drugs in diabetic pregnancy are in focus. The reader is presented with evidence discussing the importance of prepregnancy counseling and treatment during pregnancy in women with type 1 diabetes. Expert opinion: Tight glycemic control...

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

Science.gov (United States)

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

2016-04-01

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

Key terms for the assessment of the safety of vaccines in pregnancy: Results of a global consultative process to initiate harmonization of adverse event definitions.

Science.gov (United States)

Munoz, Flor M; Eckert, Linda O; Katz, Mark A; Lambach, Philipp; Ortiz, Justin R; Bauwens, Jorgen; Bonhoeffer, Jan

2015-11-25

The variability of terms and definitions of Adverse Events Following Immunization (AEFI) represents a missed opportunity for optimal monitoring of safety of immunization in pregnancy. In 2014, the Brighton Collaboration Foundation and the World Health Organization (WHO) collaborated to address this gap. Two Brighton Collaboration interdisciplinary taskforces were formed. A landscape analysis included: (1) a systematic literature review of adverse event definitions used in vaccine studies during pregnancy; (2) a worldwide stakeholder survey of available terms and definitions; (3) and a series of taskforce meetings. Based on available evidence, taskforces proposed key terms and concept definitions to be refined, prioritized, and endorsed by a global expert consultation convened by WHO in Geneva, Switzerland in July 2014. Using pre-specified criteria, 45 maternal and 62 fetal/neonatal events were prioritized, and key terms and concept definitions were endorsed. In addition recommendations to further improve safety monitoring of immunization in pregnancy programs were specified. This includes elaboration of disease concepts into standardized case definitions with sufficient applicability and positive predictive value to be of use for monitoring the safety of immunization in pregnancy globally, as well as the development of guidance, tools, and datasets in support of a globally concerted approach. There is a need to improve the safety monitoring of immunization in pregnancy programs. A consensus list of terms and concept definitions of key events for monitoring immunization in pregnancy is available. Immediate actions to further strengthen monitoring of immunization in pregnancy programs are identified and recommended. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

Science.gov (United States)

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

2017-07-01

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

Use of TNF-inhibitors and ustekinumab for psoriasis during pregnancy

DEFF Research Database (Denmark)

Lund, Tamara; Thomsen, Simon Francis

2017-01-01

From 2002 to 2016 a total of seven women with severe refractory psoriasis were exposed to the TNF-inhibitors infliximab and adalimumab or to the IL12/23 inhibitor ustekinumab during one or more pregnancies. Maternal, fetal or teratogenic toxicity were not detected during pregnancy and puerperium....... All pregnancies were uneventful and resulted in delivery of 10 healthy children in total, one of the women is due February 2017. Postpartum, five of the women were lactating, but none of the women or newborns developed adverse reactions. Data on safety of treatment during breastfeeding are sparse...

Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

Directory of Open Access Journals (Sweden)

Mario Ferreira Peixoto

Full Text Available OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009 enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day (Group 1] and 70 increased dosing [(> 800/200 mg/day (Group 2]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.

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

Science.gov (United States)

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

2013-04-01

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

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

Science.gov (United States)

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

2011-05-11

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

Obesity in pregnancy

DEFF Research Database (Denmark)

Nøhr, Ellen Aagaard

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

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 ...

Environmental perturbation of the circadian clock disrupts pregnancy in the mouse.

Directory of Open Access Journals (Sweden)

Keith C Summa

Full Text Available The circadian clock has been linked to reproduction at many levels in mammals. Epidemiological studies of female shift workers have reported increased rates of reproductive abnormalities and adverse pregnancy outcomes, although whether the cause is circadian disruption or another factor associated with shift work is unknown. Here we test whether environmental disruption of circadian rhythms, using repeated shifts of the light:dark (LD cycle, adversely affects reproductive success in mice.Young adult female C57BL/6J (B6 mice were paired with B6 males until copulation was verified by visual identification of vaginal plug formation. Females were then randomly assigned to one of three groups: control, phase-delay or phase-advance. Controls remained on a constant 12-hr light:12-hr dark cycle, whereas phase-delayed and phase-advanced mice were subjected to 6-hr delays or advances in the LD cycle every 5-6 days, respectively. The number of copulations resulting in term pregnancies was determined. Control females had a full-term pregnancy success rate of 90% (11/12, which fell to 50% (9/18; p<0.1 in the phase-delay group and 22% (4/18; p<0.01 in the phase-advance group.Repeated shifting of the LD cycle, which disrupts endogenous circadian timekeeping, dramatically reduces pregnancy success in mice. Advances of the LD cycle have a greater negative impact on pregnancy outcomes and, in non-pregnant female mice, require longer for circadian re-entrainment, suggesting that the magnitude or duration of circadian misalignment may be related to the severity of the adverse impact on pregnancy. These results explicitly link disruptions of circadian entrainment to adverse pregnancy outcomes in mammals, which may have important implications for the reproductive health of female shift workers, women with circadian rhythm sleep disorders and/or women with disturbed circadian rhythms for other reasons.

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

LENUS (Irish Health Repository)

McCarthy, Fergus P

2012-01-31

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

Early childhood adversity potentiates the adverse association between prenatal organophosphate pesticide exposure and child IQ: The CHAMACOS cohort.

Science.gov (United States)

Stein, Lauren J; Gunier, Robert B; Harley, Kim; Kogut, Katherine; Bradman, Asa; Eskenazi, Brenda

2016-09-01

Previous studies have observed an adverse association between prenatal exposure to organophosphate pesticide (OPs) and child cognition, but few studies consider the potential role of social stressors in modifying this relationship. We seek to explore the potential role of early social adversities in modifying the relationship between OPs and child IQ in an agricultural Mexican American population. Participants from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a prospective longitudinal pre-birth cohort study, include 329 singleton infants and their mothers followed from pregnancy through age 7. Dialkyl phosphate metabolite concentrations (DAPs), a biomarker of organophosphate pesticide exposure, were measured in maternal urine collected twice during pregnancy and averaged. Child cognitive ability was assessed at 7 years using the Wechsler Intelligence Scale for Children - Fourth Edition. Demographic characteristics and adversity information were collected during interviews and home visits at numerous time points from pregnancy until age 7. Among low-income Latina mothers and their children in the Salinas Valley, total adversity and specific domains of adversity including poor learning environment and adverse parent-child relationships were negatively associated with child cognition. Adverse associations between DAP concentrations and IQ were stronger in children experiencing greater adversity; these associations varied by child sex. For example, the association between prenatal OP exposure and Full-Scale IQ is potentiated among boys who experienced high adversity in the learning environment (β=-13.3; p-value child IQ differently among male and female children. These findings emphasize the need to consider plausible interactive pathways between social adversities and environmental exposures. Copyright © 2016 Elsevier B.V. All rights reserved.

Adverse effects of perinatal nicotine exposure on reproductive outcomes.

Science.gov (United States)

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

2015-12-01

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

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.

Glycemic Index and Pregnancy: A Systematic Literature Review

Directory of Open Access Journals (Sweden)

Jimmy Chun Yu Louie

2010-01-01

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

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

Science.gov (United States)

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

2013-08-01

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

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

Science.gov (United States)

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

2017-03-11

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

The Threat of Aerobic Vaginitis to Pregnancy and Neonatal Morbidity.

Science.gov (United States)

Kaambo, Eveline; Africa, Charlene W J

2017-06-01

Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to provide evidence of the threat of untreated AV on pregnancy outcomes. More than 300 papers on preterm delivery were extracted from several research domains and filtered to include only AV-associated bacteria such as Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Group B streptococci and their association with adverse pregnancy outcomes. Due to the diverse sample groups, study techniques and outcomes, a meta-analysis was not conducted. The review revealed that the association of AV with adverse pregnancy outcomes has not been as widely researched as bacterial vaginosis (BV) and needs further investigation. Furthermore, the frequent misdiagnosis of AV coupled with the emerging antimicrobial resistance associated with bacteria implicated in AV and neonatal nosocomial infections pose a problem for prophylaxis and treatment to reduce the risk of maternal and neonatal morbidity and mortality.

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

Directory of Open Access Journals (Sweden)

Allan W. Taylor

2013-01-01

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

Teenage pregnancy in type 1 diabetes mellitus.

LENUS (Irish Health Repository)

Carmody, David

2010-03-01

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

Adverse pregnancy and neonatal outcomes in polycystic ovary syndrome women

Directory of Open Access Journals (Sweden)

Roshan Nikbakht

2016-02-01

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

Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: A population study of 2.6 million pregnancies

Science.gov (United States)

Class, Quetzal A.; Lichtenstein, Paul; Långström, Niklas; D'Onofrio, Brian M.

2011-01-01

Objective To identify the impact of timing of prenatal stress exposure on offspring risk for shortened gestational age (GA), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) using a population-based sample. Methods Swedish longitudinal population registries were linked to study all individuals born in Sweden 1973–2004. Prenatal maternal stress exposure was defined as death of the father of the child or first degree relative of the mother. Using linear and logistic regression, timing of stress exposure was examined across pregnancy, by month, and by novel periods created based on month of stress exposure findings. Results A total of 2,618,777 live-born, singleton infants without congenital anomalies were included; 32,286 exposed to prenatal maternal stress. Examining associations between stress exposure and outcome by the month revealed that risk increases mid-gestation, particularly following months 5 and 6. Combining months 1–4, 5 and 6, and 7–9 as potential periods of differing vulnerability, it was found that stress during period 2 (months 5 and 6) was associated with the greatest risk for shortened GA (−0.52 days, SE=0.15, p=0.0006), PTB (OR=1.24, 99% CI=1.08–1.42), LBW (OR=1.38, 99% CI=1.19–1.61), and SGA (OR=1.25, 99% CI=1.05–1.49). Conclusions Risk for shortened GA, PTB, LBW, and SGA are greater following stress exposure during the 5th and/or 6th month of pregnancy. It may be beneficial to refine future analyses to these months. Possible mechanisms include alterations in the hypothalamic-pituitary-adrenal axis and associated stress-responsive molecular regulators. PMID:21321257

Alert Regarding Cisplatin-induced Severe Adverse Events in Cancer Patients with Xeroderma Pigmentosum.

Science.gov (United States)

Sumiyoshi, Makoto; Soda, Hiroshi; Sadanaga, Noriaki; Taniguchi, Hirokazu; Ikeda, Takaya; Maruta, Hiroshi; Dotsu, Yosuke; Ogawara, Daiki; Fukuda, Yuichi; Mukae, Hiroshi

2017-01-01

Xeroderma pigmentosum (XP) is a genetic disease in which DNA repair mechanisms are impaired. Cisplatin (CDDP) exerts cytotoxic effects by forming mainly intrastrand DNA cross-links, and sensitivity to CDDP depends on the DNA repair system. Several in vitro studies have suggested that treatment with CDDP may cause enhanced adverse events as well as anti-tumor activity in cancer patients with XP. This article is the first to describe two cancer patients with XP showing severe adverse events following CDDP-based chemotherapy. Physicians should pay attention when administering CDDP in cancer patients with XP.

Medical abortion and the risk of subsequent adverse pregnancy outcomes

DEFF Research Database (Denmark)

Virk, Jasveer; Zhang, Jun; Olsen, Jørn

2007-01-01

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

Epigallocatechin gallate enhances treatment efficacy of oral nifedipine against pregnancy-induced severe pre-eclampsia: A double-blind, randomized and placebo-controlled clinical study.

Science.gov (United States)

Shi, D-D; Guo, J-J; Zhou, L; Wang, N

2018-02-01

Oral nifedipine is commonly used to treat pre-eclampsia, one of the most severe complications during pregnancy, but its clinical efficacy is less than ideal. Epigallocatechin gallate (EGCG), a natural compound from green tea, could benefit cardiovascular health especially hypertension. We investigated the clinical efficacy of EGCG, when complemented with oral nifedipine, in treating pre-eclampsia. A total of 350 pregnant women with severe pre-eclampsia were recruited and randomized to receive oral nifedipine, together with placebo (NIF+placebo) or EGCG (NIF+EGCG). The primary treatment outcome was the time needed to control blood pressure and interval time before a new hypertensive crisis, whereas the secondary treatment outcome was the number of treatment doses to effectively control blood pressure, maternal adverse effects and neonatal complications. Comparing NIF+EGCG group to NIF+placebo group, the time needed to control blood pressure was significantly shorter (NIF+EGCG 31.2±16.7 minutes, NIF+placebo 45.3±21.9 minutes; 95% CI 9.7-18.5 minutes), whereas interval time before a new hypertensive crisis was significantly prolonged (NIF+EGCG 7.2±2.9 hours, NIF+placebo 4.1±3.7 hours; 95% CI 2.3-3.9 hours), and the number of treatment dosages needed to effectively control blood pressure was also lower. Between the two treatment groups, no differences in incidence rates of maternal adverse effects or neonatal complications were observed. EGCG is both safe and effective in enhancing treatment efficacy of oral nifedipine against pregnancy-induced severe pre-eclampsia, but formal validation is required prior to its recommendation for use outside of clinical trials. © 2017 John Wiley & Sons Ltd.

Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy

Science.gov (United States)

Law, Ruth; Maltepe, Caroline; Bozzo, Pina; Einarson, Adrienne

2010-01-01

QUESTION In addition to suffering from nausea and vomiting of pregnancy, which is being treated with antiemetics, some of my pregnant patients complain of heartburn and acid reflux. Should these symptoms also be treated and, if so, which acid-reducing medications are safe for use during pregnancy? ANSWER Increased severity of nausea and vomiting of pregnancy is associated with the presence of heartburn and acid reflux. Antacids, histamine-2 receptor antagonists, and proton pump inhibitors can be used safely during pregnancy, as large studies have been published with no evidence of adverse fetal effects. PMID:20154244

Rheumatic heart disease in pregnancy: a report of 2 cases | Ziruma ...

African Journals Online (AJOL)

Pregnant women with severe mitral stenosis tend to experience clinical decompensation with approximately 50% mortality and they may experience adverse effects of the medication they are taking, notably congenital malformations from warfarin exposure. Corrective heart surgery may increase the risk of pregnancy loss.

Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review.

Science.gov (United States)

Martillotti, G; Boehlen, F; Robert-Ebadi, H; Jastrow, N; Righini, M; Blondon, M

2017-10-01

Essentials The evidence on how to manage life-threatening pregnancy-related pulmonary embolism (PE) is scarce. We systematically reviewed all available cases of (sub)massive PE until December 2016. Thrombolysis in such severe PE was associated with a high maternal survival (94%). The major bleeding risk was much greater in the postpartum (58%) than antepartum period (18%). Background Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. Methods We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or extracorporeal membrane oxygenation (ECMO), occurring during pregnancy or within 6 weeks of delivery. Main outcomes were maternal survival and major bleeding, premature delivery, and fetal survival and bleeding. Results We found 127 cases of severe PE (at least 83% massive; 23% with cardiac arrest) treated with at least one modality. Among 83 women with thrombolysis, survival was 94% (95% CI, 86-98). The risk of major bleeding was 17.5% during pregnancy and 58.3% in the postpartum period, mainly because of severe postpartum hemorrhages. Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated during pregnancy. Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95% CI, 71-95) and 20.0%, with fetal deaths possibly related to surgery in 20.0%. About half of severe postpartum PEs occurred within 24 h of delivery. Conclusions Published cases of thrombolysis for massive PE during pregnancy and the postpartum period suggest a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis, other therapeutic options (catheter [or surgical] thrombectomy, ECMO) may be

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

The impact of vitamin D on pregnancy

DEFF Research Database (Denmark)

Christesen, Henrik T; Falkenberg, Tine; Lamont, Ronald F

2012-01-01

Hypovitaminosis D is common in pregnancy. To systematically review the evidence on vitamin D-dependent pregnancy outcomes, PubMed and Embase were searched for randomized control trials, cohort and case-control studies. In randomized control trials (n = 7), larger doses of vitamin D resulted...... in higher 25-hydroxylated vitamin D (25OHD) levels (n = 6), increased maternal weight gain (n = 1), and fewer classical vitamin D deficiency symptoms (n = 1). In observational studies (n = 32), lower vitamin D intake, or low 25OHD-levels, were associated with adverse fertility parameters (n = 2...... to preeclampsia (n = 5) or gestational diabetes (n = 2). Increased odds of pregnancy-associated breast cancer with 25OHD >25.8 nmol/L were observed (n = 1). In conclusion, an effect of vitamin D on several pregnancy outcomes is suggested....

Cryptorchidism and maternal alcohol consumption during pregnancy

DEFF Research Database (Denmark)

Damgaard, Ida N; Jensen, Tina Kold; Petersen, Jørgen H

2007-01-01

Prenatal exposure to alcohol can adversely affect the fetus. We investigated the association between maternal alcohol consumption during pregnancy and cryptorchidism (undescended testis) among newborn boys.......Prenatal exposure to alcohol can adversely affect the fetus. We investigated the association between maternal alcohol consumption during pregnancy and cryptorchidism (undescended testis) among newborn boys....

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

Science.gov (United States)

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

2017-11-27

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

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

Science.gov (United States)

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

2014-03-01

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

Etiology of adverse prenatal Outcome in overweight women

Directory of Open Access Journals (Sweden)

Ameneh Safarzadeh

2016-09-01

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

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

Directory of Open Access Journals (Sweden)

Norman J. Blumenthal

2017-01-01

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

Type of Labour in the First Pregnancy and Cumulative Maternal Morbidity.

Science.gov (United States)

Allen, Victoria M; Baskett, Thomas F; O'Connell, Colleen M

2015-08-01

To estimate cumulative maternal morbidity among women who delivered at term in their first pregnancy on the basis of type of labour in the first pregnancy. Using a 25-year population-based cohort (1988 to 2012) derived from the Nova Scotia Atlee Perinatal Database, we determined the type of labour in successive pregnancies in low-risk, nulliparous women at term in their first pregnancy (who had at least one subsequent pregnancy), and the maternal outcomes in subsequent deliveries based on the type of labour in the first pregnancy. A total of 36 871 pregnancies satisfied inclusion and exclusion criteria, 1346 of which were delivered by Caesarean section without labour in the first pregnancy. Rates of most adverse maternal outcomes were low (≤1%). The type of labour in the first pregnancy influenced the subsequent risk of postpartum hemorrhage and blood transfusion, and the risks increased with successive deliveries when labours were spontaneous in onset or were induced. The risks for abnormal placentation were low with subsequent deliveries, including following CS without labour in the first pregnancy, and risks for overall severe maternal morbidity were less than 10% for all subsequent deliveries. The absolute risks for severe maternal morbidity outcomes in a population of women without a high number of subsequent pregnancies were small (regardless of type of labour in the first pregnancy); this provides important information for women, families, and caregivers when considering pregnancy outcomes related to type of labour.

Outcome of pregnancy in survivors of Wilms' tumor

International Nuclear Information System (INIS)

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

1987-01-01

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

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

NARCIS (Netherlands)

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

2008-01-01

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

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

NARCIS (Netherlands)

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

2008-01-01

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

Management of coexisting Hodgkin's disease and pregnancy

International Nuclear Information System (INIS)

Nisce, L.Z.; Tome, M.A.; He, S.; Lee, B.J. III; Kutcher, G.J.

1986-01-01

The management of pregnant women with active Hodgkin's disease (H.D.) should be individualized depending on the stage, the presence of infradiaphragmatic involvement, and age of gestation. Seventeen women aged 16-31 years with coexisting H.D. and pregnancy were followed between 1969 and 1982. H.D. was diagnosed during pregnancy in 15 patients and two became pregnant while on treatment. Seven women whose pregnancies were allowed to proceed uninterrupted were irradiated to supradiaphragmatic sites to doses of 1500-2000 rad during the second or third trimester; all had full term spontaneous normal deliveries and normal infants. Fetal doses ranged from 2-50 rad. Two patients treated with Vinblastine throughout three pregnancies delivered normal full term infants. Pregnancy was interrupted in six patients at 6-20 weeks of gestation for various reasons. In spite of several months delay in initiation of definitive therapy, the outcome of H.D. was not adversely affected in the majority of uninterrupted pregnancies as evidenced by long term disease-free survivals of 6-11 years in four of seven patients who were irradiated; the children now aged 6-11 years are also alive and reported normal

Maternal Arterial Murmur in Pregnancy

DEFF Research Database (Denmark)

Riknagel, Diana

2017-01-01

Alternative methods of assessing the placental function are called for in the attempt to clarify the pathophysiology behind adverse pregnancy outcome as fetal growth restriction. A new concept of using cardiovascular sounds emitted near the uterine arteries in pregnancy is investigated...

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

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

Vitamin D deficiency in early pregnancy.

Directory of Open Access Journals (Sweden)

Shannon K Flood-Nichols

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

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

Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment?

Science.gov (United States)

Tanriover, Mine Durusu; Oz, S Gul; Sozen, Tumay; Kilicarslan, Alpaslan; Guven, Gulay Sain

2009-04-01

Pregnancy- and lactation-associated osteoporosis is an uncommon condition that may be a consequence of preexisting low bone density, loss of bone mineral content during pregnancy, and increased bone turnover. To present a case of severe osteoporosis associated with pregnancy and lactation and its treatment protocol. A tertiary care hospital. A young female after twin pregnancy presenting with severe osteoporosis. The diagnosis was done on the basis of bone mineral density (BMD) measurement. The patient was treated with first alendronate and then strontium ranelate. She was considered as a candidate for kyphoplasty. A dramatic increase in the BMD and palliation of back pain were observed. Strontium ranelate may be a new alternative in the treatment of pregnancy- and lactation-associated osteoporosis.

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.

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

Science.gov (United States)

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

2011-01-01

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

Chronic Kidney Disease in Pregnancy.

Science.gov (United States)

Koratala, Abhilash; Bhattacharya, Deepti; Kazory, Amir

2017-09-01

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

Prevalence of Celiac Disease and its Effects on Pregnancy

Directory of Open Access Journals (Sweden)

E Nazemalhosseini-Mojarad

2012-05-01

Full Text Available Introduction: One of the coeliac disease(CD symptoms is infertility and adverse pregnancy outcomes. Furthermore, we are not cognizant of any CD reports in pregnancy in Iran. Therefore, this study aims to prospectively estimate the prevalence of undiagnosed CD in a population of pregnant women as well as its complications in pregnancy. Methods: 796 pregnant women with mean age of 26 years(SD= 26 and mean pregnancy duration of 5.4 months participated in this descriptive study from 2007 to 2008. Total IgA test and antitissue transglutaminase(tTGA antibodies were measured. Those with positive TGA underwent histological biopsy specimens according to modified Marsh classification. Results: A positive CD serology for tTGA was obderved in 17(2.1% out of 796 pregnant women. Out of the 17 seropositive patients, 10 had abnormal histology compatible with CD(Marsh I-IIIc symptoms. Two pregnant women had already experienced miscarriage. Moreover, 3 patients had born low birth weight babies. Conclusion: In this study, there was no significant relationship between CD and high incidence of adverse outcomes. Overall, 1 out of 66 pregnant women(1.5% rate of prevalence suffered from CD. Celiac disease shows different severity in different individuals. In other words, not every celiac patient is at high risk for its complications. This may propose that gluten free diet could be avoided in the patients who have a normal pregnancy

Use of diuretics during pregnancy

Science.gov (United States)

Al-Balas, Mosa’b; Bozzo, Pina; Einarson, Adrienne

2009-01-01

ABSTRACT QUESTION Several of my pregnant patients use diuretics for hypertension. I have heard that diuretics cannot be used in pregnancy because of the reduction of plasma volume and the potential for decreasing placental perfusion, as well as a possible diabetogenic effect. ANSWER Many studies—including a meta-analysis of almost 7000 neonates exposed to diuretics during pregnancy—did not find an increased risk of adverse effects, such as birth defects, fetal growth restriction, thrombocytopenia, or diabetes, among neonates exposed to diuretics in utero. PMID:19155365

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

Directory of Open Access Journals (Sweden)

Anita Valsaladevi

2017-07-01

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

Periodontal disease and pregnancy outcomes: time to move on?

Science.gov (United States)

Srinivas, Sindhu K; Parry, Samuel

2012-02-01

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

The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy

Science.gov (United States)

Gill, Simerpal Kaur; Maltepe, Caroline; Koren, Gideon

2009-01-01

BACKGROUND: Heartburn (HB) and acid reflux (RF) in the non-pregnant population can cause nausea and vomiting; therefore, it is plausible that in women with nausea and vomiting of pregnancy (NVP), HB/RF may increase the severity of symptoms. OBJECTIVE: To determine whether HB/RF during pregnancy contribute to increased severity of NVP. METHODS: A prospectively collected cohort of women who were experiencing NVP and HB, RF or both (n=194) was studied. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale and its Well-being scale was used to compare the severity of the study cohort’s symptoms. This cohort was compared with a group of women experiencing NVP but no HB/RF (n=188). Multiple linear regression was used to control for the effects of confounding factors. RESULTS: Women with HB/RF reported higher PUQE scores (9.6±2.6) compared with controls (8.9±2.6) (P=0.02). Similarly, Well-being scores for women experiencing HB/RF were lower (4.3±2.1) compared with controls (4.9±2.0) (P=0.01). Multiple linear regression analysis demonstrated that increased PUQE scores (P=0.003) and decreased Well-being scores (P=0.005) were due to the presence of HB/RF as opposed to confounding factors such as pre-existing gastrointestinal conditions/symptoms, hyperemesis gravidarum in previous pregnancies and comorbidities. CONCLUSION: The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP. PMID:19373420

Risk factors for and perinatal outcomes of major depression during pregnancy

DEFF Research Database (Denmark)

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

2014-01-01

was substantial to modest for small-for-gestational age newborn (care associated with major depression, whereas SES made only a minor contribution. CONCLUSIONS: Physician-diagnosed major depression......OBJECTIVES: To identify risk factors for and the consequences (several adverse perinatal outcomes) of physician-diagnosed major depression during pregnancy treated in specialised healthcare. DESIGN: A population-based cross-sectional study. SETTING: Data were gathered from Finnish health registers...... for 1996-2010. PARTICIPANTS: All singleton births (n=511,938) for 2002-2010 in Finland. PRIMARY OUTCOME MEASURES: Prevalence, risk factors and consequences of major depression during pregnancy. RESULTS: Among 511,938 women, 0.8% experienced major depression during pregnancy, of which 46.9% had a history...

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

NARCIS (Netherlands)

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

2016-01-01

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

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

DEFF Research Database (Denmark)

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

2015-01-01

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

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

Science.gov (United States)

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.

Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

Science.gov (United States)

Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Braxter, Betty J; Eckhardt, Cara L; Himes, Katherine P; Bodnar, Lisa M

2018-03-01

Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes. © 2018 John Wiley & Sons Ltd.

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

Directory of Open Access Journals (Sweden)

Lori Newman

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

Weathering the storm; a review of pre-pregnancy stress and risk of spontaneous abortion.

Science.gov (United States)

Frazier, Tyralynn; Hogue, Carol J Rowland; Bonney, Elizabeth A; Yount, Kathryn M; Pearce, Brad D

2018-06-01

The Weathering Effect is a theory that links stress exposure, over the life-course, with racial disparities in reproductive outcomes, through the effects of social adversity on a woman's body. The concept of maternal "weathering" captures cumulative somatic and psychological adversities that can exacerbate the effects of aging. Much of the evidence for weathering comes from observational studies linking self-report measures with reproductive outcomes. The purpose of this review is to explore biological mechanisms that underlie these observations. We focus on spontaneous abortion because this event is understudied despite evidence of racial disparities in this outcome. Spontaneous abortion is the most common pregnancy failure, and it happens early in pregnancy. Early pregnancy is a time most susceptible to the harmful effects of immune dysregulation that may, in part, result from adversities experienced before pregnancy begins. In exploring these mechanisms, we draw on well-defined signaling processes observed in the stressor-depression relationship. Pro-inflammatory dysregulation, for example, has particular relevance to immunological control occurring early in pregnancy. Early pregnancy immunologic changes affect the trajectories of pregnancy via control of trophoblastic invasion. Within the first few weeks of pregnancy, uterine derived cytokines operate within cytokine networks and play a critical role in this invasion. Programming for pro-inflammatory dysregulation can occur before conception. This dysregulation, brought into early pregnancy, has implications for viability and success of the index pregnancy. These patterns suggest early pregnancy health is susceptible to stress processing pathways that influence this immunologic control in the first six to eight weeks of pregnancy. In this review, we discuss the known mediating role of immune factors in the stressor-depression relationship. We also discuss how adversity experienced before the index pregnancy, or

Risk of Adverse Pregnancy Outcome After Paternal Exposure to Methotrexate Within 90 Days Before Pregnancy

DEFF Research Database (Denmark)

Eck, Lasse Karlsen; Jensen, Thomas Bo; Mastrogiannis, Dimitrios

2017-01-01

OBJECTIVE: To study the association between paternal exposure to methotrexate within the 90-day period before pregnancy and congenital malformations and stillbirth in the offspring. METHODS: We conducted a nationwide register study. Our cohort consisted of all live births in Denmark between 1997...... group and no increased risk of preterm birth (adjusted OR 1.31, 95% CI 0.66-2.59) among the children from exposed fathers. CONCLUSION: We found no association between paternal exposure to methotrexate within 90 days before pregnancy and congenital malformations, stillbirths, or preterm birth. Available...

[Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia].

Science.gov (United States)

Guo, Xiao-Hui; Sun, Yan-Feng; Wang, Jiang-Bo; Han, Shu-Zhen; Miao, Jing; Cui, Min

2017-03-01

To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes. According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded. Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (Prisk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.

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

Science.gov (United States)

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

2007-09-01

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

[Chorionicity and adverse perinatal outcome].

Science.gov (United States)

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

2005-01-01

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

Understanding Pregnancy Anxiety: Concepts, Correlates, and Consequences

Science.gov (United States)

Guardino, Christine M.; Schetter, Christine Dunkel

2014-01-01

Pregnancy anxiety is a particular emotional state tied to pregnancy-specific concerns, such as worries about the health of the baby and childbirth. A growing body of research demonstrates that pregnancy anxiety is an important risk factor for preterm birth and other adverse birth and child development outcomes. This article defines and describes…

Periodontal Disease and Pregnancy Outcomes

OpenAIRE

Babalola, Dolapo A.; Omole, Folashade

2010-01-01

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

The risk of adverse pregnancy outcome after bariatric surgery

DEFF Research Database (Denmark)

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

2013-01-01

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

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

Directory of Open Access Journals (Sweden)

Ratnasooriya W.D.

2003-01-01

Full Text Available The root extract of Salacia reticulata Wight (family: Celastraceae is used in Sri Lanka by traditional practitioners as a herbal therapy for glycemic control even during pregnancy. It is recognized that some clinically used antidiabetic drugs have harmful effects on pregnancy but the effects of the S. reticulata root extract on reproductive outcome is unknown and deserves examination. We determined the effects of the S. reticulata root extract on the reproductive outcome of Wistar rats (250-260 g when administered orally (10 g/kg during early (days 1-7 and mid- (days 7-14 pregnancy. The root extract significantly (P<0.05 enhanced post-implantation losses (control vs treatment: early pregnancy, 4.7 ± 2.4 vs 49.3 ± 13%; mid-pregnancy, 4.7 ± 2.4 vs 41.7 ± 16.1%. Gestational length was unaltered but the pups born had a low birth weight (P<0.05 (early pregnancy, 6.8 ± 0.1 vs 5.3 ± 0.1 g; mid-pregnancy, 6.8 ± 0.1 vs 5.0 ± 0.1 g and low birth index (P<0.05 (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9%; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1%, fetal survival ratio (P<0.05 (early pregnancy, 95.2 ± 2.4 vs 50.7 ± 12.9; mid-pregnancy, 95.2 ± 2.4 vs 58.3 ± 16.1, and viability index (P<0.05 (early pregnancy, 94.9 ± 2.6 vs 49.5 ± 12.5%; mid-pregnancy, 94.9 ± 2.6 vs 57.1 ± 16.1%. However, the root extract was non-teratogenic. We conclude that the S. reticulata root extract can be hazardous to successful pregnancy in women and should not be used in pregnancy complicated by diabetes.

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

Science.gov (United States)

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

2003-07-01

The root extract of Salacia reticulata Wight (family: Celastraceae) is used in Sri Lanka by traditional practitioners as a herbal therapy for glycemic control even during pregnancy. It is recognized that some clinically used antidiabetic drugs have harmful effects on pregnancy but the effects of the S. reticulata root extract on reproductive outcome is unknown and deserves examination. We determined the effects of the S. reticulata root extract on the reproductive outcome of Wistar rats (250-260 g) when administered orally (10 g/kg) during early (days 1-7) and mid- (days 7-14) pregnancy. The root extract significantly (P<0.05) enhanced post-implantation losses (control vs treatment: early pregnancy, 4.7 2.4 vs 49.3 13%; mid-pregnancy, 4.7 2.4 vs 41.7 16.1%). Gestational length was unaltered but the pups born had a low birth weight (P<0.05) (early pregnancy, 6.8 0.1 vs 5.3 0.1 g; mid-pregnancy, 6.8 0.1 vs 5.0 0.1 g) and low birth index (P<0.05) (early pregnancy, 95.2 2.4 vs 50.7 12.9%; mid-pregnancy, 95.2 2.4 vs 58.3 16.1%), fetal survival ratio (P<0.05) (early pregnancy, 95.2 2.4 vs 50.7 12.9; mid-pregnancy, 95.2 2.4 vs 58.3 16.1), and viability index (P<0.05) (early pregnancy, 94.9 2.6 vs 49.5 12.5%; mid-pregnancy, 94.9 2.6 vs 57.1 16.1%). However, the root extract was non-teratogenic. We conclude that the S. reticulata root extract can be hazardous to successful pregnancy in women and should not be used in pregnancy complicated by diabetes.

Hypercholesterolaemia in pregnancy as a predictor of adverse ...

African Journals Online (AJOL)

support the fetus, the placenta, and the yolk sac have yet to be established, and those effects could markedly influence the outcome of pregnancy and long-term .... streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. In- timal accumulation of low density lipoprotein and its.

Periodontal disease and pregnancy hypertension: a clinical correlation.

Science.gov (United States)

Pralhad, Swati; Thomas, Betsy; Kushtagi, Pralhad

2013-08-01

Periodontal disease is thought to be associated with increased risk of systemic diseases and adverse pregnancy outcomes, including pregnancy hypertension (PH). The aim of the present study is to find the prevalence of periodontal disease in females with PH in a rural-based medical institute. The present case control study was performed with 200 females, 100 with PH and 100 without PH. Antenatal periodontal screening was performed within 72 hours of their hospital admission for delivery. The periodontal parameters assessed were oral hygiene index-simplified, gingival index, mean probing depth, and loss of attachment. Prevalence of periodontal disease was 65.5% and was significantly higher (P periodontal disease and PH on bivariate multiple logistic regression analysis. Nulliparous females were at higher odds to develop periodontal disease and PH (odds ratio = 1.7; 95% CI = 0.5 to 6.1). As the severity of periodontal disease increased from moderate to severe, the severity of hypertension also increased (r(2) = 0.8 and 0.5 for moderate and severe periodontal disease, respectively). Periodontal disease is more prevalent in females with PH.

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

Science.gov (United States)

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

2015-07-01

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

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.

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

Science.gov (United States)

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

2011-12-01

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

Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy.

Science.gov (United States)

Kriplani, Alka; Mahey, Reeta; Dash, Biswa Bhusan; Kulshreshta, Vidushi; Agarwal, Nutan; Bhatla, Neerja

2013-01-01

Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement. In India, women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anaemia are to be treated with parentral iron therapy. This study was undertaken to evaluate the response and effect of intravenous iron sucrose complex (ISC) given to pregnant women with IDA. A prospective study was conducted (June 2009 to June 2011) in the department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. One hundred pregnant women with haemoglobin between 5-9 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron sucrose complex in a dose of 200 mg twice weekly schedule after calculating the dose requirement. The mean haemoglobin raised from 7.63 ± 0.61 to 11.20 ± 0.73 g% (Panaemia. Intravenous iron sucrose can be used in hospital settings and tertiary urban hospitals where it can replace intramuscular therapy due to injection related side effects. Further, long-term comparative studies are required to recommend its use at peripheral level.

A NOVEL EFFECT OF DIOXIN: EXPOSURE DURING PREGNANCY SEVERELY IMPAIRS MAMMARY GLAND DIFFERENTIATION

Science.gov (United States)

A novel effect of dioxin: Exposure during pregnancy severely impairs mammary gland differentiation.Beth A. Vorderstrasse1, Suzanne E. Fenton2, Andrea A. Bohn3, Jennifer A. Cundiff1, and B. Paige Lawrence1,3,4 1Department of Pharmaceutical Sciences, Washington State Universi...

The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

Science.gov (United States)

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

2016-11-01

To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (Phypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412. © 2016 The Authors.

Nutrition in pregnancy: Basic principles and recommendations

Directory of Open Access Journals (Sweden)

Plećaš Draga

2014-01-01

Full Text Available Healthy diet in pregnancy should guarantee proper fetal growth and development, maintain (and promote maternal health and enable lactation. Nutritional counseling and interventions need to be an integral part of antenatal care and continue during pregnancy in order to reduce the risk of maternal, fetal and neonatal complications, as well as the short- and long-term adverse outcomes. Adverse pregnancy outcomes are more common in women who begin the gestation as undernourished or obese in comparison to pregnant women whose weight is within normal ranges. Increased nutritional and energy needs in pregnancy are met through numerous metabolic adaptations; pregnancy is successfully achieved within wide range of variations in energy supply and weight gain. However, if nutrient restriction exceeds the limits of adaptive responses, evidence indicates that fetus will develop the alternative metabolic competence that might emerge as a disease (type 2 diabetes, hypertension, coronary heart disease and stroke in adult life.

Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial.

Science.gov (United States)

Barakat, Ruben; Pelaez, Mireia; Lopez, Carmina; Lucia, Alejandro; Ruiz, Jonatan R

2013-07-01

To examine the effect of regular moderate-intensity exercise (three training sessions/week) on the incidence of gestational diabetes mellitus (GDM, primary outcome). We also examined if the exercise intervention modifies the association between GDM and birth weight and risk of macrosomia, gestational age, risk of caesarean delivery and maternal weight gain (secondary outcomes). We randomly assigned 510 healthy gravida to either an exercise intervention or a usual care (control) group (n=255 each). The exercise programme focused on moderate-intensity resistance and aerobic exercises (three times/week, 50-55 min/session). GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group (IADPSG). The intervention did not reduce the risk of developing GDM (OR 0.84, 95% CI 0.50 to 1.40) when using the WHO criteria. We observed that the intervention reduced by 58% the GDM-related risk (WHO criteria) of having a newborn with macrosomia (OR 1.76, 95% CI 0.04 to 78.90 vs 4.22, 95% CI 1.35 to 13.19) in exercise and control groups, respectively), and by 34% the GDM-related risk of having acute and elective caesarean delivery (OR 1.30, 95% CI 0.44 to 3.84 vs 1.99, 95% CI 0.98 to 4.06 in exercise and control groups, respectively). Gestational age was similar across the treatment groups (control, exercise) and GDM category (GDM or non-GDM), and maternal weight gain was ∼12% lower in the exercise group independent of whether women developed GDM. The results were similar when the IADPSG criteria were used instead. Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes.

Maternal mortality and severe maternal morbidity from acute fatty liver of pregnancy in the Netherlands

NARCIS (Netherlands)

Dekker, Ruth R.; Schutte, Joke M.; Stekelenburg, Jelle; Zwart, Joost J.; van Roosmalen, Jos

Objective: To assess maternal death and severe maternal morbidity from acute fatty liver of pregnancy (AFLP) in the Netherlands. Study design: A retrospective study of all cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of severe maternal morbidity in the

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

Science.gov (United States)

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

2009-08-01

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

Periodontal Disease and Pregnancy Outcomes

Directory of Open Access Journals (Sweden)

Dolapo A. Babalola

2010-01-01

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

Remission of eating disorder during pregnancy

DEFF Research Database (Denmark)

Madsen, Ida Ringsborg; Hørder, Kirsten; Støving, René Klinkby

2009-01-01

Eating disorder during pregnancy is associated with a diversity of adverse outcomes and is of potential danger to both mother and child. There is, however, a tendency for remission of the eating disorder during pregnancy with improvement of symptoms such as restrictive dieting, binging and purgin...

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.

Severe hydronephrosis secondary to uterine artery pseudoaneurysm in the early second trimester of pregnancy: A case report.

Science.gov (United States)

Amano, Tsukuru; Tokoro, Shinsuke; Tsuji, Shunichiro; Inoue, Takashi; Kimura, Fuminori; Murakami, Takashi

2017-09-25

Uterine artery pseudoaneurysm (UAP) normally presents genital bleeding in the puerperal period, and severe hydronephrosis rarely presents during pregnancy. We report a rare case of severe ureteral obstruction accompanied by uterine artery pseudoaneurysm in the early second trimester of pregnancy, which was successfully treated by surgical intervention. A 42-year-old nulligravid woman who had undergone myomectomy 3 years earlier was referred to our hospital for acute left abdominal pain at the 17th week of gestation. Ultrasonography showed severe left hydronephrosis and a 6-cm mass in the parauterine space. Color Doppler ultrasonography revealed a spinning turbulent flow pattern inside the mass lesion. Contrast-enhanced computed tomography revealed the left uterine artery feeding blood flow to the mass and left ureteral obstruction by the mass. These results indicated left hydronephrosis secondary to left uterine artery pseudoaneurysm. To resolve the problem, laparotomy was performed. As uterine artery isolation was impossible, ligation of the left internal iliac artery and releasing of the ureteral obstruction were carried out. The hydronephrosis and abdominal pain promptly resolved after the surgery. Thereafter, fetal development proceeded normally in the remaining months of the pregnancy. A healthy baby was delivered through cesarean section at 36 weeks gestational age. At the cesarean section, the left lower uterine segment where the UAP had been present was not visible because of the firm adhesion in around it. Uterine artery pseudoaneurysm can cause hydronephrosis in the early second trimester of pregnancy. Ligation of the unilateral internal iliac artery is a safe and effective intervention to block the blood flow to the uterine artery pseudoaneurysm during pregnancy, when uterine artery ligation seems not possible. In the pregnancy after previous surgical procedures to the uterus, uterine artery pseudoaneurysm should be considered in the differential

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

Directory of Open Access Journals (Sweden)

Kavitha Reddy Kothapally

2016-09-01

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

Mortality Associated with Severe Sepsis Among Age-Similar Women with and without Pregnancy-Associated Hospitalization in Texas: A Population-Based Study.

Science.gov (United States)

Oud, Lavi

2016-06-10

BACKGROUND The reported mortality among women with pregnancy-associated severe sepsis (PASS) has been considerably lower than among severely septic patients in the general population, with the difference being attributed to the younger age and lack of chronic illness among the women with PASS. However, no comparative studies were reported to date between patients with PASS and age-similar women with severe sepsis not associated with pregnancy (NPSS). MATERIAL AND METHODS We used the Texas Inpatient Public Use Data File to compare the crude and adjusted hospital mortality between women with severe sepsis, aged 20-34 years, with and without pregnancy-associated hospitalizations during 2001-2010, following exclusion of those with reported chronic comorbidities, as well as alcohol and drug abuse. RESULTS Crude hospital mortality among PASS vs. NPSS hospitalizations was lower for the whole cohort (6.7% vs. 14.1% [p<0.0001]) and those with ≥3 organ failures (17.6% vs. 33.2% [p=0.0100]). Adjusted PASS mortality (odds ratio [95% CI]) was 0.57 (0.38-0.86) [p=0.0070]. CONCLUSIONS Hospital mortality was unexpectedly markedly and consistently lower among women with severe sepsis associated with pregnancy, as compared with contemporaneous, age-similar women with severe sepsis not associated with pregnancy, without reported chronic comorbidities. Further studies are warranted to examine the sources of the observed differences and to corroborate our findings.

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

Science.gov (United States)

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

2013-01-01

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

Non-pharmacological management of migraine during pregnancy.

Science.gov (United States)

Airola, Gisella; Allais, Gianni; Castagnoli Gabellari, Ilaria; Rolando, Sara; Mana, Ornella; Benedetto, Chiara

2010-06-01

Migrainous women note a significant improvement in their headaches during pregnancy. However, persistent or residual attacks need to be treated, keeping in mind that many drugs have potential dangerous effects on embryo and foetus. It is evident, therefore, that hygiene and behaviour measures capable of ensuring the best possible well-being (regular meals and balanced diet, restriction of alcohol and smoking, regular sleeping pattern, moderate physical exercise and relaxation) are advisable during pregnancy. Among non-pharmacological migraine prophylaxis only relaxation techniques, in particular biofeedback, and acupuncture have accumulated sufficient evidence in support of their efficacy and safety. Some vitamins and dietary supplements have been proposed: the prophylactic properties of magnesium, riboflavin and coenzyme Q10 are probably low, but their lack of severe adverse effects makes them good treatment options.

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

Science.gov (United States)

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

2013-12-09

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

Update on Valvular Heart Disease in Pregnancy.

Science.gov (United States)

Safi, Lucy M; Tsiaras, Sarah V

2017-09-01

Valvular heart disease in women of childbearing age poses an increased risk of adverse maternal and fetal outcomes, and management in pregnancy can be challenging. Ideally, patients with suspected valvular disease should have preconception counseling by a multidisciplinary team including cardiologists with expertise in pregnancy and a maternal-fetal medicine specialist. Preconception planning should include a cardiac assessment of maternal risk, determination of frequency of surveillance, and a cardiovascular management plan during delivery. Women with valvular heart disease should be followed closely by a cardiologist and monitored for signs and symptoms of congestive heart failure and arrhythmias. In general, stenotic lesions may become more symptomatic in pregnancy, whereas regurgitant lesions are generally well tolerated. Left-sided valvular lesions have higher complication rates than right-sided lesions. For patients with asymptomatic valvular stenosis, medical management during pregnancy may include beta blockade and/or diuretics. Exercise stress testing prior to pregnancy in sedentary patients can be helpful to unmask symptoms and determine functional capacity. Patients with symptomatic, severe left-sided valvular obstruction have a high maternal risk of cardiovascular events during pregnancy, and percutaneous balloon valvuloplasty or surgery is recommended prior to pregnancy. The type of prosthetic valve (mechanical vs bioprosthetic) should be selected after a careful discussion with the patient. Invasive procedures are generally reserved for when medical management fails. The second trimester may be the optimal time for intervention as fetal organogenesis is complete and the cardiac positioning has not been affected by the gravid uterus.

How common is substantial weight gain after pregnancy?

Science.gov (United States)

Sumithran, Priya; Houlihan, Christine; Shub, Alexis; Churilov, Leonid; Pritchard, Natasha; Price, Sarah; Ekinci, Elif; Proietto, Joseph; Permezel, Michael

2017-11-20

Although population-based studies indicate that on average, women gain 1-2kg between pregnancies, women with obesity often attribute its development to childbearing. There is little contemporary data available regarding how commonly this occurs, particularly in women of different body mass index (BMI) categories. The aim of this study was to examine inter-pregnancy weight changes among women at a tertiary obstetric hospital in Melbourne, Australia. This was a retrospective review of data from the Birthing Outcomes System electronic record of 19,617 women aged 20 years or older, who delivered at least two consecutive singleton infants at ≥37 weeks' gestation at Mercy Hospital for Women between December 1994 and December 2015. A logistic regression model was used to assess the relationship between gain of ≥4kg/m 2 between pregnancies and maternal BMI category in the first pregnancy, adjusting for covariates of maternal age, inter-pregnancy interval, and socioeconomic status. Gain of ≥4kg/m 2 between the first two pregnancies occurred in 7.5% of normal weight women, 10.5% of overweight women, and 13.4% of women with obesity. One in five women who were normal weight in their first pregnancy increased to overweight or obese BMI categories in their second pregnancy. Substantial weight gain in relation to pregnancy affects a considerable proportion of women. Since inter-pregnancy weight gain is associated with several complications in the next pregnancy and longer term, avoiding excessive weight gain during and between pregnancies may prevent adverse health consequences in mothers and offspring. Copyright © 2017 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance.

Science.gov (United States)

Seeger, Harald; Salfeld, Peter; Eisel, Rüdiger; Wagner, Carsten A; Mohebbi, Nilufar

2017-06-01

Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis. Several physiologic changes occur in normal pregnancy including alterations in acid-base and electrolyte homeostasis as well as in GFR. However, data on pregnancy in women with inherited dRTA are scarce. We report the course of pregnancy in three women with hereditary dRTA. Complications observed were severe metabolic acidosis, profound hypokalemia aggravated by hyperemesis gravidarum, recurrent urinary tract infection (UTI) and ureteric obstruction leading to renal failure. However, the outcome of all five pregnancies (1 pregnancy each for mothers n. 1 and 2; 3 pregnancies for mother n. 3) was excellent due to timely interventions. Our findings highlight the importance of close nephrologic monitoring of women with inherited dRTA during pregnancy. In addition to routine assessment of creatinine and proteinuria, caregivers should especially focus on acid-base status, plasma potassium and urinary tract infections. Patients should be screened for renal obstruction in the case of typical symptoms, UTI or renal failure. Furthermore, genetic identification of the underlying mutation may (a) support early nephrologic referral during pregnancy and a better management of the affected woman, and (b) help to avoid delayed diagnosis and reduce complications in affected newborns.

Recurrent pregnancy loss in patients with thyroid dysfunction

Directory of Open Access Journals (Sweden)

Debanjali Sarkar

2012-01-01

Full Text Available Purpose of the Review: Thyroid disturbances are common in women during their reproductive years. Thyroid dysfunction interferes with human reproductive physiology, reduces the likelihood of pregnancy and adversely affects pregnancy outcome, thus becoming relevant in the algorithm of reproductive dysfunction. This review highlights the "gap" in knowledge regarding the contribution of thyroid dysfunction in reproduction. Literature Reviewed: Following implantation, the maintenance of the pregnancy is dependent on a multitude of endocrinological events that will eventually aid in the successful growth and development of the fetus. It is estimated that approximately 8-12% of all pregnancy losses are the result of endocrine factors. Autoimmune thyroid disease is present in around 4% of young females and up to 15% are at risk because they are thyroid antibody-positive. There is a strong relationship between thyroid immunity on one hand and infertility, miscarriage, and thyroid disturbances in pregnancy and postpartum, on the other hand. Even minimal hypothyroidism can increase rates of miscarriage and fetal death and may also have adverse effects on later cognitive development of the offspring. Hyperthyroidism during pregnancy may also have adverse consequences. Summary: Pregnant women with subclinical hypothyroidism or thyroid antibodies have an increased risk of complications, especially pre-eclampsia, perinatal mortality, and miscarriage. Universal screening for thyroid hormone abnormalities is not routinely recommended at present, but thyroid function must be examined in female with fetal loss or menstrual disturbances. Practitioners providing health care for women should be alert to thyroid disorders as an underlying etiology for recurrent pregnancy loss.

SSRI use in pregnancy : A study in 6 European databases

NARCIS (Netherlands)

Jordan, S.; Charlton, R.A.; Tingay, K.; Thayer, D.S.; Davies, G.I.; Morgan, M.; Tucker, D.; Watkins, A.; Gini, R.; Pierini, A.; Hansen, A.; Garne, E.; Nybo, A.; Puccini, A.; Neville, A.J.; Bos, Jens; De Jong-Van Den Berg, L.T.W.; De Vries, C.S.; Dolk, H.; Petersen, I.; Man, S.

2015-01-01

Objective / Background Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with adverse pregnancy outcomes, including congenital heart disease. Objectives: To describe utilisation patterns of SSRIs 1 year before, during and 1 year after pregnancy in primary

Urinary cortisol and depression in early pregnancy: role of adiposity and race.

Science.gov (United States)

Luiza, John W; Gallaher, Marcia J; Powers, Robert W

2015-02-13

Depression before and during pregnancy is associated with adverse birth outcomes including low birth weight and preterm birth. Abnormal maternal cortisol has been hypothesized as one mediator between depression and adverse birth outcomes. The relationship between cortisol and depression in pregnancy is exhibited most strongly in the African American population, and most studies have focused either on circulating or placental levels of cortisol. The utility of urinary cortisol in early pregnancy related to depression and adiposity has not been investigated. Twenty-five pregnant African American women identified by the Edinburgh Depression Scale as having depression were investigated and matched by body mass index (BMI), age, race, and infant birth weight centile to non-depressed subjects. Maternal urine and plasma cortisol in early pregnancy were quantified and investigated in relation to depression and adiposity. Morning urine cortisol levels tracked positively with plasma cortisol (r(2) = 0.25, p cortisol between depressed and non-depressed pregnant women. Plasma cortisol was significantly negatively associated with several measures of maternal adiposity including percent body fat (r(2) = -0.10, p obese women were found to have significantly higher cortisol levels compared to women with depression, obesity or both (p obese pregnant women evidence atypical cortisol levels compared to non-depressed non-obese pregnant women. Plasma cortisol in early pregnancy is negatively associated with measures of maternal adiposity. Atypical low circulating maternal cortisol among depressed (lean and obese) and non-depressed obese pregnant African American women may indicate hypothalamic-pituitary axis dysfunction in early pregnancy.

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

Directory of Open Access Journals (Sweden)

Wen Shi

2004-11-01

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

Race/ethnicity, educational attainment, and pregnancy complications in New York City women with pre-existing diabetes.

Science.gov (United States)

James-Todd, Tamarra; Janevic, Teresa; Brown, Florence M; Savitz, David A

2014-03-01

More women are entering pregnancy with pre-existing diabetes. Disease severity, glycaemic control, and predictors of pregnancy complications may differ by race/ethnicity or educational attainment, leading to differences in adverse pregnancy outcomes. We used linked New York City hospital record and birth certificate data for 6291 singleton births among women with pre-existing diabetes between 1995 and 2003. We defined maternal race/ethnicity as non-Hispanic white, non-Hispanic black, Hispanic, South Asian, and East Asian, and education level as 12 years. Our outcomes were pre-eclampsia, preterm birth (PTB) (pregnancy complications. Non-Hispanic black, Hispanic, and South Asian women with pre-existing diabetes may benefit from targeted interventions to improve pregnancy outcomes. © 2013 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.

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

Directory of Open Access Journals (Sweden)

Bijaya K Padhi

2015-07-01

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

Employee entitlements during pregnancy and maternal psychological well-being.

Science.gov (United States)

Cooklin, Amanda R; Rowe, Heather J; Fisher, Jane R W

2007-12-01

Antenatal psychological well-being is multifactorially determined, including by social circumstances. Evidence suggests that workplace conditions are salient determinants of mental health, but it is not known whether employment conditions influence antenatal psychological well-being. To investigate the relationship between employment conditions and antenatal psychological well-being in Australian women. A sociodemographically diverse consecutive cohort of employed nulliparous women was recruited in late pregnancy. Data were collected by a structured interview assessing sociodemographic characteristics, employment arrangements, experience of pregnancy-related discrimination, and access to maternity leave entitlements. Participants completed two standardised psychometric measures of maternal mood: the Edinburgh Depression Scale (EDS) and the Profile of Mood States (PoMS). Comparisons of self-reported mood were made between women by experience of workplace adversity, using a composite measure of workplace events. Of 205 eligible women, 165 agreed to participate. Of these, 114 of 165 (69%) reported at least one form of workplace adversity during pregnancy. More women without private health insurance (78%) reported workplace adversity than those who were privately insured (57%) (chi2(1)=6.95, P=0.008). Women experiencing workplace adversity had significantly worse psychological well-being as indicated by the EDS score (7.7+/-5.1) than those who were experiencing no workplace adversity (5.5+/-3.4), mean difference (95% CI)=-2.2 (-3.7 to -0.8), P=0.003. Similar results were reported for the PoMS. Workplace adversity during pregnancy is associated with poorer maternal psychological well-being. Workplace conditions and entitlements are salient factors for consideration in assessments of antenatal psychosocial well-being.

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

Science.gov (United States)

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

2017-07-11

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

Pregnancy Anxiety and Prenatal Cortisol Trajectories

Science.gov (United States)

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

Outcomes in Continuing Pregnancies Diagnosed with a Severe Fetal Abnormality and Implication of Antenatal Neonatology Consultation: A 10-Year Retrospective Study.

Science.gov (United States)

Hostalery, Laura; Tosello, Barthélémy

2017-06-01

To describe a population choosing to continue their pregnancy despite a severe fetal abnormality and to evaluate the role of antenatal neonatology consultation in perinatal decision-making. A 10-year (2005-2015) retrospective descriptive study in a single Multidisciplinary Prenatal Diagnosis Center in South France. A series of pregnancies with severe fetal abnormalities were collected by a person outside the decision making process and/or the child's care. Thirty-nine pregnancies were included, among which 12 couples chose the perinatal palliative care. In total, there were 25 live births (10 later died, with median of survival of 52.5 h [16-943.5]); only five infants received a palliative care plan at birth. The choice to continue a pregnancy diagnosed with severe fetal pathology is on the rise in France. Treatment options point to standardize perinatal palliative care provided by trained perinatal professionals using standardized practices.

Impact of Pre-Pregnancy BMI on B Vitamin and Inflammatory Status in Early Pregnancy: An Observational Cohort Study

Directory of Open Access Journals (Sweden)

Anne-Lise Bjørke-Monsen

2016-11-01

Full Text Available Maternal nutrition and inflammation have been suggested as mediators in the development of various adverse pregnancy outcomes associated with maternal obesity. We have investigated the relation between pre-pregnancy BMI, B vitamin status, and inflammatory markers in a group of healthy pregnant women. Cobalamin, folate, pyridoxal 5′-phosphate, and riboflavin; and the metabolic markers homocysteine, methylmalonic acid, and 3-hydroxykynurenine/xanthurenic acid ratio (HK/XA; and markers of cellular inflammation, neopterin and kynurenine/tryptophan ratio (KTR were determined in pregnancy week 18 and related to pre-pregnancy body mass index (BMI, in 2797 women from the Norwegian Mother and Child Cohort Study (MoBa. Pre-pregnancy BMI was inversely related to folate, cobalamin, pyridoxal 5′-phosphate (PLP, and riboflavin (p < 0.001, and associated with increased neopterin and KTR levels (p < 0.001. Inflammation seemed to be an independent predictor of low vitamin B6 status, as verified by low PLP and high HK/XA ratio. A high pre-pregnancy BMI is a risk factor for low B vitamin status and increased cellular inflammation. As an optimal micronutrient status is vital for normal fetal development, the observed lower B vitamin levels may contribute to adverse pregnancy outcomes associated with maternal obesity and B vitamin status should be assessed in women with high BMI before they get pregnant.

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

Directory of Open Access Journals (Sweden)

Nicolaos Vitoratos

2006-01-01

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

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

Science.gov (United States)

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

2006-01-01

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

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

Directory of Open Access Journals (Sweden)

2006-01-01

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

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

Science.gov (United States)

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

2006-01-01

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

Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions.

Science.gov (United States)

Trottier, Kathryn; MacDonald, Danielle E

2017-08-01

This paper provides an updated review of the literature on the relationship between psychological trauma exposure, other severe adverse experiences, and eating disorders. Trauma exposure and other severe adverse experiences (e.g., emotional abuse) in both childhood and adulthood are associated with eating disorders. The relationship between traumatic and other adverse experiences and eating disorders appears to be mediated by emotional and behavioral dysregulation, as well as by cognitive factors such as self-criticism. Biological vulnerabilities may also be relevant to this relationship. Overall, the literature is limited by predominantly cross-sectional designs. There is clear evidence of a correlational relationship between trauma exposure and other severe adverse events, and eating disorders. Both risk and maintenance factor hypotheses have been put forth; however, prospective research testing these hypotheses remains limited. Future research should use prospective designs and focus on trauma-related symptoms (rather than trauma exposure) in order to advance research on risk and maintaining factors for eating disorders and inform treatment directions.

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

Science.gov (United States)

Muganyizi, Projestine S; Kidanto, Hussein

2013-01-01

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

Brucellosis in pregnancy: clinical aspects and obstetric outcomes.

Science.gov (United States)

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

2015-09-01

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

Effect of Pregnancy on Postural Tachycardia Syndrome

Science.gov (United States)

Kimpinski, Kurt; Iodice, Valeria; Sandroni, Paola; Low, Phillip A.

2010-01-01

OBJECTIVES: To compare the clinical presentation, autonomic dysfunction, and pregnancy outcomes in parous and nulliparous women with postural tachycardia syndrome (POTS) and in women with POTS before and after pregnancy. PATIENTS AND METHODS: This study consists of women who had at least 1 pregnancy during which time they met criteria for POTS between May 1993 and July 2009. All patients underwent standard autonomic testing. POTS was defined as a heart rate (HR) increase of greater than 30 beats/min on head-up tilt (HUT) with symptoms of orthostatic intolerance. Patients' charts were reviewed retrospectively to determine pregnancy outcomes. RESULTS: Clinical characteristics related to POTS did not differ between parous and nulliparous women except for disease duration (parous, 3.7±2.6; nulliparous, 2.1±2.2; Pchange in HR on HUT: parous, 42.6±12.0 beats/min; nulliparous, 41.3±10.6 beats/min; P=.39). Of 116 total pregnancies, adverse pregnancy outcomes were reported in 9% and maternal complications in 1%. No complication was related to POTS. There was a trend toward modest improvement in autonomic dysfunction before and after pregnancy (change in HR on HUT: before pregnancy, 38.1±22.7 beats/min; after pregnancy, 21.9±14.9 beats/min; P=.07). CONCLUSION: The long-term impact of pregnancy on POTS does not appear to be clinically important. However, there does appear to be a trend toward improvement in the short-term postpartum period. Adverse pregnancy events were similar to those seen in the general public and do not present a barrier to women with POTS who want to have children. PMID:20516426

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

Science.gov (United States)

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

2014-07-01

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

Pregnancy-Associated Plasma Protein A Levels in Late First Trimester Pregnancies with Small-for-Gestational Age Neonates: A Prospective Case-Control Study.

Science.gov (United States)

Agarwal, Rachna; Kumari, Radhika; Mehndiratta, Mohit; Radhakrishnan, Gita; Faridi, M M A; Chandra, Nilesh

2017-08-01

We aimed to investigate the association of pregnancy associated plasma protein A (PAPP-A) levels in late first trimester with small for gestational age (SGA) neonates and adverse pregnancy outcomes in a low-income setting. The inclusion criteria were late first trimester (11-13 + 6 weeks) women with singleton and non-anomalous pregnancy. Enrolled participants were sampled for PAPP-A and prospectively followed up for delivery outcome and antenatal complications. A multiple of median (MoM) was calculated and statistically compared between groups. Out of total 284 subjects, 14.54% delivered SGA babies and formed cases (Group A), 66.5% delivered appropriate for gestational age (AGA) neonates with uneventful antenatal period (controls, Group B), and 19.3% were AGA group with adverse pregnancy complications (Group C). The late first trimester median PAPP-A MoM was significantly lower (0.61) in Group A compared to Group B (1.47). Using receiver operating characteristic (ROC) curve for PAPP-A MoM, optimal cutoff value was found at 0.45 MoM, with positive predictive value of 56.2%, specificity of 92.6% and sensitivity of 45%. The median interquartile range (IQR) of PAPP-A MoM value in Group C in comparison with Group B was significantly lower except for abruption. At PAPP-A MoM cutoff value <1, <0.8, <0.6 and <0.4, the odds ratio for adverse pregnancy outcome was 8.30, 7.29, 10.97 and 10.60, respectively, indicating an inverse relationship. With 0.45 MoM cutoff of PAPP-A, the detection rate, specificity and positive predictive value for SGA were 45, 92.6 and 56.2%, respectively. As PAPP-A MoM values decreased, the odds ratio of having adverse pregnancy outcomes increased.

Acute starvation ketoacidosis in pregnancy with severe hypertriglyceridemia: A case report.

Science.gov (United States)

Hui, Li; Shuying, Li

2018-05-01

Pregnant women are more prone to ketosis due to the relative insulin resistance, accelerated lipolysis and increased free fatty acids. We report a pregnant woman with hyperlipidemia, who experienced severe metabolic acidosis after a short period of starvation. Based on her clinical symptoms, exclusion diagnosis and therapeutic diagnosis, her condition was diagnosed as starvation ketoacidosis. An emergency caesarean section under general anesthesia was implemented 2 hours after her admission. The metabolic acidosis was treated with fluid resuscitation using compound sodium lactate, bicarbonate, and 5% dextrose together with insulin 6U. Both mother and baby were discharged clinically well. Starvation ketoacidosis may happen in special patient who was in pregnancy and with severe hypertriglyceridemia, after just one day fasting and vomiting.

Lower levels of circulating IGF-I in Type 1 diabetic women with frequent severe hypoglycaemia during pregnancy

DEFF Research Database (Denmark)

Ringholm Nielsen, L; Juul, A; Pedersen-Bjergaard, U

2008-01-01

Severe hypoglycaemia is a significant problem in pregnant women with Type 1 diabetes. We explored whether frequent severe hypoglycaemia during pregnancy in women with Type 1 diabetes is related to placental growth hormone (GH) and insulin-like growth factor I (IGF-I) levels....

Euglycemic diabetic ketoacidosis in pregnancy

International Nuclear Information System (INIS)

Tarif, N.; Al-Badr, W.

2007-01-01

Diabetic ketoacidosis (DKA) can be a catastrophic event during pregnancy, complicating almost nine percent of diabetics in pregnancy. It includes both maternal and fetal mortality. Ketosis has been implicated in fetal distress and causes adverse neurological outcome. DKA with relatively low blood sugar levels is called euglycemic DKA, which is a rare entity and reported usually in type I diabetic patients. A 37-years-old Saudi female patient known to have type II diabetes developed euglycemic [blood glucose level 4.3 mmol/L (78 mg/dl) DKA while in her fifth pregnancy. She responded to intravenous dextrose and insulin with gradual improvement. Euglycemic DKA should be considered in type II diabetics during pregnancy and treated promptly. (author)

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

OpenAIRE

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

2011-01-01

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

Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation: Findings from the pregnancy and childhood epigenetics (PACE) consortium

NARCIS (Netherlands)

G.C. Sharp (Gemma C.); L.A. Salas (Lucas A.); C. Monnereau; C. Allard (Catherine); P. Yousefi (Paul); Everson, T.M. (Todd M.); J. Bohlin (Jon); Z. Xu (Zongli); Huang, R.-C. (Rae-Chi); S.E. Reese (Sarah E.); C.-J. Xu (Cheng-Jian); N. Baïz (Nour); Hoyo, C. (Cathrine); Agha, G. (Golareh); Roy, R. (Ritu); J. Holloway (John); Ghantous, A. (Akram); S.K. Merid (Simon Kebede); K.M. Bakulski (Kelly M.); A.M. Küpers (Marlijn); Zhang, H. (Hongmei); R.C. Richmond (Rebecca C.); Page, C.M. (Christian M.); Duijts, L. (Liesbeth); Lie, R.T. (Rolv T.); Melton, P.E. (Phillip E.); J.M. Vonk (Judith); C. Nohr (Christian); Williams-DeVane, C. (ClarLynda); K. Huen (Karen); S.L. Rifas-Shiman (Sheryl); Ruiz-Arenas, C. (Carlos); Gonseth, S. (Semira); Rezwan, F.I. (Faisal I.); Z. Herceg (Zdenko); Ekström, S. (Sandra); Croen, L. (Lisa); F. Falahi (Fahimeh); Perron, P. (Patrice); M.R. Karagas (Margaret); B.M. Quraishi (Bilal M.); M.J. Suderman (Matthew J.); Magnus, M.C. (Maria C.); V.W.V. Jaddoe (Vincent); Taylor, J.A. (Jack A.); D. Anderson (Denise); Zhao, S. (Shanshan); H.A. Smit (Henriëtte); Josey, M.J. (Michele J.); Bradman, A. (Asa); A.A. Baccarelli (Andrea A.); M. Bustamante (Mariona); S.E. Håberg (Siri E); G. Pershagen (Göran); I. Hertz-Picciotto (Irva); Newschaffer, C. (Craig); W.E. Corpeleijn (Willemijn); L. Bouchard (Luigi); Lawlor, D.A. (Debbie A.); Maguire, R.L. (Rachel L.); L.F. Barcellos (Lisa); Smith, G.D. (George Davey); B. Eskenazi (B.); Karmaus, W. (Wilfried); Marsit, C.J. (Carmen J.); M.-F. Hivert (Marie-France); H. Snieder (Harold); Fallin, M.D. (M. Daniele); Melén, E. (Erik); M.C. Munthe-Kaas (Monica Cheng); H. Arshad (Hasan); J. Wiemels (Joseph); I. Annesi-Maesano; M. Vrijheid (Martine); E. Oken (Emily); Holland, N. (Nina); Murphy, S.K. (Susan K.); T.I.A. Sørensen (Thorkild); G.H. Koppelman (Gerard); J.P. Newnham (John); A.J. Wilcox (Allen); W. Nystad (Wenche); S.J. London (Stephanie J.); J.F. Felix (Janine); C.L. Relton (Caroline)

2017-01-01

textabstractPre-pregnancy maternal obesity is associated with adverse offspring outcomes at birth and later in life. Individual studies have shown that epigenetic modifications such as DNA methylation could contribute. Within the Pregnancy and Childhood Epigenetics (PACE) Consortium, we

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...

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

Science.gov (United States)

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

2015-01-01

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

Challenges in the concurrent management of malaria and HIV in pregnancy in sub-Saharan Africa.

Science.gov (United States)

Brentlinger, Paula E; Behrens, Christopher B; Micek, Mark A

2006-02-01

Approximately one million pregnancies are complicated by both malaria and HIV infection in sub-Saharan Africa annually. Both infections have been associated with maternal and infant morbidity and mortality. Intermittent preventive treatment, usually with sulfadoxine-pyrimethamine, has been shown to prevent pregnancy-related malaria and its complications. Several different regimens of antiretroviral therapy are now available to prevent mother-to-child transmission of HIV and/or progression of maternal HIV infection during pregnancy. However, no published studies have yet shown whether standard intermittent preventive treatment and antiretroviral regimens are medically and operationally compatible in pregnancy. We reviewed existing policies regarding prevention and treatment of HIV and malaria in pregnancy, as well as published literature on adverse effects of antiretrovirals and antimalarials commonly used in pregnancy in developing countries, and found that concurrent prescription of sulfadoxine-pyrimethamine, co-trimoxazole (trimethoprim-sulfamethoxazole), and antiretroviral agents including nevirapine and zidovudine per existing protocols for prevention of malaria and vertical HIV transmission may result in adverse drug interactions or overlapping, diagnostically challenging drug toxicities. Insecticide-treated bednets should be provided for HIV-infected pregnant women at risk for malaria. Sulfadoxine-pyrimethamine should be prescribed cautiously in women concurrently receiving daily nevirapine and/or zidovudine, and should be avoided in women on daily co-trimoxazole. Further research is urgently needed to define safe and effective protocols for concurrent management of HIV and malaria in pregnancy, and to define appropriate interventions for different populations subject to differing levels of malaria transmission and antimalarial drug resistance.

Severe adverse drug reaction following Crotalidae Polyvalent Immune Fab (Ovine) administration for copperhead snakebite.

Science.gov (United States)

Lepak, Maryjoy R; Bochenek, Samantha H; Bush, Sean P

2015-01-01

To present the case of a severe anaphylactic/anaphylactoid reaction to Crotalidae Polyvalent Immune Fab (Ovine) in a patient bitten by a copperhead snake. A 68-year-old man presented with progressive envenomation after receiving a copperhead snakebite on each hand. Crotalinae Fab antivenom was administered. While the initial and only dose was partially infusing, the patient developed an adverse drug reaction (ADR) of urticaria and hypotension, which resolved with cessation of the infusion, recurred with resumption of the infusion, and ultimately was completed with supportive care. An additional episode of hypotension, urticaria, and angioedema occurred shortly after antivenom therapy completion. Epinephrine was administered, resolving the reaction with complete patient recovery. The event received a Naranjo score of 10, indicating a definite ADR. Treating copperhead snakebites with antivenom is a matter of debate. Concern over adverse events and cost induce some physicians to manage copperhead bites without antivenom because they are generally milder in severity. As demonstrated in this case, severe ADR can occur with Crotalinae Fab antivenom, and its efficacy for copperhead envenoming needs to be better established via placebo-controlled, randomized trials. © The Author(s) 2014.

Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation : findings from the pregnancy and childhood epigenetics (PACE) consortium

NARCIS (Netherlands)

Sharp, Gemma C; Salas, Lucas A; Monnereau, Claire; Allard, Catherine; Yousefi, Paul; Everson, Todd M; Bohlin, Jon; Xu, Zongli; Huang, Rae-Chi; Reese, Sarah E; Xu, Cheng-Jian; Baïz, Nour; Hoyo, Cathrine; Agha, Golareh; Roy, Ritu; Holloway, John W; Ghantous, Akram; Merid, Simon K; Bakulski, Kelly M; Küpers, Leanne K; Zhang, Hongmei; Richmond, Rebecca C; Page, Christian M; Duijts, Liesbeth; Lie, Rolv T; Melton, Phillip E; Vonk, Judith M; Nohr, Ellen A; Williams-DeVane, ClarLynda; Huen, Karen; Rifas-Shiman, Sheryl L; Ruiz-Arenas, Carlos; Gonseth, Semira; Rezwan, Faisal I; Herceg, Zdenko; Ekström, Sandra; Croen, Lisa; Falahi, Fahimeh; Perron, Patrice; Karagas, Margaret R; Quraishi, Bilal M; Suderman, Matthew; Magnus, Maria C; Jaddoe, Vincent W V; Taylor, Jack A; Anderson, Denise; Zhao, Shanshan; Smit, Henriette A; Josey, Michele J; Bradman, Asa; Baccarelli, Andrea A; Bustamante, Mariona; Håberg, Siri E; Pershagen, Göran; Hertz-Picciotto, Irva; Newschaffer, Craig; Corpeleijn, Eva; Bouchard, Luigi; Lawlor, Debbie A; Maguire, Rachel L; Barcellos, Lisa F; Davey Smith, George; Eskenazi, Brenda; Karmaus, Wilfried; Marsit, Carmen J; Hivert, Marie-France; Snieder, Harold; Fallin, M Daniele; Melén, Erik; Munthe-Kaas, Monica C; Arshad, Hasan; Wiemels, Joseph L; Annesi-Maesano, Isabella; Vrijheid, Martine; Oken, Emily; Holland, Nina; Murphy, Susan K; Sørensen, Thorkild I A; Koppelman, Gerard H; Newnham, John P; Wilcox, Allen J; Nystad, Wenche; London, Stephanie J; Felix, Janine F; Relton, Caroline L

2017-01-01

Pre-pregnancy maternal obesity is associated with adverse offspring outcomes at birth and later in life. Individual studies have shown that epigenetic modifications such as DNA methylation could contribute. Within the Pregnancy and Childhood Epigenetics (PACE) Consortium, we meta-analysed the

Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation : Findings from the pregnancy and childhood epigenetics (PACE) consortium

NARCIS (Netherlands)

Sharp, Gemma C.; Salas, Lucas A.; Monnereau, Claire; Allard, Catherine; Yousefi, Paul; Everson, Todd M.; Bohlin, Jon; Xu, Zongli; Huang, Rae Chi; Reese, Sarah E.; Xu, Cheng-Jian; Baïz, Nour; Hoyo, Cathrine; Agha, Golareh; Roy, Ritu; Holloway, John W.; Ghantous, Akram; Merid, Simon K.; Bakulski, Kelly M.; Küpers, Leanne K.; Zhang, Hongmei; Richmond, Rebecca C.; Page, Christian M.; Duijts, Liesbeth; Lie, Rolv T.; Melton, Phillip E.; Vonk, Judith M.; Nohr, Ellen A.; Williams-DeVane, Clar Lynda; Huen, Karen; Rifas-Shiman, Sheryl L.; Ruiz-Arenas, Carlos; Gonseth, Semira; Rezwan, Faisal I.; Herceg, Zdenko; Ekström, Sandra; Croen, Lisa; Falahi, Fahimeh; Perron, Patrice; Karagas, Margaret R; Quraishi, Bilal M.; Suderman, Matthew J.; Magnus, Maria C.; Jaddoe, Vincent W V; Taylor, Jack A; Anderson, Denise; Zhao, Shanshan; Smit, Henriette A.; Josey, Michele J.; Bradman, Asa; Baccarelli, Andrea A.; Bustamante, Mariona; Håberg, Siri E.; Pershagen, Göran; Hertz-Picciotto, Irva; Newschaffer, Craig; Corpeleijn, Eva; Bouchard, Luigi; Lawlor, Debbie A.; Maguire, Rachel L.; Barcellos, Lisa F.; Smith, George Davey; Eskenazi, Brenda; Karmaus, Wilfried; Marsit, Carmen J.; Hivert, Marie-France; Snieder, Harold; Fallin, M. Daniele; Melén, Erik; Munthe-Kaas, Monica C.; Arshad, S Hasan; Wiemels, Joseph L.; Annesi-Maesano, Isabella; Vrijheid, Martine; Oken, Emily; Holland, Nina; Murphy, Susan K.; Sørensen, Thorkild I A; Koppelman, Gerard H; Newnham, John P; Wilcox, Allen J.; Nystad, Wenche; London, Stephanie J.; Felix, Janine F.; Relton, Caroline L

2017-01-01

Pre-pregnancy maternal obesity is associated with adverse offspring outcomes at birth and later in life. Individual studies have shown that epigenetic modifications such as DNA methylation could contribute. Within the Pregnancy and Childhood Epigenetics (PACE) Consortium, we meta-analysed the

Pregnancy as a cardiac stress model

Science.gov (United States)

Chung, Eunhee; Leinwand, Leslie A.

2014-01-01

Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiac adaptation during normal pregnancy. This review provides an overview of the cardiac consequences of pregnancy, including haemodynamic, functional, structural, and morphological adaptations, as well as molecular phenotypes. In addition, this review describes the signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation. PMID:24448313

Partner, workplace, and stranger abuse during pregnancy in Germany.

Science.gov (United States)

Stöckl, Heidi; Hertlein, Linda; Friese, Klaus; Stöckl, Doris

2010-11-01

To investigate the prevalence, perpetrators, sociodemographic correlates, and health impacts of psychological, physical, and sexual abuse during pregnancy among women attending a maternity ward in Germany. A written questionnaire was given to pregnant women in a maternity ward of a university hospital in Munich. Abuse during pregnancy was assessed using the Abuse Assessment Screen. Of 552 women, 401 completed the questionnaire for a response rate of 72.6%. The prevalence of psychological, physical, or sexual abuse during pregnancy by any perpetrator was 6.7% (n = 27); the main perpetrators were women's partners and work colleagues. After controlling for the effect of age, psychological, physical, or sexual abuse during pregnancy was significantly associated with a history of abuse, low education level of the woman and the father of her child, short relationship duration, unintended pregnancy, financial problems caused by the pregnancy, having more than 3 children, and insufficient social support. Women who reported abuse during pregnancy were significantly more likely to smoke and to have adverse maternal health outcomes. Psychological, physical, or sexual abuse during pregnancy was experienced by 1 in 15 women who attended a maternity ward in Munich and adversely affected maternal health outcomes. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Urinary Tract Infection and Bacteriuria in Pregnancy.

Science.gov (United States)

Glaser, Alexander P; Schaeffer, Anthony J

2015-11-01

Bacteriuria during pregnancy may be classified as asymptomatic bacteriuria, infections of the lower urinary tract (cystitis), or infections of the upper urinary tract (pyelonephritis). Lower tract bacteriuria is associated with an increased risk of developing pyelonephritis in pregnancy, which is itself associated with adverse maternal and fetal outcomes. Pregnant women should be screened for the presence of bacteriuria early in pregnancy. All bacteriuria in pregnancy should be treated, and antimicrobial choice in pregnancy should reflect safety for both the mother and the fetus. After treatment of bacteriuria, patients should be followed closely due to risk of recurrent bacteriuria. Copyright © 2015 Elsevier Inc. All rights reserved.

The association between occurrence and severity of subclinical and clinical mastitis on pregnancies per artificial insemination at first service of Holstein cows.

Science.gov (United States)

Fuenzalida, M J; Fricke, P M; Ruegg, P L

2015-06-01

The objective of this prospective study was to determine associations between occurrence and severity of clinical (CM) and subclinical mastitis (SM) during a defined breeding risk period (BRP, 3d before to 32d after artificial insemination) on pregnancies per artificial insemination at first service (P/AI1). Dairy cows (n=3,144) from 4 Wisconsin herds were categorized based on the occurrence of one or more CM or SM events during and before the BRP: (1) healthy, (2) mastitis before BRP, (3) SM during BRP, (4) chronic SM, (5) CM during BRP, or (6) chronic CM. Clinical mastitis cases were categorized based on etiology (gram-negative, gram-positive, and no growth) and severity (mild, moderate, or severe). Compared with healthy cows, the odds of pregnancy were 0.56, 0.67, and 0.75 for cows experiencing chronic CM, CM, or SM during the BRP, respectively. The occurrence of chronic SM was not associated with reduced probability of P/AI1. Compared with healthy cows, the odds of pregnancy were 0.71 and 0.54 for cows experiencing mild or moderate-severe cases of CM during the BRP, respectively. The odds of pregnancy for cows experiencing CM caused by gram-negative or gram-positive bacteria during the BRP were 0.47 and 0.59, respectively. The occurrence of CM that resulted in no growth of bacteria in cultured milk samples was not associated with reductions in P/AI1. Regardless of etiology, microbiologically positive cases of CM with moderate or severe symptoms were associated with substantial reductions in P/AI1. Etiology, severity, and timing of CM were associated with decreases in the probability of pregnancy at first artificial insemination. Severity of the case was more important than etiology; however, regardless of severity, microbiologically negative cases were not associated with reduced probability of pregnancy. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Jiabi Qin

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

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

Science.gov (United States)

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

2014-01-01

Background To estimate probability of adverse pregnancy outcomes (APOs) among women with and without syphilis through a systematic review of published literatures. Methodology/Principal Findings Chinese and English literatures were searched for studies assessing pregnancy outcomes in the presence of maternal syphilis through August 2013. The prevalence estimates were summarized and analyzed by meta-analysis. Fifty-four literatures involving 11398 syphilitic women and 43342 non-syphilitic women were included from 4187 records initially found. Among untreated mothers with syphilis, pooled estimates were 76.8% for all APOs, 36.0% for congenital syphilis, 23.2% for preterm, 23.4% for low birth weight, 26.4% for stillbirth or fetal loss, 14.9% for miscarriage and 16.2% for neonatal deaths. Among syphilitic mother receiving treatment only in the late trimester (>28 weeks), pooled estimates were 64.4% for APOs, 40.6% for congenital syphilis, 17.6% for preterm, 12.4% for low birth weight, and 21.3% for stillbirth or fetal loss. Among syphilitic mothers with high titers (≥1∶8), pooled estimates were 42.8% for all APOs, 25.8% for congenital syphilis, 15.1% for preterm, 9.4% for low birth weight, 14.6% for stillbirth or fetal loss and 16.0% for neonatal deaths. Among non-syphilitic mothers, the pooled estimates were 13.7% for all APOs, 7.2% for preterm birth, 4.5% for low birth weight, 3.7% for stillbirth or fetal loss, 2.3% for miscarriage and 2.0% for neonatal death. Begg's rank correlation test indicated little evidence of publication bias (P>0.10). Substantial heterogeneity was found across studies in the estimates of all adverse outcomes for both women with syphilis (I 2 = 93.9%; Psyphilis (I 2 = 94.8%; PSyphilis continues to be an important cause of substantial perinatal morbidity and mortality, which reminds that policy-makers charged with resource allocation that the elimination of mother-to-child transmission of syphilis is a public health priority. PMID

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.

Bleeding during Pregnancy

Science.gov (United States)

... 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 ...

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

Science.gov (United States)

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

2018-02-24

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

The association between maltreatment in childhood and pre-pregnancy obesity in women attending an antenatal clinic in Australia.

Directory of Open Access Journals (Sweden)

Katharine Hollingsworth

Full Text Available INTRODUCTION: Obesity in pregnancy is associated with increased risk of complications and adverse outcomes in mother and child. Childhood adverse experiences are known to have numerous negative physical and emotional sequelae. We aimed to examine if exposure to abuse and/or neglect in childhood increased the likelihood of pre-pregnancy obesity. METHODS: Demographic and clinical data including weight, height, mental health as measured by the General Health Questionnaire and exposure to childhood trauma as measured by the childhood trauma questionnaire was collected from 239 women attending antenatal care at an Australian tertiary hospital. RESULTS: More than one quarter of women were obese prior to pregnancy and approximately 20% of women self reported experiencing moderate to severe physical, sexual or emotional abuse. Almost 60% of women scored in the clinical range on the GHQ. Pre-pregnancy obesity in women attending antenatal care was associated with a self-reported history of emotional or physical abuse with those exposed to moderate or severe emotional or physical abuse having increased odds of being obese prior to pregnancy (O.R. and 95% CI: 2.40; 1.19-4.84 and 2.38; 1.18-4.79 respectively. There was no significant association between other forms of childhood maltreatment, demographic or current mental health status and pre-pregnancy obesity. CONCLUSIONS: The high rates of obesity, mental health problems and self reported childhood maltreatment in the Australian antenatal population are serious public health concerns due to the extra health risks conferred on mother and offspring. Exposure to physical or emotional abuse during childhood increases the likelihood of obesity in women attending antenatal care. Further research is required to determine reasons for this association.

Thrombocytopenia during Pregnancy and Its Outcome – A Prospective Study

Directory of Open Access Journals (Sweden)

Pallavi Satish Vishwekar

2017-01-01

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

Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications.

Science.gov (United States)

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

2016-01-01

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

Viral Infections in Pregnancy: A Focus on Ebola Virus.

Science.gov (United States)

Olgun, Nicole S

2018-01-30

During gestation, the immune response of the placenta to viruses and other pathogens plays an important role in determining a pregnant woman's vulnerability toward infectious diseases. Located at the maternal- fetal interface, trophoblast cells serve to minimize the spread of viruses between the host and developing fetus through an intricate system of innate antiviral immune signaling. Adverse pregnancy outcomes, ranging from learning disabilities to preterm birth and fetal death, are all documented results of a viral breach in the placental barrier. Viral infections during pregnancy can also be spread through blood and vaginal secretions, and during the post-natal period, via breast milk. Thus, even in the absence of vertical transmission of viral infection to the fetus, maternal health can still be compromised and threaten the pregnancy. The most common viral DNA isolates found in gestation are adenovirus, cytomegalovirus, and enterovirus. However, with the recent pandemic of Ebola virus, and the first documented case of a neonate to survive due to experimental therapies in 2017, it is becoming increasingly apparent that the changing roles and impacts of viral infection during pregnancy needs to be better understood, while strategies to minimize adverse pregnancy outcomes need to be identified. This review focuses on the adverse impacts of viral infection during gestation, with an emphasis on Ebola virus. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

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

Science.gov (United States)

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

2018-04-25

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

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

Directory of Open Access Journals (Sweden)

Adeladza K Amegah

Full Text Available BACKGROUND: The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES. Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. METHODS: A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. RESULTS: In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145 reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87, low education (187 g; 95% CI: 355-20, studentship during pregnancy (291 g; 95% CI: 506-76 and low income (147 g; 95% CI: 277-17. In causal pathway analysis, malaria infection (6-20%, poor nutrition (2-51% and indoor air pollution (10-62% mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21 risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56 of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49 and 278% (RR: 3.78; 95% CI: 1.39-10.27 increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. CONCLUSION: We provide evidence of the effects of socioeconomic deprivation

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

Science.gov (United States)

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

2013-01-01

The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES. A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire. In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk. We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition

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

Science.gov (United States)

Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

2017-01-01

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

Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain.

NARCIS (Netherlands)

Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van

2004-01-01

STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant

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

Directory of Open Access Journals (Sweden)

Upendranath Upadhyay

2017-04-01

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

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

OpenAIRE

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

2006-01-01

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

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

Science.gov (United States)

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

2018-05-03

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

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.

The impact of maternal obesity during pregnancy on offspring immunity.

Science.gov (United States)

Wilson, Randall M; Messaoudi, Ilhem

2015-12-15

In the United States, approximately 64% of women of childbearing age are either overweight or obese. Maternal obesity during pregnancy is associated with a greater risk for adverse maternal-fetal outcomes. Adverse health outcomes for the offspring can persist into adulthood, increasing the incidence of several chronic conditions including cardiovascular disease, diabetes, and asthma. Since these diseases have a significant inflammatory component, these observations are indicative of perturbation of the normal development and maturation of the immune system of the offspring in utero. This hypothesis is strongly supported by data from several rodent studies. Although the mechanisms of these perturbations are not fully understood, it is thought that increased placental inflammation due to obesity may directly affect neonatal development through alterations in nutrient transport. In this review we examine the impact of maternal obesity on the neonatal immune system, and potential mechanisms for the changes observed. Published by Elsevier Ireland Ltd.

A Time Interval of More Than 18 Months Between a Pregnancy and a Roux-en-Y Gastric Bypass Increases the Risk of Iron Deficiency and Anaemia in Pregnancy

DEFF Research Database (Denmark)

Crusell, Mie Korslund Wiinblad; Nilas, Lisbeth; Svare, Jens

2016-01-01

OBJECTIVE: The aim of the study is to explore the impact of time between Roux-en-Y gastric bypass (RYGB) and pregnancy on obstetrical outcome and nutritional derangements. METHODS: In a retrospective cross-sectional study of pregnant women admitted for antenatal care at two tertiary hospitals, we...... examined 153 women with RYGB and a singleton pregnancy of at least 24 weeks. The women were stratified according to a pregnancy nutritional parameters and glycated haemoglobin 1Ac (HbA1c) in second and third trimester...... of adverse pregnancy outcome or birth weight between the two groups. CONCLUSION: A long surgery-to-pregnancy time interval after a RYGB increases the risk of iron deficiency anaemia but not of other nutritional deficits. Time interval does not seem to have an adverse effect on the obstetrical outcome...

Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management.

Science.gov (United States)

Page, Charlotte M; Hughes, Brenna L; Rhee, Eleanor H J; Kuller, Jeffrey A

2017-06-01

An estimated 1% to 2.5% of pregnant women in the United States are infected with hepatitis C virus (HCV), which carries approximately a 6% risk of mother-to-infant transmission. The aims of this article are to review the current evidence on HCV in pregnancy and to provide updated recommendations for management. Original research articles, review articles, and guidelines on HCV in general and specifically in pregnancy were reviewed, as were drug safety profiles from the Food and Drug Administration. Pregnancy appears to have a beneficial effect on the course of maternal chronic HCV infection. However, it is associated with an increased risk of adverse fetal outcomes, including fetal growth restriction and low birth weight, and can be transmitted to the infant in utero or during the peripartum period. No perinatal intervention has been shown to reduce the risk of vertical transmission, but some may increase this risk. To date, no treatment regimens for HCV have been approved for use in pregnancy, but the new ribavirin-free, direct-acting antiviral regimens are being used with high efficacy outside pregnancy. Hepatitis C virus infection in pregnancy generally does not adversely affect maternal well-being but is associated with adverse effects on the fetus because of pregnancy complications and vertical transmission. There are currently no approved treatment regimens for HCV in pregnancy; this should be an active area of research in obstetrics.

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

Science.gov (United States)

Xiang, Lan; Wei, Zhaolian; Cao, Yunxia

2014-01-01

Objective To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes. Methods A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH. Results It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial. Conclusions Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy. PMID:25369062

Early Pregnancy Loss

Science.gov (United States)

... 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 ...

The Treatment of Allergic Respiratory Disease During Pregnancy.

Science.gov (United States)

Namazy, Jai; Schatz, M

2016-01-01

Pregnancy may be complicated by new-onset or preexisting asthma and allergic rhinitis.This article reviews the recognition and management of asthma and allergic rhinitis during pregnancy, paying close attention to the general principles of allergy and use of asthma medication during pregnancy. Both allergic rhinitis and asthma can adversely affect both maternal quality of life and, in the case of maternal asthma, perinatal outcomes. Optimal management is thus important for both mother and baby. This article reviews the safety of asthma and allergy medications commonly used during pregnancy.

Pregnancy in teenagers under 16 years old: perinatal adversities

Directory of Open Access Journals (Sweden)

José Ricardo Dias Bertagnon

2005-03-01

Full Text Available Objectives: To verify the prevalence of pregnancy among adolescentsunder 16 years of age, the risk of pregnancy-induced hypertensionand neonatal complications in the population attend at the HospitalGeral do Grajaú. Methods: Data related to every delivery performedat the Hospital Geral do Grajaú (HGG from January 1st, 2000 to April30th, 2004 were collected. The sample was divided into two groupsof pregnant women: one consisting of adolescents aged under 16years, and the other comprising all other pregnant women attendedat the Institution. Maternal age, prevalence of pregnancy-inducedhypertension, number of prenatal visits, mode of delivery, gestationalage, birth weight and one-minute Apgar score were analyzed. Forstatistical analysis the t test was used considering p<0.05. Dataregarding pregnant teenagers were compared to those related tothe general patient population of the Obstetrics Clinic of the HGG.These data were obtained from the HGG’s Hospital RecordsDepartment. Results: Two hundred and thirty-one pregnantteenagers under 16 years of age were analyzed. This correspondsto 2.61% of the total obstetric population studied in this Institution.Among them, 53,2% did not attend prenatal care visits adequately,that is, they attended less than 5 visits. The prevalence of pregnancyinducedhypertension among these teenagers was 3.46%. Cesareansection was performed in 22% of the teenagers studied. There were12.1% of low-birth weight newborns and 23.8% preterm infants, ofwhom 6.4% had a one-minute Apgar score = 3, and 17.7% had anApgar score = 7. A statistically significant difference was observedregarding inadequate prenatal care, one-minute Apgar score = 3and prematurity, compared to the data from the total pregnantpopulation of the Institution. Conclusions: A higher risk of pregnancyinducedhypertension among pregnant adolescents aged under 16years compared to the general population of patients of theInstitution was not observed. However, the age

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

Science.gov (United States)

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

2017-08-01

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

Building a knowledge base of severe adverse drug events based on AERS reporting data using semantic web technologies.

Science.gov (United States)

Jiang, Guoqian; Wang, Liwei; Liu, Hongfang; Solbrig, Harold R; Chute, Christopher G

2013-01-01

A semantically coded knowledge base of adverse drug events (ADEs) with severity information is critical for clinical decision support systems and translational research applications. However it remains challenging to measure and identify the severity information of ADEs. The objective of the study is to develop and evaluate a semantic web based approach for building a knowledge base of severe ADEs based on the FDA Adverse Event Reporting System (AERS) reporting data. We utilized a normalized AERS reporting dataset and extracted putative drug-ADE pairs and their associated outcome codes in the domain of cardiac disorders. We validated the drug-ADE associations using ADE datasets from SIDe Effect Resource (SIDER) and the UMLS. We leveraged the Common Terminology Criteria for Adverse Event (CTCAE) grading system and classified the ADEs into the CTCAE in the Web Ontology Language (OWL). We identified and validated 2,444 unique Drug-ADE pairs in the domain of cardiac disorders, of which 760 pairs are in Grade 5, 775 pairs in Grade 4 and 2,196 pairs in Grade 3.

Obstetrical complications in dichorionic twin pregnancies in women with polycystic ovary syndrome

DEFF Research Database (Denmark)

Jonsdottir, Fjola; Nilas, Lisbeth; Andreasen, Kirsten R

2017-01-01

INTRODUCTION: Both women with polycystic ovary syndrome (PCOS) and women with twin pregnancies have increased risk of adverse pregnancy outcome. The aim of this study was to investigate the impact of PCOS and maternal androgen levels on the outcome of dichorionic twin pregnancy. MATERIAL...

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

Directory of Open Access Journals (Sweden)

Xiao-Hua Liu

2016-02-01

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

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

Science.gov (United States)

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

2015-12-01

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

The role of maternal anorexia nervosa and bulimia nervosa before and during pregnancy in early childhood wheezing: Findings from the NINFEA birth cohort study.

Science.gov (United States)

Popovic, Maja; Pizzi, Costanza; Rusconi, Franca; Gagliardi, Luigi; Galassi, Claudia; Trevisan, Morena; Merletti, Franco; Richiardi, Lorenzo

2018-05-02

This study evaluates associations of maternal eating disorders (bulimia nervosa, anorexia nervosa, and purging behaviors) with infant wheezing and examines the effects of eating disorders on several wheezing determinants. We studied 5,150 singletons from the NINFEA birth cohort. Maternal bulimia nervosa and anorexia nervosa diagnoses were ascertained from the questionnaires completed in pregnancy and 6 months after delivery, and were analyzed as: ever diagnosis, only before pregnancy, and during pregnancy. Purging behaviors were assessed for 12 months before or during pregnancy. The associations with wheezing between 6 and 18 months of age were assessed in models adjusted for a priori selected confounders. Children born to mothers with lifetime eating disorders were at an increased risk of developing wheezing (adjusted OR 1.68; [95% CI: 1.08, 2.60]), and this risk further increased when the disorders were active during pregnancy (2.52 [1.23, 5.19]). Increased risk of offspring wheezing was observed also for purging behaviors without history of eating disorder diagnosis (1.50 [1.10, 2.04]). The observed associations were not explained by comorbid depression and/or anxiety. Bulimia nervosa and/or anorexia nervosa during pregnancy were also associated with several risk factors for wheezing, including maternal smoking, adverse pregnancy outcomes, shorter breastfeeding duration, and day-care attendance. The associations of maternal eating disorders with offspring wheezing suggest long-term adverse respiratory outcomes in children of mothers with eating disorders. A better understanding of mechanisms implicated is necessary to help reduce the respiratory disease burden in these children. © 2018 Wiley Periodicals, Inc.

Maternal periodontal disease is associated with oxidative stress during pregnancy.

Science.gov (United States)

Hickman, M Ashley; Boggess, Kim A; Moss, Kevin L; Beck, James D; Offenbacher, Steven

2011-03-01

We sought to determine if maternal periodontal disease is associated with oxidative stress as measured by serum 8-isoprostane. A secondary analysis was conducted using prospective data from the Oral Conditions and Pregnancy Study. Healthy women enrolled at periodontal disease status was categorized as healthy, mild, or moderate to severe by clinical criteria. Maternal serum was analyzed for 8-isoprostane using ultrasensitive enzyme-linked immunosorbent assay. Elevated 8-isoprostane level was defined as ≥ 75th percentile. Maternal factors associated with elevated 8-isoprostane were determined using chi-square or T test. Multivariable logistic regression was used to assess association between elevated 8-isoprostane and maternal factors. Seven hundred ninety-one women had complete data. Median (interquartile) 8-isoprostane serum level was 1806 (16 to 81,870) pg/dL. Using bivariate analysis, maternal age, race, marital status, utilization of public assistance, and mild or moderate to severe periodontal disease were associated with elevated serum 8-isoprostane. Using logistic regression, moderate to severe periodontal disease (adjusted odds ratio 2.9, 95% confidence interval: 1.7 to 5.0) remained significantly associated with an elevated serum 8-isoprostane level. Maternal periodontal disease is associated with oxidative stress during pregnancy. Further study is needed to determine the role of maternal oxidative stress in periodontal disease-associated adverse pregnancy outcomes. © Thieme Medical Publishers.

Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region.

Science.gov (United States)

Kumar, Ritesh; Thakur, Surinder; Bhawani, Rajesh; Kanga, Anil; Ranjan, Asha

2016-10-01

Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment. All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc. We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for nonpregnant females. There was no difference in the severity of scrub typhus between pregnant and nonpregnant women. No mortality was found in these patients. On follow-up, they had normal peripartum and postpartum periods. All were treated with azithromycin 500 mg once a day for 5 days. Although rare, scrub typhus should be considered in differential diagnosis of fever in pregnant patients especially in scrub season. Azithromycin should be the drug of choice in pregnancy as it has no adverse effect on fetus and pregnancy outcome.

Pregnancy-associated osteoporosis presenting severe vertebral fractures.

Science.gov (United States)

Ozturk, Cihat; Atamaz, Funda Calis; Akkurt, Halil; Akkoc, Yesim

2014-01-01

The syndrome of pregnancy-associated osteoporosis (PAO) is a rare disorder which occurs either in late pregnancy or early post-partum period leading to fragility fracture(s), most commonly in the vertebral bodies. We presented two cases with PAO who had compression fractures at multiple levels involving five vertebrae in one case and 10 vertebrae in the other. Their spinal bone mineral density values were below -2.5 standard deviations. Anti-osteoporotic treatments with nasal calcitonin 400 IU/day, vitamin D 300.000 IU single dose, calcium 1000 mg/day, vitamin D 880 IU/day were initiated. In one case, kyphoplasty was performed by a spinal surgeon. In addition to a thoracolumbosacral orthosis, a rehabilitation program including muscle strengthening, range of motion, relaxation and weight-bearing exercises was started for both cases. These cases emphasize that all pregnant women with complaints of back/lumbar pain should be carefully evaluated. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Multiple Pregnancies in CKD Patients: An Explosive Mix

Science.gov (United States)

Arduino, Silvana; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Biolcati, Marlisa; Pagano, Arianna; Bossotti, Carlotta; Vasario, Elena; Borgarello, Valentina; Daidola, Germana; Ferraresi, Martina; Gaglioti, Pietro; Todros, Tullia

2013-01-01

Summary Background and objectives CKD and multiple pregnancies bear important risks for pregnancy outcomes. The aim of the study was to define the risk for adverse pregnancy-related outcomes in multiple pregnancies in CKD patients in comparison with a control group of “low-risk” multiple pregnancies. Design, setting, participants, & measurements The study was performed in the Maternal Hospital of the University of Turin, Italy. Of 314 pregnancies referred in CKD (2000–2011), 20 were multiple (15 twin deliveries). Control groups consisted of 379 low-risk multiple pregnancies (314 twin deliveries) and 19 (15 twin deliveries) cases with hypertension-collagen diseases. Baseline data and outcomes were compared by univariate and logistic regression analyses. Results The prevalence of multiple pregnancies was relatively high in the CKD population (6.4%); all referred cases were in early CKD stages (I-II); both creatinine (0.68 to 0.79 mg/dl; P=0.010) and proteinuria (0.81 to 3.42 g/d; P=0.041) significantly increased from referral to delivery. No significant difference in demographic data at baseline was found between cases and low-risk controls. CKD was associated with higher risk of adverse pregnancy outcomes versus low-risk twin pregnancies. Statistical significance was reached for preterm delivery (<34 weeks: 60% vs 26.4%; P=0.005; <32 weeks: 53.3% vs 12.7%; P<0.001), small for gestational age babies (28.6% vs 8.1%; P<0.001), need for Neonatal Intensive Care Unit (60% vs 12.7%; P<0.001), weight discordance between twins (40% vs 17.8%; P=0.032), and neonatal and perinatal mortality (6.6% vs 0.8%; P=0.032). Conclusion This study suggests that maternal-fetal risks are increased in multiple pregnancies in the early CKD stages. PMID:23124785

Ankylosing Spondylitis and Pregnancy: A Literature Review.

Science.gov (United States)

Giovannopoulou, Eirini; Gkasdaris, Grigorios; Kapetanakis, Stylianos; Kontomanolis, Emmanuel

2017-01-01

Ankylosing Spondylitis (AS) is the prototype of a group of systemic rheumatic diseases collectively referred to as Spondylarthitides (SpA). It has now become clear that AS is not as rare as previously thought and, although it has an early onset in life affecting patients in their reproductive years, it has not been proved to adversely affect fertility in females. The aim of this review is to summarize all the recent data on AS and pregnancy in terms of fertility, disease course and pregnancy outcome from a clinical perspective. A literature research was conducted based on the following medical databases: Pubmed/ Medline and the Cochrane Library. We searched for randomized controlled studies, casecontrol studies, cohort studies, patient and drug registers in relation to pregnancy and AS. The existing data do not support a causal relationship between AS and infertility. The state of pregnancy is not associated with reduced disease activity in patients with AS. Additionally, AS tends to adversely affect health-related quality of life during pregnancy, in comparison with normal population and patients with rheumatoid arthritis. As far as the obstetrical outcome is concerned, there is no consensus on the significant association between AS and specific pregnancy, delivery and fetal complications. Previous studies are highly heterogenous and mainly retrospective and thus, the existing data are controversial and inconclusive. Subsequent studies are required to enlighten our knowledge on the interaction between AS and pregnancy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Bi-directional relationship between pregnancy and periodontal disease.

Science.gov (United States)

Armitage, Gary C

2013-02-01

During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined. © 2013 John Wiley & Sons A/S.

Which drugs can be used during pregnancy?

Science.gov (United States)

Malm, Heli; Ellfolk, Maria

In many cases the decisions on drug therapy during pregnancy have to be made without evidence-based information about the effectiveness and safety of the treatment. While few drugs are known with certainty to be harmful for fetal development, the evidence for evaluating harm to the fetus is insufficient for the majority of drugs. The differentiation of fetal organs takes place during the early weeks of pregnancy, whereby it is imperative that the mother's medication be revised already when planning a pregnancy. A drug should primarily be chosen, for which experience has accumulated about its use during pregnancy and is not suspected or known to be associated with adverse effects.

Cancer and pregnancy

International Nuclear Information System (INIS)

Williams, S.F.; Bitran, J.D.

1985-01-01

The most common malignancies occurring in women of child-bearing ages include breast, cervical, genital, and GI malignancies, and melanoma, lymphoma, and leukemia. Pregnancy does not appear to adversely affect the outcome of most tumors but may affect those that are known to be hormonally dependent. The approach in general to malignancy during pregnancy needs to be individualized. Therapy, whether by radiation or with cytotoxic drugs, has the greatest potential for fetal risk during the first trimester but more acceptable risk in the second and third trimesters. There are many unanswered questions concerning long-term effects of malignancy and its therapy upon the surviving child. 58 references

[Urinary tract infection in pregnancy and menopause].

Science.gov (United States)

Broseta Rico, Enrique; Jiménez Cruz, Juan Fernando

2002-11-01

To review the topic of urinary tract infections (UTI) during pregnancy and menopause. UTI during pregnancy and menopause have great relevance in the field of urologic infections; during pregnancy because of the particularities involved in its diagnosis and treatment and potential consequences to the fetus and mother; menopausal UTI because this group of women is numerous and represents a growing section of the general population pyramid, due to the aging of population in developed countries associated with longer life expectancies and grater demand for quality of life. We performed a bibliographic review combined with our personal experience. During pregnancy there are several functional and anatomical changes that condition not only a higher risk of UTI, but also an additional treatment difficulty due to antimicrobial pharmacokinetics alterations and potential damage to the fetus. Despite efforts to find an easy, fast and reliable test for bacteriuria detection, urine culture continues to be the first diagnostic test for its detection and follow up during pregnancy. Penicillin derivates and cephalosporins continue to be the first choice because their lack of adverse effects on either fetus or mother. Alternative options like phosphomicin and aztreonam although they show low toxicity there is need for more studies supporting their suitability for the treatment of pregnancy UTIs. Menopausal female UTI have their different features from those in younger women. Hormonal alterations derived from gonadal atrophy associate functional changes in the vaginal ecosystem, making it prone to enterobacteriaceae colonization as a first step up to the urinary tract. This associated with genitourinary tract anatomical alterations inherent t aging make UTI extraordinary prevalent in this growing segment of population. Treatment lines focus on hormonal alteration correction and proper antimicrobial prophylaxis and vaccines in a close future. UTIs during pregnancy and menopause have

Galectin signature in normal pregnancy and preeclampsia.

Science.gov (United States)

Blois, Sandra M; Barrientos, Gabriela

2014-03-01

Members of the galectin family are expressed within the female reproductive tract and have been shown to be involved in multiple biological functions that support the progression of pregnancy. Specific expression patterns of different members of this family have been identified at the maternal decidua and on the placental side. In some cases, mechanisms by which galectins exert their functions have been delineated in adverse pregnancy outcomes. This review summarizes studies on galectins that have been documented to be important for pregnancy maintenance, either supporting the maternal adaptation to pregnancy or the placentation process. In addition, we focus our discussion on the role of galectins in preeclampsia, a specific life-threatening pregnancy disorder. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings

Directory of Open Access Journals (Sweden)

Dixson George R

2006-10-01

Full Text Available Abstract Objective To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. Materials and methods A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. Results Chest tubes were required in several (but not all hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. Conclusion Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.

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

Science.gov (United States)

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

2017-04-01

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

Biopsychosocial determinants of pregnancy length and fetal growth.

Science.gov (United States)

St-Laurent, Jennifer; De Wals, Philippe; Moutquin, Jean-Marie; Niyonsenga, Theophile; Noiseux, Manon; Czernis, Loretta

2008-05-01

The causes and mechanisms related to preterm delivery and intrauterine growth restriction are poorly understood. Our objective was to assess the direct and indirect effects of psychosocial and biomedical factors on the duration of pregnancy and fetal growth. A self-administered questionnaire was distributed to pregnant women attending prenatal ultrasound clinics in nine hospitals in the Montérégie region in the province of Quebec, Canada, from November 1997 to May 1998. Prenatal questionnaires were linked with birth certificates. Theoretical models explaining pregnancy length and fetal growth were developed and tested, using path analysis. In order to reduce the number of variables from the questionnaire, a principal component analysis was performed, and the three most important new dimensions were retained as explanatory variables in the final models. Data were available for 1602 singleton pregnancies. The biophysical score, covering both maternal age and the pre-pregnancy body mass index, was the only variable statistically associated with pregnancy length. Smoking, obstetric history, maternal health and biophysical indices were direct predictors of fetal growth. Perceived stress, social support and self-esteem were not directly related to pregnancy outcomes, but were determinants of smoking and the above-mentioned biomedical variables. More studies are needed to identify the mechanisms by which adverse psychosocial factors are translated into adverse biological effects.

The effect of Porphyromonas gingivalis lipopolysaccharide on pregnancy in the rat

NARCIS (Netherlands)

Kunnen, A; van Pampus, M G; Aarnoudse, J G; van der Schans, C P; Abbas, F; Faas, M M

OBJECTIVE: Periodontitis, mostly associated with Porphyromonas gingivalis, has frequently been related to adverse pregnancy outcomes. We therefore investigated whether lipopolysaccharides of P. gingivalis (Pg-LPS) induced pregnancy complications in the rat. METHODS: Experiment 1: pregnant rats (day

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

Science.gov (United States)

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

2015-01-01

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

Risk of Ectopic Pregnancy in Women With Inflammatory Bowel Disease

DEFF Research Database (Denmark)

de Silva, Punyanganie S; Hansen, Helene H; Wehberg, Sonja

2018-01-01

BACKGROUND & AIMS: Few data are available on adverse events of pregnancy in women with inflammatory bowel diseases (IBDs), such as ectopic pregnancy. We assessed the risk of an ectopic pregnancy in pregnancies of women in Denmark with IBD compared with those without IBD over a 22-year period. We...... also examined the disease-specific risks of ectopic pregnancies in pregnancies of women with ulcerative colitis (UC) or Crohn's disease (CD) who underwent IBD-related surgical procedures. METHODS: We performed a retrospective study of all women of child-bearing age (ages, 15-50 y) registered...

Effective treatment of severe pregnancy and lactation-related osteoporosis with teriparatide: case report and review of the literature.

Science.gov (United States)

Polat, Sefika Burcak; Evranos, Berna; Aydin, Cevdet; Cuhaci, Neslihan; Ersoy, Reyhan; Cakir, Bekir

2015-07-01

Pregnancy or lactation-related osteoporosis (PLO) is a very rare and debilitating condition which is usually diagnosed during the last trimester of the pregnancy or early postpartum period. Herein, we report a case with severe PLO and multiple vertebral compression fractures that were successfully treated with teriparatide. Twenty-three-year-old female patient was admitted to our clinic two months after her first spontaneous vaginal delivery with the complaint of severe back pain. Bone mineral density was measured using dual energy X-ray absorptiometry (DEXA), and low T- and Z-scores were observed in lumbar vertebrae. In vertebral MRI, severe height loss was detected in thoracic (T) 5,7,10,11,12 vertebrae. After exclusion of the other possible causes of OP, she was diagnosed to have PLO and the lactation was stopped. She was treated with calcium 1000 mg/day, cholecalciferol 800 mg/day and teriparatide 20 µg/day. At the 12th and 18th month of therapy, BMD was increased by 8% and 27%, respectively, at the lumbar spine and pain was completely relieved in few months. There are pharmacological therapy modalities that can be used in PLO. Bisphosphonates are effective, but there are some concerns that they accumulate in bone and may expose fetus in subsequent pregnancies. Teriparatide is a strong candidate to be the optimal medical therapy in severe cases since it is effective and safe.

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

Science.gov (United States)

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

2015-05-01

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

Drugs use during pregnancy at Medani Maternity Hospital, Sudan ...

African Journals Online (AJOL)

Background: There is a limited knowledge on use of drugs during pregnancy including beneficial and possible adverse effects of drugs on both the mother and the fetus. Objective: To investigate epidemiology of use of drugs during pregnancy. Methods: A cross sectional hospital based study at Medani Hospital during the ...

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

Directory of Open Access Journals (Sweden)

Kovač Mirjana

2011-01-01

Full Text Available Background. Presence of inherited thrombophilia is an additional risk factor for maternal thromboembolism and certain adverse pregnancy outcomes, including recurrent fetal loss, placental abruption, intrauterine growth restriction and earlyonset severe preeclampsia. Pregnant women with thrombophilia, especially those with antithrombin (AT deficiency, are at high risk of both kinds of complications. Case report. We presented a pregnant women with congenital antithrombin deficiency in the first pregnancy, whose mother had had four times pregnancy-related deep vein thrombosis, and antithrombin deficiency. With the regular laboratory monitoring of hemostatic parameters and gynaecology surveillance including the follow-up of placental vascular flow, the whole pregnancy proceeded without complications. The prophylactic therapy with low molecular weight heparin was introduced from the 20th week of gestation and one dose of substitution therapy with antithrombin concentrate was administrated before delivery. Pregnancy and labour were terminated without complications at the 37th week of gestation, resulting in the delivery of a healthy male newborn of 3.6 kg body weight, 52 cm long, and with the Apgar scores of 9/10. Conclusion. A timely made diagnosis of thrombophilia, accompanied with regular obstetrics check-ups and follow-ups of hemostatic parameters during pregnancy, as well as the use of adequate prophylactic and substitution therapy, are the successful tools for the prevention of possible maternal complications and pregnancy itself in our patient with congenital AT deficiency.

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

Directory of Open Access Journals (Sweden)

Vivatkusol Y

2017-05-01

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

Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity.

Science.gov (United States)

Brown, Nicole M; Brown, Suzette N; Briggs, Rahil D; Germán, Miguelina; Belamarich, Peter F; Oyeku, Suzette O

Although identifying adverse childhood experiences (ACEs) among children with behavioral disorders is an important step in providing targeted therapy and support, little is known about the burden of ACEs among children with attention deficit-hyperactivity disorder (ADHD). We described the prevalence of ACEs in children with and without ADHD, and examined associations between ACE type, ACE score, and ADHD diagnosis and severity. Using the 2011 to 2012 National Survey of Children's Health, we identified children aged 4 to 17 years whose parents indicated presence and severity of ADHD, and their child's exposure to 9 ACEs. Multivariate logistic regression was used to estimate associations between ACEs, ACE score, and parent-reported ADHD and ADHD severity, adjusted for sociodemographic characteristics. In our sample (N = 76,227, representing 58,029,495 children), children with ADHD had a higher prevalence of each ACE compared with children without ADHD. Children who experienced socioeconomic hardship (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.21-1.59), divorce (aOR, 1.34; 95% CI, 1.16-1.55), familial mental illness (aOR, 1.55; 95% CI, 1.26-1.90), neighborhood violence (aOR, 1.47; 95% CI, 1.23-1.75), and incarceration (aOR, 1.39; 95% CI, 1.12-1.72) were more likely to have ADHD. A graded relationship was observed between ACE score and ADHD. Children with ACE scores of 2, 3, and ≥4 were significantly more likely to have moderate to severe ADHD. Children with ADHD have higher ACE exposure compared with children without ADHD. There was a significant association between ACE score, ADHD, and moderate to severe ADHD. Efforts to improve ADHD assessment and management should consider routinely evaluating for ACEs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Fetal growth and adverse birth outcomes in women receiving prescriptions for acetaminophen during pregnancy

DEFF Research Database (Denmark)

Thulstrup, Ane Marie; Sørensen, Henrik Toft; Nielsen, Gunnar Lauge

1999-01-01

not receive any prescription at all. We found more malformations among those who received a prescription with an odds ratio of 2.3 (95% CI 1.0-5.4), but the type of malformations did not indicate a causal link. When restricting the study to first time pregnancies, we identified 58 women who received......We studied the association between acetaminophen exposure during pregnancy and the prevalence of congenital abnormalities and fetal growth. Our study included 123 women who had received a prescription of acetaminophen during pregnancy and/or 30 days before conception and 13,329 controls who did...

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

Science.gov (United States)

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

2014-01-01

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

Stress and emotional problems during pregnancy and excessive infant crying

NARCIS (Netherlands)

van der Wal, Marcel F.; van Eijsden, Manon; Bonsel, Gouke J.

2007-01-01

OBJECTIVE: There is evidence that stress and emotional problems during pregnancy are related to adverse health outcomes of the child at birth and in later life. The aim of this study was to determine the association between stress and emotional problems during pregnancy and excessive infant crying.

Immunological Adaptations to Pregnancy in Women with Type 1 Diabetes

NARCIS (Netherlands)

Groen, Bart; van der Wijk, Anne-Eva; van den Berg, Paul P.; Lefrandt, Joop D.; van den Berg, Gerrit; Sollie, Krystina M.; de Vos, Paul; Links, Thera P.; Faas, Marijke M.

2015-01-01

Despite adequate glycemic control, pregnancy outcome of women with type 1 diabetes (T1D) is still unfavorable as compared to healthy women. In a rat-model of T1D under normoglycemic conditions, adverse pregnancy outcome was also observed, which was associated with aberrant immunological adaptations

Severe hepatotoxic adverse reaction in a healthy schoolgirl after treatment with flucloxacillin

Directory of Open Access Journals (Sweden)

C-J Törnhage

2009-03-01

Full Text Available C-J Törnhage1, G Brunlöf2, S M Wallerstedt21Department of Paediatrics, Central Hospital, Skaraborg, Skövde, Sweden; 2Department of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, SwedenAbstract: This is the first detailed description of a severe hepatotoxic reaction in a previously healthy 9-year-old schoolgirl after ingestion of some flucloxacillin tablets. She was clinically well within one week and alanine aminotransferase in serum was normalized in one month. Follow up for more than one year was normal.Keywords: adverse reaction, children, flucloxacillin, hepatopathy

Rheumatic diseases and pregnancy

African Journals Online (AJOL)

women with rheumatic diseases constitute a high-risk population, with potential adverse fetal ... who are not actively planning a pregnancy, or are taking drugs that are ... disease.[9] Fetal loss (miscarriage or stillbirth) occurs in about 20% of ..... trimester,[3] with up to 70% of patients needing NSAIDs. .... No. Use low dose.

Heart Failure: Diagnosis, Severity Estimation and Prediction of Adverse Events Through Machine Learning Techniques

Directory of Open Access Journals (Sweden)

Evanthia E. Tripoliti

Full Text Available Heart failure is a serious condition with high prevalence (about 2% in the adult population in developed countries, and more than 8% in patients older than 75 years. About 3–5% of hospital admissions are linked with heart failure incidents. Heart failure is the first cause of admission by healthcare professionals in their clinical practice. The costs are very high, reaching up to 2% of the total health costs in the developed countries. Building an effective disease management strategy requires analysis of large amount of data, early detection of the disease, assessment of the severity and early prediction of adverse events. This will inhibit the progression of the disease, will improve the quality of life of the patients and will reduce the associated medical costs. Toward this direction machine learning techniques have been employed. The aim of this paper is to present the state-of-the-art of the machine learning methodologies applied for the assessment of heart failure. More specifically, models predicting the presence, estimating the subtype, assessing the severity of heart failure and predicting the presence of adverse events, such as destabilizations, re-hospitalizations, and mortality are presented. According to the authors' knowledge, it is the first time that such a comprehensive review, focusing on all aspects of the management of heart failure, is presented. Keywords: Heart failure, Diagnosis, Prediction, Severity estimation, Classification, Data mining

An Update on Teen Pregnancy.

Science.gov (United States)

Ahern, Nancy R; Bramlett, Traci

2016-02-01

After years of high teen birth rates, there is currently a decline in U.S. pregnancy and birth rates among teens. Nevertheless, these rates continue to be higher than those of most global counterparts, and psychosocial and physical adversities still occur for pregnant teens and their children. The declining birth rates may be due to teens making better choices about contraceptive use and sexual behaviors. Psychiatric-mental health nurses are in key positions to enhance pregnancy prevention for teens. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 25-28.]. Copyright 2016, SLACK Incorporated.

Impact of antepartum diagnostic amnioinfusion on targeted ultrasound imaging of pregnancies presenting with severe oligo- and anhydramnios: An analysis of 61 cases.

Science.gov (United States)

Vikraman, Seneesh Kumar; Chandra, Vipin; Balakrishnan, Bijoy; Batra, Meenu; Sethumadhavan, Sreeja; Patil, Swapneel Neelkanth; Nair, Sabila; Kannoly, Gopinathan

2017-05-01

The primary objective our study was to assess the role of diagnostic antepartum amnioinfusion on the yield from targeted ultrasounds performed in pregnancies with severe oligo- and anhydramnios. This was a retrospective and descriptive study, conducted in the fetal medicine units of two private tertiary care referral centers in south India. The details of all the cases of diagnostic amnioinfusion performed at these two centers from January 2009 to June 2016 were collected and analyzed. Inclusion criteria were pregnancies between 17 and 26 weeks of gestational age with severe oligo- or anhydramnios. Pregnancies with obvious preterm premature rupture of membranes (PPROM) were excluded. The primary outcome measure was the improvement in diagnostic information pertaining to cause of severe oligo- and anhydramnios, and the nature of such anomalies. A total of 61 cases of were identified. The median gestational age at performance of the procedure was 22 weeks [IQR, 19.5-23]. The mean volume of normal saline infused was 314±54ml. A significant increase in the single vertical pocket (SVP) was observed following the procedure (pre-procedure SVP=0.6±0.9cm, post procedure SVP=3.4±1.7; paired t test, pamnioinfusion is a valuable ancillary technique in prenatal diagnosis as it increases the diagnostic yield from pregnancies presenting with severe oligo- and anhydramnios. Copyright © 2017 Elsevier B.V. All rights reserved.

Poverty, near-poverty, and hardship around the time of pregnancy.

Science.gov (United States)

Braveman, Paula; Marchi, Kristen; Egerter, Susan; Kim, Soowon; Metzler, Marilyn; Stancil, Tonya; Libet, Moreen

2010-01-01

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income poverty level [FPL]) and 20% near-poor (101-200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship. While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships; e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.

Pre-pregnancy obesity and maternal nutritional biomarker status during pregnancy: a factor analysis.

Science.gov (United States)

Tomedi, Laura E; Chang, Chung-Chou H; Newby, P K; Evans, Rhobert W; Luther, James F; Wisner, Katherine L; Bodnar, Lisa M

2013-08-01

Pre-pregnancy obesity has been associated with adverse birth outcomes. Poor essential fatty acid (EFA) and micronutrient status during pregnancy may contribute to these associations. We assessed the associations between pre-pregnancy BMI and nutritional patterns of maternal micronutrient and EFA status during mid-pregnancy. A cross-sectional analysis from a prospective cohort study. Women provided non-fasting blood samples at ≥ 20 weeks’ gestation that were assayed for red cell EFA; plasma folate, homocysteine and ascorbic acid; and serum retinol, 25-hydroxyvitamin D, a-tocopherol, soluble transferrin receptors and carotenoids. These nutritional biomarkers were employed in a factor analysis and three patterns were derived: EFA, Micronutrients and Carotenoids. The Antidepressant Use During Pregnancy Study, Pittsburgh, PA, USA. Pregnant women (n 129). After adjustment for parity, race/ethnicity and age, obese pregnant women were 3.0 (95% CI 1.1, 7.7) times more likely to be in the lowest tertile of the EFA pattern and 4.5 (95% CI 1.7, 12.3) times more likely to be in the lowest tertile of the Carotenoid pattern compared with their lean counterparts. We found no association between pre-pregnancy obesity and the Micronutrient pattern after confounder adjustment. Our results suggest that obese pregnant women have diminished EFA and carotenoid concentrations.

Predictors of Ramadan fasting during pregnancy

Directory of Open Access Journals (Sweden)

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.

GITELMAN SYNDROME AND PREGNANCY- A RARE CASE REPORT

Directory of Open Access Journals (Sweden)

Venkatachalam Sibiya

2017-09-01

Full Text Available PRESENTATION OF CASE A 22 years old G2 P1 D1 came with complaints of shivering of both upper limb and lower limb. She was diagnosed with Gitelman syndrome in previous pregnancy. Previous was a preterm delivery due to polyhydramnios and the baby died at 12 days of life due to some congenital malformation of heart. In previous pregnancy, patient presented with paralysis at 6 months of gestation and was treated conservatively by correcting the electrolytes level. In the present pregnancy, patient had persistent hypokalaemia and hypomagnesaemia, which was treated. Anomaly scan was done. No gross anomaly was detected. Patient is symptomatically better and she is continuing her pregnancy, hope better outcome since GS has no adverse effect on pregnancy.

Screening for Thyroid Dysfunction in Pregnancy: Is It Worthwhile?

Directory of Open Access Journals (Sweden)

John H. Lazarus

2011-01-01

Full Text Available There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.

Deflation of gastric band balloon in pregnancy for improving outcomes.

Science.gov (United States)

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

2013-04-30

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

Reduced infant birthweight consequent upon maternal exposure to severe life events

DEFF Research Database (Denmark)

Khashan, Ali; McNamee, R.; Pedersen, Marianne Giørtz

2008-01-01

OBJECTIVE: To investigate the association between maternal exposure to severe life events and fetal growth (birthweight and small for gestational age). Stress has been associated with adverse pregnancy outcome. METHODS: Mothers of 1.38 million singleton live births in Denmark between January 1......). There was a significant association between maternal exposure to death of a relative and risk of a baby weighing below the 10th percentile (adjusted relative risk (RR) = 1.17, 95% CI = 1.13, 1.22) and 5th percentile (adjusted RR = 1.22, 95% CI = 1.15, 1.29). CONCLUSIONS: Mothers exposed to severe life events before...... conception or during pregnancy have babies with significantly lower birthweight. If this association is causal, the potential mechanisms of stress-related effects on birthweight include changes in lifestyle due to the exposure and stress-related dysregulation of the hypothalamic-pituitary-adrenal axis during...

Factor V Leiden mutation in pregnancy.

Science.gov (United States)

Cohen, Susan Murphy

2004-01-01

Normal maternal adaptation to pregnancy significantly increases the risk for thrombus formation. Inherited thrombophilias further increase risk for deep venous thrombosis and adverse outcome in pregnancy. Factor V Leiden mutation is the most common inherited thrombophilia, occurring in approximately 5% of the White and 1% of the Black populations. Nurses should be knowledgeable about screening for and diagnosis of factor V Leiden mutation, risk reduction counseling, recommended care of the affected patient, and implications of anticoagulant therapy during the perinatal period.

Aberrant Pregnancy Adaptations in the Peripheral Immune Response in Type 1 Diabetes : A Rat Model

NARCIS (Netherlands)

Groen, Bart; Links, Thera P; Lefrandt, Joop D; van den Berg, Paul P; de Vos, Paul; Faas, Marijke M

2013-01-01

Introduction: Despite tight glycemic control, pregnancy complication rate in type 1 diabetes patients is higher than in normal pregnancy. Other etiological factors may be responsible for the development of adverse pregnancy outcome. Acceptance of the semi-allogeneic fetus is accompanied by

Teenage pregnancy.

Science.gov (United States)

Molina Cartes, Ramiro; González Araya, Electra

2012-01-01

Teen pregnancy is a social problem not resolved in developing and some developed countries. Adolescent fecundity has become the most exact bio-demographic and health indicator of development. In developing countries that are expected to follow the sexual behaviour patterns of developed countries, without offering the levels of education and services for adolescents, the consequences will be adolescent fecundity and STI prevalence increase. The ignorance about sexuality and reproduction both in parents, teachers and adolescents increases the early initiation of coital relations and of unwanted pregnancies. Extreme poverty and being the son or daughter of an adolescent mother are risk factors of repeating the early pregnancy model. The application of predictive risk criteria in pregnant adolescents to facilitate the rational use of Health Services to diminish the maternal and perinatal mortality is discussed as well as the social factors associated with adolescent pregnancy as socioeconomic levels, structure - types and characteristics of the family, early leaving school, schooling after delivery, female employment, lack of sexual education, parental and family attitudes in different periods of adolescent pregnancy, adolescent decisions on pregnancy and children, unstable partner relationship and adoption as an option. Social consequences are analyzed as: incomplete education, more numerous families, difficulties in maternal role, abandonment by the partner, fewer possibilities of having a stable, qualified and well-paid job, greater difficulty in improving their socioeconomic level and less probability of social advancement, lack of protection of the recognition of the child. Finally, based on evidence, some measures that can reduce adverse consequences on adolescent mothers, fathers and their children are suggested. Copyright © 2012 S. Karger AG, Basel.

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

Directory of Open Access Journals (Sweden)

Santiago Garcia-Tizon Larroca

2017-02-01

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

The Use and Safety of TNF Inhibitors during Pregnancy in Women with Psoriasis: A Review

Directory of Open Access Journals (Sweden)

Cæcilie Bachdal Johansen

2018-05-01

Full Text Available Psoriasis is a chronic immune-mediated inflammatory disease affecting women of childbearing potential. Biologic agents, notably Tumor Necrosis Factor inhibitors (TNFi, are the only current non-contraindicated systemic treatment option during pregnancy. TNFi comprised of complete immunoglobulin G (IgG antibodies antibodies (adalimumab, golimumab, and infliximab actively cross the placenta from the second trimester and are detectable in the child up to one year postpartum. Data on safety of TNFi are conflicting; however a trend towards drug-specific harm has been reported, with increased risk of congenital malformations and preterm birth. TNFi exposure may alter the immune system of the infant towards hypersensitivity and reduced response to intracellular infections. Confounding by indication should be considered, as chronic inflammatory disease itself may pose a risk of adverse pregnancy outcomes. The quality of the current evidence is very low and no studies specifically address TNFi safety in women with psoriasis. Nonetheless, risks associated with TNFi treatment must be balanced against the as-yet uncertain risk of adverse outcomes in infants born to women with severe psoriasis. We searched PubMed using Medical Subject Headings (MeSH terms and identified relevant studies and guidelines. Herein, we present the current knowledge of the use and safety of TNFi during pregnancy in women with psoriasis.

Potential exposure to endocrine disrupting chemicals and selected adverse pregnancy outcomes

DEFF Research Database (Denmark)

Bengtsson, Jessica; Thygesen, Pernille Søgaard; Kaerlev, Linda

2017-01-01

potential occupational exposure to endocrine disrupting chemicals (EDC) of the mother during pregnancy is associated with preterm birth and low birth weight. Methods: Pregnant women referred to an Occupational Health Clinic (OHC) in two Danish regions (Copenhagen or Aarhus) between 1984 and 2010, suspected...... on the suspicion of other exposures than EDC (n = 620), and to a sample of births by all occupationally active women in the same geographical regions (n = 346,544), including 1,077 births of the referred women’s non-referred pregnancies. Results: No indications of reduced birth weight or increased risk of preterm...... birth were found among women potentially exposed to EDC. Women potentially exposed to EDC had children with a higher birth weight compared to the sample of occupationally active women but not compared to other women referred to an OHC. Conclusions: Potential maternal exposure to EDC at Danish workplaces...

FEMALE FARMWORKERS’ PERCEPTIONS OF HEAT-RELATED ILLNESS AND PREGNANCY HEALTH

OpenAIRE

Flocks, Joan; Mac, Valerie Vi Thien; Runkle, Jennifer; Tovar-Aguilar, Jose Antonio; Economos, Jeannie; McCauley, Linda A.

2013-01-01

While agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women’s perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack c...

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

Science.gov (United States)

Hasanjanzadeh, Parvin; Faramarzi, Mahbobeh

2017-04-01

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

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

Directory of Open Access Journals (Sweden)

Tandu-Umba B

2014-12-01

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

Intravenous iron sucrose therapy for moderate to severe anaemia in pregnancy

Directory of Open Access Journals (Sweden)

Alka Kriplani

2013-01-01

Full Text Available Background & objectives: Iron deficiency anaemia (IDA is the most common nutritional deficiency in pregnancy. Prophylactic oral iron is recommended during pregnancy to meet the increased requirement. In India, women become pregnant with low baseline haemoglobin level resulting in high incidence of moderate to severe anaemia in pregnancy where oral iron therapy cannot meet the requirement. Pregnant women with moderate anaemia are to be treated with parentral iron therapy. This study was undertaken to evaluate the response and effect of intravenous iron sucrose complex (ISC given to pregnant women with IDA. Methods: A prospective study was conducted (June 2009 to June 2011 in the department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi. One hundred pregnant women with haemoglobin between 5-9 g% with diagnosed iron deficiency attending antenatal clinic were given intravenous iron sucrose complex in a dose of 200 mg twice weekly schedule after calculating the dose requirement. Results: The mean haemoglobin raised from 7.63 ± 0.61 to 11.20 ± 0.73 g% (P<0.001 after eight wk of therapy. There was significant rise in serum ferritin levels (from 11.2 ± 4.7 to 69 ± 23.1 μg/l (P<0.001. Reticulocyte count increased significantly after two wk of starting therapy (from 1.5 ± 0.6 to 4.6±0.8%.Other parameters including serum iron levels and red cell indices were also improved significantly. Only one woman was lost to follow up. No major side effects or anaphylactic reactions were noted during study period. Interpretation & conclusions: Parentral iron therapy was effective in increasing haemoglobin, serum ferritin and other haematological parameters in pregnant women with moderate anaemia. Intravenous iron sucrose can be used in hospital settings and tertiary urban hospitals where it can replace intramuscular therapy due to injection related side effects. Further, long-term comparative studies are required to recommend its

Twin pregnancy complicated by severe hemolytic disease of the fetus and newborn due to anti-g and anti-C.

Science.gov (United States)

Trevett, Thomas N; Moise, Kenneth J

2005-11-01

Hemolytic disease of the fetus and newborn caused by anti-G antibodies is rare, and in most previously reported cases, leads to a mild anemia. The RhG antigen is usually found in association with both RhD and RhC. We report a case of a twin pregnancy affected by both anti-G and anti-C alloantibodies leading to severe hemolytic disease of the fetus and newborn requiring multiple intrauterine transfusions and prolonged postnatal therapy. A patient with a prolonged history of previously affected pregnancies due to anti-D and anti-C was subsequently found to be affected with anti-G instead. She required aggressive therapy during her pregnancy, initially with intravenous immune globulin and plasmapheresis until umbilical blood sampling and intrauterine transfusions were feasible. Although hemolytic disease of the fetus and newborn due to anti-G antibodies is rare and usually mild, these pregnancies should be followed up closely and in utero therapy should be offered if necessary.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

Directory of Open Access Journals (Sweden)

Nucci Luciana Bertoldi

2001-01-01

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

Potential exposure to endocrine disrupting chemicals and selected adverse pregnancy outcomes

DEFF Research Database (Denmark)

Bengtsson, Jessica; Thygesen, Pernille Søgaard; Kaerlev, Linda

2017-01-01

potential occupational exposure to endocrine disrupting chemicals (EDC) of the mother during pregnancy is associated with preterm birth and low birth weight. Methods: Pregnant women referred to an Occupational Health Clinic (OHC) in two Danish regions (Copenhagen or Aarhus) between 1984 and 2010, suspected...

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

Science.gov (United States)

Papapanou, Panos N.

2015-01-01

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

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)