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Sample records for alcohol-exposed pregnancy risk

  1. A Dual-Focus Motivational Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy

    ERIC Educational Resources Information Center

    Velasquez, Mary M.; Ingersoll, Karen S.; Sobell, Mark B.; Floyd, R. Louise; Sobell, Linda Carter; von Sternberg, Kirk

    2010-01-01

    Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large…

  2. Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk

    PubMed Central

    Ingersoll, Karen S.; Ceperich, Sherry D.; Hettema, Jennifer E.; Farrell-Carnahan, Leah; Penberthy, J. Kim

    2013-01-01

    Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care. PMID:23192220

  3. A Quick Drinking Screen for identifying women at risk for an alcohol-exposed pregnancy.

    PubMed

    Dum, Mariam; Sobell, Linda Carter; Sobell, Mark B; Heinecke, Nicholas; Voluse, Andrew; Johnson, Kenneth

    2009-09-01

    Two previous studies comparing the Quick Drinking Screen (QDS) with the Timeline Followback (TLFB) found that these two instruments yielded similar reports of alcohol use for clinical and nonclinical populations of problem drinkers. The current study evaluated the correspondence between these two drinking measures with women at risk of an Alcohol-Exposed Pregnancy (AEP). Participants were 355 women who voluntarily participated in a research study during 2005 through 2007 designed to prevent AEPs. All women were screened by phone for eligibility using the QDS and approximately 2 weeks later completed a 3-month TLFB by mail. Results of this study, analyzed in 2008, paralleled previous studies showing that the QDS and the TLFB, two very different drinking measures, collected similar aggregate drinking data for women who drink heavily and are at risk of an AEP. Correspondence between the two drinking measures met acceptable levels of reliability. The present study found that the QDS has demonstrated efficacy for screening women whose level of alcohol use puts them at risk for an AEP. Although the QDS does not yield detailed drinking information, it could be used when it is not possible or necessary to gather daily drinking data. PMID:19406583

  4. Preventing Alcohol-Exposed Pregnancy among American-Indian Youth

    ERIC Educational Resources Information Center

    Jensen, Jamie; Kenyon, DenYelle Baete; Hanson, Jessica D.

    2016-01-01

    Research has determined that the prevention of alcohol-exposed pregnancies (AEP) must occur preconceptually, either by reducing alcohol intake in women planning pregnancy or at risk for becoming pregnant, or by preventing pregnancy in women drinking at risky levels. One such AEP prevention programme with non-pregnant American-Indian (AI) women is…

  5. CHOICES: an integrated behavioral intervention to prevent alcohol-exposed pregnancies among high-risk women in community settings.

    PubMed

    Velasquez, Mary M; von Sternberg, Kirk; Parrish, Danielle E

    2013-01-01

    CHOICES is an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. The intervention uses motivational interviewing and cognitive-behavioral strategies, and targets adoption of effective contraception and reduction of alcohol use. The CHOICES intervention includes four manual-guided counseling sessions delivered by behavioral health counselors and one contraceptive session with a family planning clinician. CHOICES's efficacy has been established through a series of randomized controlled trials in settings including primary care, university hospital-based obstetrical/gynecology practices, urban jails, substance abuse treatment settings, and a media-recruited sample in three large cities. This article describes the CHOICES line of research including the epidemiology, feasibility, and efficacy studies. It also details the CHOICES intervention and the components of each session. In addition, the authors describe current studies testing modifications of the CHOICES intervention, the dissemination efforts to date, and implications for social work practice. PMID:23731416

  6. Feasibility and Promise of a Remote-Delivered Preconception Motivational Interviewing Intervention to Reduce Risk for Alcohol-Exposed Pregnancy

    PubMed Central

    Farrell-Carnahan, Leah; Hettema, Jennifer; Jackson, Justin; Kamalanathan, Shivi; Ritterband, Lee M.

    2013-01-01

    Abstract Background: Alcohol-exposed pregnancy (AEP) is a leading cause of birth defects. Effective face-to-face preconception interventions based on motivational interviewing (MI) exist and should be translated into remote formats for maximum public health impact. This study investigated the feasibility and promise of a one-session, remote-delivered, preconception, MI-based AEP intervention (EARLY Remote) for non–treatment-seeking community women. Subjects and Methods: This was a single-arm, prospective pilot intervention study. All participants received the intervention via telephone and mail. Feasibility of remote-delivery methods, treatment engagement, treatment credibility, MI treatment integrity, and therapeutic alliance were examined. Outcomes were 3- and 6-month drinks per drinking day (DDD), rate of unreliable contraception, and proportion of women at risk for AEP due to continued risk drinking and no or unreliable contraception use. Results: Feasibility of remote delivery was established; participants were engaged by the intervention and rated it as credible. Integrity to MI and therapeutic alliance were good. Both DDD and rate of unreliable contraception decreased significantly over time. Proportions of women who drank at risk levels, used unreliable or no contraception, and/or were at risk for AEP in the past 90 days decreased significantly from baseline to 6 months. Conclusions: Remote delivery was feasible, and the translated remote intervention may reduce AEP risk. Refinement of EARLY Remote may facilitate its placement within a spectrum of effective MI-based preconception AEP interventions as part of a stepped-care approach. EARLY Remote may have an important role within a stepped-care model for dissemination to geographically disperse women at risk for AEP. This could result in substantial public health impact through reduction of AEP on a larger scale. PMID:23763608

  7. Reducing alcohol-exposed pregnancy risk in college women: Initial outcomes of a clinical trial of a motivational intervention

    PubMed Central

    Ingersoll, Karen S.; Ceperich, Sherry Dyche; Nettleman, Mary D.; Karanda, Kimberly; Brocksen, Sally; Johnson, Betty Anne

    2010-01-01

    A significant number of college women are at risk for alcohol-exposed pregnancy (AEP) owing to binge drinking paired with using contraception ineffectively. This article describes a randomized controlled trial of a one-session motivational interviewing-based intervention to reduce AEP risk among college women and presents 1-month outcomes demonstrating the early impact of this intervention. There were 228 female students from a mid-Atlantic urban university enrolled in the trial. Eligibility criteria were being in the age range of 18–24 years and being at risk for AEP. Risk for AEP was defined as having sexual intercourse with a man in the past 90 days while using contraception ineffectively (no use, incorrect use of an effective method, or use of an ineffective method only); drinking at risky levels was defined as engaging in at least one binge in the past 90 days or consuming an average of eight standard drinks per week. One-month outcome data were available for 212 of the 228 enrolled women (a follow-up rate of 93%), with complete data available for 105 women assigned to the control condition and 94 assigned to the intervention condition. At 1-month follow-up, 15% of the control subjects and 25% of the intervention women reported no risk drinking, a significant difference favoring the intervention group. Significantly fewer control subjects (48%) used effective contraception at 1-month follow-up as compared with intervention women (64%), χ2(1) = 5.1, p < .03. Significantly more intervention women (74%) were no longer at risk for AEP at 1 month as compared with control subjects (54%), χ2(1) = 8.15, p < .005. Factors that were associated with continued AEP risk at 1-month follow-up were a higher number of standard drinks per day consumed in the month prior to baseline (odds ratio, 1.1) and assignment to the control condition (odds ratio, 2.9). The risks of unintended pregnancy and AEP among drinking women in college merit greater prevention efforts. The

  8. Preventing alcohol-exposed pregnancy among American-Indian youth

    PubMed Central

    Jensen, Jamie; Baete Kenyon, Den Yelle; Hanson, Jessica D.

    2015-01-01

    Research has determined that the prevention of alcohol-exposed pregnancies (AEP) must occur pre-conceptually with women, either by reducing alcohol intake in women planning pregnancy or at-risk for becoming pregnant, or by preventing pregnancy in women drinking at risky levels. One such AEP prevention programme with non-pregnant American Indian women is the Oglala Sioux Tribe (OST) CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) Programme, which shows promise in reducing AEP risk in American Indian women aged 18 or older. A community needs assessment was conducted with key informant interviews and focus groups with an emphasis on how to expand OST CHOICES. To identify interconnected themes, a content analysis methodology was used on the qualitative feedback from the focus groups and interviews. Altogether, key informant interviews were completed with 25 health and social service professionals. Eight focus groups were held with 58 American Indian participants, including adult women of child-bearing age, elder women, and adult men. Several sub-themes regarding the prevention of AEP with youth were identified, expanding the OST CHOICES curriculum into the schools, and the role of family and culture within AEP prevention.

  9. Prevalence and characteristics of women at risk for an alcohol-exposed pregnancy (AEP) in the United States: estimates from the National Survey of Family Growth.

    PubMed

    Cannon, Michael J; Guo, Jing; Denny, Clark H; Green, Patricia P; Miracle, Heidi; Sniezek, Joseph E; Floyd, R Louise

    2015-04-01

    Non-pregnant women can avoid alcohol-exposed pregnancies (AEPs) by modifying drinking and/or contraceptive practices. The purpose of this study was to estimate the number and characteristics of women in the United States who are at risk of AEPs. We analyzed data from in-person interviews obtained from a national probability sample (i.e., the National Survey of Family Growth) of reproductive-aged women conducted from January 2002 to March 2003. To be at risk of AEP, a woman had to have met the following criteria in the last month: (1) was drinking; (2) had vaginal intercourse with a man; and (3) did not use contraception. During a 1-month period, nearly 2 million U.S. women were at risk of an AEP (95 % confidence interval 1,760,079-2,288,104), including more than 600,000 who were binge drinking. Thus, 3.4 %, or 1 in 30, of all non-pregnant women were at risk of an AEP. Most demographic and behavioral characteristics were not clearly associated with AEP risk. However, pregnancy intention was strongly associated with AEP risk (prevalence ratio = 12.0, P < 0.001) because women often continued to drink even after they stopped using contraception. Nearly 2 million U.S. women are at AEP risk and therefore at risk of having children born with fetal alcohol spectrum disorders. For pregnant women and women intending a pregnancy, there is an urgent need for wider implementation of prevention programs and policy approaches that can reduce the risk for this serious public health problem. PMID:24996954

  10. A Web-Based Intervention to Reduce Alcohol-Exposed Pregnancies in the Community

    ERIC Educational Resources Information Center

    Tenkku, Leigh E.; Mengel, Mark B.; Nicholson, Robert A.; Hile, Matthew G.; Morris, Daniel S.; Salas, Joanne

    2011-01-01

    Despite warnings that drinking during pregnancy is unsafe, many women are still at risk for an alcohol-exposed pregnancy (AEP). This article describes the outcomes of a web-based, self-guided change intervention designed to lower the risk for AEPs in a community. A sample of 458 women, between the ages of 18 and 44 years and at risk for an AEP…

  11. Importance of Social Support in Preventing Alcohol-Exposed Pregnancies with American Indian Communities

    PubMed Central

    Jensen, Jamie

    2014-01-01

    Background Recent research concludes that prevention of alcohol-exposed pregnancies (AEP) must occur with preconceptional women, either by reducing alcohol consumption in women at-risk or planning pregnancy or preventing pregnancy in women drinking at risky levels. One AEP prevention program currently underway with non-pregnant American Indian women is the Oglala Sioux Tribe (OST) CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) Program. The OST CHOICES Program shows promise in lowering the AEP risk in American Indian women, and it is a natural next step to evaluate the potential impact that social support can have on further encouraging behavioral changes. Methods Focus groups with community members and key informant interviews with health and social service professionals were completed. To uncover and interpret interrelated themes, a conventional content analysis methodology was used. Results Eight focus groups were held with 58 American Indian participants, including adult women of child-bearing age, elder women, and adult men. Key informant interviews were completed with 25 health and social service professionals. Based on input from the focus groups and key informant interviews, several subthemes regarding social support in the prevention of AEP stood out, including the role of family (especially elders), the impact community can have, and the important function of culture. Conclusions In this study, we highlighted the important influence that social support can have on AEP prevention, especially among the American Indian population, where social support has cultural and historical significance. PMID:24974087

  12. Depressive Symptoms Moderate Treatment Response to Brief Intervention for Prevention of Alcohol Exposed Pregnancy

    PubMed Central

    Penberthy, J. Kim; Hook, Joshua; Hettema, Jennifer; Farrell-Carnahan, Leah; Ingersoll, Karen

    2013-01-01

    The previously published randomized controlled trial, EARLY, tested the efficacy of a Motivational Interviewing (MI) plus Feedback condition against a Video Information (VI) condition and an Informational Brochure (IB) condition in reducing drinking and/or increasing contraception effectiveness, and found that drinking and rates of effective contraception improved in all conditions. In this reanalysis of the data from EARLY, potential moderating effects of depressive, global distress, and anxiety symptoms in response to the 3 brief interventions to reduce alcohol exposed pregnancy risk were examined. Women with higher levels of depression at baseline reported greater improvements in the MI plus Feedback condition versus the VI and IB conditions with depression moderating both drinking and contraceptive effectiveness. Global distress moderated only drinking behavior in the MI plus Feedback but not other groups and anxiety was not a moderator of outcome in any of the intervention groups. Depressed or distressed women at risk for AEP may benefit from an AEP risk reduction intervention that incorporates interaction with a treatment provider versus educational information provided via video or written materials. PMID:23810264

  13. The impact of micronutrient supplementation in alcohol-exposed pregnancies on information processing skills in Ukrainian infants.

    PubMed

    Kable, J A; Coles, C D; Keen, C L; Uriu-Adams, J Y; Jones, K L; Yevtushok, L; Kulikovsky, Y; Wertelecki, W; Pedersen, T L; Chambers, C D

    2015-11-01

    The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) was explored in a clinical trial conducted in Ukraine. Cardiac orienting responses (ORs) during a habituation/dishabituation learning paradigm were obtained from 6 to 12 month-olds to assess neurophysiological encoding and memory. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to a group (No study-provided supplements, multivitamin/mineral supplement, or multivitamin/mineral supplement plus choline supplement). Heart rate was collected for 30 s prior to stimulus onset and 12 s post-stimulus onset. Difference values (∆HR) for the first 3 trials of each condition were aggregated for analysis. Gestational blood samples were collected to assess maternal nutritional status and changes as a function of the intervention. Choline supplementation resulted in a greater ∆HR on the visual habituation trials for all infants and for the infants with no PAE on the dishabituation trials. The latency of the response was reduced in both conditions for all infants whose mothers received choline supplementation. Change in gestational choline level was positively related to ∆HR during habituation trials and levels of one choline metabolite, dimethylglycine (DMG), predicted ∆HR during habituation trials and latency of responses. A trend was found between DMG and ∆HR on the dishabituation trials and latency of the response. Supplementation did not affect ORs to auditory stimuli. Choline supplementation when administered together with routinely recommended multivitamin/mineral prenatal supplements during pregnancy may provide a beneficial impact to basic learning mechanisms involved in encoding and memory of environmental events in alcohol-exposed pregnancies as well as non- or low alcohol-exposed pregnancies. Changes in maternal nutrient status suggested that one mechanism by which choline supplementation may positively impact brain development is

  14. Development and Implementation of CHOICES Group to Reduce Drinking, Improve Contraception, and Prevent Alcohol-Exposed Pregnancies in American Indian Women.

    PubMed

    Hanson, Jessica D; Ingersoll, Karen; Pourier, Susan

    2015-12-01

    Public health officials assert that prevention of alcohol-exposed pregnancies (AEP) should begin before conception, by reducing alcohol consumption in women at-risk for or planning pregnancy, and/or preventing pregnancy in women who are drinking at risky levels. One such effort is the Oglala Sioux Tribe (OST) CHOICES Program. While the OST CHOICES Program has been successfully implemented, a community-based needs assessment determined that the OST CHOICES intervention should expand and be delivered in a group setting using group motivational interviewing (MI) techniques. After extensive group MI and CHOICES group trainings, recruitment for CHOICES Group began and within a ten month period, a total of twelve groups with non-pregnant American Indian women were held for this pilot intervention. Evaluations completed by participants indicated that CHOICES Group sessions positively engaged members, had low levels of anger or tension, and had average levels of avoidance of personal responsibility. An evaluation of the CHOICES Group leaders indicated strengths in certain MI skills, although improvement is needed in some core MI and group leadership skills. This is an important expansion of a successful AEP prevention program (CHOICES), as well as a novel application of MI, and recommendations and future plans for this intervention are outlined. PMID:26265591

  15. CHOICES: An Empirically Supported Intervention for Preventing Alcohol-Exposed Pregnancy in Community Settings

    ERIC Educational Resources Information Center

    Johnson, Shannon K.; Velasquez, Mary M.; von Sternberg, Kirk

    2015-01-01

    Examples of behavioral interventions that are efficacious in the research setting as well as practical and translatable to the "real-world" are critically needed as models for social work researchers and clinicians. This article presents the Changing High-Risk Alcohol Use and Improving Contraception Effectiveness Study (CHOICES)…

  16. The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community

    PubMed Central

    Hanson, Jessica D.; Pourier, Susan

    2015-01-01

    Alcohol-exposed pregnancies are a health issue for many American Indian communities. The goal of this manuscript is to outline how an existing alcohol-exposed pregnancy prevention program with non-pregnant women (Project CHOICES) was modified to fit the needs and norms of an American Indian community. The Oglala Sioux Tribe CHOICES Program was developed and implemented using community feedback through initial meetings, reviewing materials, gathering input into recruitment and intervention logistics, and conducting interviews to evaluate the program. The intervention was implemented and has been enrolling non-pregnant American Indian women for the past several years. While data collection is ongoing, it has shown preliminary success in changing behaviors and in impacting how the community views the prevention of alcohol-exposed pregnancies. Overall, this study highlights the potential to expand this prevention program to other sites and with other populations, such as adolescents. By the end of this article, readers will comprehend the steps necessary to replicate such a program at other tribal and rural sites. PMID:26703670

  17. Reducing the Risks of Teenage Pregnancy.

    ERIC Educational Resources Information Center

    Mitchell, M. Faith

    1984-01-01

    Reviews the medical and social risks of teenage pregnancy and describes two successful programs dealing with pregnancy and parenting: the St. Paul Maternal and Infant Care Project in Minnesota and the Teenage Pregnancy and Parenting Project in San Francisco. (SK)

  18. Exercise in Pregnancy: First Trimester Risks.

    PubMed

    Hegaard, Hanne K; Ersbøll, Anne S; Damm, Peter

    2016-09-01

    Most national guidelines recommend moderate exercise during pregnancy, but this is not followed by the majority of pregnant women. Fear of exercise risks is among reported barriers. In contrast to most reviews focusing on late pregnancy risks, this review evaluates the association between exercise in the first trimester and the risk of miscarriage. A systematic review based on the EMBASE and PUBMED databases was conducted and 5 studies assessing the association between early pregnancy exercise and miscarriage were identified. Diverging findings were reported making no clear conclusion possible. New studies with participants included in the prepregnancy period are needed. PMID:27042797

  19. Preventing adolescent pregnancy and associated risks.

    PubMed Central

    Miller, R.

    1995-01-01

    Adolescent pregnancy is a complex and frustrating problem that exacts a large social and personal cost. This year approximately 40,000 Canadian teenagers will become pregnant. With proper prevention, this number could be reduced. Pregnant teenagers seem to be at increased risk for some obstetric complications and their children for some neonatal complications. Family physicians who see patients over the course of a lifetime are in a good position to prevent adolescent pregnancy and the associated complications. PMID:8520241

  20. PREGNANCY RISK ASSESSMENT MONITORING SYSTEM (PRAMS)

    EPA Science Inventory

    PRAMS, the Pregnancy Risk Assessment Monitoring System, is an ongoing state-specific population based surveillance system of the Centers for Disease Control and Prevention (CDC) and state health departments designed to improve the health of mothers and infants by reducing adverse...

  1. Obesity in pregnancy: risks and management

    PubMed Central

    Fitzsimons, Kate J; Modder, Jo; Greer, Ian A

    2009-01-01

    Maternal obesity is now considered one of the most commonly occurring risk factors seen in obstetric practice. Compared with women with a healthy pre-pregnancy weight, women with obesity are at increased risk of miscarriage, gestational diabetes, preeclampsia, venous thromboembolism, induced labour, caesarean section, anaesthetic complications and wound infections, and they are less likely to initiate or maintain breastfeeding. Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. Intrauterine exposure to obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood. This article reviews the prevalence of obesity in pregnancy and the associated maternal and fetal complications. Recommendations and suggestions for pre-conception, antenatal and postnatal care of women with obesity are presented, and current research in the UK and future research priorities are considered.

  2. Risk of varicella infection during late pregnancy.

    PubMed Central

    Koren, Gideon

    2003-01-01

    QUESTION: I have a patient who contracted varicella at 26 weeks' gestation. She is very concerned and would consider termination if it were earlier in the pregnancy. What are the current predictions of risk for her fetus? ANSWER: Based on review of all available studies, we could not detect a single case of congenital varicella syndrome in the third trimester of pregnancy (0/208), as compared with 5/645 (0.78%) in the first and 9/592 (1.52%) in the second trimester (P < .01 third vs first and second). You can reassure your patient. PMID:14649980

  3. Psychotropics in pregnancy: weighing the risks.

    PubMed

    Grover, Sandeep; Avasthi, Ajit; Sharma, Yogesh

    2006-04-01

    With increase in the use of newer psychotropics, there is a growing concern in relation to the teratogenicity. Unfortunately, it is not possible to carry out prospective studies in pregnant women and as a result physicians caring for such patients have to rely on case reports, case series, and retrospective studies. Available evidence shows that the safety of psychotropics in pregnancy is still unresolved and the decision to prescribe psychotropics in pregnancy should be taken in the light of severity of mental disease, and drugs should be prescribed only when the potential risk to the foetus from exposure is outweighed by the risk of untreated maternal disorder. In this review we discussed the current evidence of the teratogenic risks with psychotropic drugs commonly used to treat psychiatric disorders and also focused on decision making in such patients. PMID:16783040

  4. Risk, pregnancy and complementary and alternative medicine.

    PubMed

    Mitchell, Mary

    2010-05-01

    Since the 1990's sociologists such as Giddens and Beck have highlighted the complexities of contemporary western societies in relation to risk. The "risk society" is one in which the advantages of scientific and technological developments are overshadowed with risks and dangers: leading to a world dominated by anxiety and uncertainty. Although a complex set of interrelated phenomena the risk society can be summarised under three main changes: including globalisation, scepticism about expert knowledge, Thompson: 27 and the degree of autonomy individuals have in our detraditionalised society to determine their own life choices (Beck: 13). The discourses of the "risk society" inevitably impact on women during pregnancy and the potential influence this discourse may have in relation to healthcare choices, particularly in the field of complementary and alternative medicine (CAM) are explored. In this paper it is argued that the apparently growing use of CAM during pregnancy and childbirth could be interpreted as a response by women to these discourses, that decisions made with regard to CAM may signify a desire for personal fulfilment and a need for autonomy and active participation in healthcare during pregnancy and childbirth. PMID:20347843

  5. Women with Epilepsy: Drug Risks and Safety During Pregnancy

    MedlinePlus

    ... Guideline for PATIENTS and their FAMILIES WOMEN WITH EPILEPSY: DRUG RISKS AND SAFETY DURING PREGNANCY This fact ... you understand which drugs are safest for treating epilepsy during pregnancy. It also gives information on how ...

  6. Teen Pregnancy: Not Simply a Result of Adolescent Ignorance. and Poor and at Risk for Pregnancy.

    ERIC Educational Resources Information Center

    Newcomer, Susan; Roesel, Rosalyn

    1987-01-01

    Consists of two articles on teen pregnancy. Newcomer describes why pregnancy prevention programs do not always work and tells what must be done to make them more effective. She also discusses curriculum content. Roesel describes a program to serve adolescents who are at risk for pregnancy. (CH)

  7. Inter-Pregnancy Weight Change and the Risk of Recurrent Pregnancy Complications

    PubMed Central

    Wallace, Jacqueline M.; Bhattacharya, Sohinee; Campbell, Doris M.; Horgan, Graham W.

    2016-01-01

    Women with specific adverse pregnancy outcomes in their first pregnancy may be receptive to inter-pregnancy weight management guidance aimed at preventing these complications reoccurring in subsequent pregnancies. Thus the association between inter-pregnancy weight change and the risk of recurrent pregnancy complications at the second pregnancy was investigated in a retrospective cohort study of 24,520 women with their first-ever and second consecutive deliveries in Aberdeen using logistic regression. Compared with women who were weight stable, weight loss (>2BMI units) between pregnancies was associated with an increased risk of recurrent small for gestational age (SGA) birth and elective Cesarean-section, and was protective against recurrent pre-eclampsia, placental oversize and large for gestational age (LGA) birth. Conversely weight gain (>2BMI units) between pregnancies increased the risk of recurrent gestational hypertension, placental oversize and LGA birth and was protective against recurrent low placental weight and SGA birth. The relationships between weight gain, and placental and birth weight extremes were evident only in women with a healthy weight at first pregnancy (BMI<25units), while that between weight gain and the increased risk of recurrent gestational hypertension was largely independent of first pregnancy BMI. No relationship was detected between inter-pregnancy weight change and the risk of recurrent spontaneous preterm delivery, labour induction, instrumental delivery, emergency Cesarean-section or postpartum hemorrhage. Therefor inter-pregnancy weight change impacts the risk of recurrent hypertensive disorders, SGA and LGA birth and women with a prior history of these specific conditions may benefit from targeted nutritional advice to either lose or gain weight after their first pregnancy. PMID:27145132

  8. Cocaine use as a risk factor for abdominal pregnancy.

    PubMed Central

    Audain, L.; Brown, W. E.; Smith, D. M.; Clark, J. F.

    1998-01-01

    Failure to diagnose abdominal pregnancies can have disastrous morbidity/mortality consequences for mother and fetus. To make the diagnosis of abdominal pregnancy requires that the physician have a high index of suspicion and that he or she have a good understanding of the risk factors of abdominal pregnancy. This article presents data suggesting that maternal cocaine use is a risk factor for abdominal pregnancy, reviews the literature on the maternal/fetal effects of maternal cocaine use and the risk factors of abdominal pregnancy, and analyzes 55 cases of abdominal pregnancy. Maternal cocaine use correlated with a 20% rate of increase in the incidence of abdominal pregnancy compared with the 70% rate of decrease in the "before cocaine" time period. Recommendations are offered for management. PMID:9617068

  9. Short Gap Between Pregnancies Tied to Higher Autism Risk?

    MedlinePlus

    ... html Short Gap Between Pregnancies Tied to Higher Autism Risk? Data review can't prove cause-and- ... in close succession may increase the risk of autism in children, a large new research review suggests. ...

  10. Risks Associated With Smallpox Vaccination in Pregnancy

    PubMed Central

    Badell, Martina L.; Meaney-Delman, Dana; Tuuli, Methodius G.; Rasmussen, Sonja A.; Petersen, Brett W.; Sheffield, Jeanne S.; Beigi, Richard H.; Damon, Inger K.; Jamieson, Denise J.

    2016-01-01

    Objective To estimate the maternal and fetal risks of smallpox vaccination during pregnancy. Data Sources MEDLINE, Web of Science, EMBASE, Global Health, ClinicalTrials.gov, and CINHAL from inception to September 2014. Methods of Study Selection We included published articles containing primary data regarding smallpox vaccination during pregnancy that reported maternal or fetal outcomes (spontaneous abortion, congenital defect, stillbirth, preterm birth, or fetal vaccinia). Tabulations, Integration, and Results The primary search yielded 887 articles. After hand-searching, 37 articles were included: 18 articles with fetal outcome data and 19 case reports of fetal vaccinia. Outcomes of smallpox vaccination in 12,201 pregnant women were included. Smallpox vaccination was not associated with an increased risk of spontaneous abortion (pooled relative risk [RR] 1.03, confidence interval [CI] 0.76–1.41), stillbirth (pooled RR 1.03, CI 0.75–1.40), or preterm birth (pooled RR 0.84, CI 0.62–1.15). When vaccination in any trimester was considered, smallpox vaccination was not associated with an increased risk of congenital defects (pooled RR 1.25, CI 0.99–1.56); however, first-trimester exposure was associated with an increased risk of congenital defects (2.4% compared with 1.5%, pooled RR 1.34, CI 1.02–1.77). No cases of fetal vaccinia were reported in the studies examining fetal outcomes; 21 cases of fetal vaccinia were identified in the literature, of which three neonates survived. Conclusion The overall risk associated with maternal smallpox vaccination appears low. No association between smallpox vaccination and spontaneous abortion, preterm birth, or stillbirth was identified. First-trimester vaccination was associated with a small increase in congenital defects, but the effect size was small and based on limited data. Fetal vaccinia appears to be a rare consequence of maternal smallpox vaccination but is associated with a high rate of fetal loss. PMID

  11. Postural balance and the risk of falling during pregnancy.

    PubMed

    Cakmak, Bulent; Ribeiro, Ana Paula; Inanir, Ahmet

    2016-01-01

    Pregnancy is a physiological process and many changes occur in a woman's body during pregnancy. These changes occur in all systems to varying degrees, including the cardiovascular, respiratory, genitourinary, and musculoskeletal systems. The hormonal, anatomical, and physiological changes occurring during pregnancy result in weight gain, decreased abdominal muscle strength and neuromuscular control, increased ligamentous laxity, and spinal lordosis. These alterations shift the centre of gravity of the body, altering the postural balance and increasing the risk of falls. Falls during pregnancy can cause maternal and foetal complications, such as maternal bone fractures, head injuries, internal haemorrhage, abruption placenta, rupture of the uterus and membranes, and occasionally maternal death or intrauterine foetal demise. Preventative strategies, such as physical exercise and the use of maternity support belts, can increase postural stability and reduce the risk of falls during pregnancy. This article reviews studies that have investigated changes in postural balance and risk of falling during pregnancy. PMID:26212584

  12. Dermatoses of Pregnancy - Clues to Diagnosis, Fetal Risk and Therapy

    PubMed Central

    2011-01-01

    The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical characteristics, in particular timing of onset, morphology and localization of skin lesions are crucial for diagnosis which, in case of pemphigoid gestationis and intrahepatic cholestasis of pregnancy, will be confirmed by specific immunofluorescence and laboratory findings. While polymorphic and atopic eruptions of pregnancy are distressing only to the mother because of pruritus, pemphigoid gestationis may be associated with prematurity and small-for-date babies and intrahepatic cholestasis of pregnancy poses an increased risk for fetal distress, prematurity, and stillbirth. Corticosteroids and antihistamines control pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy; intrahepatic cholestasis of pregnancy, in contrast, should be treated with ursodeoxycholic acid. This review will focus on the new classification of pregnancy dermatoses, discuss them in detail, and present a practical algorithm to facilitate the management of the pregnant patient with skin lesions. PMID:21909194

  13. Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings.

    PubMed

    Weissgerber, Tracey L; Turner, Stephen T; Mosley, Thomas H; Kardia, Sharon L R; Hanis, Craig L; Milic, Natasa M; Garovic, Vesna D

    2016-03-01

    Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan-Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27-2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension. PMID:26315531

  14. Acetaminophen During Pregnancy May Up Risk of ADHD in Kids

    MedlinePlus

    ... html Acetaminophen During Pregnancy May Up Risk of ADHD in Kids But only association found, and researchers ... their child will develop behavioral problems such as attention-deficit/hyperactivity disorder (ADHD), a new study suggests. Acetaminophen is generally ...

  15. Couples' Pre-Pregnancy Caffeine Consumption Linked to Miscarriage Risk

    MedlinePlus

    ... Thursday, March 24, 2016 Couples’ pre-pregnancy caffeine consumption linked to miscarriage risk NIH study finds daily ... such lifestyle factors as cigarette use, caffeinated beverage consumption and multivitamin use among 344 couples with a ...

  16. Who Is at Increased Risk of Health Problems during Pregnancy?

    MedlinePlus

    ... obese mothers also have an increased risk of neural tube defects (NTDs), stillbirth, and being large for ... Reviewed: 07/15/2013 Related A-Z Topics Neural Tube Defects (NTDs) Preeclampsia and Eclampsia Pregnancy All ...

  17. [Early pregnancy risk: development and validation of a predictive instrument].

    PubMed

    Burrows, R; Rosales, M E; Díaz, M; Muzzo, S

    1994-06-01

    An early pregnancy risk scale, with scores ranging from 11 to 66 points from lower to higher risk, was constructed using variables associated with teenager's pregnancy. This scale was applied to 3000 female teenagers, coming from Metropolitan Santiago public schools. The sample was divided in three risk groups: group A (high risk) with scores equal or over 35 points, group B (low risk) with scores equal or below 20 points and group B (intermediate risk) with scores between 20.1 and 34.9 points. These girls were followed during 2 years. During this period, 84 girls became pregnant, 24 of 184 (13%) in group A, 60 of 2332 (2.6%) in group C and none of 307 in group B. There were 104 school desertions in group A and 37 in group B. To study associations and analyze risk, the sample was divided in two risk groups: high, with scores over 27 and low, with scores below 27. There was a high association between pregnancy risk score and the occurrence of pregnancy (RR 5.25 p < 0.0001) and school desertion (RR 3.32 p < 0.0001). Pregnancy was predicted with a 78% sensitivity and 55.6% specificity. School desertion was predicted with a 74% sensitivity and 56% specificity. The importance variable weighing using multiple regression models, to improve the predictor's sensitivity and specificity, is discussed. PMID:7732221

  18. Gestational Diabetes Mellitus: Risks and Management during and after Pregnancy

    PubMed Central

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

    2015-01-01

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

  19. Radiation therapy in pregnancy: risk calculation and risk minimization.

    PubMed

    Greskovich, J F; Macklis, R M

    2000-12-01

    The benefits of radiation therapy (RT) as part of a treatment regimen for cancer must be weighed against the potential risk of harm to the patient and in the pregnant patient, the risk to the developing fetus. Information necessary for determining the potential effects of RT on the developing fetus include the gestational age, absorbed fetal dose-equivalent, and dose-rate. The risk periods in humans for RT-induced prenatal or neonatal death, congenital anomalies, severe mental retardation (SMR), temporary (TGR) or permanent growth retardation (PGR), carcinogenesis, sterility, and germ cell mutations have been elicited directly from the study of Japanese victims of the atomic bombs and unintentional medical exposures, and indirectly from animal experiments. The wide range of congenital anomalies elicited from animal studies have not occurred in the Japanese atomic bomb victims exposed in utero. The major congenital anomaly observed in the Japanese cohort has been microcephaly. The highest risk period for SMR correlates with the proliferation, differentiation, and, most importantly, migration of neurons from their proliferative zones. PGR was apparent 17 years after ionizing radiation (IR) exposure at Hiroshima in children who were within 1,500 meters of the hypocenter. Children were on average 2.25 cm shorter, 3 kg lighter, and had head diameters 1.1 cm smaller than age-matched children. The projected lifetime risk of cancer mortality in the Japanese cohort is 14% per gray. The risk of a radiation-induced hereditary disorder is reported to be approximately 1% per gray. RT plays a major role in the definitive treatment of cervical and breast carcinomas, Hodgkin's disease, and non-Hodgkin's lymphoma. With appropriate abdominal shielding in place, the estimated fetal dose can be reduced by 50% or greater in most cases. In certain clinical situations, RT may be administered during pregnancy. PMID:11130470

  20. The over-estimation of risk in pregnancy.

    PubMed

    Robinson, Monique; Pennell, Craig E; McLean, Neil J; Oddy, Wendy H; Newnham, John P

    2011-06-01

    The concept of risk is especially salient to obstetric care. Unknown factors can still be responsible for peri-natal morbidity and mortality in circumstances that appeared to present little risk, while perfectly healthy infants are born in high-risk circumstances: a contradiction that patients and providers struggle with on a daily basis. With such contradictions comes the potential for the over-estimation of risk during pregnancy in order to assure a positive outcome. Understanding and addressing the estimation of risk during pregnancy requires acknowledging the history of obstetric risk in addition to understanding risk-related psychological theory. A relationship of trust between provider and patient is vital in addressing risk over-estimation, as is encouraging the development of self-efficacy in patients. Ultimately obstetric care is complex and efforts to avoid pre-natal risk exposure based on heightened perceptions of threat may do more harm than the perceived threat itself. PMID:21480770

  1. Adolescent substance use and unplanned pregnancy: strategies for risk reduction

    PubMed Central

    Connery, Hilary S.; Albright, Brittany B.; Rodolico, John M.

    2014-01-01

    Synopsis Substance use among adolescents increases the risk of unplanned pregnancies, which then increases the risk of fetal exposure to addictive, teratogenic substances. Specific interventions are necessary to target pregnancy planning and contraception among reproductive age substance users. Screening for substance use using the CRAFFT is recommended in all health care settings treating adolescent patients. Screening for tobacco and nicotine use is also recommended along with provision of smoking cessation interventions. Using motivational interviewing style and strategies is recommended to engage adolescents in discussions related to reducing substance use, risky sexual behavior, and probability of unplanned pregnancy or late-detection pregnancy. Earlier interventions that strengthen autonomy and resourcefulness in recognizing and caring for an unplanned conception is a form of advanced directive that may well reduce fetal exposure to tobacco, alcohol, and drugs and simultaneously empower girls and women in self-care. PMID:24845484

  2. Inter-pregnancy weight change impacts placental weight and is associated with the risk of adverse pregnancy outcomes in the second pregnancy

    PubMed Central

    2014-01-01

    Background The inter-pregnancy period is considered a teachable moment when women are receptive to weight- management guidance aimed at optimising pregnancy outcome in subsequent pregnancies. In population based studies inter-pregnancy weight change is associated with several adverse pregnancy outcomes but the impact on placental size is unknown. Methods The association between inter-pregnancy weight change and the primary risk of adverse pregnancy outcomes in the second pregnancy was investigated in 12,740 women with first two consecutive deliveries at a single hospital using logistic regression. Results Compared with women who were weight stable, weight loss (>1BMI unit) between pregnancies was associated with an increased risk of spontaneous preterm delivery, low placental weight and small for gestational age (SGA) birth, while weight gain (>3BMI units) increased the risk of pre-eclampsia, gestational hypertension, emergency caesarean section, placental oversize and large for gestational age (LGA) birth at the second pregnancy. The relationship between weight gain and pre-eclampsia risk was evident in women who were overweight at first pregnancy only (BMI ≥25 units), while that between weight loss and preterm delivery was confined to women with a healthy weight at first pregnancy (BMI <25 units). In contrast, the association between weight loss and SGA was independent of first pregnancy BMI. A higher percentage of women who were obese at first pregnancy were likely to experience a large weight gain (P < 0.01) or weight loss (P < 0.001) between consecutive pregnancies compared with the normal BMI reference group. Conclusion Inter-pregnancy weight change in either direction increases the risk of a number of contrasting pregnancy complications, including extremes of placental weight. The placenta may lie on the causal pathway between BMI change and the risk of LGA or SGA birth. PMID:24450357

  3. High-Risk Cardiac Disease in Pregnancy: Part I.

    PubMed

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G; Silverside, Candice K

    2016-07-26

    The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated during pregnancy and women can deliver safely with favorable outcomes, there are some cardiac conditions that have significant maternal and fetal morbidity and mortality. The purpose of this paper is to review the available published reports and provide recommendations on the management of women with high-risk cardiovascular conditions during pregnancy. PMID:27443437

  4. Pregnancy and Thoracic Aortic Disease: Managing the Risks.

    PubMed

    Wanga, Shaynah; Silversides, Candice; Dore, Annie; de Waard, Vivian; Mulder, Barbara

    2016-01-01

    The most common aortopathies in women of childbearing age are bicuspid aortic valve, coarctation of the aorta, Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, SMAD3 aortopathy, Turner syndrome, and familial thoracic aneurysm and dissection. The hemodynamic and hormonal changes of pregnancy increase the risk of progressive dilatation or dissection of the aorta in these women. The presence of hypertension increases the risk further. Therefore, appropriate preconception counselling is advised. For women who become pregnant, serial follow-up by a specialized multidisciplinary team throughout pregnancy and postpartum period is required. In this review we discuss risk assessment and management strategies for women with aortopathies. PMID:26604124

  5. Pregnancy at 65, risks and complications

    PubMed Central

    Verma, Shailja; Agarwal, Krishna; Gandhi, Gauri

    2016-01-01

    A 65-year-old postmenopausal pregnant woman was referred with antepartum hemorrhage at 29 weeks of gestation. Postadmission diagnosed with chronic hypertension, gestational diabetes mellitus, valvular heart disease, and placenta previa. Her pregnancy was terminated by cesarean delivery at 32 weeks as she had a bout of bleeding per vaginum. Most of the placenta was adherent with no plane of cleavage; therefore, cesarean hysterectomy was performed. Baby birth weight was 1650 g and was shifted to nursery for observation and mother needed Intensive Care Unit care postcesarean. On the 15th day, both healthy mother and baby were discharged. Although pregnancy is possible in postmenopausal women with hormone support but the incidence of complications remain very high. It raises a need for developing well-laid guidelines for performing in vitro fertilization in older age group women. PMID:27382238

  6. Does Iron Increase the Risk of Malaria in Pregnancy?

    PubMed

    Moya-Alvarez, Violeta; Cottrell, Gilles; Ouédraogo, Smaila; Accrombessi, Manfred; Massougbodgi, Achille; Cot, Michel

    2015-04-01

    Background.  Pregnancy-associated malaria (PAM) remains a significant health concern in sub-Saharan Africa. Cross-sectional studies report that iron might be associated with increased malaria morbidity, raising fears that current iron supplementation policies will cause harm in the present context of increasing resistance against intermittent preventive treatment in pregnancy (IPTp). Therefore, it is necessary to assess the relation of iron levels with malaria risk during the entire pregnancy. Methods.  To investigate the association of maternal iron levels on malaria risk in the context of an IPTp clinical trial, 1005 human immunodeficiency virus-negative, pregnant Beninese women were monitored throughout their pregnancy between January 2010 and May 2011. Multilevel models with random intercept at the individual levels and random slope for gestational age were used to analyze the factors associated with increased risk of a positive blood smear and increased Plasmodium falciparum density. Results.  During the follow-up, 29% of the women had at least 1 episode of malaria. On average, women had 0.52 positive smears (95% confidence interval [CI], 0.44-0.60). High iron levels (measured by the log10 of ferritin corrected on inflammation) were significantly associated with increased risk of a positive blood smear (adjusted odds ratio = 1.75; 95% CI, 1.46-2.11; P < .001) and high P falciparum density (beta estimate = 0.22; 95% CI, 0.18-0.27; P < .001) during the follow-up period adjusted on pregnancy parameters, comorbidities, environmental and socioeconomic indicators, and IPTp regime. Furthermore, iron-deficient women were significantly less likely to have a positive blood smear and high P falciparum density (P < .001 in both cases). Conclusions.  Iron levels were positively associated with increased PAM during pregnancy in the context of IPTp. Supplementary interventional studies are needed to determine the benefits and risks of differently dosed iron and

  7. The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

    PubMed Central

    2016-01-01

    The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth. PMID:27366008

  8. The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center.

    PubMed

    Jeon, Ji Hyun; Hwang, Yu Im; Shin, Im Hee; Park, Chan Woo; Yang, Kwang Moon; Kim, Hye Ok

    2016-07-01

    The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth. PMID:27366008

  9. Contraceptive use and risk of unintended pregnancy in California.

    PubMed

    Foster, Diana G; Bley, Julia; Mikanda, John; Induni, Marta; Arons, Abigail; Baumrind, Nikki; Darney, Philip D; Stewart, Felicia

    2004-07-01

    California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods. PMID:15208050

  10. Risk Factors for Adolescent Pregnancy Reports among African American Males

    ERIC Educational Resources Information Center

    Miller-Johnson, Shari; C. Winn, Donna-Marie; Coie, John D.; Malone, Patrick S.; Lochman, John

    2004-01-01

    This study examined childhood and adolescent risk factors for males' reports of getting someone pregnant during adolescence. These questions were examined in an urban sample of 335 African American males involved in a prospective, longitudinal study. Childhood aggression significantly predicted reported pregnancies during adolescence. Boys who…

  11. Teenage Pregnancy among Latinas: Examining Risk and Protective Factors

    ERIC Educational Resources Information Center

    Dogan-Ates, Aysun; Carrion-Basham, Carla Y.

    2007-01-01

    This study investigated the role of three groups of risk and protective factors (e.g., individual, family, and extrafamilial) that are associated with teen pregnancy. Two groups of Latina adolescents (aged 15 to 19), nonpregnant/ nonparenting (NP; N = 48) and pregnant/parenting (P; N = 46), completed a demographic survey, an adolescent profile…

  12. Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium

    PubMed Central

    Wang, Shuo; Zhao, Yuan-li; Teo, Mario; Guo, Peng; Zhang, Dong; Wang, Rong; Cao, Yong; Ye, Xun; Kang, Shuai

    2014-01-01

    Objective: To determine whether the risk of arteriovenous malformation (AVM) rupture is increased during pregnancy and puerperium. Methods: Participants included 979 female patients with intracranial AVM admitted to Beijing Tiantan Hospital between 1960 and 2010. Two neurosurgery residents reviewed medical records for each case. Of them, 393 patients with ruptured AVM between 18 and 40 years of age were used for case-crossover analysis. Number of children born and clinical information during pregnancy and puerperium were retrieved to identify whether AVM rupture occurred during this period. Results: Of the 979 women, 797 hemorrhages occurred during 25,578 patient-years of follow-up, yielding an annual hemorrhage rate of 3.11%. The annual AVM hemorrhage rate in patients aged 18 to 40 years (n = 579) was 2.78%, lower than the rate in other age groups (odds ratio = 0.75, 95% confidence interval 0.65–0.86, p < 0.05). Of the 393 patients with rupture of AVM aged 18 to 40 years, 12 hemorrhages occurred in 12 patients over 452 pregnancies, yielding a hemorrhage rate of 2.65% per pregnancy or 3.32% per year. Among the remaining 381 patients, 441 hemorrhages occurred during 10,627 patient-years of follow-up, yielding an annual hemorrhage rate of 4.14%. The odds ratio for rupture of AVM during pregnancy and puerperium, compared with the control period, was 0.71 (95% confidence interval 0.61–0.82). Conclusions: No increased risk of hemorrhage was found in patients with cerebral AVM during pregnancy and the puerperium. We therefore would not advise against pregnancy in women with intracranial AVM. PMID:24759847

  13. Risk factors for depressive symptoms during pregnancy: a systematic review

    PubMed Central

    Lancaster, Christie A.; Gold, Katherine J.; Flynn, Heather A.; Yoo, Harim; Marcus, Sheila M.; Davis, Matthew M.

    2010-01-01

    The purpose of this study was to evaluate risk factors for antepartum depressive symptoms that can be assessed in routine obstetric care. We evaluated articles in the Englishlanguage literature from 1980 through 2008. Studies were selected if they evaluated the association between antepartum depressive symptoms and ≥1 risk factors. For each risk factor, 2 blinded, independent reviewers evaluated the overall trend of evidence. In total, 57 studies met eligibility criteria. Maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality were associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses. Life stress, lack of social support, and domestic violence continued to demonstrate a significant association in multivariate analyses. Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy. PMID:20096252

  14. Borreliosis during pregnancy: a risk for the unborn child?

    PubMed

    Mylonas, Ioannis

    2011-07-01

    Little is known regarding the possible harmful effects of Borrelia infections in pregnancy, since such a risk analysis is difficult to perform. Transplacental transmission of Borrelia burgdorferi has been documented in several animal studies. Therefore, it had been thought that fetal infection and teratogenicity was possible from B. burgdorferi, especially considering the similarities between Lyme borreliosis and syphilis. However, several clinical, serological, and epidemiological studies have failed to confirm a causal association between B. burgdorferi infection and a pregnancy adverse outcome. Moreover, there have been no reported cases of transmission of Borrelia via breast milk. However, the therapeutic approach to pregnant women with Lyme disease should be antibiotic treatment, according to the clinical manifestation and the timing of the tick bite. An effective vaccine is not yet available and the prevention of Lyme borreliosis depends on public and physician education, and appropriate antibiotic therapy during pregnancy. PMID:20925520

  15. Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk.

    PubMed

    Chapman, Rachel R

    2003-07-01

    Despite high infant and maternal mortality rates, many Mozambican women with access to prenatal services delay prenatal clinic consultations, limiting opportunity for prevention and treatment of preventable pregnancy complications. Ethnographic research, interviews with health providers and longitudinal pregnancy case studies with 83 women were conducted in Central Mozambique to examine pregnant women's underutilization of clinic-based prenatal services. The study found that pregnancy beliefs and prenatal practices reflect women's attempts to influence reproduction under conditions of vulnerability at multiple levels. Women reported high maternal reproductive morbidity, frequent pregnancy wastage, and immense pressure to bear children throughout their reproductive years. Reproductive vulnerability is intensified by poverty and an intense burden placed on poor, peri-urban women farmers for family subsistence and continuous fertility in a period of economic austerity, land shortages, and increasing social conflict and inequality. In this environment of economic insecurity exacerbated by congested living conditions, women report competing for scarce resources, including male support and income. This vulnerability heightens women's perceptions that they and their unborn infants will be targets of witchcraft or sorcery by jealous neighbors and kin. They respond by hiding pregnancy and delaying prenatal care. Within the context of women's perceived reproductive risks, delayed prenatal care can be seen as a strategy to protect pregnancy from purposeful human and spirit harm. Women mobilized limited resources to acquire prenatal care outside the formal clinic setting. It is concluded that provision of clinical prenatal services is insufficient to reduce reproductive risks for the most socially and economically marginal since it is their vulnerability that prevents women from using available services. Confidential maternity services and social safety nets for greater

  16. Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy

    PubMed Central

    Hansen, Craig; Joski, Peter; Freiman, Heather C.; Andrade, Susan; Toh, Sengwee; Dublin, Sascha; Cheetham, T. Craig; Cooper, William O.; Pawloski, Pamala A.; Li, De-Kun; Beaton, Sarah J.; Scott, Pamela E.; Hammad, Tarek; Davis, Robert

    2013-01-01

    Background Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8% of pregnancies. Objective Assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. Methods We identified women aged 15 to 45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans’ administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. Results There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7%, increasing from 5.5% in 2001 to 7.8% in 2007. A total of 9.7% (n=55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6%, 6.7%, and 2.4% respectively. The prevalence of maintenance-only use doubled during the study period from 0.4% to 0.8%, while rescue-only use decreased from 7.4% to 5.8%. Conclusions In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time. PMID:23108737

  17. Corticosteroid use during pregnancy and risk of orofacial clefts

    PubMed Central

    Hviid, Anders; Mølgaard-Nielsen, Ditte

    2011-01-01

    Background The association between the risk of orofacial clefts in infants and the use of corticosteroids during pregnancy is unclear from the available evidence. We conducted a nationwide cohort study of all live births in Denmark over a 12-year period. Methods We collected data on all live births in Denmark from Jan. 1, 1996, to Sept. 30, 2008. We included live births for which information was available from nationwide health registries on the use of corticosteroids during pregnancy, the diagnosis of an orofacial cleft and possible confounders. Results There were 832 636 live births during the study period. Exposure to corticosteroids during the first trimester occurred in 51 973 of the pregnancies. A total of 1232 isolated orofacial clefts (i.e., cleft lip, cleft palate, or cleft lip and cleft palate) were diagnosed within the first year of life, including 84 instances in which the infant had been exposed to corticosteroids during the first trimester of pregnancy. We did not identify any statistically significant increased risk of orofacial clefts associated with the use of corticosteroids: cleft lip with or without cleft palate, prevalence odds ratio (OR) 1.05 (95% confidence interval [CI] 0.80–1.38]; cleft palate alone, prevalence OR 1.23 (95% CI 0.83–1.82). Odds ratios for risk of orofacial clefts by method of delivery (i.e., oral, inhalant, nasal spray, or dermatologic and other topicals) were consistent with the overall results of the study and did not display significant heterogeneity, although the OR for cleft lip with or without cleft palate associated with the use of dermatologic corticosteroids was 1.45 (95% CI 1.03–2.05). Interpretation Our results add to the safety information on a class of drugs commonly used during pregnancy. Our study did not show an increased risk of orofacial clefts with the use of corticosteroids during pregnancy. Indepth investigation of the pattern of association between orofacial clefts and the use of dermatologic

  18. Hypertensive Disorders of Pregnancy - A Life-Long Risk?!

    PubMed

    Schausberger, C E; Jacobs, V R; Bogner, G; Wolfrum-Ristau, P; Fischer, T

    2013-01-01

    Background: Arterial hypertension is one of the most important causes of cardiovascular diseases, and the latter are responsible for almost half of the deaths in the industrialised nations. Hypertensive disorders of pregnancy constitute one of the most frequent causes of feto-maternal morbidity and mortality; on the other hand the occurrence of a hypertensive disorder of pregnancy represents a risk for the later development of hypertension and the cardiovascular risks resulting therefrom. The aim of this article is to demonstrate the association of hypertensive disorders of pregnancy with consecutive cardiovascular diseases. Materials and Methods: Specific selective literature research. Results: After the occurrence of a hypertensive disorder of pregnancy the relative risks for hypertension are 3.7 (2.70-5.05), for ischaemic heart disease 2.2 (1.86-2.52), for cerebral insult 1.8 (1.45-2.27) and for mortality resulting from cardiovascular causes 1.5 (1.05-2.14) and are thus significant. According to a recent study 56 % of internal specialists and 23 % of gynecologists do not know about the association of preeclampsia with ischemic heart disease, 48 % and 38 % respectively are not aware of the link with stroke and 79 % and 77 % respectively are not aware of the association with a reduced life expectancy after preeclampsia. The presence of hypertension is not known by many of the patients, merely 28-38 % receive an appropriate therapy. Conclusion: Adequate follow-up after hypertensive disorders of pregnancy and the early recognition of and therapy for hypertension represent the cornerstones in the prevention of late cardiovascular sequelae. General practitioners, specialist for internal medicine and gynaecologists have a special responsibility with regard to the reduction of later complications. PMID:24771883

  19. Does Iron Increase the Risk of Malaria in Pregnancy?

    PubMed Central

    Moya-Alvarez, Violeta; Cottrell, Gilles; Ouédraogo, Smaila; Accrombessi, Manfred; Massougbodgi, Achille; Cot, Michel

    2015-01-01

    Background. Pregnancy-associated malaria (PAM) remains a significant health concern in sub-Saharan Africa. Cross-sectional studies report that iron might be associated with increased malaria morbidity, raising fears that current iron supplementation policies will cause harm in the present context of increasing resistance against intermittent preventive treatment in pregnancy (IPTp). Therefore, it is necessary to assess the relation of iron levels with malaria risk during the entire pregnancy. Methods. To investigate the association of maternal iron levels on malaria risk in the context of an IPTp clinical trial, 1005 human immunodeficiency virus-negative, pregnant Beninese women were monitored throughout their pregnancy between January 2010 and May 2011. Multilevel models with random intercept at the individual levels and random slope for gestational age were used to analyze the factors associated with increased risk of a positive blood smear and increased Plasmodium falciparum density. Results. During the follow-up, 29% of the women had at least 1 episode of malaria. On average, women had 0.52 positive smears (95% confidence interval [CI], 0.44–0.60). High iron levels (measured by the log10 of ferritin corrected on inflammation) were significantly associated with increased risk of a positive blood smear (adjusted odds ratio = 1.75; 95% CI, 1.46–2.11; P < .001) and high P falciparum density (beta estimate = 0.22; 95% CI, 0.18–0.27; P < .001) during the follow-up period adjusted on pregnancy parameters, comorbidities, environmental and socioeconomic indicators, and IPTp regime. Furthermore, iron-deficient women were significantly less likely to have a positive blood smear and high P falciparum density (P < .001 in both cases). Conclusions. Iron levels were positively associated with increased PAM during pregnancy in the context of IPTp. Supplementary interventional studies are needed to determine the benefits and risks of differently dosed iron and

  20. Fetal and umbilical Doppler ultrasound in high-risk pregnancies

    PubMed Central

    Alfirevic, Zarko; Stampalija, Tamara; Gyte, Gillian ML

    2014-01-01

    Background Abnormal blood flow patterns in fetal circulation detected by Doppler ultrasound may indicate poor fetal prognosis. It is also possible false positive Doppler ultrasound findings could encourage inappropriate early delivery. Objectives The objective of this review was to assess the effects of Doppler ultrasound used to assess fetal well-being in high-risk pregnancies on obstetric care and fetal outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (September 2009) and the reference lists of identified studies. Selection criteria Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in high-risk pregnancies compared to no Doppler ultrasound. Data collection and analysis Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked. Main results Eighteen completed studies involving just over 10,000 women were included. The trials were generally of unclear quality with some evidence of possible publication bias. The use of Doppler ultrasound in high-risk pregnancy was associated a reduction in perinatal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.52 to 0.98, 16 studies, 10,225 babies, 1.2% versus 1.7 %, numbers needed to treat = 203; 95%CI 103 to 4352). There were also fewer inductions of labour (average RR 0.89, 95% CI 0.80 to 0.99, 10 studies, 5633 women, random effects) and fewer caesarean sections (RR 0.90, 95% CI 0.84 to 0.97, 14 studies, 7918 women). No difference was found in operative vaginal births (RR 0.95, 95% CI 0.80 to 1.14, four studies, 2813 women) nor in Apgar scores less than seven at five minutes (RR 0.92, 95% CI 0.69 to 1.24, seven studies, 6321 babies). Authors’ conclusions Current evidence suggests that the use of Doppler ultrasound in high-risk pregnancies reduced the risk of perinatal deaths and resulted in less

  1. The risks of unwanted pregnancy: a Latin American perspective.

    PubMed

    Viel, B

    1989-02-01

    The author discusses induced abortion, asserting that it is the most important risk associated with unwanted pregnancy in Latin America. Comparison is made between Cuba, where abortion is legal, and Chile, where it is illegal. The impact of socioeconomic factors, the Catholic church, governmental policies, and family planning programs on the availability of abortion is described. The negative health effects of illegal abortion and unwanted births are also reviewed. PMID:12281957

  2. Placental morphologic and functional imaging in high-risk pregnancies.

    PubMed

    Gudmundsson, Saemundur; Dubiel, Mariusz; Sladkevicius, Povilas

    2009-08-01

    The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies. PMID:19631087

  3. Risk management of seasonal influenza during pregnancy: current perspectives

    PubMed Central

    Yudin, Mark H

    2014-01-01

    Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009–2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women. PMID:25114593

  4. Risk Factors for Hyperglycaemia in Pregnancy in Tamil Nadu, India

    PubMed Central

    Kragelund Nielsen, Karoline; Damm, Peter; Kapur, Anil; Balaji, Vijayam; Balaji, Madhuri S.; Seshiah, Veerasamy; Bygbjerg, Ib C.

    2016-01-01

    Introduction Hyperglycaemia in pregnancy (HIP), i.e. gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP), increases the risk of various short- and long-term adverse outcomes. However, much remains to be understood about the role of different risk factors in development of HIP. Objective The aims of this observational study were to examine the role of potential risk factors for HIP, and to investigate whether any single or accumulated risk factor(s) could be used to predict HIP among women attending GDM screening at three centres in urban, semi-urban and rural Tamil Nadu, India. Methodology Pregnant women underwent a 75 g oral glucose tolerance test. Data on potential risk factors was collected and analysed using logistical regression analysis. Receiver operating characteristic (ROC) curves, sensitivity, specificity and predictive values were calculated for significant risk factors and a risk factor scoring variable was constructed. Results HIP was prevalent in 18.9% of the study population (16.3% GDM; 2.6% DIP). Increasing age and BMI as well as having a mother only or both parents with diabetes were significant independent risk factors for HIP. Among women attending the rural health centre a doubling of income corresponded to an 80% increased risk of HIP (OR 1.80, 95%CI 1.10–2.93; p = 0.019), whereas it was not significantly associated with HIP among women attending the other health centres. The performance of the individual risk factors and the constructed scoring variable differed substantially between the three health centres, but none of them were good enough to discriminate between those with and without HIP. Conclusions The findings highlight the importance of socio-economic circumstances and intergenerational risk transmission in the occurrence of HIP as well as the need for universal screening. PMID:26991305

  5. [Pregnancy and work environment. Practical guidelines for risk assessment].

    PubMed

    Carlstedt-Duke, Bodil; Gustavsson, Per

    2002-01-10

    Pregnant women are a natural part of the workforce in Sweden. A few types of exposure in the work environment are strictly regulated for pregnant women due to well-known risks of miscarriage, malformations or mental retardation in the child. However, a much larger number of types of exposure may pose risks for negative effects on the pregnancy. Chemical, physical and psychosocial factors may interact with personal medical conditions, and a risk assessment must always be performed with the individual in mind. This article addresses the most common questions about pregnancy and the work environment. According to Swedish law, an employer must perform an assessment of the risks in the work environment for the pregnant woman. If the work environment is considered to be hazardous, the particular exposure in question should be reduced or work tasks changed. If neither of these are possible, the woman has a right to compensation from the Social Insurance Office. Self-employed women are currently excluded from this right. PMID:11871167

  6. Risk of Fetal Death after Treatment with Antipsychotic Medications during Pregnancy

    PubMed Central

    Sørensen, Merete Juul; Kjaersgaard, Maiken Ina Siegismund; Pedersen, Henrik Søndergaard; Vestergaard, Mogens; Christensen, Jacob; Olsen, Jørn; Parner, Erik; Pedersen, Lars Henning; Bech, Bodil Hammer

    2015-01-01

    Background Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth. Methods In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively. Results Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19). Conclusions The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to

  7. Unexpected complications of low-risk pregnancies in the United States

    PubMed Central

    Danilack, Valery A.; Nunes, Anthony P.; Phipps, Maureen G.

    2016-01-01

    OBJECTIVE Determining appropriate sites of care for any type of medical issue assumes successful matching of patient risks to facility capabilities and resources. In obstetrics, predicting patients who will have a need for additional resources beyond routine obstetric and neonatal care is difficult. Women without prenatal risk factors and their newborns may experience unexpected complications during delivery or postpartum. In this study, we report the risk of unexpected maternal and newborn complications among pregnancies without identified prenatal risk factors. STUDY DESIGN We conducted a cross-sectional investigation utilizing US natality data to analyze 10 million birth certificate records from 2011 through 2013. We categorized pregnancies as low risk (no prenatal risk factors) or high risk (at least 1 prenatal risk factor) according to 19 demographic, medical, and pregnancy characteristics. We evaluated 21 individual unexpected or adverse intrapartum and postpartum outcomes in addition to a composite indicator of any adverse outcome. RESULTS Among 10,458,616 pregnancies, 38% were identified as low risk and 62% were identified as high risk for unexpected complications. At least 1 unexpected complication was indicated on the birth certificate for 46% of all pregnancies, 29% of low-risk pregnancies, and 57% of high-risk pregnancies. While the risk for unexpected or adverse outcomes was greatly reduced for the low-risk group compared to the high-risk group overall and for several of the individual outcomes, low-risk pregnancies had higher risks of vacuum delivery, forceps delivery, meconium staining, and chorioamnionitis compared to high-risk pregnancies. CONCLUSION Of births, 29% identified to be low risk had an unexpected complication that would require nonroutine obstetric or neonatal care. Additionally, for select outcomes, risks were higher in the low-risk group compared to the group with identified risk factors. This information is important for planning

  8. Vitamin D status in early pregnancy and risk of preeclampsia

    PubMed Central

    Achkar, Madonna; Dodds, Linda; Giguère, Yves; Forest, Jean-Claude; Armson, B. Anthony; Woolcott, Christy; Agellon, Sherry; Spencer, Anne; Weiler, Hope A.

    2016-01-01

    OBJECTIVE We sought to examine the association between maternal serum 25-hydroxyvitamin D (25[OH]D) concentration in early pregnancy and the subsequent diagnosis of preeclampsia (PE). STUDY DESIGN This was a nested case-control study from 2 prospective Canadian cohorts conducted in Quebec City, Quebec, and Halifax, Nova Scotia, from 2002 through 2010. Participants were pregnant women (n=169 cases with PE and 1975 controls). Maternal serum was drawn <20 weeks of gestation, and 25(OH)D measurement was performed. Cases were ascertained from medical records. Logistic regression analysis was used to estimate adjusted odds ratios with 95% confidence intervals. RESULTS Women who developed PE had a significantly lower 25(OH)D concentration at a mean gestational age of 14 weeks compared with women in the control group (mean ± SD 25[OH]D 47.2 ± 17.7 vs 52.3 ± 17.2 nmol/L, P < .0001). Women with 25(OH)D <30 nmol/L compared to those with at least 50 nmol/L had a greater risk of developing PE (adjusted odds ratio, 2.23; 95% confidence interval, 1.29–3.83) after adjustment for prepregnancy body mass index, maternal age, smoking, parity, season and year of blood collection, gestational week at blood collection, and cohort site. Exploratory analysis with cubic splines demonstrated a dose-response relationship between maternal 25(OH)D and risk of PE, up to levels around 50 nmol/L, where the association appeared to plateau. CONCLUSION Maternal vitamin D deficiency early in pregnancy defined as 25(OH)D<30 nmol/L may be an independent risk factor for PE. The relevance of vitamin D supplementation for women of child-bearing age should be explored as a strategy for reducing PE and for promoting a healthier pregnancy. PMID:25446694

  9. Adverse pregnancy outcomes and cardiovascular risk factor management.

    PubMed

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

    2015-06-01

    Cardiovascular disease (CVD) is the leading health threat to American women. In addition to establish risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman's risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger women often use their obstetrician/gynecologist as their primary health provider, this is an opportune time to diagnose and treat CVD risk factors early. Embedding preventive care providers such as nurse practitioners or physician assistants within OB/GYN practices can be considered, with referral to family medicine or internist for ongoing risk assessment and management. The American Heart Association (AHA)/American Stroke Association (ASA) stroke prevention guidelines tailored to women recommend that women with a history of pre-eclampsia can be evaluated for hypertension and other CVD risk factors within 6 months to 1-year post-partum. Given the burden and impact of CVD on women in our society, the entire medical community must work to establish feasible practice and referral patterns for assessment and treatment of CVD risk factors. PMID:26159741

  10. Adverse Pregnancy Outcomes and Cardiovascular Risk Factor Management

    PubMed Central

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

    2015-01-01

    Cardiovascular disease (CVD) is the leading health threat to American women. In addition to established risk factors for hypertension, hyperlipidemia, diabetes, smoking, and obesity, adverse pregnancy outcomes (APOs) including pre-eclampsia, eclampsia, and gestational diabetes are now recognized as factors that increase a woman’s risk for future CVD. CVD risk factor burden is disproportionately higher in those of low socioeconomic status and in ethnic/racial minority women. Since younger women often use their obstetrician/gynecologist as their primary health provider, this is an opportune time to diagnose and treat CVD risk factors early. Embedding preventive care providers such as nurse practitioners or physician assistants within OB/GYN practices can be considered, with referral to family medicine or internist for ongoing risk assessment and management. The American Heart Association (AHA)/American Stroke Association (ASA) stroke prevention guidelines tailored to women recommend that women with a history of pre-eclampsia be evaluated for hypertension and other CVD risk factors within 6 months to 1 year post-partum. Given the burden and impact of CVD on women our society, the entire medical community must work to establish feasible practice and referral patterns for assessment and treatment of CVD risk factors. PMID:26159741

  11. Understanding the Association of Biomedical, Psychosocial and Behavioral Risks with Adverse Pregnancy Outcomes

    PubMed Central

    Kiely, Michele; El-Mohandes, Ayman A.E.; Gantz, Marie G.; Chowdhury, Dhuly; Thornberry, Jutta S.; El-Khorazaty, M. Nabil

    2011-01-01

    Objectives This study investigates the relationship between diabetes, hypertension, preeclampsia, and Body Mass Index (BMI) -- the most common and interrelated medical conditions occurring during pregnancy; sociodemographic and behavioral risk factors; and adverse pregnancy outcomes in high-risk urban African American women in Washington, DC. Methods Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: 1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes, 2) identify the relative importance of various predictors of adverse pregnancy outcomes, and 3) characterize women at the highest risk of poor pregnancy outcomes. Results Overall, the strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; and employment was the first splitter for miscarriage. Conclusions Preconceptional factors play a very important role in pregnancy outcomes. For many of these women, the risks that they bring into the pregnancy were more likely to impact their pregnancy outcome than events during pregnancy. PMID:21785892

  12. Physical abuse during pregnancy: prevalence and risk factors

    PubMed Central

    Muhajarine, N; D'Arcy, C

    1999-01-01

    BACKGROUND: Violence during pregnancy is a health and social problem that poses particular risks to the woman and her fetus. To address the lack of Canadian information on this issue, the authors studied the prevalence and predictors of physical abuse in a sample of pregnant women in Saskatoon. METHODS: Of 728 women receiving prenatal services through the Saskatoon District public health system between Apr. 1, 1993, and Mar. 31, 1994, 605 gave informed consent to participate in the study and were interviewed in the second trimester. Of these, 543 were interviewed again late in the third trimester. During the initial interview, information was collected on the women's sociodemographic characteristics, the current pregnancy, health practices and psychosocial variables. The second interview focused on the women's experience of physical abuse during the pregnancy and during the preceding year, the demographic characteristics and the use of alcohol or illicit drugs by their male partner. RESULTS: In all, 31 (5.7%) of the women reported experiencing physical abuse during pregnancy; 46 (8.5%) reported experiencing it within the 12 months preceding the second interview. Of the 31 women 20 (63.3%) reported that the perpetrator was her husband, boyfriend or ex-husband. Although all ethnic groups of women suffered abuse, aboriginal women were at greater risk than nonaboriginal women (adjusted odds ratio 2.8, 95% confidence interval [CI] 1.0-7.8). Women whose partner had a drinking problem were 3.4 times (95% CI 1.2-9.9) more likely to have been abused than women whose partner did not have a drinking problem. Perceived stress and number of negative life events in the preceding year were also predictors of abuse. Abused women tended to report having fewer people with whom they could talk about personal issues or get together; however, they reported socializing with a larger number of people in the month before the second interview than did the women who were not abused

  13. Assessing perinatal depression as an indicator of risk for pregnancy-associated cardiovascular disease.

    PubMed

    Nicholson, Lauren; Lecour, Sandrine; Wedegärtner, Sonja; Kindermann, Ingrid; Böhm, Michael; Sliwa, Karen

    2016-01-01

    Cardiovascular conditions associated with pregnancy are serious complications. In general, depression is a well-known risk indicator for cardiovascular disease (CVD). Mental distress and depression are associated with physiological responses such as inflammation and oxidative stress. Both inflammation and oxidative stress have been implicated in the pathophysiology of CVDs associated with pregnancy. This article discusses whether depression could represent a risk indicator for CVDs in pregnancy, in particular in pre-eclampsia and peripartum cardiomyopathy (PPCM). PMID:27213860

  14. Pregnancy in Adolescent Females with Serious Emotional Disturbance: Risk Factors and Outcomes.

    ERIC Educational Resources Information Center

    Yampolskaya, Svetlana; Brown, Eric C.; Greenbaum, Paul E.

    This 7-year study examined the consequences of early pregnancy and parenting for girls with serious emotional disturbances (SED) and risk factors identified with teenage pregnancy. Risk factors that were examined included sociodemographic characteristics, psychological characteristics, and psychopathology. The 109 participants in the study were…

  15. Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy?

    ERIC Educational Resources Information Center

    Ellis, Bruce J.; Bates, John E.; Dodge, Kenneth A.; Fergusson, David M.; Horwood, L. John; Pettit, Gregory S.; Woodward, Lianne

    2003-01-01

    Longitudinal studies in two countries investigated impact of father absence on girls' early sexual activity (ESA) and teenage pregnancy. Findings indicated that greater exposure to father absence strongly related to elevated ESA and adolescent pregnancy risk. Elevated risk was not explained (U.S. sample) or only partly explained (New Zealand…

  16. Excess Pre-Pregnancy Weight May Slightly Raise Baby's Cerebral Palsy Risk

    MedlinePlus

    ... Excess Pre-Pregnancy Weight May Slightly Raise Baby's Cerebral Palsy Risk But, study found overall odds remain quite ... slight increased risk of having a baby with cerebral palsy, a new study suggests. After reviewing data from ...

  17. Automatic Classification of Structured Product Labels for Pregnancy Risk Drug Categories, a Machine Learning Approach

    PubMed Central

    Rodriguez, Laritza M.; Fushman, Dina Demner

    2015-01-01

    With regular expressions and manual review, 18,342 FDA-approved drug product labels were processed to determine if the five standard pregnancy drug risk categories were mentioned in the label. After excluding 81 drugs with multiple-risk categories, 83% of the labels had a risk category within the text and 17% labels did not. We trained a Sequential Minimal Optimization algorithm on the labels containing pregnancy risk information segmented into standard document sections. For the evaluation of the classifier on the testing set, we used the Micromedex drug risk categories. The precautions section had the best performance for assigning drug risk categories, achieving Accuracy 0.79, Precision 0.66, Recall 0.64 and F1 measure 0.65. Missing pregnancy risk categories could be suggested using machine learning algorithms trained on the existing publicly available pregnancy risk information. PMID:26958248

  18. Prenatal diagnosis of osteochondrodysplasias in high risk pregnancy.

    PubMed

    Gordienko IYu; Grechanina EYa; Sopko, N I; Tarapurova, E N; Mikchailets, L P

    1996-05-01

    We collected data on 39 prenatally diagnosed osteochondrodysplasias. We detected 30 (76.9%) cases in the first and second trimesters, including 18 (46.2%) with two twins before the 24th week of gestation. Of 39 cases 11 (28.2%) had osteogenesis imperfecta (OI) type II. Verification of the prenatal diagnosis was attempted in 26 cases on the basis of the data obtained from ultrasonographs, radiographs, external examination, and autopsy protocols. The prenatal diagnosis was confirmed in 19 (73%) fetuses. In 13 cases verification was not possible because one or several investigations could not be performed. Counselling followed all identified cases with osteochondrodysplasia. We present the pedigree of two families indicating the possibility of early prenatal diagnosis of achondrogenesis type I and metatropic dysplasia. We propose indications for ultrasonographic anatomical screening with subsequent phenotype analysis in high risk pregnancy to provide for the prenatal detection of malformations and hereditary diseases. PMID:8723093

  19. Prenatal exposure to amphetamines. Risks and adverse outcomes in pregnancy.

    PubMed

    Plessinger, M A

    1998-03-01

    Based on findings in humans and the confirmation of prenatal exposures in animals, amphetamines and methamphetamines increase the risk of an adverse outcome when abused during pregnancy. Clefting, cardiac anomalies, and fetal growth reduction deficits that have been seen in infants exposed to amphetamines during pregnancy have all been reproduced in animal studies involving prenatal exposures to amphetamines. The differential effects of amphetamines between genetic strains of mice and between species demonstrate that pharmacokinetics and the genetic disposition of the mother and developing embryo can have an enormous influence on enhancing or reducing these potential risks. The effects of prenatal exposure to amphetamines in producing altered behavior in humans appear less compelling when one considers other confounding variables of human environment, genetics, and polydrug abuse. In view of the animal data concerning altered behavior and learning tasks in comparison with learning deficits observed in humans, the influence of the confounding variables in humans may serve to increase the sensitivity of the developing embryo/fetus to prenatal exposure to amphetamines. These factors and others may predispose the developing conceptus to the damaging effects of amphetamines by actually lowering the threshold of susceptibility at the sites where damage occurs. Knowledge of the effects of prenatal exposure of the fetus and the mother to designer amphetamines is lacking. Based on the few studies in which designer drugs have been examined in animal models, more questions are raised than answered. Possible reasons why no malformations or significant fetal effects were found in the study by St. Omer include the genetic strain of rat used, the conservative exposure profile, or the fact that the placenta metabolized MDMA before reaching the embryo. These questions underscore the need for further investigations concerning the prenatal exposure effects of designer compounds and

  20. [SSRI antidepressant use during pregnancy and the assessment of the risk-benefit ratio].

    PubMed

    Weisskopf, Etienne; Fumeaux, Céline J Fischer; Bickle Graz, Myriam; Harari, Mathild Morisod; Epiney, Manuella; Tolsa, Cristina Borradori; Rouiller, Sylvie; Tolsa, Jean-François; Eap, Chin B; Vial, Yvan; Csajka, Chantal; Panchaud, Alice

    2016-03-16

    Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy and the postpartum period. The abundant data available make selective serotonin reuptake inhibitors (SSRIs) the first line treatment in pregnancy when a pharmacological treatment is required. Risks associated with the use of SSRIs during pregnancy are limited (moderate effect size) and are often not distinguishable from those inherent to the mother's disease. Yet, several questions regarding the SSRI safety profile for the unborn child are still under debate or require additional epidemiological data. The decision of SSRI use during pregnancy needs an individual evaluation of the risk-benefit balance. PMID:27149719

  1. Assessment of foetal risk associated with 93 non-US-FDA approved medications during pregnancy

    PubMed Central

    Al-jedai, Ahmed H.; Balhareth, Sakra S.; Algain, Roaa A.

    2012-01-01

    Health care practitioners utilize the United States-Food and Drug Administration (US-FDA) pregnancy categorization (A, B, C, D, X) for making decision on the appropriateness of certain medications during pregnancy. Many non US-FDA approved medications are registered and marketed in Saudi Arabia. However, these medications do not have an assigned pregnancy risk categorization like those approved in the US. The objective of this review is to evaluate, report, and categorize the foetal risk associated with non-US-FDA approved medications registered by the Saudi Food and Drug Authority (S-FDA) according to the US-FDA pregnancy risk categorization system. We identified 109 non-US-FDA approved medications in the Saudi National Formulary (SNF) as of October 2007. We searched for data on functional or anatomical birth defects or embryocidal-associated risk using different databases and references. An algorithm for risk assessment was used to determine a pregnancy risk category for each medication. Out of 93 eligible medications, 73% were assigned category risk C, 10 medications (11%) were assigned category risk D, and 12 medications (13%) were assigned category risk B. Only three medications were judged to be safe during pregnancy based on the available evidence and were assigned category risk A. Inconsistencies in defining and reporting the foetal risk category among different drug regulatory authorities could create confusion and affect prescribing. We believe that standardization and inclusion of this information in the medication package insert is extremely important to all health care practitioners. PMID:23960803

  2. The 2011 Survey on Hypertensive Disorders of Pregnancy (HDP) in China: Prevalence, Risk Factors, Complications, Pregnancy and Perinatal Outcomes

    PubMed Central

    Ye, Chun; Ruan, Yan; Zou, Liying; Li, Guanghui; Li, Changdong; Chen, Yi; Jia, Chaoxia; Megson, Ian L.; Wei, Jun; Zhang, Weiyuan

    2014-01-01

    Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP. PMID:24937406

  3. Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure.

    PubMed

    Rose, C; Gill, J; Zalunardo, N; Johnston, O; Mehrotra, A; Gill, J S

    2016-08-01

    The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year. PMID:26946063

  4. Antidepressant Use in Pregnancy and the Risk of Cardiac Defects

    PubMed Central

    Huybrechts, Krista F.; Palmsten, Kristin; Avorn, Jerry; Cohen, Lee S.; Holmes, Lewis B.; Franklin, Jessica M.; Mogun, Helen; Levin, Raisa; Kowal, Mary; Setoguchi, Soko; Hernandez-Diaz, Sonia

    2014-01-01

    Background There is controversy regarding whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants in pregnancy is associated with increased risks for congenital cardiac defects. In particular, concerns exist about a possible association between paroxetine and right ventricular outflow tract obstruction (RVOTO), and between sertraline and ventricular septal defects (VSD). Methods We performed a cohort study nested in the 2000–2007 nationwide Medicaid Analytic eXtract. The study included 949,504 pregnant women enrolled in Medicaid from three months before conception through one month post delivery, and their live-born infants. We compared the risk of major cardiac defects in women with antidepressant medication use during the first trimester versus no use, restricting the cohort to women with depression and using propensity score adjustment to control for depression severity and other potential confounders. Results 64,389 women (6.8%) used antidepressants during the first trimester. Overall, 6,403 infants not exposed to antidepressants were born with a cardiac defect (72.3 per 10,000), compared with 580 infants exposed (90.1 per 10,000). Associations between antidepressant use and cardiac defects were attenuated with increasing levels of adjustment for confounding. For SSRIs, relative risks for any cardiac defect were 1.25 (95%CI, 1.13–1.38) unadjusted, 1.12 (1.00–1.26) depression-restricted, and 1.06 (0.93–1.22) depression-restricted and fully-adjusted. We found no significant associations between the use of paroxetine and RVOTO (1.07, 0.59–1.93), or the use of sertraline and VSD (1.04, 0.76–1.41). Conclusions Results of this large population-based cohort study suggest no substantial increased risk of cardiac malformations attributable to SSRIs. PMID:24941178

  5. Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies.

    PubMed

    Morikawa, Mamoru; Yamada, Takashi; Yamada, Takahiro; Sato, Shoji; Minakami, Hisanori

    2012-08-01

    This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during 2002-2009. The gestational week at delivery (mean±SD) was 31.8±3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22(-0/7), gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30(-0/7) and 36(-0/7). PMID:22853819

  6. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

    PubMed Central

    Cheong-See, Fiona; Schuit, Ewoud; Arroyo-Manzano, David; Khalil, Asma; Barrett, Jon; Joseph, K S; Asztalos, Elizabeth; Hack, Karien; Lewi, Liesbeth; Lim, Arianne; Liem, Sophie; Norman, Jane E; Morrison, John; Combs, C Andrew; Garite, Thomas J; Maurel, Kimberly; Serra, Vicente; Perales, Alfredo; Rode, Line; Worda, Katharina; Nassar, Anwar; Aboulghar, Mona; Rouse, Dwight; Thom, Elizabeth; Breathnach, Fionnuala; Nakayama, Soichiro; Russo, Francesca Maria; Robinson, Julian N; Dodd, Jodie M; Newman, Roger B; Bhattacharya, Sohinee; Tang, Selphee; Mol, Ben Willem J; Thilaganathan, Basky; Thangaratinam, Shakila

    2016-01-01

    Objective To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. Design Systematic review and meta-analysis. Data sources Medline, Embase, and Cochrane databases (until December 2015). Review methods Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks’ gestation. Results 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks’ gestation (risk difference 1.2/1000, 95% confidence interval −1.3 to 3.6; I2=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I2=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (−12.4 to 17.4/1000; I2=0%). The rates of neonatal morbidity showed a consistent reduction with increasing

  7. Young women's education and behavioural risk trajectories: clarifying their association with unintended-pregnancy resolution.

    PubMed

    Gomez-Scott, Jessica; Cooney, Teresa M

    2014-06-01

    In the USA, most pregnancies occurring to teenage women are unplanned, making both the decisions regarding their resolution and the consequences of those decisions important topics of inquiry. Substantial debate surrounds the potential consequences for young women of either carrying an unintended pregnancy to term or voluntarily terminating it. The present study utilises data from The US National Longitudinal Study of Adolescent Health prospectively to examine the predictors of pregnancy resolution decisions in terms of young women's educational goals and their engagement in risk behaviours. Additionally, the long-term consequences of these decisions for education and risk-taking behaviours are identified. Results indicate that young women with strong educational goals have a greater likelihood of terminating an unintended pregnancy than those with low aspirations, and that pregnancy termination predicts higher educational attainment compared to motherhood. Risk behaviours did not predict pregnancy-resolution decisions, but young women who became mothers reported lower rates of subsequent substance use and fewer sexual partners post-pregnancy than those who terminated the pregnancy or who had never been pregnant. Motherhood appears to be a catalyst for lifestyle change among young women, limiting substance use and sexual partnering, in contrast to abortion, which appears to allow adolescents to continue risk-taking trajectories. PMID:24735279

  8. Reducing the Risk of Adolescent Pregnancy: Toward Certification of Family Life Educators.

    ERIC Educational Resources Information Center

    Jorgensen, Stephen R.; Alexander, Sharon

    1981-01-01

    Following a review of major research findings on adolescent pregnancy-risk and the consequences of adolescent pregnancy, the authors consider how schools can best address this social problem. They specifically argue for the improvement of high school family life educators through training and certification standards. (Author/SJL)

  9. Maternal Pre-Pregnancy Obesity and Risk for Inattention and Negative Emotionality in Children

    ERIC Educational Resources Information Center

    Rodriguez, Alina

    2010-01-01

    Objective: This study aimed to replicate and extend previous work showing an association between maternal pre-pregnancy adiposity and risk for attention deficit hyperactivity disorder (ADHD) symptoms in children. Methods: A Swedish population-based prospective pregnancy-offspring cohort was followed up when children were 5 years old (N = 1,714).…

  10. Pregnancy

    MedlinePlus

    ... each trimester are described below. 1 First Trimester (Week 1 to Week 12) The events that lead to pregnancy begin ... and oxygen to the fetus. 2 Second Trimester (Week 13 to Week 28) At 16 weeks, and ...

  11. Teenage Pregnancy

    MedlinePlus

    ... plan to get pregnant, but many do. Teen pregnancies carry extra health risks to both the mother ... later on. They have a higher risk for pregnancy-related high blood pressure and its complications. Risks ...

  12. Venous Thromboembolism Risk and Adequacy of Prophylaxis in High Risk Pregnancy in the Arabian Gulf

    PubMed Central

    Alsayegh, Faisal; Al-Jassar, Waleed; Wani, Salima; Tahlak, Muna; Al-Bahar, Awatef; Al-Kharusi, Lamya; Al-Tamimi, Halima; El-Taher, Faten; Mahmood, Naeema; Al-Zakwani, Ibrahim

    2016-01-01

    Objectives: To estimate the prevalence of venous thromboembolism (VTE) risk factors in pregnancy and the proportion of pregnancies at risk of VTE that received the recommended prophylaxis according to the American College of Chest Physicians (ACCP) 2012 published guidelines in antenatal clinics in the Arabian Gulf. Methods: The evaluation of venous thromboembolism (EVE)-Risk project was a non-interventional, cross-sectional, multi-centre, multi-national study of all eligible pregnant women (≥17 years) screened during antenatal clinics from 7 centres in the Arabian Gulf countries (United Arab Emirates, Kuwait, Bahrain, Qatar and Oman). Pregnant women were recruited during a 3-month period between September and December 2012. Results: Of 4,131 screened pregnant women, 32% (n=1,337) had ≥1 risk factors for VTE. Common VTE risk factors included obesity (76%), multiparity (33%), recurrent miscarriages (9.1%), varicose veins (6.9%), thrombophilia (2.6%), immobilization (2.0%), sickle cell disease (2.8%) and previous VTE (1.6%). Only 8.3% (n=111) of the high risk patients were on the recommended VTE prophylaxis. Enoxaparin was used in 80% (n=89) of the cases followed by tinzaparin (4%; n=4). Antiplatelet agents were prescribed in 11% (n=149) of pregnant women. Of those on anticoagulants (n=111), 59% (n=66) were also co-prescribed antiplatelet agents. Side effects (mainly local bruising at the injection site) were reported in 12% (n=13) of the cases. Conclusion: A large proportion of pregnant women in the Arabian Gulf countries have ≥1 VTE risk factor with even a smaller fraction on prophylaxis. VTE risk assessment must be adopted to identify those at risk who would need VTE prophylaxis.

  13. Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study.

    PubMed

    Lee, Suzanne; Ayers, Susan; Holden, Des

    2016-07-01

    Objective To examine the perception of risk among a group of women with high risk pregnancies who were either planning to give birth in hospital, or at home despite medical advice to the contrary. The intention was to consider differences and similarities between the groups to examine how perception of risk relates to choice of place of birth. Design Qualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England. Participants Twenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths. Measurements and findings Semi-structured interviews to investigate women's understanding and assessment of risk. Results were analysed using thematic analysis. Five themes emerged: understanding of situation; judgement of risk; reassuring factors; impact of risk; and coping with risk. Women from both groups had some understanding of the implications of their medical/obstetric conditions. They displayed concerns about their babies' wellbeing. Women planning homebirths assessed their risks as lower and expressed less concerns than women planning hospital births. Women planning hospital births more frequently described following professional advice. Key conclusions Risk perception is individual and subjective. Women with high risk pregnancies who plan to give birth at home perceive risk differently to women who plan hospital births. Implications for practice Healthcare professionals working with women with high risk pregnancies should be aware of the potential for differences in definitions and perceptions of risk within this group. PMID:27040523

  14. Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study.

    PubMed

    Elenga, Narcisse; Adeline, Aurélie; Balcaen, John; Vaz, Tania; Calvez, Mélanie; Terraz, Anne; Accrombessi, Laetitia; Carles, Gabriel

    2016-01-01

    Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease. PMID:27403164

  15. Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study

    PubMed Central

    Elenga, Narcisse; Adeline, Aurélie; Balcaen, John; Vaz, Tania; Calvez, Mélanie; Terraz, Anne; Accrombessi, Laetitia; Carles, Gabriel

    2016-01-01

    Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease. PMID:27403164

  16. Reading and Writing as Risk-Reduction: The School's Role in Preventing Teenage Pregnancies.

    ERIC Educational Resources Information Center

    Pittman, Karen J.

    1989-01-01

    Schools can reduce teenage pregnancy by providing specific sex education, counseling, and health services, and by improving schooling for high risk students. Emphasizes early childhood education and alternative programs for pregnant adolescents and adolescent parents. (FMW)

  17. Women’s Knowledge, Attitudes and Behavior about Maternal Risk Factors in Pregnancy

    PubMed Central

    Esposito, Giuseppe; Ambrosio, Rossella; Napolitano, Francesco; Di Giuseppe, Gabriella

    2015-01-01

    Background The aims of this study were to assess the levels of knowledge, attitudes and behaviors of women about the main maternal risk factors in pregnancy and to identify the factors linked to the main outcomes of interest. Materials and Methods A cross-sectional survey was conducted in 513 pregnant women randomly selected from the gynecological ambulatory services of five hospitals located in Naples, Italy. Results Only 42% of women correctly knew all the main maternal risk factors in pregnancy (alcohol, smoking, passive smoking and obesity). Only 21.7% of women were very worried about causing harm to the fetus or child with their risk behaviors, and 22.3% of women reported smoking during pregnancy. Approximately one-third of women (28.9%) reported regularly drinking alcohol before pregnancy and 74.8% of these women reported stopping drinking alcohol during pregnancy. However, only 27.3% of women who were drinking alcohol during pregnancy had the intention of stopping. Only 43.7% of women indicated that during ambulatory gynecological examinations they received information from physicians about the possible damage resulting from all the main risk factors in pregnancy (alcohol, smoking, passive smoking and obesity). Conclusion The results indicate that pregnant women lack knowledge regarding the main maternal risk factors. Pregnant women claim to receive little information during gynecological examinations and, therefore, some continue to smoke and drink alcohol during pregnancy. Our results suggest an urgent need for the design of interventions to improve women’s levels of knowledge and to promote appropriate behavior in relation to the major risk factors in pregnancy. PMID:26714032

  18. Risk Factors and Birth Outcomes of Anaemia in Early Pregnancy in a Nulliparous Cohort

    PubMed Central

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

    2015-01-01

    Background Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality. Objective The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of ‘low risk’ women participating in a large international multicentre prospective study (n = 5 609), to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation. Methods The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization’s definition of anaemia in pregnancy (haemoglobin < 11g/dL). Binary logistic regression with adjustment for potential confounders (country, maternal age, having a marital partner, ethnic origin, years of schooling, and having paid work) was the main method of analysis. Results The hallmark findings were the low prevalence of anaemia (2.2%), that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78), and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score < 7 at one and five minutes). Adverse pregnancy outcomes were however more common in those with anaemia than in those without. Conclusion In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia’s conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy. PMID:25875012

  19. Pregnancy after aortic root replacement in Loeys-Dietz syndrome: High risk of aortic dissection.

    PubMed

    Braverman, Alan C; Moon, Marc R; Geraghty, Patrick; Willing, Marcia; Bach, Christopher; Kouchoukos, Nicholas T

    2016-08-01

    Loeys-Dietz syndrome due to mutations in TGFBR1 and 2 is associated with early and aggressive aortic aneurysm and branch vessel disease. There are reports of uncomplicated pregnancy in this condition, but there is an increased risk of aortic dissection and uterine rupture. Women with underlying aortic root aneurysm are cautioned about the risk of pregnancy-related aortic dissection. Prophylactic aortic root replacement is recommended in women with aortopathy and aortic root dilatation to lessen the risk of pregnancy. There is limited information in the literature about the outcomes of pregnancy after root replacement in Loeys-Dietz syndrome. We present a case series of three women with Loeys-Dietz syndrome who underwent elective aortic root replacement for aneurysm disease and subsequently became pregnant and underwent Cesarean section delivery. Each of these women were treated with beta blockers throughout pregnancy. Surveillance echocardiograms and noncontrast MRA studies during pregnancy remained stable demonstrating no evidence for aortic enlargement. Despite the normal aortic imaging and careful observation, two of the three women suffered acute aortic dissection in the postpartum period. These cases highlight the high risk of pregnancy following aortic root replacement in Loeys-Dietz syndrome. Women with this disorder are recommended to be counseled accordingly. © 2016 Wiley Periodicals, Inc. PMID:27125181

  20. A simple model for prediction postpartum PTSD in high-risk pregnancies.

    PubMed

    Shlomi Polachek, Inbal; Dulitzky, Mordechai; Margolis-Dorfman, Lilia; Simchen, Michal J

    2016-06-01

    This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population. PMID:26399873

  1. Smoking Before the First Pregnancy and the Risk of Breast Cancer: A Meta-Analysis

    PubMed Central

    DeRoo, Lisa A.; Cummings, Peter; Mueller, Beth A.

    2011-01-01

    The authors conducted a meta-analysis of the association between smoking before a first pregnancy, when undifferentiated breast tissue may be vulnerable to tobacco carcinogens, and the risk of breast cancer. A search of the published literature through August 2010 identified 23 papers reporting on associations between smoking before a first pregnancy and breast cancer. Odds ratios or hazard ratios and 95% confidence intervals, adjusted for known or suspected breast cancer risk factors, were abstracted from each study. Data were pooled using both fixed- and random-effects models. The fixed-effect summary risk ratio for breast cancer among the women who smoked before their first pregnancy versus women who had never smoked was 1.10 (95% confidence interval: 1.07, 1.14); the random-effects estimate was similar. The separate fixed-effect risk ratios for smoking only before the first pregnancy (5 studies) or only after the first pregnancy (16 studies) were both 1.07, providing no evidence that breast tissue is more susceptible to malignant transformation from smoking before the first pregnancy. While these small summary risk ratios may represent causal effects, residual confounding could readily produce estimates of this size in the absence of any causal effect. PMID:21719745

  2. Truancy and teenage pregnancy in English adolescent girls: can we identify those at risk?

    PubMed Central

    Zhou, Yin; Puradiredja, Dewi Ismajani; Abel, Gary

    2016-01-01

    Background Truancy has been linked to risky sexual behaviours in teenagers. However, no studies in England have examined the association between truancy and teenage pregnancy, and the use of truancy as a marker of teenagers at risk of pregnancy. Methods Using logistic regression, we investigated the association between truancy at age 15 and the likelihood of teenage pregnancy by age 19 among 3837 female teenagers who participated in the Longitudinal Study of Young People of England. We calculated the areas under the ROC curves of four models to determine how useful truancy would be as a marker of future teenage pregnancy. Results Truancy showed a dose–response association with teenage pregnancy after adjusting for ethnicity, educational intentions at age 16, parental socioeconomic status and family composition (‘several days at a time’ versus ‘none’, odds ratio 3.48 95% confidence interval 1.90–6.36, P < 0.001). Inclusion of risk behaviours improved the accuracy of predictive models only marginally (area under the ROC curve 0.76 full model versus 0.71 sociodemographic characteristics only). Conclusions Truancy is independently associated with teenage pregnancy among English adolescent girls. However, the discriminatory powers of models were low, suggesting that interventions addressing the whole population, rather than targeting high-risk individuals, might be more effective in reducing teenage pregnancy rates. PMID:25784667

  3. Maternal fish consumption during pregnancy and risk of early childhood asthma.

    PubMed

    Salam, Muhammad T; Li, Yu-Fen; Langholz, Bryan; Gilliland, Frank D

    2005-01-01

    Maternal fish consumption during pregnancy may affect children's asthma risk by modulating early-life immune development. Type of fish intake may be important because of differences in fatty acid content. To test this hypothesis, we conducted a nested case-control study, selecting subjects from the Children's Health Study, a population-based study of school-aged children in southern California. Cases had physician-diagnosed asthma and controls were asthma-free by age 5 years. Mothers or guardians provided information on fish consumption during pregnancy in telephone interviews. We computed odds ratio (OR) and 95% confidence interval (CI) by using conditional logistic regression models that accounted for the sampling. In children born to mothers with a history of asthma, the OR of asthma was 0.20 (95% CI = 0.06-0.65) when mothers ate oily fish at least monthly during pregnancy compared with no consumption (p(trend) = 0.006). Maternal oily fish consumption during pregnancy did not benefit children of non-asthmatic mothers. In contrast, fish stick (a source of trans-fats) consumption during pregnancy increased asthma risk in children (OR = 2.04; 95% CI = 1.18-3.51). Our results suggest that maternal oily fish intake during pregnancy may protect offspring from asthma; however, eating fish sticks during pregnancy may increase asthma risk in children. PMID:16293548

  4. Adolescent males involved in pregnancy: associations of forced sexual contact and risk behaviors.

    PubMed

    Pierre, N; Shrier, L A; Emans, S J; DuRant, R H

    1998-12-01

    The hypothesis that adolescent males who cause a pregnancy are more likely to have been victims of forced sexual contact and to have engaged in health risk and problem behaviors in the recent past than their sexually active counterparts who have not been involved in a pregnancy was investigated through use of a subset of data from the Massachusetts (US) 1995 Youth Risk Behavior Survey. 99 (12%) of the 824 sexually active male survey respondents reported having caused a pregnancy. A history of forced sexual contact was reported by 8.1%. Among those acknowledging forced sexual conduct, 36.4% had caused a pregnancy; of those without such a history, only 9.4% were involved in a pregnancy (p 0.00001). In addition, males who were involved in a pregnancy reported a greater likelihood of engaging in 16 health risk and problem behaviors in the previous 1, 3, and 12 months than those not involved in a pregnancy. Multiple logistic regression analysis identified 5 significant, independent predictors of having impregnated a female adolescent: number of sex partners in the previous 3 months (adjusted odds ratio (OR), 1.43; 95% confidence interval (CI), 1.25-1.65); history of forced sexual contact (OR, 3.56; 95% CI, 1.79-7.09); carrying weapons on school property (OR, 1.39; 95% CI, 1.18-1.64); cigarettes smoked/day (OR, 1.22; 95% CI, 1.08-1.38); and condom nonuse at last intercourse (OR, 1.80; 95% CI, 1.06-3.02). This model correctly classified 89.9% of sexually active male students who had been involved in a pregnancy. These findings suggest a need to screen sexually active males for these risk factors, especially a history of forced sexual contact, as part of interventions aimed at preventing adolescent pregnancy. PMID:9870330

  5. Changes in Cosmetics Use during Pregnancy and Risk Perception by Women

    PubMed Central

    Marie, Cécile; Cabut, Sophie; Vendittelli, Françoise; Sauvant-Rochat, Marie-Pierre

    2016-01-01

    Cosmetic products contain various chemical substances that may be potential carcinogen and endocrine disruptors. Women’s changes in cosmetics use during pregnancy and their risk perception of these products have not been extensively investigated. The main objective of this study was to describe the proportion of pregnant women changing cosmetics use and the proportion of non-pregnant women intending to do so if they became pregnant. The secondary objectives were to compare, among the pregnant women, the proportions of those using cosmetics before and during pregnancy, and to describe among pregnant and non-pregnant women, the risk perception of these products. A cross-sectional study was carried out in a gynaecology clinic and four community pharmacies. One hundred and twenty-eight women (60 non-pregnant and 68 pregnant women) replied to a self-administered questionnaire. Cosmetics use was identified for 28 products. The results showed that few women intended to change or had changed cosmetics use during pregnancy. Nail polish was used by fewer pregnant women compared to the period before pregnancy (p < 0.05). Fifty-five percent of the women considered cosmetics use as a risk during pregnancy and 65% would have appreciated advice about these products. Our findings indicate that all perinatal health professionals should be ready to advise women about the benefits and risks of using cosmetics during pregnancy. PMID:27043593

  6. Changes in Cosmetics Use during Pregnancy and Risk Perception by Women.

    PubMed

    Marie, Cécile; Cabut, Sophie; Vendittelli, Françoise; Sauvant-Rochat, Marie-Pierre

    2016-04-01

    Cosmetic products contain various chemical substances that may be potential carcinogen and endocrine disruptors. Women's changes in cosmetics use during pregnancy and their risk perception of these products have not been extensively investigated. The main objective of this study was to describe the proportion of pregnant women changing cosmetics use and the proportion of non-pregnant women intending to do so if they became pregnant. The secondary objectives were to compare, among the pregnant women, the proportions of those using cosmetics before and during pregnancy, and to describe among pregnant and non-pregnant women, the risk perception of these products. A cross-sectional study was carried out in a gynaecology clinic and four community pharmacies. One hundred and twenty-eight women (60 non-pregnant and 68 pregnant women) replied to a self-administered questionnaire. Cosmetics use was identified for 28 products. The results showed that few women intended to change or had changed cosmetics use during pregnancy. Nail polish was used by fewer pregnant women compared to the period before pregnancy (p < 0.05). Fifty-five percent of the women considered cosmetics use as a risk during pregnancy and 65% would have appreciated advice about these products. Our findings indicate that all perinatal health professionals should be ready to advise women about the benefits and risks of using cosmetics during pregnancy. PMID:27043593

  7. [Epilepsy and pregnancy. Balancing between risks to the mother and child].

    PubMed

    Tomson, T; Danielsson, B R; Winbladh, B

    1997-08-20

    Pregnancy may be especially problematic for the epileptic woman, obstetric complications tend to be more frequent, and seizure control and the pharmacokinetics of anticonvulsants may be affected. The risk of seizures is particularly high during labour and delivery-almost 10-fold higher than at other times during pregnancy. As uncontrolled generalised tonic-clonic seizures may be hazardous to both gravida and fetus, the use of anticonvulsants to prevent their occurrence is to be recommended during pregnancy even though all anticonvulsant drugs are potential teratogens. There is a 2- to 3-fold increase in the risk of birth defects in conjunction with fetal exposure to these drugs. Although the mechanisms mediating the teratogenic effects have not been identified, interference with folate metabolism, formation of toxic metabolites and drug-induced fetal hypoxia have been suggested. Despite the incompleteness of our knowledge, some recommendations can be made for the management of pregnant women with epilepsy. Pre-pregnancy counselling is important. Epileptic women contemplating pregnancy need to be informed of the pros and cons, and any major change in anticonvulsant therapy should be made before conception. Monotherapy is preferable, using the drug appropriate to seizure type and epilepsy syndrome at the lowest dosage and serum level that protects against tonic-clonic seizure. The clinical situation needs to be assessed and drug levels need to be monitored more frequently during pregnancy than otherwise. Patients on anticonvulsant treatment during pregnancy also need to be informed of the possibility of antenatal diagnosis. The use of new anticonvulsant drugs during pregnancy represents a particular challenge, since available clinical data may be insufficient to indicate their teratogenic potential Such a drug should be used in pregnancy only if essential to obtain seizure control. Moreover, the outcome of all such pregnancies needs to be carefully documented. PMID

  8. The impact of micronutrient supplementation in alcohol-exposed pregnancies on information processing skills in Ukrainian infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objectives: The role that micronutrients play in ameliorating the impact of prenatal alcohol exposure was explored in a clinical trial conducted in the Ukraine. Cardiac orienting responses during a habituation/dishabituation learning paradigm were obtained from 6-12 month-olds to assess neurodevelop...

  9. Single-session motivational intervention to decrease alcohol use during pregnancy

    PubMed Central

    Osterman, Robin L.; Carle, Adam C.; Ammerman, Robert T.; Gates, Donna

    2014-01-01

    This randomized clinical trial tested the effectiveness of a single-session of motivational interviewing (MI) to decrease alcohol use during pregnancy, while examining theory-based mechanisms of the intervention. Eligible pregnant women who drank any amount of alcohol in the previous year (n=122) were randomized to an intervention or comparison group. Drinking behaviors, basic psychological need satisfaction, and autonomous motivation to decrease prenatal alcohol use were measured at baseline, 30 day postbaseline, and 30 day postpartum follow-ups. Poisson and linear regression with generalized estimating equations were used to evaluate treatment effects over time. Although MI was not found effective in decreasing alcohol use, low levels of reported alcohol use by the women at baseline left little room for improvement due to the intervention. To prevent fetal alcohol spectrum disorders, future studies will use self-report and biomarkers to more accurately identify women in need of interventions to reduce their risk of alcohol-exposed pregnancies. PMID:24637202

  10. Parental Attitudes about Teenage Pregnancy: Impact on Sexual Risk Behaviour of African-American Youth

    ERIC Educational Resources Information Center

    Annang, Lucy; Lian, Brad; Fletcher, Faith E.; Jackson, Dawnyéa

    2014-01-01

    African-American youth suffer disproportionately from sexual risk consequences including unintended pregnancy and sexually transmitted infections. Parents educating young people about sex may be one approach to reduce sexual risk behaviour among this population. The purpose of this study was to determine young people's perceptions of…

  11. Physical activity from menarche to first pregnancy and risk of breast cancer.

    PubMed

    Liu, Ying; Tobias, Deirdre K; Sturgeon, Kathleen M; Rosner, Bernard; Malik, Vasanti; Cespedes, Elizabeth; Joshi, Amit D; Eliassen, A Heather; Colditz, Graham A

    2016-09-15

    Breast tissue is particularly susceptible to exposures between menarche and first pregnancy, and a longer interval between these reproductive events is associated with elevated breast cancer risk. Physical activity during this time period may offset breast cancer risk, particularly for those at highest risk with longer menarche-to-first-pregnancy intervals. We used data from 65,576 parous women in the Nurses' Health Study II free of cancer in 1989 (baseline) and recalled their leisure-time physical activity at ages 12-34 in 1997. Current activity was collected at baseline and over follow-up. Relative risks (RRs) were estimated using multivariable Cox proportional hazards regression models. Between 1989 and 2011, 2,069 invasive breast cancer cases were identified. Total recreational activity between menarche and first pregnancy was not significantly associated with the risk of breast cancer. However, physical activity between menarche and first pregnancy was associated with significantly lower breast cancer risk among women in the highest category of a menarche-to first-pregnancy interval (≥20 years; RR for the highest versus the lowest quartile = 0.73, 95% confidence interval = 0.55-0.97; Ptrend  = 0.045; Pinteraction  = 0.048). This was not observed in women with a shorter interval. Physical activity between menarche and first pregnancy was associated with a lower risk of breast cancer among women with at least 20 years between these reproductive events. This may provide a modifiable factor that women can intervene on to mitigate their breast cancer risk associated with a longer interval. PMID:27130486

  12. Reducing the Risk: Building Skills To Prevent Pregnancy.

    ERIC Educational Resources Information Center

    Barth, Richard P.

    This teacher's guide focuses on ways to prevent teenage pregnancy by teaching and practicing the interpersonal skills necessary to help teenagers abstain or utilize effective contraception methods. The practice in this carefully-tested, 15-lesson curriculum comes in the form of role plays, class discussions, and homework assignments that focus on…

  13. What Are the Factors That Put a Pregnancy at Risk?

    MedlinePlus

    ... a higher chance of having birth defects and fetal alcohol spectrum disorder (FASD). FASD is the technical name for the ... Centers for Disease Control and Prevention. (n.d.). Fetal alcohol spectrum disorders: Alcohol use in pregnancy . Retrieved June 13, 2012, ...

  14. A Meta-Analysis of Maternal Smoking during Pregnancy and Autism Spectrum Disorder Risk in Offspring

    PubMed Central

    Tang, Shiming; Wang, Ying; Gong, Xuan; Wang, Gaohua

    2015-01-01

    The association between maternal smoking during pregnancy and autism spectrum disorder (ASD) risk in offspring has been investigated in several studies, but the evidence is not conclusive. We, therefore, conducted this meta-analysis to explore whether an association exists between maternal smoking during pregnancy and ASD risk in offspring. We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies of maternal smoking during pregnancy and ASD risk in offspring up to 10 June 2015. The random-effects model was used to combine results from individual studies. 15 observational studies (6 cohort studies and 9 case-control studies), with 17,890 ASD cases and 1,810,258 participants were included for analysis. The pooled odds ratio (OR) was 1.02 (95% confidence interval (CI): 0.93–1.13) comparing mothers who smoked during pregnancy with those who did not. Subgroup and sensitivity analysis suggested the overall result of this analysis was robust. Results from this meta-analysis indicate that maternal smoking during pregnancy is not associated with ASD risk in offspring. Further well-designed cohort studies are needed to confirm the present findings. PMID:26343689

  15. Adverse Pregnancy Conditions, Infertility, and Future Cardiovascular Risk: Implications for Mother and Child

    PubMed Central

    Park, Ki; Wei, Janet; Minissian, Margo; Merz, C. Noel Bairey

    2016-01-01

    Adverse pregnancy conditions in women are common and have been associated with adverse cardiovascular and metabolic outcomes such as myocardial infarction and stroke. As risk stratification in women is often suboptimal, recognition of non-traditional risk factors such as hypertensive disorders of pregnancy and premature delivery has become increasingly important. Additionally, such conditions may also increase the risk of cardiovascular disease in the children of afflicted women. In this review, we aim to highlight these conditions, along with infertility, and the association between such conditions and various cardiovascular outcomes and related maternal risk along with potential translation of risk to offspring. We will also discuss proposed mechanisms driving these associations as well as potential opportunities for screening and risk modification. PMID:26037616

  16. Thrombophilia and venous thromboembolism in pregnancy: a meta-analysis of genetic risk.

    PubMed

    Ziakas, Panayiotis D; Poulou, Loukia S; Pavlou, Matthaios; Zintzaras, Elias

    2015-08-01

    Three common polymorphic variants, namely Factor V Leiden (FVL), Prothrombin G20210A (PT G20210A) and Methylenetetrahydrofolate Reductase (MTHFR) C677T are candidate genes for venous thromboembolism (VTE) in pregnancy. We performed a literature review and meta-analysis of pertinent genetic association studies (GAS) in pregnancy, to quantify the genetic risk of VTE in pregnancy. We used the model-free approach of generalized odds ratio (ORG) to estimate gene-to-disease association and explored the mode of inheritance using the degree of dominance h index. Twelve case-control GAS studies provided the full genotype distributions for at least one candidate gene to assess the genetic risk. FVL was associated with a significant risk of VTE in pregnancy (ORG 7.28; 95% confidence interval 5.53-9.58) and a dominant mode of inheritance (h=0.76), that is the effect of heterozygous carriers will lie close to the homozygous mutant genotype. PT G20210A mutation was also associated with a significant VTE risk (ORG 5.43; 95% CI 3.66-8.03) and had an over-dominant mode of inheritance (h=1.5), suggesting that the effect of heterozygous carriers may exceed that of homozygous mutant. MTHFR C677T had no association with VTE risk in pregnancy (ORG 1.24; 95% CI 0.88-1.73). Our analysis provided robust data on VTE in pregnancy, relative to FVL and PT G20210A status and suggested that the genetic effects of heterozygous over homozygous carriers do not justify stratification of heterozygous as "lower risk" over homozygous mutants. On clinical grounds this may impact decisions to preferentially exclude heterozygous from anticoagulation prophylaxis. PMID:26115054

  17. Pregnancy is not a risk factor for gallstone disease: Results of a randomly selected population sample

    PubMed Central

    Walcher, Thomas; Haenle, Mark Martin; Kron, Martina; Hay, Birgit; Mason, Richard Andrew; von Schmiesing, Alexa Friederike Alice; Imhof, Armin; Koenig, Wolfgang; Kern, Peter; Boehm, Bernhard Otto; Kratzer, Wolfgang

    2005-01-01

    AIM: To investigate the prevalence, risk factors, and selection of the study population for cholecystolithiasis in an urban population in Germany, in relation to our own findings and to the results in the international literature. METHODS: A total of 2 147 persons (1 111 females, age 42.8 ± 12.7 years; 1 036 males, age 42.3 ± 13.1 years) participating in an investigation on the prevalence of Echinococcus multilocularis were studied for risk factors and prevalence of gallbladder stone disease. Risk factors were assessed by means of a standardized interview and calculation of body mass index (BMI). A diagnostic ultrasound examination of the gallbladder was performed. Data were analyzed by multiple logistic regression, using the SAS statistical software package. RESULTS: Gallbladder stones were detected in 171 study participants (8.0%, n = 2 147). Risk factors for the development of gallbladder stone disease included age, sex, BMI, and positive family history. In a separate analysis of female study participants, pregnancy (yes/no) and number of pregnancies did not exert any influence. CONCLUSION: Findings of the present study confirm that age, female sex, BMI, and positive family history are risk factors for the development of gallbladder stone disease. Pregnancy and the number of pregnancies, however, could not be shown to be risk factors. There seem to be no differences in the respective prevalence for gallbladder stone disease in urban and rural populations. PMID:16425387

  18. Pregnancy risk among the younger sisters of pregnant and childbearing adolescents.

    PubMed

    East, P L; Felice, M E

    1992-04-01

    There is increasing evidence that younger sisters of childbearing teenagers are at increased risk for adolescent childbearing. We critically review this research and discuss three plausible theoretical explanations (social modeling, shared parenting influences, and shared societal risk) why the younger sisters of childbearing adolescents would themselves be at risk for teenage pregnancy. Considerations for preventive interventions aimed at the younger sisters of pregnant teenagers and directions for future research are discussed. PMID:1577959

  19. Characterization of the Risks of Adverse Outcomes Following Rubella Infection in Pregnancy.

    PubMed

    Thompson, Kimberly M; Simons, Emily A; Badizadegan, Kamran; Reef, Susan E; Cooper, Louis Z

    2016-07-01

    Although most infections with the rubella virus result in relatively minor sequelae, rubella infection in early pregnancy may lead to severe adverse outcomes for the fetus. First recognized in 1941, congenital rubella syndrome (CRS) can manifest with a diverse range of symptoms, including congenital cataracts, glaucoma, and cardiac defects, as well as hearing and intellectual disability. The gestational age of the fetus at the time of the maternal rubella infection impacts the probability and severity of outcomes, with infection in early pregnancy increasing the risks of spontaneous termination (miscarriage), fetal death (stillbirth), birth defects, and reduced survival for live-born infants. Rubella vaccination continues to change the epidemiology of rubella and CRS globally, but no models currently exist to evaluate the economic benefits of rubella management. This systematic review provides an overall assessment of the weight of the evidence for the outcomes associated with rubella infections in the first 20 weeks of pregnancy. We identified, evaluated, and graded 31 studies (all from developed countries) that reported on the pregnancy outcomes of at least 30 maternal rubella infections. We used the available evidence to estimate the increased risks of spontaneous termination, fetal death, infant death, and CRS as a function of the timing of rubella infection in pregnancy and decisions about induced termination. These data support the characterization of the disability-adjusted life years for outcomes associated with rubella infection in pregnancy. We find significant impacts associated with maternal rubella infections in early pregnancy, which economic analyses will miss if they only focus on live births of CRS cases. Our estimates of fetal loss from increased induced terminations due to maternal rubella infections provide context that may help to explain the relatively low numbers of observed CRS cases per year despite potentially large burdens of disease. Our

  20. Impacts of Abstinence Education on Teen Sexual Activity, Risk of Pregnancy, and Risk of Sexually Transmitted Diseases

    ERIC Educational Resources Information Center

    Trenholm, Christopher; Devaney, Barbara; Fortson, Kenneth; Clark, Melissa; Bridgespan, Lisa Quay; Wheeler, Justin

    2008-01-01

    This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a…

  1. Self-reported Vitamin Supplementation in Early Pregnancy and Risk of Miscarriage

    PubMed Central

    Olshan, Andrew F.; Herring, Amy H.; Savitz, David A.; Siega-Riz, Anna Maria; Hartmann, Katherine E.

    2009-01-01

    Miscarriage is a common and poorly understood adverse pregnancy outcome. In this study, the authors sought to evaluate the relation between self-reported use of prenatal vitamins in early pregnancy and the risk of miscarriage. Between 2000 and 2008, 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy. Approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage (odds ratio = 0.43, 95% confidence interval: 0.30, 0.60) in comparison with no exposure. These results should be viewed in the context of a potentially preventive biologic mechanism mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy. PMID:19372214

  2. Pregnancy ultrasound

    MedlinePlus

    ... findings that might indicate an increased risk for Down syndrome A pregnancy ultrasound may also be done in ... weeks of pregnancy to look for signs of Down syndrome or other problems in the developing baby. This ...

  3. Early Pregnancy among Adolescent Females with Serious Emotional Disturbances: Risk Factors and Outcomes.

    ERIC Educational Resources Information Center

    Yampolskaya, Svetlana; Brown, Eric C.; Greenbaum, Paul E.

    2002-01-01

    A study involving 109 female adolescents with serious emotional disturbances (ages 9-18) found the following risk factors for early pregnancy: being African American, low family income, dropping out of school, conduct disorder, and substance use disorder. However, according to multivariate analysis, only dropping out of school was a significant…

  4. Management of High-Risk Pregnancy: Report of a Combined Obstetrical and Neonatal Intensive Care Unit

    PubMed Central

    Effer, S. B.

    1969-01-01

    The methodology, equipment and personnel required to carry out an intensive-care program in the management of high-risk pregnancies have been outlined. The perinatal mortality rate has been determined and its etiology has been analyzed. There appear to be three conditions in which the degree of high risk is such as to warrant provision of the complete facilities of the service we described, viz., (a) severe pre-eclampsia; (b) marked intrauterine growth retardation with placental insufficiency as determined from serial measurements of uterine growth and estriol determinations; and (c) irreversible labour in premature pregnancies where a birth weight of 2200 g. or less is anticipated. Numerous other conditions that we have monitored have perhaps had their good outcome because of monitoring facilities. A less sophisticated and more easily applied method of monitoring should be available within the context of routine labour and delivery rooms. There is a pressing need to re-evaluate and change some of our methods of educating our undergraduate, postgraduate and practising physicians and to provide continuing education in the realm of prenatal care and recognition of high-risk pregnancy. Regionalization and centralization of this type of intensive care for high-risk pregnancies are required. Indispensable to the success of this type of project is the incorporation, without physical, emotional or intellectual barriers, of both a pediatric and an obstetrical component within the intensive-care unit. ImagesFIG. 3 PMID:5344991

  5. Women with Intellectual Disability at Risk of Adverse Pregnancy and Birth Outcomes

    ERIC Educational Resources Information Center

    Mcconnell, D.; Mayes, R.; Llewellyn, G.

    2008-01-01

    Background: An increasing number of women with intellectual disability (ID) have children. Cross-sectional, clinical population data suggest that these women face an increased risk of delivering preterm and/or low birthweight babies. The aim of this study was to explore the prevalence of poor pregnancy and birth outcomes in women with ID and/or…

  6. Research on Adolescent Pregnancy-Risk: Implications for Sex Education Programs.

    ERIC Educational Resources Information Center

    Jorgensen, Stephen R.; Alexander, Sharon J.

    1983-01-01

    A complex set of issues plague the efforts of public school sex education programs to reduce the level of pregnancy risk among adolescents. Issues include: (1) uncertain status of sex education; (2) training the teacher; (3) support among school leaders; (4) other influences on adolescent development; (5) developmental characteristics of…

  7. Risk and Protective Factors Predictive of Adolescent Pregnancy: A Longitudinal, Prospective Study

    ERIC Educational Resources Information Center

    East, Patricia L.; Khoo, Siek Toon; Reyes, Barbara T.

    2006-01-01

    One hundred twenty-eight Latina and African American girls from high-risk environments (e.g., poverty, family history of teen parenting, etc.) were studied from age 13 through age 19 to prospectively identify the protective factors that might guard against teenage pregnancy. Results indicated that involved and strict parenting during early…

  8. Enzyme analysis of amniotic fluid for prenatal diagnosis of cystic fibrosis in high-risk pregnancies.

    PubMed

    Peretz, H; Chemke, J; Usher, S; Legum, C; Graff, E

    1988-12-01

    We determined the activity concentrations of alkaline phosphatase (ALP), ALP isoenzymes, gamma-glutamyltransferase (GGT), and alpha-glucosidase (AGL) in 1200 unselected amniotic fluids and in amniotic fluids from 40 pregnancies at high risk for cystic fibrosis (CF). From the results we established the normal range and CF-predictive cutoff values for these enzymes in the second trimester of pregnancy. In all predicted normal pregnancies that went to term, normal children were born. Among the predicted affected pregnancies, 14 were terminated and two went to term, one resulting in a CF-affected child and the other in a healthy child. Evidence for CF was found in all 13 aborted fetuses examined (the parents of one refused to allow autopsy). We noted no differences in the amniotic fluid enzyme activities for the Arab and various Jewish ethnic groups living in Israel. We conclude that prenatal diagnosis of CF among the Israeli population at risk for CF is feasible by means of a reliable, fast, and economic test in the second trimester of pregnancy. PMID:2904307

  9. Are adolescents who report prior sexual abuse at higher risk for pregnancy?

    PubMed

    Rainey, D Y; Stevens-Simon, C; Kaplan, D W

    1995-10-01

    Adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy. This may result from earlier, more frequent, less well-protected sexual activity or from a greater desire to conceive. To determine the relative contribution of these two possible explanations to the reported association between sexual abuse and adolescent pregnancy, we studied the reproductive and sexual histories of 200 sexually active 13-18 year old females in relation to self-reported sexual abuse. Anonymous questionnaires revealed that 40 (20%) of the 200 subjects reported sexual abuse. Analyses revealed no group differences in the median age of first voluntary intercourse, the frequency of sexual intercourse, or the consistency of birth control use. Compared to their nonabused peers, however, teenagers reporting abuse were more likely to be trying to conceive (35% vs. 14% p < .01), to have boyfriends pressuring them to conceive (76% vs. 44% p < .01), and to have fears about infertility (38% vs. 16% p < .01). Our findings suggest that childhood sexual abuse may increase the risk of adolescent pregnancy by fostering the desire to conceive. Further study is needed to determine why a disproportionate number of sexually abused adolescents desire pregnancy. The efficacy of adolescent pregnancy prevention programs may be improved by identifying previously abused adolescents and by designing educational interventions that specifically address their desire to conceive. PMID:8556442

  10. The effects of ambivalent fertility desires on pregnancy risk in young women in Michigan, United States

    PubMed Central

    Miller, Warren B.; Barber, Jennifer S.; Gatny, Heather H.

    2012-01-01

    Many different definitions of the construct of motivational ambivalence have appeared in the literature on reproductive health. Using a theoretical framework in which motivational ambivalence is defined as an interaction between positive and negative pregnancy desires, we propose two hypotheses. The first is that positive and negative pregnancy desires independently predict the risk of an unplanned pregnancy. The second is that ambivalence and three related constructs that are also based on the interaction between positive and negative desires are each important predictors of pregnancy risk. We use weekly journal data collected from a U.S. sample of 1,003 women aged 18–19 years and conduct hazard model analysis to test our hypotheses. Using both dummy and continuous predictors, we report results that confirm both hypotheses. The proposed interaction framework has demonstrated validity, compares favorably with previously reported alternative approaches, and incorporates a set of constructs that have potential importance for further research directed at the prevention of unplanned pregnancy. PMID:23234316

  11. The border of reproductive control: undocumented immigration as a risk factor for unintended pregnancy in Switzerland.

    PubMed

    Casillas, Alejandra; Bodenmann, Patrick; Epiney, Manuella; Gétaz, Laurent; Irion, Olivier; Gaspoz, Jean-Michel; Wolff, Hans

    2015-04-01

    Unintended pregnancies reflect an unmet need for family planning, and are part of health disparities. Using the only database to inquire about pregnancy intention among women in Switzerland, this study examined the relationship between immigrant documentation and unintended pregnancy (UP). Among pregnant women presenting to a Swiss hospital, we compared pregnancy intention between documented and undocumented women. We used logistic regression to examine whether undocumented status was associated with UP after adjusting for other significant predictors. Undocumented women had more unintended pregnancies (75.2 vs. 20.6%, p = 0.00). Undocumented status was associated with UP after adjustment (OR 6.23, 95% CI 1.83-21.2), as was a history of psychological problems (OR 4.09, 95% CI 1.32-12.7). Contraception non-use was notably associated with lower odds of UP (OR 0.01, 95% CI 0.004-0.04). Undocumented status was significantly associated with UP, even after adjusting for well-recognized risk factors. This highlights the tremendous risk of undocumented status on UP among women in Switzerland. PMID:24186358

  12. Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China

    PubMed Central

    Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A.; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

    2015-01-01

    Background Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. Methods The study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Results Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84). Conclusion The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP. PMID:26305565

  13. [Bipolar disorder, pregnancy and the postpartum--risks and possibilities of pharmacotherapy].

    PubMed

    Krüger, Stephanie

    2009-06-01

    Pregnancy and the postpartum are times of increased risk for women with bipolar disorder to develop mood episodes, especially depressions that may require pharmacotherapy. If mood stabilizing agents are discontinued prior or due to pregnancy, the risk for relapse increases dramatically. On the other hand, there is no psychotropic drug that is completely risk-free for the unborn. Some mood stabilizing medications are teratogenic, others can cause severe perinatal complications. Thus, the decision whether to treat the pregnant women with psychotropic drugs is difficult to make. In this paper, the reproductive risks of mood stabilizing agents, antidepressants, neuroleptics and benzodiazepines for the fetus are reviewed. During the postpartum period severe mood disorders can occur. The signs and symptoms of these disorders are reviewed and therapeutic strategies are discussed. PMID:19496044

  14. Predictors of Alcohol Use Prior to Pregnancy Recognition among Township Women in Cape Town, South Africa

    PubMed Central

    O'Connor, Mary J.; Tomlinson, Mark; LeRoux, Ingrid M.; Stewart, Jacqueline; Greco, Erin; Rotheram-Borus, Mary Jane

    2010-01-01

    South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASDs) in the world. The purpose of this study was to identify high risk factors associated with drinking alcohol prior to pregnancy recognition in 24 neighborhoods in the Cape Flats outside Cape Town, South Africa. An interviewer assessed risk among 619 pregnant Black/African women between the ages of 18 and 41 years. Logistic regression analyses explored factors associated with drinking alcohol post conception but prior to pregnancy recognition. Forced multiple logistic regression analysis revealed that drinking prior to pregnancy recognition was associated with being younger, single, having better living conditions, smoking, having a longer gestation prior to pregnancy recognition, having a greater number of sexual partners, and a higher incidence of intimate partner violence. Depressive symptoms tended to be higher among alcohol users. These risk factors were consistent with other research on the characteristics of South African women having children with a diagnosis of Fetal Alcohol Spectrum Disorders and/or of non pregnant women at high risk for an alcohol-exposed pregnancy. These findings highlight the need for women of child-bearing age to be routinely screened for alcohol use and its associated risk factors. Intervention efforts could be integrated into health initiatives already present in South Africa including the prevention and treatment of HIV/AIDS, tuberculosis, and malnutrition. Preconception care is particularly important since pregnancy recognition often occurs several weeks to months following conception and could be implemented by South African community health workers. These endeavors should facilitate national goals of healthier pregnancies and the elimination of FASDs in South Africa. PMID:21084142

  15. Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

    PubMed Central

    Smith, Gordon C S; Malone, Fergal D; Ball, Robert H; Nyberg, David A; Comstock, Christine H; Hankins, Gary D V; Berkowitz, Richard L; Gross, Susan J; Dugoff, Lorraine; Craigo, Sabrina D; Timor-Tritsch, Ilan E; Carr, Stephen R; Wolfe, Honor M; D'Alton, Mary E

    2007-01-01

    Objective To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant. Design Prospective cohort study of 38 033 pregnancies between 1999 and 2003. Setting 15 centres representing major regions of the United States. Participants 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age. Main outcome measures Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant. Results For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy. Conclusion Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity. PMID:17355993

  16. Carbohydrate Intake as a Risk Factor for Biliary Sludge and Stones during Pregnancy

    PubMed Central

    Wong, Alan C.; Ko, Cynthia W.

    2013-01-01

    Summary Background High carbohydrate intake has been linked to insulin resistance, obesity, and abnormal serum lipid profiles—conditions which favor gallstone formation. Goals The aim of this study was to evaluate the effect of dietary carbohydrate intake on incident gallbladder disease, defined as biliary sludge and stones, during pregnancy. Study We prospectively studied 3,070 pregnant women who underwent serial gallbladder ultrasound during pregnancy and at 4-6 weeks postpartum. All women had at least 2 study ultrasounds for comparison. A semi-quantitative food frequency questionnaire was completed by subjects in the early 3rd trimester. Multivariate logistic regression was performed to assess the risk of incident gallbladder disease across quartiles total and individual carbohydrate and individual carbohydrates (starch, sucrose, galactose, fructose, and lactose) intake. Results The cumulative incidence of gallbladder disease was 10.2% by 4-6 weeks postpartum. The risk of incident gallbladder disease during pregnancy was significantly higher among women in the highest quartile of total carbohydrate intake vs. those in the lowest quartile (odds ratio 2.09, 95% confidence interval 1.02-4.27). High intake of fructose was associated with increased risk even after additional adjustment for total carbohydrate intake (odds ratio 2.18, 95% confidence interval 1.23-3.86, comparing highest to lowest quartile). No association was found between the intake of starch, sucrose, lactose, or galactose and the risk of incident gallbladder disease. Conclusions High consumption of total carbohydrate and fructose may increase the risk of developing gallbladder disease during pregnancy. Dietary modification during pregnancy might reduce gallstone incidence during this time period. PMID:23442841

  17. Pregnancy as a risk factor for undertreatment after bariatric surgery.

    PubMed

    Jacquemyn, Yves; Meesters, Johanna

    2014-01-01

    A pregnant woman presented at the emergency department with severe nausea and vomiting at 20 weeks of gestational age; she was known with gastric banding. Advanced imaging studies were avoided of fear to harm the fetus. The patient continued to vomit and at 23 weeks intrauterine fetal death was noted. The symptoms did not resolve after delivery and CT scan demonstrated slippage of the gastric band over the pylorus resulting in a high digestive obstruction as the cause of hyperemesis and finally resulting necrosis of the vasa brevia. The gastric band was laparoscopically removed along with the necrotic tissue. Avoidance of radiological and endoscopic investigations of fear to harm the pregnancy resulted in complications and possibly in fetal death. PMID:24408945

  18. Preconception and early pregnancy air pollution exposures and risk of gestational diabetes mellitus

    SciTech Connect

    Robledo, Candace A.; Mendola, Pauline; Yeung, Edwina; Männistö, Tuija; Sundaram, Rajeshwari; Liu, Danping; Ying, Qi; Sherman, Seth; Grantz, Katherine L.

    2015-02-15

    Background: Air pollution has been linked to gestational diabetes mellitus (GDM) but no studies have evaluated impact of preconception and early pregnancy air pollution exposures on GDM risk. Methods: Electronic medical records provided data on 219,952 singleton deliveries to mothers with (n=11,334) and without GDM (n=208,618). Average maternal exposures to particulate matter (PM) ≤ 2.5 μm (PM{sub 2.5}) and PM{sub 2.5} constituents, PM ≤ 10 μm (PM{sub 10}), nitrogen oxides (NO{sub x}), carbon monoxide, sulfur dioxide (SO{sub 2}) and ozone (O{sub 3}) were estimated for the 3-month preconception window, first trimester, and gestational weeks 1–24 based on modified Community Multiscale Air Quality models for delivery hospital referral regions. Binary regression models with robust standard errors estimated relative risks (RR) for GDM per interquartile range (IQR) increase in pollutant concentrations adjusted for study site, maternal age and race/ethnicity. Results: Preconception maternal exposure to NO{sub X} (RR=1.09, 95% CI: 1.04, 1.13) and SO{sub 2} (RR=1.05, 1.01, 1.09) were associated with increased risk of subsequent GDM and risk estimates remained elevated for first trimester exposure. Preconception O{sub 3} was associated with lower risk of subsequent GDM (RR=0.93, 0.90, 0.96) but risks increased later in pregnancy. Conclusion: Maternal exposures to NO{sub x} and SO{sub 2} preconception and during the first few weeks of pregnancy were associated with increased GDM risk. O{sub 3} appeared to increase GDM risk in association with mid-pregnancy exposure but not in earlier time windows. These common exposures merit further investigation. - Highlights: • Air pollution may be related to gestational diabetes (GDM). • No prior studies have examined preconception exposure. • Maternal exposure to NO{sub x} and SO{sub 2} before conception increased subsequent GDM risk. • NO{sub x} and SO{sub 2} exposure in the first seven weeks of pregnancy also increased

  19. Folic Acid Supplementation in Pregnancy and the Risk of Pre-Eclampsia—A Cohort Study

    PubMed Central

    Wen, Shi Wu; Guo, Yanfang; Rodger, Marc; White, Ruth Rennicks; Yang, Qiuying; Smith, Graeme N.; Perkins, Sherry L.; Walker, Mark C.

    2016-01-01

    This prospective cohort study designed to assess the effect of folic acid supplementation in pregnancy on the risk of preeclampsia (PE) took place in Ottawa, ON and Kingston, ON, Canada, from September 1, 2002 to August 31, 2008. Pregnant women, less than 20 weeks gestational age were recruited and delivered in the Ottawa region and the Kingston General Hospital. Demographic characteristics of the study participants and the patterns of supplementation of folic acid were described and occurrence of PE between women with folic acid supplementation during pregnancy and women without were compared. Multiple logistic regression was used in the estimation of the independent effect of supplementation of folic acid. Additional analyses assessing the effect of low RBC and serum folate and dose-response relationship were performed. Analyses were performed in all study participants, and then in high risk and low risk sub-groups, respectively. A total of 7,669 participants were included in the final analysis. Ninety five percent of the study participants were taking folic acid supplementation in early second trimester. The rate of PE was lower in the supplementation group than in the no supplementation group, and the difference was statistically significant in high risk women. Similar patterns of associations were observed in analysis by RBC and serum folate levels and in dose-response analysis. Folic acid supplementation in pregnancy may reduce PE risk in pregnant women, especially in those women with increased risk of developing PE. PMID:26901463

  20. Increased Risk of Asthma in Children with ADHD: Role of Prematurity and Maternal Stress during Pregnancy

    PubMed Central

    Grizenko, Natalie; Osmanlliu, Esli; Fortier, Marie-Ève; Joober, Ridha

    2015-01-01

    Objective: ADHD and asthma are prevalent conditions in childhood, with complex pathophysiology involving genetic-environmental interplay. The study objective is to examine the prevalence of asthma in our ADHD population and explore factors that may increase the risk of developing asthma in children with ADHD. Methods: We retrospectively analyzed the presence of maternal stress during pregnancy and history of asthma in 201 children diagnosed with ADHD. Results: Chi-square analysis indicated significant higher presence of asthma in our ADHD sample compared to Quebec children, χ2(1, N = 201) = 15.37, P<0.001. Only prematurity and stress during pregnancy significantly predicted asthma in a logistic regression model, χ2(2)=23.70, P<0.001, with odds ratios of 10.6 (95% CI: 2.8–39.5) and 3.2 (95% CI: 1.4–7.3), respectively. Conclusion: Children with ADHD have a higher prevalence of asthma than the general Quebec pediatric population. Children with ADHD born prematurely and/or those whose mothers experienced stress during pregnancy have a significantly increased risk of developing asthma. The study highlights the importance of potentially offering social and psychological support to mothers who experienced stress during pregnancy and/or are at risk of delivering prematurely. PMID:26379722

  1. Maternal obesity in females born small: Pregnancy complications and offspring disease risk.

    PubMed

    Mahizir, Dayana; Briffa, Jessica F; Hryciw, Deanne H; Wadley, Glenn D; Moritz, Karen M; Wlodek, Mary E

    2016-01-01

    Obesity is a major public health crisis, with 1.6 billion adults worldwide being classified as overweight or obese in 2014. Therefore, it is not surprising that the number of women who are overweight or obese at the time of conception is increasing. Obesity during pregnancy is associated with the development of gestational diabetes and preeclampsia. The developmental origins of health and disease hypothesis proposes that perturbations during critical stages of development can result in adverse fetal changes that leads to an increased risk of developing diseases in adulthood. Of particular concern, children born to obese mothers are at a greater risk of developing cardiometabolic disease. One subset of the population who are predisposed to developing obesity are children born small for gestational age, which occurs in 10% of pregnancies worldwide. Epidemiological studies report that these growth-restricted children have an increased susceptibility to type 2 diabetes, obesity, and hypertension. Importantly during pregnancy, growth-restricted females have a higher risk of developing cardiometabolic disease, indicating that they may have an exacerbated phenotype if they are also overweight or obese. Thus, the development of early pregnancy interventions targeted to obese mothers may prevent their children from developing cardiometabolic disease in adulthood. PMID:26173914

  2. Risk of fetal death after pandemic influenza infection or vaccination during pregnancy

    PubMed Central

    Håberg, Siri E; Trogstad, Lill; Gunnes, Nina; Wilcox, Allen J.; Gjessing, Håkon K.; Samuelsen, Sven Ove; Skrondal, Anders; Cappelen, Inger; Engeland, Anders; Aavitsland, Preben; Madsen, Steinar; Buajordet, Ingebjørg; Furu, Kari; Nafstad, Per; Vollset, Stein Emil; Berit, Feiring; Nøkleby, Hanne; Magnus, Per; Stoltenberg, Camilla

    2013-01-01

    Background During the 2009 influenza pandemic, pregnant women were at particular risk of serious influenza illness. This concern was further complicated by questions about vaccine safety in pregnant women raised by anecdotal reports of fetal deaths following vaccination. Methods We explored the safety of influenza vaccination of pregnant women by linking Norwegian national registries and medical consultation data to determine influenza diagnosis, vaccination status, birth outcomes, and background information for pregnant women before, during, and after the pandemic. We used Cox regression models to estimate hazard ratios of fetal death, with gestational day as the time metric and vaccination and pandemic exposure as time-dependent exposure variables. Results There were 117,347 eligible pregnancies in Norway in 2009–2010. Fetal mortality was 4.9/1000. 54% of pregnant women in their second or third trimester during the pandemic were vaccinated. Vaccination in pregnancy substantially reduced the risk of influenza diagnosis (adjusted hazard ratio, 0.30; 95% confidence interval [CI], 0.25 to 0.34). A clinical diagnosis of influenza in the mother increased the risk of fetal death (adjusted hazard ratio, 1.91; 95% CI, 1.07 to 3.41). Among pregnant women, the risk of fetal death was lower with vaccination, although this reduction was not statistically significant (adjusted hazard ratio, 0.88; 95% CI, 0.66 to 1.17). Conclusions Pandemic influenza in pregnancy was associated with increased risk of fetal death. Vaccination during pregnancy reduced the risk of influenza diagnosis. Vaccination itself did not increase fetal mortality, and may have reduced the risk of influenza-related fetal death during the pandemic. PMID:23323868

  3. Alcohol, Smoking and Drug Use among Inuit Women of Childbearing Age during Pregnancy and the Risk to Children

    PubMed Central

    Muckle, Gina; Laflamme, Dominique; Gagnon, Jocelyne; Boucher, Olivier; Jacobson, Joseph L.; Jacobson, Sandra W.

    2011-01-01

    Background Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking, is a well-known public health concern. Aim This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified. Methods 248 Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented. Results 92% of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which corresponds to 38% of pregnant women. 36% of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy and the number of young children living with the mother. Conclusions These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs. PMID:21332531

  4. Social discrimination, stress, and risk of unintended pregnancy among young women

    PubMed Central

    Kusunoki, Yasamin; Gatny, Heather; Barber, Jennifer

    2014-01-01

    Purpose Prior research linking young women’s mental health to family planning outcomes has often failed to consider their social circumstances and the intersecting biosocial mechanisms that shape stress and depression as well as reproductive outcomes during adolescence and young adulthood. We extend our previous work to investigate relationships between social discrimination, stress and depression symptoms, and unintended pregnancy among adolescent and young adult women. Methods Data were drawn from 794 women 18–20 years in a longitudinal cohort study. Baseline and weekly surveys assessed psychosocial information including discrimination (EDS), stress (PSS), depression (CES-D), and reproductive outcomes. Multi-level, mixed-effects logistic regression and discrete-time hazard models estimated associations between discrimination, mental health, and pregnancy. Baron and Kenny’s method was used to test mediation effects of stress and depression on discrimination and pregnancy. Results The mean discrimination score was 19/45 points; 20% reported moderate/high discrimination. Discrimination scores were higher among women with stress and depression symptoms versus those without symptoms (21 versus 18 points for both, p’s<0.001). Pregnancy rates (14% overall) were higher among women with moderate/high (23%) versus low (11%) discrimination (p<0.001). Discrimination was associated with stress (aRR 2.2, 95%CI 1.4,3.4), depression (aRR 2.4, CI 1.5,3.7), and subsequent pregnancy (aRR 1.8, CI 1.1,3.0). Stress and depression symptoms did not mediate discrimination’s effect on pregnancy. Conclusions Discrimination was associated with an increased risk of mental health symptoms and unintended pregnancy among these young women. The interactive social and biological influences on reproductive outcomes during adolescence and young adulthood warrant further study. PMID:25586228

  5. Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies.

    PubMed Central

    Li, D K; Mueller, B A; Hickok, D E; Daling, J R; Fantel, A G; Checkoway, H; Weiss, N S

    1996-01-01

    To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation. PMID:8633746

  6. Comorbidities of Attention Deficit Hyperactivity Disorder: Pregnancy Risk Factors and Parent Mental Health.

    PubMed

    Silva, Desiree; Houghton, Stephen; Hagemann, Erika; Bower, Carol

    2015-08-01

    Our study examined the risk of maternal smoking and alcohol consumption in pregnancy associated with child comorbidity in a community sample of children diagnosed with attention deficit hyperactivity disorder (ADHD). We used a cross sectional community retrospective questionnaire of 321 children diagnosed with ADHD. Our results suggest that maternal smoking increased the risk of oppositional defiant behavior (ODB) in children with ADHD twofold (OR 2.27; CI 1.29-4.11). Maternal alcohol consumption increased the risk although not significantly for ADHD child comorbid ODB, anxiety disorder and depression. Parent mental health significantly impacted on child comorbidity. Our study suggests that smoking in pregnancy is associated with comorbid ODB, independent of parent mental health, family history of ADHD and socioeconomic factors. Parent mental health is independently associated with comorbid ODB, anxiety disorder and depression. PMID:25179388

  7. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management.

    PubMed

    Hosseini-Carroll, Pegah; Mutyala, Monica; Seth, Abhishek; Nageeb, Shaheen; Soliman, Demiana; Boktor, Moheb; Sheth, Ankur; Chapman, Jonathon; Morris, James; Jordan, Paul; Manas, Kenneth; Becker, Felix; Alexander, Jonathan Steven

    2015-11-01

    Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using "top-down" care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. PMID:26558150

  8. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management

    PubMed Central

    Hosseini-Carroll, Pegah; Mutyala, Monica; Seth, Abhishek; Nageeb, Shaheen; Soliman, Demiana; Boktor, Moheb; Sheth, Ankur; Chapman, Jonathon; Morris, James; Jordan, Paul; Manas, Kenneth; Becker, Felix; Alexander, Jonathan Steven

    2015-01-01

    Inflammatory bowel diseases (IBD) are chronic idiopathic inflammatory conditions characterized by relapsing and remitting episodes of inflammation which can affect several different regions of the gastrointestinal tract, but also shows extra-intestinal manifestations. IBD is most frequently diagnosed during peak female reproductive years, with 25% of women with IBD conceiving after their diagnosis. While IBD therapy has improved dramatically with enhanced surveillance and more abundant and powerful treatment options, IBD disease can have important effects on pregnancy and presents several challenges for maintaining optimal outcomes for mothers with IBD and the developing fetus/neonate. Women with IBD, the medical team treating them (both gastroenterologists and obstetricians/gynecologists) must often make highly complicated choices regarding conception, pregnancy, and post-natal care (particularly breastfeeding) related to their choice of treatment options at different phases of pregnancy as well as post-partum. This current review discusses current concerns and recommendations for pregnancy during IBD and is intended for gastroenterologists, general practitioners and IBD patients intending to become, (or already) pregnant, and their families. We have addressed patterns of IBD inheritance, effects of IBD on fertility and conception (in both men and women), the effects of IBD disease activity on maintenance of pregnancy and outcomes, risks of diagnostic procedures during pregnancy and potential risks and complications associated with different classes of IBD therapeutics. We also have evaluated the clinical experience using “top-down” care with biologics, which is currently the standard care at our institution. Post-partum care and breastfeeding recommendations are also addressed. PMID:26558150

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

    PubMed Central

    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-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. PMID:26229389

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

    PubMed

    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. PMID:26229389

  11. Validation of the High-Risk Pregnancy Stress Scale in a sample of hospitalized Greek high-risk pregnant women.

    PubMed

    Gourounti, Kleanthi; Karpathiotaki, Natassa; Karapanou, Vassiliki; Antzaklis, Panos; Daskalakis, Georgios

    2016-01-01

    The aim of the authors in this study was to determine the psychometric properties of the Greek adaptation of the High-Risk Pregnancy Stress Scale (HRPSS) in a sample of high-risk hospitalized pregnant women. The sample consisted of 133 high-risk pregnant women with gestational age from 9 to 37 weeks. Data were collected between February and June of 2014. HRPSS was "forward-backward" translated from English to Greek. Principal axis factoring with promax rotation was used to test the factor structure of the HRPSS. Measures of state anxiety (STAI) and depressive symptoms (EPDS) were used to assess the convergent validity of the HRPSS. Exploratory factor analysis suggested three factors: concerns of pregnancy, movement restriction, and isolation and restriction of external activities. Construct validity was confirmed by computing correlations between the HRPSS and constructions of anxiety and depressive symptoms. Internal consistency reliability was satisfactory (α = 0.813). The original factor structure of the HRPSS was only partly replicated. The results of the exploratory factor analysis suggested that a three-factor solution instead of a two-factor solution would be the most adequate. The HRPSS is an appropriate measure for assessing the levels of concerns regarding pregnancy outcome, movement restriction, isolation, and external activity restrictions in Greek high-risk pregnant women. PMID:26624018

  12. Risk Factors and Life Processes Associated with Teenage Pregnancy: Results of a Prospective Study from Birth to 20 Years.

    ERIC Educational Resources Information Center

    Woodward, Lianne; Fergusson, David M.; Horwood, L. John

    2001-01-01

    Data gathered during a 20-year longitudinal study of New Zealand women were used to describe the extent and timing of pregnancies within the cohort up to age 20; and to examine the extent to which the risk of early pregnancy was related to a range of social background, family, individual, and peer relationship factors measured over the course of…

  13. Smoking in pregnancy and risk of cancer among young children: A population-based study.

    PubMed

    Heck, Julia E; Contreras, Zuelma A; Park, Andrew S; Davidson, Tom B; Cockburn, Myles; Ritz, Beate

    2016-08-01

    Smoking during pregnancy is a plausible risk factor for childhood cancer, yet previous studies have yielded conflicting results, and few prospective studies have been published. Data on maternal smoking were obtained from California birth certificates. We linked California birth certificates (births 2007-2011) with California Cancer Registry records for childhood cancer cases (diagnosed January 2007-September 2013) that were ages 5 or younger at diagnosis (N cases = 2,021). Controls (N = 40,356) were frequency-matched by birth year and randomly selected from birth certificate records. We used unconditional logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI) to assess the association between smoking during pregnancy and childhood cancer. We observed positive associations for gliomas (OR = 1.8, 95% CI: 1.0-3.4) and retinoblastoma (OR = 3.0, 95% CI: 1.4-6.6), particularly bilateral retinoblastoma (OR = 9.4, 95% CI 3.6-24.7) with maternal smoking in pregnancy. Maternal smoking during pregnancy may be a risk factor for retinoblastoma and certain types of childhood brain tumors. PMID:27016137

  14. Smoking and Pregnancy — A Review on the First Major Environmental Risk Factor of the Unborn

    PubMed Central

    Mund, Mathias; Louwen, Frank; Klingelhoefer, Doris; Gerber, Alexander

    2013-01-01

    Smoking cigarettes throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes and it represents the first major environmental risk of the unborn. If compared with other risk factors in the perinatal period, exposure to tobacco smoke is considered to be amongst the most harmful and it is associated with high rates of long and short term morbidity and mortality for mother and child. A variety of adverse pregnancy outcomes are linked with cigarette consumption before and during pregnancy. Maternal prenatal cigarette smoke disturbs the equilibrium among the oxidant and antioxidant system, has negative impact on the genetic and cellular level of both mother and fetus and causes a large quantity of diseases in the unborn child. These smoking-induced damages for the unborn offspring manifest themselves at various times in life and for most only a very limited range of causal treatment exists. Education, support and assistance are of high importance to decrease maternal and fetal morbidity and mortality, as there are few other avoidable factors which influence a child’s health that profoundly throughout its life. It is imperative that smoking control should be seen as a public health priority. PMID:24351784

  15. Antihistamine Use in Early Pregnancy and Risk of Birth Defects

    PubMed Central

    Li, Qian; Mitchell, Allen A.; Werler, Martha M.; Yau, Wai-Ping; Hernández-Díaz, Sonia

    2014-01-01

    Background Several studies have reported an association between use of specific antihistamines in early pregnancy and certain specific birth defects. Objective To test 16 previously-hypothesized associations between specific antihistamines and specific birth defects, and identify possible new associations. Methods We used 1998-2010 data from the Slone Epidemiology Center Birth Defects Study, a multicenter case-control surveillance program of birth defects in North America. Mothers were interviewed within six months of delivery about demographic, reproductive, medical, and behavioral factors, and details on use of prescription and non-prescription medications. We compared 1st trimester exposure to specific antihistamines between 13,213 infants with specific malformations and 6,982 non-malformed controls, using conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for potential confounders, including indication for use. Results Overall, 13.7% of controls were exposed to antihistamines during the 1st trimester. The most commonly-used medications were diphenhydramine (4.2%), loratadine (3.1%), doxylamine (1.9%), and chlorpheniramine (1.7%). Where estimates were stable, none supported the previously-hypothesized associations. Among over 100 exploratory comparisons of other specific antihistamine/defect pairs, 14 had ORs ≥1.5 of which 6 had 95% CI bounds excluding 1.0 before but not after adjustment for multiple comparisons. Conclusion Our findings do not provide meaningful support for previously-posited associations between antihistamines and major congenital anomalies; at the same time, we identified associations that had not been previously suggested. We suspect that previous associations may be chance findings in the context of multiple comparisons, a situation which may also apply to our new findings. PMID:24565715

  16. Association Between Contraceptive Use and Gestational Diabetes: Missouri Pregnancy Risk Assessment Monitoring System, 2007–2008

    PubMed Central

    Kramer, Brittney A.; Kintzel, Jeremy

    2014-01-01

    Introduction The efficacy and safety of contraceptives have been questioned for decades; however, whether a relationship exists between hormonal contraceptives and gestational diabetes (GDM) is undetermined. The aim of this study was to investigate whether maternal risk for GDM was influenced by type of contraceptive method used before pregnancy. Methods Data collected in 2007 and 2008 by the Missouri Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed to determine if type of contraception before pregnancy influenced maternal risk for GDM. We used a logistic regression model to determine the adjusted odds for GDM given exposure to hormonal forms of contraception. Results Of the 2,741 women who completed the 2007–2008 PRAMS survey, 8.3% were diagnosed with gestational diabetes, and 17.9% of the respondents had used hormonal contraceptive methods. Women who used hormonal methods of birth control had higher odds for gestational diabetes (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI], 1.32–1.55) than did women who used no contraception. A protective effect was also observed for women who had used barrier methods of contraception (AOR = 0.79; 95% CI, 0.72–0.86). Conclusion Findings suggest there may be a relationship between type of contraceptive method and GDM. More research is needed to verify contraception as a potential risk factor for GDM. PMID:25032836

  17. Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension?

    PubMed Central

    Saftlas, Audrey F.; Triche, Elizabeth W.; Beydoun, Hind; Bracken, Michael B.

    2010-01-01

    Purpose Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine if regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). Methods Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n=58), GH (n=158), and normotensive pregnancies (n=2351). Chocolate consumption (servings/week) during the 1st and 3rd trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of <1 serving/week comprised the referent group. Adjusted odds ratios (aOR) were estimated using logistic regression. Results Chocolate intake was more frequent among normotensives (80.7%) than preeclamptics (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (1st trimester: aOR=0.55, 95% CI: 0.32-0.95; 3rd trimester: aOR=0.56, 95% CI: 0.32-0.97). Only 1st trimester intake was associated with reduced odds of GH (aOR=0.65, 95% CI: 0.45-0.87). Conclusions These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia. PMID:20609337

  18. CHRONIC HYPERTENSION IN PREGNANCY AND THE RISK OF CONGENITAL MALFORMATIONS: A COHORT STUDY

    PubMed Central

    Bateman, Brian T.; Huybrechts, Krista F.; Fischer, Michael A.; Seely, Ellen W.; Ecker, Jeffrey L.; Oberg, Anna S.; Franklin, Jessica M.; Mogun, Ms. Helen; Hernandez-Diaz, Sonia

    2014-01-01

    Objective Chronic hypertension is a common medical condition in pregnancy. The purpose of the study is to examine the association between maternal chronic hypertension and the risk of congenital malformations in the offspring. Study Design We defined a cohort of 878,126 completed pregnancies linked to infant medical records using the Medicaid Analytic Extract. The risk of congenital malformations was compared between normotensive controls and those with treated and untreated chronic hypertension. Confounding was addressed using propensity score matching. Results After matching, compared to normotensive controls, pregnancies complicated by treated chronic hypertension were at increased risk of congenital malformations (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.2 to 1.5), as were pregnancies with untreated chronic hypertension (OR 1.2, 95% CI 1.1 to 1.3). In our analysis of organ-specific malformations, both treated and untreated chronic hypertension were associated with a significant increase in the risk of cardiac malformations (OR 1.6, 95% CI 1.4 to 1.9 and OR 1.5, 95% CI 1.3 to 1.7, respectively). These associations persisted across a range of sensitivity analyses. Conclusion There is a similar increase in the risk of congenital malformations (particularly cardiac malformations) associated with treated and untreated chronic hypertension that is independent of measured confounders. Studies evaluating the teratogenic potential of antihypertensive medications must control for confounding by indication. Fetuses and neonates of mothers with chronic hypertension should be carefully evaluated for potential malformations, particularly cardiac defects. PMID:25265405

  19. A Meta Analysis on Risks of Adverse Pregnancy Outcomes in Toxoplasma gondii Infection

    PubMed Central

    Zhang, Hao; Peng, Hong-Juan; Lindsay, David S.

    2014-01-01

    Objective Quantified risks of congenital Toxoplasma gondii infection and abnormal pregnancy outcomes following primary maternal infection were evaluated with meta- analysis based on published studies. Methods The related literatures were searched in multiple literature databases regardless of languages. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the risks of vertical transmission of Toxoplasma gondii and abnormal pregnancy outcomes following primary maternal infection with meta-analysis. Results 53 of the 2632 searched literatures were included in our analysis. The incidence of abnormal pregnancy outcomes in T. gondii infected pregnant women (infected group) was significantly higher than that in the uninfected pregnant women (control group) (OR = 5.10; 95% CI, 3.85–6.75). Toxoplasma gondii infection rate in the abnormal-pregnancy-outcome group was significantly higher than in the normal-pregnancy group (OR = 3.71; 95% CI, 3.31–4.15). The pooled rate of vertical transmission was 20% (95% CI, 15%–26%) in maternal infection of T. gondii. The incidences of vertical transmission in women who were infected in the first, second or third trimester of pregnancy were 5% (95%CI, 2%–16%), 13% (95%CI, 7%–23%), and 32% (95%CI, 24%–41%), respectively. The rates of vertical transmission in women who were treated with spiramycin-only, PSF (pyrimethamine + sulfadiazine + folinic acid) or PS (pyrimethamine + sulfadiazine) combined with spiramycin, or other untypical treatments were 13% (95%CI, 7%–22%), 13%(95%CI, 7%–25%), and 24%(95%CI, 18%–32%), respectively. Conclusions Toxoplasma gondii infection can result in adverse pregnancy outcomes in pregnant women. The pooled rate of vertical transmission was 20% in maternal infection and the incidences of vertical transmission increased in the first, second or third trimester of pregnancy. The pooled rates of transmission in groups treated with spiramycin-only, PSF or PS combined with

  20. Sexual Risk Behavior: HIV, STD, & Teen Pregnancy Prevention

    MedlinePlus

    ... behaviors place individuals at greatest risk for infection. HIV awareness and education should be universally integrated into all educational environments. * CDC recommends all adolescents and adults 13-64 get tested for HIV at least once as part of routine medical ...

  1. Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

    PubMed

    Yen, Ting-Ting; Lin, Ching-Heng; Shiao, Jiun-Yih; Liang, Kai-Li

    2016-05-01

    Conclusion Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke. Objectives This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy. Method Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000-2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses. Results Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30-39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke. PMID:27052963

  2. Relapsing fever in pregnancy: analysis of high-risk factors.

    PubMed

    Melkert, P W

    1988-10-01

    The diagnosis of tick-borne relapsing fever was established in 27 pregnant patients by demonstration of Borrelia spirochaetes in a thick blood smear and the borrelia index was estimated to calculate the density of the spirochaetaemia. Clinical findings are described and compared with those reported from Rwanda. The results suggest that the density of the spirochaetaemia and the gestational age are the main high-risk factors. PMID:3191046

  3. The association between perception of health during pregnancy and the risk of cardiovascular disease: a prospective study.

    PubMed

    Zulkifly, Hanis Hanum; Clavarino, Alexandra; Kassab, Yaman Walid; Dingle, Kaeleen

    2016-01-01

    There is some evidence that self-rated perceptions of health are predictive of objective health outcomes, including cardiovascular disease, and mortality. The objective of this study was to examine the prospective association between perceptions of health during pregnancy and cardiovascular risk factors of mothers 21 years after the pregnancy. Data used were from the Mater University Study of Pregnancy (MUSP), a community-based prospective birth cohort study begun in Brisbane, Australia, in 1981. Logistic regression analyses were conducted. Data were available for 3692 women. Women who perceived themselves as not having a straight forward pregnancy had twice the odds (adjusted OR 2.0, 95 % CI 1.1-3.8) of being diagnosed with heart disease 21 years after the pregnancy when compared with women with a straight forward pregnancy (event rate of 5.2 versus 2.6 %). Women who experienced complications (other than serious pregnancy complications) during their pregnancy were also at 30 % increased odds (adjusted OR 1.3, 95 % CI 1.0-1.6) of having hypertension 21 years later (event rate of 25.7 versus 20 %). As a whole, our study suggests that pregnant women who perceived that they had complications and did not have a straight forward pregnancy were likely to experience poorer cardiovascular outcomes 21 years after that pregnancy. PMID:26759745

  4. [High risk infective endocarditis embolism during pregnancy: Medical or surgical management?].

    PubMed

    Echeverría, Luis Eduardo; Figueredo, Antonio; Gómez, Juan Carlos; Salazar, Leonardo Alberto; Rodriguez, Jaime Alberto; Pizarro, Camilo Ernesto; Riaño, Carlos Eduardo; Perroni, Addy; Cuadros, Alba Lucía; Villamizar, María Cristina; Suárez, Edwin Uriel

    2013-01-01

    A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks. PMID:23896064

  5. Intrahepatic cholestasis of pregnancy: A risk factor for cancer, autoimmune and cardiovascular diseases?

    PubMed

    Erlinger, Serge

    2016-04-01

    The authors show, in an elegant population-based study, a significant association between intrahepatic cholestasis of pregnancy and liver and biliary cancer. This association is most probably related to the high frequency of hepatitis C and gallstone disease in women with intrahepatic cholestasis of pregnancy, both being risk factors for liver and biliary cancer. In addition, the study clearly shows an increased risk of diabetes mellitus and autoimmune diseases, such as thyroid diseases, psoriasis, autoimmune arthropathies and Crohn's disease, and a small increase in cardiovascular diseases. In practice, a follow-up of liver function tests 6-12 weeks after delivery is strongly recommended to detect a possible associated liver disease. PMID:26500199

  6. Low Omega-3 Index in Pregnancy Is a Possible Biological Risk Factor for Postpartum Depression

    PubMed Central

    Markhus, Maria Wik; Skotheim, Siv; Graff, Ingvild Eide; Frøyland, Livar; Braarud, Hanne Cecilie; Stormark, Kjell Morten; Malde, Marian Kjellevold

    2013-01-01

    Background Depression is a common disorder affecting 10–15% women in the postpartum period. Postpartum depression can disrupt early mother-infant interaction, and constitutes a risk factor for early child development. Recently, attention has been drawn to the hypothesis that a low intake of seafood in pregnancy can be a risk factor for postpartum depression. Seafood is a unique dietary source of the marine omega-3 fatty acids and is a natural part of a healthy balanced diet that is especially important during pregnancy. Methods In a community based prospective cohort in a municipality in Western Norway, we investigated both nutritional and psychological risk factors for postpartum depression. The source population was all women who were pregnant within the period November 2009 - June 2011. The fatty acid status in red blood cells was assessed in the 28th gestation week and participants were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) three months after delivery. The aim of the present study was to investigate if a low omega-3 index in pregnancy is a possible risk factor for postpartum depression. Results In a simple regression model, the omega-3 index was associated with the EPDS score in a nonlinear inverse manner with an R square of 19. Thus, the low omega-3 index explained 19% of the variance in the EPDS score. The DPA content, DHA content, omega-3 index, omega-3/omega-6 ratio, total HUFA score, and the omega-3 HUFA score were all inversely correlated with the EPDS score. The EPDS scores of participants in the lowest omega-3 index quartile were significantly different to the three other omega-3 index quartiles. Conclusion In this study population, a low omega-3 index in late pregnancy was associated with higher depression score three months postpartum. PMID:23844041

  7. Fish consumption during pregnancy: an overview of the risks and benefits.

    PubMed

    Dovydaitis, Tiffany

    2008-01-01

    Evidence supports the benefits of fish consumption during pregnancy, primarily because of the effects of n-3 polyunsaturated fatty acids on the neurodevelopment of the fetus. Many fish may also be potent sources of methylmercury and polychlorinated biphenol exposure, which have been shown to have severe negative impacts on both the mother and fetus. Therefore, all women of childbearing age should be informed of both the benefits and risks of fish consumption. PMID:18586185

  8. Urinary Bisphenol A Levels during Pregnancy and Risk of Preterm Birth

    PubMed Central

    Ferguson, Kelly K.; Mukherjee, Bhramar; McElrath, Thomas F.; Meeker, John D.

    2015-01-01

    Background Preterm birth (PTB), a leading cause of infant mortality and morbidity, has a complex etiology with a multitude of interacting causes and risk factors. The role of environmental contaminants, particularly bisphenol A (BPA), is understudied with regard to PTB. Objectives In the present study we examined the relationship between longitudinally measured BPA exposure during gestation and PTB. Methods A nested case–control study was performed from women enrolled in a prospective birth cohort study at Brigham and Women’s Hospital in Boston, Massachusetts, during 2006–2008. Urine samples were analyzed for BPA concentrations at a minimum of three time points during pregnancy on 130 cases of PTB and 352 randomly assigned controls. Clinical classifications of PTB were defined as “spontaneous,” which was preceded by spontaneous preterm labor or preterm premature rupture of membranes, or “placental,” which was preceded by preeclampsia or intrauterine growth restriction. Results Geometric mean concentrations of BPA did not differ significantly between cases and controls. In adjusted models, urinary BPA averaged across pregnancy was not significantly associated with PTB. When examining clinical classifications of PTB, urinary BPA late in pregnancy was significantly associated with increased odds of delivering a spontaneous PTB. After stratification on infant’s sex, averaged BPA exposure during pregnancy was associated with significantly increased odds of being delivered preterm among females, but not males. Conclusions These results provide little evidence of a relationship between BPA and prematurity, though further research may be warranted given the generalizability of participant recruitment from a tertiary teaching hospital, limited sample size, and significant associations among females and within the clinical subcategories of PTB. Citation Cantonwine DE, Ferguson KK, Mukherjee B, McElrath TF, Meeker JD. 2015. Urinary bisphenol A levels during

  9. Air pollution, blood pressure, and the risk of hypertensive complications during pregnancy: the generation R study.

    PubMed

    van den Hooven, Edith H; de Kluizenaar, Yvonne; Pierik, Frank H; Hofman, Albert; van Ratingen, Sjoerd W; Zandveld, Peter Y J; Mackenbach, Johan P; Steegers, Eric A P; Miedema, Henk M E; Jaddoe, Vincent W V

    2011-03-01

    Exposure to air pollution is associated with elevated blood pressure and cardiovascular disease. We assessed the associations of exposure to particulate matter (PM(10)) and nitrogen dioxide (NO(2)) levels with blood pressure measured in each trimester of pregnancy and the risks of pregnancy-induced hypertension and preeclampsia in 7006 women participating in a prospective cohort study in the Netherlands. Information on gestational hypertensive disorders was obtained from medical records. PM(10) exposure was not associated with first trimester systolic and diastolic blood pressure, but a 10-μg/m(3) increase in PM(10) levels was associated with a 1.11-mm Hg (95% confidence interval [CI] 0.43 to 1.79) and 2.11-mm Hg (95% CI 1.34 to 2.89) increase in systolic blood pressure in the second and third trimester, respectively. Longitudinal analyses showed that elevated PM(10) exposure levels were associated with a steeper increase in systolic blood pressure throughout pregnancy (P<0.01), but not with diastolic blood pressure patterns. Elevated NO(2) exposure was associated with higher systolic blood pressure levels in the first, second, and third trimester (P<0.05), and with a more gradual increase when analyzed longitudinally (P<0.01). PM(10) exposure, but not NO(2) exposure, was associated with an increased risk of pregnancy-induced hypertension (odds ratio 1.72 [95% CI 1.12 to 2.63] per 10-μg/m(3) increase). In conclusion, our results suggest that air pollution may affect maternal cardiovascular health during pregnancy. The effects might be small but relevant on a population level. PMID:21220700

  10. Physical activity during pregnancy and offspring cardiovascular risk factors: findings from a prospective cohort study

    PubMed Central

    Millard, Louise A C; Lawlor, Debbie A; Fraser, Abigail; Howe, Laura D

    2013-01-01

    Objectives The long-term consequences of maternal physical activity during pregnancy for offspring cardiovascular health are unknown. We examined the association of maternal self-reported physical activity in pregnancy (18 weeks gestation) with offspring cardiovascular risk factors at age 15. Design Prospective cohort study. Setting The Avon Longitudinal Study of Parents and Children (ALSPAC). Participants 4665 maternal-offspring pairs (based on a sample with multiple imputation to deal with missing data) from the ALSPAC, a prospective cohort based in the South West of England with mothers recruited in pregnancy in 1991–1992. Primary and secondary outcome measures Offspring cardiovascular risk factors at age 15; body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, glucose, insulin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. Results Greater maternal physical activity was associated with lower BMI, waist circumference, glucose and insulin in unadjusted analyses. The magnitude of associations was generally small with wide CIs, and most associations attenuated towards the null after adjusting for confounders. The strongest evidence of association after adjustment for confounders was for glucose, although the 95% CI for this association includes the null; a one SD greater physical activity during pregnancy was associated with a −0.013 mmol/L difference in offspring glucose levels (equivalent to approximately one-third of a SD; 95% CI −0.027 to 0.001 mmol/L). Conclusions Our results suggest that maternal physical activity in pregnancy, measured at 18 weeks gestation, is unlikely to be an important determinant of later offspring cardiovascular health. There was some suggestion of association with offspring glucose, but given that all other associations (including insulin) were null after adjustment for confounders, this result should be interpreted with caution. PMID

  11. Risk of spontaneous preterm birth in relation to maternal experience of serious life events during pregnancy

    PubMed Central

    Barrios, Yasmin V; Sanchez, Sixto E; Qiu, Chunfang; Gelaye, Bizu; Williams, Michelle A

    2014-01-01

    Background The purpose of this study was to examine the risk of preterm birth (PTB) in relation to serious life events experienced during pregnancy in Peruvian women. Methods This case-control study included 479 PTB cases and 480 term controls. In-person interviews asked information regarding sociodemographics, medical and reproductive histories, and serious life events experienced during pregnancy. Multivariate logistic regression procedures were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared with women who did not experience a serious life event during pregnancy, those who experienced the following life events had a more than two-fold increased odds of PTB: death of first-degree relative (adjusted OR 2.10; 95% CI 1.38–3.20), divorce or separation (adjusted OR 2.09; 95% CI 1.10–4.00), financial troubles (adjusted OR 2.70; 95% CI 1.85–3.94), or serious fight with partner (adjusted OR 2.40; 95% CI 1.78–3.17). Women who experienced any serious life events during pregnancy had higher odds (adjusted OR 2.29; 95% CI 1.65–3.18) of suffering spontaneous preterm labor and preterm premature rupture of membranes (adjusted OR 2.19; 95% CI 1.56–3.08), compared with women who did not experience any such events. Associations of similar directions and extent were observed for severity of PTB (ie, very, moderate, or late PTB). The magnitude of the associations increased as increased frequency of serious life events (Ptrend <0.001). Conclusion Experiencing serious life events during pregnancy was associated with increased odds of PTB among Peruvian women. Interventions aimed at assisting women experiencing serious life events may reduce the risk of PTB. Future studies should include objective measures of stress and stress response to understand better the biological underpinnings of these associations. PMID:24591850

  12. Hypertensive disorders of pregnancy and subsequent risk of solid cancer--A nationwide cohort study.

    PubMed

    Behrens, Ida; Basit, Saima; Jensen, Allan; Lykke, Jacob Alexander; Nielsen, Lars Peter; Wohlfahrt, Jan; Kjær, Susanne K; Melbye, Mads; Boyd, Heather Allison

    2016-07-01

    Women with hypertensive disorders of pregnancy (HDP) have higher levels of antiangiogenic growth factors during pregnancy than women with normotensive pregnancies. Since angiogenesis is necessary for solid cancer growth and spread, we hypothesized that women with a history of HDP might have a reduced risk of solid cancers (cancers other than lymphomas, hematologic cancers and nonmelanoma skin cancers) later in life. In a register-based cohort study of 1.08 million women giving birth at least once between 1978 and 2011, we used Cox regression to estimate hazard ratios (HRs) comparing solid cancer rates for women with and without a history of HDP. In this cohort, 68,236 women (6.3%) had ≥1 pregnancy complicated by HDP and 42,236 women (3.9%) developed solid tumors during follow-up. A history of HDP was not associated with a clinically meaningful reduction in the overall rate of solid cancer (HR 0.96, 95% confidence interval 0.92-1.00), regardless of HDP severity or time since HDP, nor was there a general tendency toward reduced solid cancer rates across organ sites. A history of HDP was only significantly associated with decreased rates of breast and lung cancers and with increased rates of endometrial and urinary tract cancers. Overall, our results do not support the hypothesis that women with a history of HDP have a reduced overall risk of solid cancer due to a persistent post-HDP antiangiogenic state or an innate tendency toward antiangiogenesis. Observed associations with specific cancers may instead be due to other pregnancy-related mechanisms or to residual/unmeasured confounding. PMID:26919086

  13. Prevalence and risk of Down syndrome in monozygotic and dizygotic multiple pregnancies in Europe: implications for prenatal screening

    PubMed Central

    Boyle, B; Morris, JK; McConkey, R; Garne, E; Loane, M; Addor, MC; Gatt, M; Haeusler, M; Latos-Bielenska, A; Lelong, N; McDonnell, R; Mullaney, C; O’Mahony, M; Dolk, H

    2014-01-01

    Objective To determine risk of Down syndrome (DS) in multiple relative to singleton pregnancies, and compare prenatal diagnosis rates and pregnancy outcome. Design Population-based prevalence study based on EUROCAT congenital anomaly registries. Setting Eight European countries. Population 14.8 million births 1990–2009; 2.89% multiple births. Methods DS cases included livebirths, fetal deaths from 20 weeks, and terminations of pregnancy for fetal anomaly (TOPFA). Zygosity is inferred from like/unlike sex for birth denominators, and from concordance for DS cases. Main outcome measures Relative risk (RR) of DS per fetus/baby from multiple versus singleton pregnancies and per pregnancy in monozygotic/dizygotic versus singleton pregnancies. Proportion of prenatally diagnosed and pregnancy outcome. Statistical analysis Poisson and logistic regression stratified for maternal age, country and time. Results Overall, the adjusted (adj) RR of DS for fetus/babies from multiple versus singleton pregnancies was 0.58 (95% CI 0.53–0.62), similar for all maternal ages except for mothers over 44, for whom it was considerably lower. In 8.7% of twin pairs affected by DS, both co-twins were diagnosed with the condition. The adjRR of DS for monozygotic versus singleton pregnancies was 0.34 (95% CI 0.25–0.44) and for dizygotic versus singleton pregnancies 1.34 (95% CI 1.23–1.46). DS fetuses from multiple births were less likely to be prenatally diagnosed than singletons (adjOR 0.62 [95% CI 0.50–0.78]) and following diagnosis less likely to be TOPFA (adjOR 0.40 [95% CI 0.27–0.59]). Conclusions The risk of DS per fetus/baby is lower in multiple than singleton pregnancies. These estimates can be used for genetic counselling and prenatal screening. PMID:24495335

  14. Pica and Eating Attitudes: A Study of High-Risk Pregnancies.

    PubMed

    Santos, Amanda M; Benute, Gláucia R G; Nomura, Roseli M Y; Santos, Niraldo O; De Lucia, Mara C S; Francisco, Rossana P V

    2016-03-01

    Objective To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. Methods A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. Results Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: "to be considered too thin by others" (p < 0.02), and "to spend too much time thinking about food" (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. Conclusions The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals. PMID:26558792

  15. Association Between Low Dairy Intake During Pregnancy and Risk of Small-for-Gestational-Age Infants.

    PubMed

    Olmedo-Requena, Rocío; Amezcua-Prieto, Carmen; Luna-Del-Castillo, Juan de Dios; Lewis-Mikhael, Anne-Mary; Mozas-Moreno, Juan; Bueno-Cavanillas, Aurora; Jiménez-Moleón, José Juan

    2016-06-01

    Background Inadequate maternal nutrition is regarded as one of the most important indicators of fetal growth. The aim of this study was to analyze the associated risk of having a small for gestational age (SGA) infant according to the mother's dairy intake during the first half of pregnancy. Methods A prospective cohort study was performed using 1175 healthy pregnant women selected from the catchment area of Virgen de las Nieves University Hospital, Granada (Spain). SGA was defined as neonates weighing less than the 10th percentile, adjusted for gestational age. Factors associated with SGA were analyzed using logistic regression models. Population attributable fractions of SGA according to dairy intake were estimated. Results Dairy intake among women who gave birth to SGA infants was 513.9, versus 590.3 g/day for women with appropriate size for gestational age infants (P = 0.003). An increased intake of dairy products by 100 g/day during the first half of pregnancy decreased the risk of having a SGA infant by 11.0 %, aOR = 0.89 (0.83, 0.96). A dose-response gradient between dairy intake and SGA was observed. Conclusions An inadequate intake of dairy products is associated with a higher risk of SGA. Our results suggest a possible causal relation between dairy intake during pregnancy and the weight of the newborn, although we cannot discard residual confounding. These results should be further supported by properly designed studies. PMID:26971269

  16. Effects of inositol supplementation in a cohort of mothers at risk of producing an NTD pregnancy.

    PubMed

    Cavalli, Pietro; Tonni, Gabriele; Grosso, Enrico; Poggiani, Carlo

    2011-11-01

    Neural tube defects (NTDs), most commonly spina bifida and anencephaly, can be prevented with periconceptional intake of folic acid in about 70% of cases. Recurrence of NTDs despite supplementation of high dose of folic acid further suggests that a proportion of NTD cases might be resistant to folic acid. Moreover, heterogeneity of NTDs has been suggested in animal studies, indicating that only some sub-type of NTDs should be considered sensitive to folate intake. Inositol isomers (particularly myo- and chiro-inositol) can prevent folate-resistant NTDs in the curly-tail mutant mouse, suggesting that some cases of human NTDs might benefit from inositol supplementation. In humans, lower inositol blood concentration was found in pregnant women carrying NTD fetuses, whereas a periconceptional combination therapy with folic acid associated with inositol has been linked to normal live births, despite high NTD recurrence risk. Fifteen pregnancies from 12 Caucasian women from different parts of Italy with at least one previous NTD-affected pregnancy underwent periconceptional combined myo-inositol and folic acid supplementation. Maternal serum α-feto-protein levels were found in the normal range, and normal results on ultrasound examination were found in all the pregnancies that followed. No collateral effects or intense uterine contractions were demonstrated in this pilot study in any of the pregnancies after inositol supplementation, and seventeen babies were born without any type of NTD. PMID:21956977

  17. One-carbon metabolite levels in mid-pregnancy and risks of conotruncal heart defects

    PubMed Central

    Shaw, Gary M.; Yang, Wei; Carmichael, Suzan L.; Vollset, Stein Emil; Hobbs, Charlotte A.; Lammer, Edward J.; Ueland, Per M.

    2014-01-01

    Background Evidence exists for an association between use of vitamin supplements with folic acid in early pregnancy and reduced risk for offspring with conotruncal heart defects. A few observations have been made about nutrients related to one-carbon metabolism other than folate. Our prospective study attempted to extend information on nutrition and conotruncal heart defects by measuring analytes in mid-pregnancy sera. Methods This study included data from a repository of women’s mid-pregnancy serum specimens based on screened pregnancies in California from 2002–07. Each woman’s specimen was linked with delivery information to determine whether her fetus had a conotruncal heart defect or another structural malformation, or was nonmalformed. We identified 140 conotruncal cases and randomly selected 280 specimens as nonmalformed controls. Specimens were tested for a variety of analytes including: homocysteine, methylmalonic acid, folate, vitamin B12, pyridoxal phosphate, pyridoxal, pyridoxic acid, riboflavin, total choline, betaine, methionine, cysteine, cystathionine, arginine, asymmetric and symmetric dimethylarginine. Results and Conclusions We did not observe statistical evidence for substantial differences between cases and controls for any of the measured analytes. Analyses specifically targeting B-vitamins also did not reveal differences between cases and controls. PMID:24532477

  18. Lamotrigine use in pregnancy and risk of orofacial cleft and other congenital anomalies

    PubMed Central

    Wang, Hao; Loane, Maria; Morris, Joan; Garne, Ester; Addor, Marie-Claude; Arriola, Larraitz; Bakker, Marian; Barisic, Ingeborg; Doray, Berenice; Gatt, Miriam; Kallen, Karin; Khoshnood, Babak; Klungsoyr, Kari; Lahesmaa-Korpinen, Anna-Maria; Latos-Bielenska, Anna; Mejnartowicz, Jan P.; Nelen, Vera; Neville, Amanda; O'Mahony, Mary; Pierini, Anna; Rißmann, Anke; Tucker, David; Wellesley, Diana; Wiesel, Awi; de Jong-van den Berg, Lolkje T.W.

    2016-01-01

    Objective: To test previous signals of a risk of orofacial cleft (OC) and clubfoot with exposure to the antiepileptic lamotrigine, and to investigate risk of other congenital anomalies (CA). Methods: This was a population-based case–malformed control study based on 21 EUROCAT CA registries covering 10.1 million births (1995–2011), including births to 2005 in which the clubfoot signal was generated and a subsequent independent study population of 6.3 million births. A total of 226,806 babies with CA included livebirths, stillbirths, and terminations of pregnancy following prenatal diagnosis. First-trimester lamotrigine monotherapy exposure in OC cases and clubfoot cases was compared to other nonchromosomal CA (controls). Odds ratios (OR) were adjusted for registry. An exploratory analysis compared the proportion of each standard EUROCAT CA subgroup among all babies with nonchromosomal CA exposed to lamotrigine monotherapy with non-AED exposed pregnancies. Results: There were 147 lamotrigine monotherapy-exposed babies with nonchromosomal CA. For all OC, ORadj was 1.31 (95% confidence interval [CI] 0.73–2.33), isolated OC 1.45 (95% CI 0.80–2.63), isolated cleft palate 1.69 (95% CI 0.69–4.15). Overall ORadj for clubfoot was 1.83 (95% CI 1.01–3.31) and 1.43 (95% CI 0.66–3.08) in the independent study population. No other specific CA were significantly associated with lamotrigine monotherapy. Conclusions: The risk of OC was not significantly raised and we estimate the excess risk of OC to be less than 1 in every 550 exposed babies. We have not found strong independent evidence of a risk of clubfoot subsequent to our original signal. Our study cannot assess the general malformation risk among lamotrigine-exposed pregnancies. PMID:27053714

  19. Childhood maltreatment and the risk of pre-pregnancy obesity and excessive gestational weight gain.

    PubMed

    Diesel, Jill C; Bodnar, Lisa M; Day, Nancy L; Larkby, Cynthia A

    2016-07-01

    The objective of this study was to estimate whether maternal history of childhood maltreatment was associated with pre-pregnancy obesity or excessive gestational weight gain. Pregnant women (n = 472) reported pre-pregnancy weight and height and gestational weight gain and were followed up to 16 years post-partum when they reported maltreatment on the Childhood Trauma Questionnaire (CTQ). CTQ score ranged from no maltreatment (25) to severe maltreatment (125). Prenatal mental health modified the association between CTQ score and maternal weight (P < 0.15), and thus stratified models are presented. After adjusting for race, prenatal tobacco, marijuana and alcohol use, a one standard deviation (1 SD) increase in CTQ score was associated with a 45% increase in the risk of pre-pregnancy obesity among the 141 women with elevated anxiety (≥75th percentile on the State Trait Anxiety Inventory) [relative risk, RR (95% confidence interval, CI): 1.45 (1.12, 1.88)], but was not associated among less anxious (<75th percentile) women [RR (95% CI): 1.10 (0.81, 1.51)]. Risk of excessive gestational weight gain was higher [adjusted RR (95% CI): 1.21 (1.07, 1.37)] with every 1 SD increase in CTQ score for anxious women. No association was observed for less anxious women [adjusted RR (95% CI): 0.89 (0.78, 1.02)]. Prenatal depression similarly modified the association between maltreatment and weight gain. Factors such as psychological status and traumatic experiences in early childhood may contribute to pre-pregnancy obesity and excessive gestational weight gain. PMID:25138565

  20. Early pregnancy peripheral blood gene expression and risk of preterm delivery: a nested case control study

    PubMed Central

    2009-01-01

    Background Preterm delivery (PTD) is a significant public health problem associated with greater risk of mortality and morbidity in infants and mothers. Pathophysiologic processes that may lead to PTD start early in pregnancy. We investigated early pregnancy peripheral blood global gene expression and PTD risk. Methods As part of a prospective study, ribonucleic acid was extracted from blood samples (collected at 16 weeks gestational age) from 14 women who had PTD (cases) and 16 women who delivered at term (controls). Gene expressions were measured using the GeneChip® Human Genome U133 Plus 2.0 Array. Student's T-test and fold change analysis were used to identify differentially expressed genes. We used hierarchical clustering and principle components analysis to characterize signature gene expression patterns among cases and controls. Pathway and promoter sequence analyses were used to investigate functions and functional relationships as well as regulatory regions of differentially expressed genes. Results A total of 209 genes, including potential candidate genes (e.g. PTGDS, prostaglandin D2 synthase 21 kDa), were differentially expressed. A set of these genes achieved accurate pre-diagnostic separation of cases and controls. These genes participate in functions related to immune system and inflammation, organ development, metabolism (lipid, carbohydrate and amino acid) and cell signaling. Binding sites of putative transcription factors such as EGR1 (early growth response 1), TFAP2A (transcription factor AP2A), Sp1 (specificity protein 1) and Sp3 (specificity protein 3) were over represented in promoter regions of differentially expressed genes. Real-time PCR confirmed microarray expression measurements of selected genes. Conclusions PTD is associated with maternal early pregnancy peripheral blood gene expression changes. Maternal early pregnancy peripheral blood gene expression patterns may be useful for better understanding of PTD pathophysiology and PTD risk

  1. Use of acetaminophen (paracetamol) during pregnancy and the risk of autism spectrum disorder in the offspring.

    PubMed

    Andrade, Chittaranjan

    2016-02-01

    Acetaminophen (paracetamol) is available over the counter in most countries and is widely considered to be safe for use during pregnancy; studies report gestational exposures to acetaminophen that lie in the 46%-65% range. Acetaminophen influences inflammatory and immunologic mechanisms and may predispose to oxidative stress; these and other effects are hypothesized to have the potential to compromise neurodevelopment in the fetal and infant brain. Two ecological studies suggested that population-level trends in the use of acetaminophen were associated with trends in the incidence/prevalence of autism; one of these studies specifically examined acetaminophen use during pregnancy. One large prospective observational cohort study found that gestational exposure to acetaminophen (especially when the duration of exposure was 28 days or more) was associated with motor milestone delay, gross and fine motor impairments, communication impairment, impairments in internalizing and externalizing behaviors, and hyperactivity, all at age 3 years; however, social and emotional developmental behaviors were mostly unaffected. A very recent large cohort study with a 12.7-year follow-up found that gestational exposure to acetaminophen was associated with an increased risk of autism spectrum disorder, but only when a hyperkinetic disorder was also present. In the light of existing data associating acetaminophen use during pregnancy and subsequent risk of attention-deficit/hyperactivity disorder, this new finding suggests that the predisposition, if any, is toward the hyperkinetic syndrome rather than to autism. In summary, the empirical data are very limited, but whatever empirical data exist do not support the suggestion that the use of acetaminophen during pregnancy increases the risk of autism in the offspring. PMID:26930528

  2. Juvenile Delinquency and Teenage Pregnancy: A Comparison of Ecological Risk Profiles among Midwestern White and Black Female Juvenile Offenders

    ERIC Educational Resources Information Center

    Khurana, Atika; Cooksey, Elizabeth C.; Gavazzi, Stephen M.

    2011-01-01

    The authors examined ecological risk factors associated with teen pregnancy with a sample of 1,190 court-involved female juvenile offenders between 11 and 18 years of age. Data were obtained from five Midwestern juvenile county courts using a recently developed youth risk assessment instrument called the global risk assessment device (GRAD). In…

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

    PubMed

    Sangsawang, Bussara

    2014-07-01

    The most common type of urinary incontinence (UI) in pregnant women is stress urinary incontinence (SUI). The number of pregnant women with SUI was variable, the prevalence ranged from 18.6% to 75% and increased with gestational age. It can affect the quality of life (QoL) of approximately 54.3% of all pregnant women in four domains including physical activity, travel, social relationships and emotional health. Pregnancy is one of the main risk factors for the development of SUI in young women. Physiological changes during pregnancy, such as increasing pressure of the growing uterus and fetal weight on the pelvic floor muscle (PFM) throughout pregnancy, together with pregnancy-related hormonal changes such as increased progesterone, decreased relaxin, and decreased collagen levels, may lead to reduced strength and supportive and sphincteric function of the PFM. Pregnancy may associate with the reduction of the PFM strength which can develop the SUI. However, the exact causes of pregnancy-related SUI remain unclear. Multiple factors have been found to be associated with the development of SUI during pregnancy. In genetic risk factors, aging is an important role in SUI development. The other risk factors such as obesity, smoking, constipation, pre-pregnancy SUI, gestational diabetes mellitus (GDM), and pelvic floor muscle exercise (PFME) that utilized preventive strategies can reduce SUI in pregnant women. The purpose of this review is to identify the risk factors for the development of SUI in pregnant women. These understanding can be useful for health professions to inform and counsel the pregnant women to prevent and reduce the risk factors that contribute to the development of SUI during pregnancy and postpartum period. PMID:24784708

  4. A risk factor for female fertility and pregnancy: celiac disease.

    PubMed

    Stazi, A V; Mantovani, A

    2000-12-01

    Celiac disease is a genetically-based intolerance to gluten. In the past, celiac disease has been considered a rare disease of infancy characterized by chronic diarrhea and delayed growth. Besides the overt enteropathy, there are many other forms which appear later in life; target organs are not limited to the gut, but include liver, thyroid, skin and reproductive tract. It is now recognized that celiac disease is a relatively frequent disorder; the overall prevalence is at least 1:300 in Western Europe. Celiac disease may impair the reproductive life of affected women, eliciting delayed puberty, infertility, amenorrhea and precocious menopause. Clinical and epidemiological studies show that female patients with celiac disease are at higher risk of spontaneous abortions, low birth weight of the newborn and reduced duration of lactation. No adequate studies are available on the rate of birth defects in the progeny of affected women; however, celiac disease induces malabsorption and deficiency of factors essential for organogenesis, e.g. iron, folic acid and vitamin K. The overall evidence suggests that celiac disease patients can be a group particularly susceptible to reproductive toxicants; however, the pathogenesis of celiac disease-related reproductive disorders still awaits clarification. At present, like the other pathologies associated with celiac disease, the possible prevention or treatment of reproductive effects can only be achieved through a life-long maintenance of a gluten-free diet. PMID:11228068

  5. Pregnancy exposure to olanzapine, quetiapine, risperidone, aripiprazole and risk of congenital malformations. A systematic review.

    PubMed

    Ennis, Zandra Nymand; Damkier, Per

    2015-04-01

    To review available data on first-trimester exposure to olanzapine, quetiapine, risperidone and aripiprazole and risk of congenital malformations. We performed a systematic literature search in accordance with PRISMA guidelines identifying studies containing original data on first-trimester exposure and pregnancy outcome with respect to congenital malformations. Cumulated data for olanzapine were 1090 first-trimester-exposed pregnancies with 38 malformations resulting in a malformation rate of 3.5%. The corresponding numbers for quetiapine, risperidone and aripiprazole were 443/16 (3.6%), 432/22 (5.1%) and 100/5 (5.0%), respectively. Relative risk estimates and 95% confidence intervals were 1.0 (0.7-1.4) (olanzapine), 1.0 (0.6-1.7) (quetiapine), 1.5 (0.9-2.2) (risperidone) and 1.4 (0.5-3.1) (aripiprazole). First-trimester exposure to olanzapine is not associated with an increased risk of congenital malformation. Data for quetiapine and risperidone do not suggest a substantially increased risk, while the risk estimate for aripiprazole remains imprecise owing to a low amount of data. PMID:25536446

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

    PubMed Central

    Aarsand, Aasne Karine; Sandberg, Sverre

    2010-01-01

    The porphyrias comprise a heterogeneous group of rare, primarily hereditary, metabolic diseases caused by a partial deficiency in one of the eight enzymes involved in the heme biosynthesis. Our aim was to assess whether acute or cutaneous porphyria has been associated with excess risks of adverse pregnancy outcomes. A population-based cohort study was designed by record linkage between the Norwegian Porphyria Register, covering 70% of all known porphyria patients in Norway, and the Medical Birth Registry of Norway, based on all births in Norway during 1967–2006. The risks of the adverse pregnancy outcomes preeclampsia, delivery by caesarean section, low birth weight, premature delivery, small for gestational age (SGA), perinatal death, and congenital malformations were compared between porphyric mothers and the rest of the population. The 200 mothers with porphyria had 398 singletons during the study period, whereas the 1,100,391 mothers without porphyria had 2,275,317 singletons. First-time mothers with active acute porphyria had an excess risk of perinatal death [adjusted odds ratio (OR) 4.9, 95% confidence interval (CI) 1.5–16.0], as did mothers with the hereditable form of porphyria cutanea tarda (PCT) (3.0, 1.2–7.7). Sporadic PCT was associated with an excess risk of SGA [adjusted relative risk (RR) 2.0, 1.2–3.4], and for first-time mothers, low birth weight (adjusted OR 3.4, 1.2–10.0) and premature delivery (3.5, 1.2–10.5) in addition. The findings suggest women with porphyria should be monitored closely during pregnancy. PMID:20978938

  7. The value of MR angiography in predicting the risk of torsion of a pelvic spleen during pregnancy.

    PubMed

    Karantanas, A H; Stagianis, K D

    2002-02-01

    A case of an enlarged pelvic spleen, studied with MRI and MR angiography (MRA), is presented in a 32-year-old female wishing to become pregnant. An ectopic located spleen may be complicated by an acute abdomen due to torsion of the splenic vascular pedicle, resulting in splenic infarction. Displacement of the spleen and splenic pedicle during pregnancy may further increase the risk of torsion. Urgent splenectomy during pregnancy is associated with a high fetal and maternal mortality and morbidity. On the other hand, elective splenectomy of a pelvic spleen before pregnancy can result in adhesion formation, compromising the patient's fertility. The abilities of MRI and MRA in predicting the risk of these life-threatening complications during pregnancy are discussed, in order to evaluate the benefit-risk ratio of surgical treatment by splenectomy of splenopexia. PMID:11870427

  8. Impact of the 2008 Beijing Olympics on the risk of pregnancy complications.

    PubMed

    Assibey-Mensah, Vanessa; Liu, Kaibo; Thurston, Sally W; Stevens, Timothy P; Zhang, Junfeng; Zhang, Jinliang; Kane, Cathleen; Pan, Ying; Weinberger, Barry; Ohman-Strickland, Pamela; Woodruff, Tracey; Rich, David Q

    2016-07-01

    Taking advantage of the natural experiment of the 2008 Beijing Olympics (August 8 to September 24), when air pollution levels decreased by 13% to 60%, the authors assessed whether having ≥1 pregnancy month during the Olympics was associated with decreased risks of hypertensive disorders (HDs) and/or fetal-placental conditions (FPCs). Singleton births to mothers with ≥1 pregnancy month in 2008 or 2009 (N = 56,155) were included. Using generalized additive models, the authors estimated the risk of HDs and FPCs associated with (1) the 2008 Olympics compared with the same dates in 2009, and (2) increased mean ambient PM10 (particulate matter with an aerodynamic diameter <10 μm), NO2 (nitrogen dioxide), and SO2 (sulfur dioxide) concentrations during each trimester. However, no association between HDs or FPCs and having any trimester during the 2008 Olympic period was found. This may, in part, be due to a small number of pregnancy complications in this population. PMID:26066998

  9. Sex-specific risk of cardiovascular disease and cognitive decline: pregnancy and menopause

    PubMed Central

    2013-01-01

    Understanding the biology of sex differences is integral to personalized medicine. Cardiovascular disease and cognitive decline are two related conditions, with distinct sex differences in morbidity and clinical manifestations, response to treatments, and mortality. Although mortality from all-cause cardiovascular diseases has declined in women over the past five years, due in part to increased educational campaigns regarding the recognition of symptoms and application of treatment guidelines, the mortality in women still exceeds that of men. The physiological basis for these differences requires further research, with particular attention to two physiological conditions which are unique to women and associated with hormonal changes: pregnancy and menopause. Both conditions have the potential to impact life-long cardiovascular risk, including cerebrovascular function and cognition in women. This review draws on epidemiological, translational, clinical, and basic science studies to assess the impact of hypertensive pregnancy disorders on cardiovascular disease and cognitive function later in life, and examines the effects of post-menopausal hormone treatments on cardiovascular risk and cognition in midlife women. We suggest that hypertensive pregnancy disorders and menopause activate vascular components, i.e., vascular endothelium and blood elements, including platelets and leukocytes, to release cell-membrane derived microvesicles that are potential mediators of changes in cerebral blood flow, and may ultimately affect cognition in women as they age. Research into specific sex differences for these disease processes with attention to an individual’s sex chromosomal complement and hormonal status is important and timely. PMID:23537114

  10. Parental smoking during pregnancy and risk of overweight and obesity in the daughter

    PubMed Central

    Harris, Holly R.; Willett, Walter C.; Michels, Karin B.

    2013-01-01

    Objective Emerging evidence suggests that prenatal exposures may affect long-term health outcomes. In utero exposure to smoking is associated with an increased risk of overweight and obesity in children and adolescents. However, few studies have examined how prenatal exposure to parental smoking influences risk of obesity in adulthood and whether these associations are independent of childhood and adolescent adiposity. The aim of the current study was to investigate whether prenatal exposure to parental smoking influences body size in adulthood and whether any association may be mediated by childhood and adolescent body size. Methods We investigated the association between parental smoking during pregnancy and risk of overweight and obesity in adulthood and at age 18, and adiposity during childhood among 35,370 participants in the Nurses’ Health Study II. Data on smoking during pregnancy and socioeconomic variables were provided by the mothers, and anthropometric data and adult risk factors were reported by participants. Results After adjustment for socioeconomic and behavioral variables, maternal smoking during pregnancy was associated with adiposity at ages 5–10, age 18, and during adulthood. For age 18 overweight the ORs (95% CIs) for 1–14, 15–24, and 25+cigarettes/day were 1.13 (1.18–1.50), 1.40 (1.20–1.64), and 1.15 (0.79–1.69) and for obesity were 1.41 (1.14–1.75), 1.69 (1.31–2.18), and 2.36 (1.44–3.86). The corresponding ORs (95% CIs) for obesity in adulthood were 1.26 (1.16–1.37), 1.46 (1.30–1.63), and 1.43 (1.10–1.86). Risk of adiposity was not increased among daughters whose mothers stopped smoking during the first trimester (OR [95% CI] for overweight (1.03 [95% CI 0.90–1.17] and obesity (1.12 [95% CI 0.97–1.30]). Women whose fathers smoked during pregnancy were also at increased risk of overweight and obesity in adulthood with covariate-adjusted ORs (95% CIs) for obesity of 1.19 (1.11–1.29) for 1–14 cigarettes/day, 1

  11. Free Thyroxine During Early Pregnancy and Risk for Gestational Diabetes

    PubMed Central

    Haddow, James E.; Craig, Wendy Y.; Neveux, Louis M.; Palomaki, Glenn E.; Lambert-Messerlian, Geralyn; Malone, Fergal D.; D’Alton, Mary E.

    2016-01-01

    Several studies have now reported associations between gestational diabetes mellitus (GDM) and low free thyroxine (fT4) during the second and third trimesters, but not in the first trimester. The present study further examines relationships between low fT4, maternal weight, and GDM among women in the FaSTER (First and Second Trimester Evaluation of Risk) trial, in an effort to determine the extent to which thyroid hormones might contribute to causality. The FaSTER cohort includes 9351 singleton, euthyroid women; 272 of these women were subsequently classified as having GDM. Thyrotropin (TSH), fT4, and thyroid antibodies were measured at 11–14 weeks’ gestation (first trimester) and 15–18.9 weeks’ gestation (second trimester). An earlier report of this cohort documented an inverse relationship between fT4 in the second trimester and maternal weight. In the current analysis, women with GDM were significantly older (32 vs. 28 years) and weighed more (75 vs. 64.5 kg). Maternal weight and age (but not TSH) were significantly associated univariately with fT4 (dependent variable), in the order listed. Second trimester fT4 odds ratios (OR) for GDM were 2.06 [95% CI 1.37–3.09] (unadjusted); and 1.89 [95% CI 1.26–2.84] (adjusted). First trimester odds ratios were not significant: OR 1.45 [95%CI 0.97–2.16] (unadjusted) and 1.11 [95% CI 0.74–1.62] (adjusted). The second trimester fT4/GDM relationship thus appeared to strengthen as gestation progressed. In FaSTER, high maternal weight was associated with both low fT4 and a higher GDM rate in the second trimester. Peripheral deiodinase activity is known to increase with high caloric intake (represented by high weight). We speculate that weight-related low fT4 (the metabolically inactive prohormone) is a marker for deiodinase activity, serving as a substrate for conversion of fT4 to free triiodothyronine (fT3), the active hormone responsible for glucose-related metabolic activity. PMID:26910563

  12. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies

    SciTech Connect

    Stagnaro-Green, A.; Roman, S.H.; Cobin, R.H.; El-Harazy, E.; Alvarez-Marfany, M.; Davies, T.F. )

    1990-09-19

    The authors screened 552 women who presented to their obstetrician in the first trimester of pregnancy using highly sensitive enzyme-linked immunosorbent assays for the presence of thyroglobulin and thyroidperoxidase autoantibodies and found an incidence of positivity of 19.6%. The tendency to secrete detectable levels of thyroid autoantibodies was significantly correlated with an increased rate of miscarriage. Thyroid autoantibody-positive women miscarried at a rate of 17%, compared with 8.4% for the autoantibody-negative women. Individual levels of thyroglobulin and thyroidperoxidase autoantibodies were similarly related to this increased miscarriage rate, with no evidence of autoantibody specificity in the relationship. Furthermore, the increase in miscarriages could not be explained by differences in thyroid hormone levels, the presence of cardiolipin autoantibodies, maternal age, gestational age at the time of maternal entry into the study, or previous obstetric history. They conclude that thyroid autoantibodies are an independent marker of at-risk pregnancy.

  13. Desmoid tumour. The risk of recurrent or new disease with subsequent pregnancy: a case report

    PubMed Central

    Way, Jeffrey C.; Culham, Beverley A.

    1999-01-01

    Desmoid tumours are rare, benign tumours arising from fibrous tissue in muscle fascia or aponeurosis. They are most common in women of child-bearing age and most often appear during or after pregnancy in this age group. The recommended treatment is wide surgical excision, if possible, but unresectable tumours may be treated with radiotherapy, anticancer drugs, nonsteroidal anti-inflammatory agents or antiestrogenic compounds. The recurrence rate is high and seems to be related to the achievement of resection margins free of tumour. The literature is not specific about how to counsel woment who have had a desmoid tumour and subsequently wish to have a child. Patients should be advised that these tumours may be estrogen sensitive but subsequent pregnancy is not necessarily a risk factor for recurrence or development of new disease. PMID:10071588

  14. Enhancing assessment of interpersonal violence (IPV) pregnancy-related homicide risk within nursing curricula.

    PubMed

    Clements, Paul Thomas; Holt, Karyn E; Hasson, Catherine M; Fay-Hillier, Theresa

    2011-12-01

    Pregnancy and motherhood traditionally represent evolution of the next generation; yet, contemporary research and analyses confirm that this time can also be manifested in fear by the expectant mother within an environment of battering, cruelty, physical and emotional abuse, and sexual assault. Often to the surprise of many healthcare providers, the Centers for Disease Control and Prevention have consistently reported that Interpersonal Violence (IPV) related homicide is a leading cause of traumatic death among new and expectant mothers. In spite of these staggering statistical and anecdotal findings, universal screening for violence during pregnancy continues to be minimal. Forensic nurses might be prompted to respond to the consequences of violence and its resultant negative effects on expectant mothers by strategically incorporating systematic and consistent assessment into foundational nursing curricula regarding IPV as a leading risk factor for injury or death. PMID:22123040

  15. Pregnancy Disorders Appear to Modify the Risk for Retinopathy of Prematurity Associated With Neonatal Hyperoxemia and Bacteremia

    PubMed Central

    Lee, Jennifer W.; McElrath, Thomas; Chen, Minghua; Wallace, David K.; Allred, Elizabeth N.; Leviton, Alan; Dammann, Olaf

    2014-01-01

    Objective To explore (1) whether extremely low gestational age newborns exposed to inflammation-associated pregnancy disorders differ in retinopathy of prematurity (ROP) risk from infants exposed to placenta dysfunction-associated disorders, and (2) whether ROP risk associated with postnatal hyperoxemia and bacteremia differs among infants exposed to these disorders. Methods Pregnancy disorders resulting in preterm birth include inflammation-associated: preterm labor, prelabor premature rupture of membranes (pPROM), cervical insufficiency, and abruption and placenta dysfunction-associated: preeclampsia and fetal indication. The risk of severe ROP associated with pregnancy disorders was evaluated by multivariable analyses in strata defined by potential effect modifiers, postnatal hyperoxemia and bacteremia. Results Compared to preterm labor, infants delivered after pPROM were at reduced risk of plus disease (Odds ratio = 0.4, 95% confidence interval: 0.2–0.8) and prethreshold/threshold ROP (0.5, 0.3–0.8). Infants delivered after abruption had reduced risk of zone I ROP (0.2, 0.1–0.8) and prethreshold/threshold ROP (0.3, 0.1–0.7). In stratified analyses, infants born after placenta dysfunction had higher risks of severe ROP associated with subsequent postnatal hyperoxemia and bacteremia than infants born after inflammation-associated pregnancy disorders. Conclusion Infants exposed to placenta dysfunction have an increased risk of severe ROP following postnatal hyperoxemia and bacteremia compared to infants exposed to inflammation-associated pregnancy disorders. PMID:23297684

  16. Cardiovascular Risk Factors One Year After a Hypertensive Disorder of Pregnancy

    PubMed Central

    Rogers, Stephanie; Goldstein, Neal D.; Edwards, David G.; Weintraub, William S.

    2015-01-01

    Abstract Objective To identify differences in women's cardiovascular risk, independent of obesity, one year after delivery of a pregnancy complicated by a hypertensive disorder of pregnancy (HDP). Methods We compared traditional and novel cardiovascular risk factors of women recruited at delivery following the diagnosis of an HDP with those of women with uncomplicated pregnancies, at 3 months and 12–18 months postpartum. Measures included blood pressure, fasting lipids, inflammatory biomarkers, and measures of insulin resistance. Multiple linear regressions were used to adjust for body mass index (BMI) and other characteristics. Results We studied 71 subjects: 31 women with HDP and 40 with an uncomplicated pregnancy. There were no significant differences between groups for total cholesterol, HDL-c, LDL-c, triglycerides, HgbA1c, or homeostasis model assessment-estimated insulin resistance. Values for tumor necrosis factor-α were significantly higher in the HDP group (p<0.01), while those for interleukin-6 and c-reactive protein were not. A diagnosis of HDP was associated with a 9 mm Hg difference in systolic blood pressure at both 3 months and 1 year, after adjustment for age, BMI, race, family history of cardiovascular disease, tobacco use, and insurance. Conclusions Women with HDP had significantly higher blood pressure 3 months and 1 year after delivery, independent of obesity. There were no significant differences in lipids or measures of insulin resistance after adjusting for BMI. Elevated blood pressure may account for the observed associations between HDP and future cardiovascular disease. PMID:25247261

  17. Maternal-Fetal Cancer Risk Assessment of Ochratoxin A during Pregnancy

    PubMed Central

    Woo, Chit Shing Jackson; El-Nezami, Hani

    2016-01-01

    Increasing evidence has demonstrated that in utero exposure to environmental chemicals may interfere with fetal development and increase the risk of disease and cancer development later in life. Ochratoxin A (OTA) has been proven to induce diverse toxic effects including teratogenicity, carcinogenicity, immunotoxicity and potential endocrine disruption. Due to the continuous and widespread occurrence of OTA as a potential contaminant of staple foods, there is increasing concern of in utero exposure of fetus to this mycotoxin. In this study, maternal-fetal risk assessment of OTA during pregnancy was conducted using the benchmark dose approach for genotoxic carcinogens. The daily intake of OTA for Egyptian pregnant women was estimated based on their serum OTA level using the refined Klaassen equation for pregnancy. Fetal exposure level was also estimated based on the maternal data. Comparison between the estimated daily exposure and the negligible cancer risk intake (NCRI), and the calculation of margin of exposure (MOE) implicated that OTA exposure from dietary intake would be of low health concern for this general subpopulation of Egyptian women. This subpopulation of pregnant women was generally estimated not to be in high-risk for toxicity induced by OTA. PMID:27023600

  18. More than Poverty—Teen Pregnancy Risk and Reports of Child Abuse Reports and Neglect

    PubMed Central

    Lara, Gerassi; Melissa, Jonson-Reid; Katie, Plax; Brett, Drake

    2015-01-01

    Purpose To compare risk for teen pregnancies between children living in poverty with no Child Protection Services (CPS) report history, and those in poverty with a history of CPS report. Methods Children selected from families in poverty, both with and without CPS report histories were prospectively followed from 1993–2009 using electronic administrative records from agencies including child protective services, emergency departments, Medicaid services and juvenile courts. A total of 3281 adolescent females were followed until age 18. Results For teens with history of poverty only, 16.8% had been pregnant at least once by age 17. In teens with history of both poverty and report of child abuse or neglect, 28.9% had been pregnant at least once by age 17. While multivariate survival analyses revealed several other significant factors at the family and youth services levels, a report of maltreatment remained significant (about a 66% higher risk). Conclusions Maltreatment is a significant risk factor for teen pregnancy among low income youth even after controlling for neighborhood disadvantage, other caregiver risks and indicators of individual emotional and behavioral problems. PMID:26206437

  19. Maternal-Fetal Cancer Risk Assessment of Ochratoxin A during Pregnancy.

    PubMed

    Woo, Chit Shing Jackson; El-Nezami, Hani

    2016-04-01

    Increasing evidence has demonstrated that in utero exposure to environmental chemicals may interfere with fetal development and increase the risk of disease and cancer development later in life. Ochratoxin A (OTA) has been proven to induce diverse toxic effects including teratogenicity, carcinogenicity, immunotoxicity and potential endocrine disruption. Due to the continuous and widespread occurrence of OTA as a potential contaminant of staple foods, there is increasing concern of in utero exposure of fetus to this mycotoxin. In this study, maternal-fetal risk assessment of OTA during pregnancy was conducted using the benchmark dose approach for genotoxic carcinogens. The daily intake of OTA for Egyptian pregnant women was estimated based on their serum OTA level using the refined Klaassen equation for pregnancy. Fetal exposure level was also estimated based on the maternal data. Comparison between the estimated daily exposure and the negligible cancer risk intake (NCRI), and the calculation of margin of exposure (MOE) implicated that OTA exposure from dietary intake would be of low health concern for this general subpopulation of Egyptian women. This subpopulation of pregnant women was generally estimated not to be in high-risk for toxicity induced by OTA. PMID:27023600

  20. Caffeine consumption during pregnancy and risk of preterm birth: a meta-analysis1234

    PubMed Central

    Maslova, Ekaterina; Bhattacharya, Sayanti; Lin, Shih-Wen; Michels, Karin B

    2010-01-01

    Background: The effect of caffeine intake during pregnancy on the risk of preterm delivery has been studied for the past 3 decades with inconsistent results. Objective: We performed a meta-analysis examining the association between caffeine consumption during pregnancy and risk of preterm birth. Design: We searched MEDLINE and EMBASE articles published between 1966 and July 2010, cross-referenced reference lists of the retrieved articles, and identified 15 cohort and 7 case-control studies that met inclusion criteria for this meta-analysis. Results: The combined odds ratios (ORs) obtained by using fixed-effects models for cohort studies were 1.11 (95% CI: 0.96, 1.28), 1.10 (95% CI: 1.01, 1.19), and 1.08 (95% CI: 0.93, 1.27) for risk of preterm birth comparing the highest with the lowest level of caffeine intake (or no intake) (mg/d) during the first, second, and third trimesters, respectively. Results for the case-control studies yielded no associations for the first (OR: 1.07; 95% CI: 0.84, 1.37), second (OR: 1.17; 95% CI: 0.94, 1.45), or third (OR: 0.94; 95% CI: 0.79, 1.12) trimesters. No overall heterogeneity was found by region, publication decade, exposure and outcome assessment, caffeine sources, or adjustment for confounding, which was largely driven by individual studies. Conclusion: In this meta-analysis, we observed no important association between caffeine intake during pregnancy and the risk of preterm birth for cohort and case-control studies. PMID:20844077

  1. MINIMIZING THE RISK OF PREGNANCY, SEXUALLY TRANSMITTED DISEASES, AND HIV AMONG INCARCERATED ADOLESCENT GIRLS

    PubMed Central

    ST LAWRENCE, JANET S.; SNODGRASS, C. EDWARD; ROBERTSON, ANGELA; BAIRD-THOMAS, CONNIE

    2010-01-01

    Delinquent girls are at elevated risk for unplanned pregnancy and sexually transmitted diseases when compared with non-delinquent peers. Participants—234 incarcerated female juveniles—completed demographic, individual, partner, peer, and family measures and were tested for sexually transmitted diseases. Disease rates were as follows: chlamydia (20%), gonorrhea (4%), and syphilis (1%). Stepwise multiple linear regression analysis assessed the relationship of the predictor variable sets with sexual risk. Demographic and individual variables had the strongest associations with risk. Peer, partner, or family variables did not account for significant additional variance. The results suggest that an intervention could be delivered during the window of opportunity during the girls’ incarceration, changing their knowledge, attitudes, and skills that are implicated in risky sexual behavior before they are released back into the community. PMID:20585415

  2. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling.

    PubMed Central

    Einarson, A; Selby, P; Koren, G

    2001-01-01

    OBJECTIVE: To assess the consequences to mother and baby of abruptly discontinuing antidepressant or benzodiazepine medication during pregnancy and to assess the impact of our counselling. PARTICIPANTS: All women who consulted the Motherisk Program between November 1996 and December 1997 and who stopped taking antidepressant or benzodiazepine medication when pregnancy was confirmed agreed to participate in the study. DESIGN AND INTERVENTIONS: Subjects were interviewed, received counselling, and completed a questionnaire 1 month after their initial call and after the birth of their baby. RESULTS: Of 36 women who completed the study, 34 discontinued their medication abruptly for fear of harming the fetus, 28 on the advice of their physician; 26 (70.3%) women reported physical and psychological adverse effects, 11 reported psychological effects only, and 11 reported suicidal ideation (4 were admitted to hospital). After counselling, 22 of 36 (61.1%) women resumed taking their medication, and 4 found that they no longer required it. One woman had a therapeutic abortion and 2 experienced spontaneous abortions; there were therefore 35 healthy babies (including 2 sets of twins) born to 33 women; 14 of 21 mothers breast-fed their babies while taking their psychotropic medication, with no adverse effects reported. CONCLUSIONS: When assessing the risks and benefits of taking psychotropic medication during pregnancy, women and their physicians should be aware that the abrupt discontinuation of psychotropic drugs can lead to serious adverse effects. Counselling is effective in reassuring women to adhere to therapy. PMID:11212593

  3. Risk Factors and Early Predictors for Heterotopic Pregnancy after In Vitro Fertilization.

    PubMed

    Liu, Meiju; Zhang, Xiuqing; Geng, Ling; Xia, Mingdi; Zhai, Junyu; Zhang, Wei; Zhang, Yuchao; Sun, Yinhua; Zhang, Jiangtao; Zhu, Dongyi; Zhao, Han; Chen, Zi-Jiang

    2015-01-01

    This study investigated the risk factors and early predictors for heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET). From January 2008 to January 2013, 41 cases of HP and 72 cases of intrauterine twin pregnancy after IVF-ET were recruited and retrospectively analyzed. Compared with intrauterine twin pregnancy group, the HP group had a lower basal luteinizing hormone (LH) level (P = 0.005) and more cases had a history of hydrosalpinx (P = 0.008). After 14 days of IVF-ET, the serum β-HCG (β-human chorionic gonadotropin), E2 (Estradiol) and P (Progesterone) levels were lower in HP group (P<0.001, respectively). Moreover, vaginal bleeding and abdominal pain were the significant features of HP before diagnosis (P<0.001, respectively). Further by logistic regression, serum β-hCG, P levels on the 14th day after ET, and vaginal bleeding were identified as the independent factors of HP. These results indicate that when two or more embryos transferred in IVF procedure, β-hCG, P levels on the 14th day after ET, and vaginal bleeding could be taken as predictors for HP. PMID:26510008

  4. Risk Factors and Early Predictors for Heterotopic Pregnancy after In Vitro Fertilization

    PubMed Central

    Geng, Ling; Xia, Mingdi; Zhai, Junyu; Zhang, Wei; Zhang, Yuchao; Sun, Yinhua; Zhang, Jiangtao; Zhu, Dongyi; Zhao, Han; Chen, Zi-Jiang

    2015-01-01

    This study investigated the risk factors and early predictors for heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET). From January 2008 to January 2013, 41 cases of HP and 72 cases of intrauterine twin pregnancy after IVF-ET were recruited and retrospectively analyzed. Compared with intrauterine twin pregnancy group, the HP group had a lower basal luteinizing hormone (LH) level (P = 0.005) and more cases had a history of hydrosalpinx (P = 0.008). After 14 days of IVF-ET, the serum β-HCG (β-human chorionic gonadotropin), E2 (Estradiol) and P (Progesterone) levels were lower in HP group (P<0.001, respectively). Moreover, vaginal bleeding and abdominal pain were the significant features of HP before diagnosis (P<0.001, respectively). Further by logistic regression, serum β-hCG, P levels on the 14th day after ET, and vaginal bleeding were identified as the independent factors of HP. These results indicate that when two or more embryos transferred in IVF procedure, β-hCG, P levels on the 14th day after ET, and vaginal bleeding could be taken as predictors for HP. PMID:26510008

  5. [The socio-cultural and eating aspects of women experiencing risk pregnancies].

    PubMed

    Sámano, Reyna Sámano; Martínez, Estela Godinez; Pérez, Irma Romero; Miranda, Georgina Sánchez; Polis, José Manuel Espíndola; Courtois, Mayra Lilia Chávez

    2014-05-01

    To promote a healthy diet, the dietary guidance should consider socio-cultural factors as they influence both the food standards and preferences of each population. The aim of this study was to describe the socio-cultural contexts of pregnancy and feeding in the domestic arena, using a qualitative approach. In-depth interviews were conducted using the data saturation technique with six women experiencing high-risk pregnancy. The interviews were transcribed and analyzed in accordance with the Bardin method and the IT Atlas program. The following aspects were identified: uncertainty due to unplanned pregnancy and limited partner support; a few dietary changes to improve health; perception of bad and good feeding habits, although it did not comply with the characteristics of a good diet; omission of fruit and vegetable group from dinner. The people in charge of preparing and serving food were not always the pregnant woman; food products perceived as being harmful were consumed and beneficial products were rarely consumed. This highlighted the need to train professionals to consider the socio-cultural context when providing dietary guidance. PMID:24897207

  6. Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants?

    PubMed Central

    Dejin-Karlsson, E; Hanson, B S; Ostergren, P O; Sjöberg, N O; Marsal, K

    1998-01-01

    OBJECTIVES: This study tested the hypothesis that women who deliver small-for-gestational-age infants are more often exposed to passive smoking at home or at work. METHODS: Among a 1-year cohort of nulliparous women in the city of Malmö, Sweden 872 (87.7%) women completed a questionnaire during their first prenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n = 826), 6.7% of infants were classified as small for their gestational age. RESULTS: Passive smoking in early pregnancy was shown to double a woman's risk of delivering a small-for-gestational-age infant, independent of potential confounding factors such as age, height, weight, nationality, educational level, and the mother's own active smoking (odds ratio [OR] = 2.7). A stratified analysis indicated interactional effects of maternal smoking and passive smoking on relative small-for-gestational-age risk. CONCLUSIONS: Based on an attributable risk estimate, a considerable reduction in the incidence of small-for-gestational-age births could be reached if pregnant women were not exposed to passive smoking. PMID:9772856

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

    PubMed Central

    Runkle, Jennifer; Flocks, Joan; Economos, Jeannie; Tovar-Aguilar, J. Antonio; McCauley, Linda

    2014-01-01

    The agricultural industry has some of the highest incidence rates and numbers of occupational injuries and illnesses in the United States. Injuries and illnesses in agriculture result from accidents, falls, excessive heat, repetitive motion and adverse pesticide exposure. Women working in agriculture are exposed to the same hazards and risks as their male counterparts, but can face additional adverse impacts on their reproductive health. Yet, few occupational risk assessment studies have considered the reproductive health of female farmworkers. The objective of this community-based participatory research study was to conduct a retrospective, cross-sectional survey to collect information on workplace conditions and behaviors and maternal, pregnancy and infant health outcomes among a sample of female nursery and fernery farmworkers in Central Florida. Survey results showed that nursery workers were more likely to report health symptoms during their pregnancy than fernery workers. We also observed a self-reported increased risk of respiratory illness in the first year of life for infants whose mothers worked in ferneries. Our findings confirm that agricultural work presents potential reproductive hazards for women of childbearing age. PMID:25101767

  8. Promotive effect of zinc supplementation on the growth of children from high-risk pregnancy

    SciTech Connect

    Hong, Z.Y.; Zhang, Y.W. )

    1991-03-15

    The objective of this study was to determine whether Zn deficiency is one of the factors involved in the growth retardation of infants from high risk pregnancy. At birth, 102 high risk children were divided into 3 groups: breast-feeding group; test group (cow's milk and supplemented with elemental zinc 1-2 ug/kg/d; and control group). The test and control groups were divided by double blind, randomized, pair-matched method. Anthropometric data on infants were collected at 0, 3 and 6 mos. At 3 mos, the increase in body length, weight and serum Zn concentration in both breast-feeding and test group exceeded that of the control group. From 4th month all of these children were given yolk, meat, fish as subsidiary foods and in the second test period the growth rate of these 3 groups of children were not different. But at the end of 6 mos the weight and length increases of the breast-feeding and the test group children still exceeded that of the control group. It is concluded that children from high risk pregnancy should receive mother's milk. If they cannot be breast-fed they should receive a zinc-supplemented formula.

  9. Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

    PubMed Central

    MUGO, Nelly R.; HEFFRON, Renee; DONNELL, Deborah; WALD, Anna; WERE, Edwin O.; REES, Helen; CELUM, Connie; KIARIE, James N.; COHEN, Craig R.; KAYINTEKORE, Kayitesi; BAETEN, Jared M.

    2011-01-01

    Background Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. Methods In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. Results 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). Conclusions HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness. PMID:21785321

  10. Unplanned pregnancy in adolescents: association with family structure, employed mother, and female friends with health-risk habits and behaviors.

    PubMed

    Vázquez-Nava, Francisco; Vázquez-Rodriguez, Carlos F; Saldívar-González, Atenógenes H; Vázquez-Rodríguez, Eliza M; Córdova-Fernández, José A; Felizardo-Ávalos, Jorge; Sánchez-Márquez, Wilberto

    2014-02-01

    Previous publications have suggested that living in a nonintact family household and socializing with girlfriends who smoke or who consume alcoholic beverages favor the development of health-risk habits and customs in adolescents. However, their relationship with unplanned pregnancy in adolescents has not been determined. We investigated the association between family structure, employed mother, and female friends with health-risk habits and behaviors with unplanned pregnancy in adolescents (n = 3,130). After adjusting for low maternal educational level and low family income, logistic regression analyses showed that having an employed mother and socializing with girlfriends who have health-risk habits or behaviors, rather than living in a nonintact family household, appear to be the most important health-risk factors for unplanned pregnancy in adolescents. It is important for health-care programs for adolescents to be revised and for their strategies be strengthened in order to reach the objectives for which they were created. PMID:23949273

  11. Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus

    PubMed Central

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

    2015-01-01

    Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16–41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003–2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: “high refined grains, fats, oils and fruit juice”, “high nuts, seeds, fat and soybean; low milk and cheese”, and “high added sugar and organ meats; low fruits, vegetables and seafood”. GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4–17.0) for “high refined grains, fats, oils and fruit juice” pattern, 7.5 (1.8–32.3) for “high nuts, seeds, fat and soybean; low milk and cheese” pattern, and 22.3 (3.9–127.4) for “high added sugar and organ meats; low fruits, vegetables and seafood” pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight

  12. Dietary Patterns during Pregnancy Are Associated with Risk of Gestational Diabetes Mellitus.

    PubMed

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

    2015-11-01

    Maternal dietary patterns before and during pregnancy play important roles in the development of gestational diabetes mellitus (GDM). We aimed to identify dietary patterns during pregnancy that are associated with GDM risk in pregnant U.S. women. From a 24 h dietary recall of 253 pregnant women (16-41 years) included in the National Health and Nutrition Examination Survey (NHANES) 2003-2012, food items were aggregated into 28 food groups based on Food Patterns Equivalents Database. Three dietary patterns were identified by reduced rank regression with responses including prepregnancy body mass index (BMI), dietary fiber, and ratio of poly- and monounsaturated fatty acids to saturated fatty acid: "high refined grains, fats, oils and fruit juice", "high nuts, seeds, fat and soybean; low milk and cheese", and "high added sugar and organ meats; low fruits, vegetables and seafood". GDM was diagnosed using fasting plasma glucose levels ≥5.1 mmol/L for gestation <24 weeks. Multivariable logistic regression models were used to estimate adjusted odds ratio (AOR) and 95% confidence intervals (CIs) for GDM, after controlling for maternal age, race/ethnicity, education, family poverty income ratio, marital status, prepregnancy BMI, gestational weight gain, energy intake, physical activity, and log-transformed C-reactive protein (CRP). All statistical analyses accounted for the appropriate survey design and sample weights of the NHANES. Of 249 pregnant women, 34 pregnant women (14%) had GDM. Multivariable AOR (95% CIs) of GDM for comparisons between the highest vs. lowest tertiles were 4.9 (1.4-17.0) for "high refined grains, fats, oils and fruit juice" pattern, 7.5 (1.8-32.3) for "high nuts, seeds, fat and soybean; low milk and cheese" pattern, and 22.3 (3.9-127.4) for "high added sugar and organ meats; low fruits, vegetables and seafood" pattern after controlling for maternal sociodemographic variables, prepregnancy BMI, gestational weight gain, energy intake and log

  13. Elevated Corticotropin-Releasing Hormone in Human Pregnancy Increases the Risk of Postpartum Depressive Symptoms

    PubMed Central

    Yim, Ilona S.; Glynn, Laura M.; Schetter, Christine Dunkel; Hobel, Calvin J.; Chicz-DeMet, Aleksandra; Sandman, Curt A.

    2009-01-01

    Context Postpartum depression (PPD) is common and has serious implications for the mother and her newborn. A possible link between placental corticotropin-releasing hormone (pCRH) and PPD incidence has been discussed, but there is a lack of empirical evidence. Objective To determine whether accelerated pCRH increases throughout pregnancy are associated with PPD symptoms. Design Pregnant women were recruited into this longitudinal cohort study. Blood samples were obtained at 15, 19, 25, 31 and 37 weeks gestational age (GA) for assessment of pCRH, cortisol and ACTH. Depressive symptoms were assessed with a standardized questionnaire at the last four pregnancy visits and postpartum. Setting Subjects were recruited from two Southern California Medical Centers, and visits were conducted in university research laboratories. Participants 100 adult women with a singleton pregnancy. Main Outcome Measure PPD symptoms were assessed 8.7 weeks (SD = 2.94 wks) after delivery with the Edinburgh Postnatal Depression Scale. Results Sixteen women developed PPD symptoms. At 25 weeks GA, pCRH was a strong predictor of PPD symptoms (R2 = .21, β = .46, p < .001), an effect that remained significant after controlling for prenatal depressive symptoms. No significant associations were found for cortisol and ACTH. Receiver Operating Characteristic curve analyses revealed that pCRH at 25 weeks GA is a useful diagnostic test (area under the curve = .78, p = .001). Sensitivity (.75) and specificity (.74) at the ideal cut-off point (56.86 pg/ml pCRH) were high. Growth curve analyses indicated that pCRH trajectories in women with PPD symptoms are significantly accelerated between 23 and 26 weeks GA. Conclusion There is a critical period in mid-pregnancy during which pCRH is a sensitive and specific early diagnostic test for PPD symptoms. If replicated, these results have implications for identification and treatment of pregnant women at risk of PPD. PMID:19188538

  14. Inter-Pregnancy Intervals and the Risk of Autism Spectrum Disorder: Results of a Population-Based Study

    ERIC Educational Resources Information Center

    Durkin, Maureen S.; DuBois, Lindsay A.; Maenner, Matthew J.

    2015-01-01

    Recent studies have reported an increased risk of autism among second-born children conceived <12 versus >36 months after the birth of a sibling. Confirmation of this finding would point to inter-pregnancy interval (IPI) as a potentially modifiable risk factor for autism. This study evaluated the relationship between IPI and autism spectrum…

  15. Risk Perception of Pregnancy Promotes Disapproval of Gestational Surrogacy: Analysis of a Nationally Representative Opinion Survey in Japan

    PubMed Central

    Suzuki, Kohta; Sawa, Rintaro; Muto, Kaori; Kusuda, Satoshi; Banno, Kouji; Yamagata, Zentaro

    2011-01-01

    Background To clarify the relationship between the general attitude towards gestational surrogacy and risk perception about pregnancy and infertility treatment. Materials and Methods This study analysed the data of nationally representative cross-sectional surveys from 2007 concerning assisted reproductive technologies. The participants represented the general Japanese population. We used this data to carry out multivariate analysis. The main outcome measures were adjusted odds ratios and 95% confidence intervals from logistic regression models for factors including the effect of pregnancy risk perception on the attitude toward gestational surrogacy. Results In this survey, 3412 participants responded (response rate of 68.2%). With regard to the attitude towards gestational surrogacy, 54.0% of the respondents approved of it, and 29.7% stated that they were undecided. The perception of a high level of risk concerning ectopic pregnancy, threatened miscarriage or premature birth, and pregnancy-induced hypertension influenced the participants’ attitudes towards gestational surrogacy. Moreover, this perception of risk also contributed to a disapproval of the technique. Conclusion Our findings suggest that a person who understands the risks associated with pregnancy might clearly express their disapproval of gestational surrogacy. PMID:24963363

  16. Use of acetaminophen (paracetamol) during pregnancy and the risk of attention-deficit/hyperactivity disorder in the offspring.

    PubMed

    Andrade, Chittaranjan

    2016-03-01

    Prenatal exposure to acetaminophen may result in compromised neurodevelopment through inflammatory and immunologic mechanisms, through predisposition to oxidative stress, and through endocrine, endogenous cannabinoid, and other mechanisms. Several small and large prospective studies have found an association between gestational acetaminophen exposure and attention-deficit/hyperactivity disorder (ADHD)-like behaviors, use of ADHD medication, and ADHD diagnoses in offspring during childhood; the only negative study was a small investigation that examined only one aspect of attention as an outcome. Creditably, most of the studies adjusted analyses for many (but not all) confounds associated with ADHD risk. Importantly, one pivotal study also adjusted for pain, infection, inflammation, and fever to reduce confounding by indication; this study found a dose-dependent risk. In the light of the finding of a single study that infection and fever during pregnancy by themselves do not raise the ADHD risk, it appears possible that the use of acetaminophen during pregnancy is itself responsible for the increased risk of ADHD. This suggests that acetaminophen may not be as safe in pregnancy as is widely believed. However, since fever during pregnancy may itself be associated with adverse gestational outcomes, given the present level of uncertainty about the ADHD risk with acetaminophen, it is suggested that, until more data are available, the use of acetaminophen in pregnancy should not be denied in situations in which the need for the drug is clear. PMID:27046315

  17. [Unemployment during pregnancy: direct or indirect risk factor of prematurity and fetus hypotrophy?].

    PubMed

    Hanke, W

    1999-01-01

    The question as to whether in a transitional phase in the political and socio-economic development in Poland, an increased threat of unemployment may also produce health effects manifested by an elevated risk for prematurity and fetus hypotrophy is one of important challenges. If the answer is positive then this issue should have much stronger impact on political and economic decisions. The data obtained from numerous studies carried out in countries of western Europe and the United States shows that the job performance during pregnancy under conditions free from occupational exposure and arduousness does not directly augment the risk of detrimental effect to the health of pregnant woman or her fetus. Just on the contrary, it was found that job performance during pregnancy, and strictly speaking steady employment during this period may somewhat become a 'protective factor'. In Poland, the highest rate of unemployment is observed among women in the 18-24 age group, that is at the age most suitable for procreation. Nowadays it is common that the decision on child-bearing is postponed until the economic status of the woman or her family comes to be more stable. On the other hand, in the population of women looking for a job but determined to set up a family prematurity is quite common that results only in part from an excessive effect of risk factors for this pathology very typical of this social group, like smoking, single parenthood, early or late child-bearing age. After adjusting these factors, the risk of prematurity decreased considerably but it was still high. It is thought that stress and the sense of threat and uncertainty is mostly responsible for this phenomenon. An increased risk of fetus hypotrophy among unemployed women after considering all confounding factors, was not observed. PMID:10746241

  18. Understanding Pregnancy and Birth Issues

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues Understanding Pregnancy and Birth Issues Past Issues / Winter 2008 Table ... turn Javascript on. What is a High-Risk Pregnancy? All pregnancies involve a certain degree of risk ...

  19. Medication Use in Pregnancy in Relation to the Risk of Isolated Clubfoot in Offspring

    PubMed Central

    Werler, Martha M.; Yazdy, Mahsa M.; Kasser, James R.; Mahan, Susan T.; Meyer, Robert E.; Anderka, Marlene; Druschel, Charlotte M.; Mitchell, Allen A.

    2014-01-01

    Clubfoot, a common major structural malformation, develops early in gestation. Epidemiologic studies have identified higher risks among boys, first-born children, and babies with a family history of clubfoot, but studies of risks associated with maternal exposures are lacking. We conducted the first large-scale, population-based, case-control study of clubfoot with detailed information on maternal medication use in pregnancy. Study subjects were ascertained from birth defect registries in Massachusetts, New York, and North Carolina during 2007–2011. Cases were 646 mothers of children with clubfoot without other major structural malformations (i.e., isolated clubfoot); controls were mothers of 2,037 children born without major malformations. Mothers were interviewed within 12 months of delivery about medication use, including product, timing, and frequency. Odds ratios were estimated for exposure to 27 medications in pregnancy months 2–4 after adjustment for study site, infant sex, first-born status, body mass index (weight (kg)/height (m)2), and smoking. Odds ratios were less than 1.20 for 14 of the medications; of the remainder, most odds ratios were only slightly elevated (range, 1.21–1.66), with wide confidence intervals. The use of antiviral drugs was more common in clubfoot cases than in controls (odds ratio = 4.22, 95% confidence interval: 1.52, 11.73). Most of these results are new findings and require confirmation in other studies. PMID:24824985

  20. Genome-Wide Identification of Epigenetic Hotspots Potentially Related to Cardiovascular Risk in Adult Women after a Complicated Pregnancy

    PubMed Central

    Oudejans, Cees; Poutsma, Ankie; Michel, Omar; Mulders, Joyce; Visser, Allerdien; van Dijk, Marie; Nauta, Tessa; Bokslag, Anouk; Paulus, Walter; de Haas, Andreas; Koolwijk, Pieter; de Groot, Christianne J. M.

    2016-01-01

    Background The physiological demands of pregnancy on the maternal cardiovascular system can catapult women into a metabolic syndrome that predisposes to atherosclerosis in later life. We sought to identify the nature of the epigenomic changes associated with the increased cardiovascular disease (CVD) risk in adult women following pre-eclampsia. Findings We assessed the genome wide epigenetic profile by methyl-C sequencing of monozygotic parous twin sister pairs discordant for a severe variant of pre-eclampsia. In the adult twin sisters at risk for CVD as a consequence of a complicated pregnancy, a set of 12 differentially methylated regions with at least 50% difference in methylation percentage and the same directional change was found to be shared between the affected twin sisters and significantly different compared to their unaffected monozygous sisters. Conclusion The current epigenetic marker set will permit targeted analysis of differentially methylated regions potentially related to CVD risk in large cohorts of adult women following complicated pregnancies. PMID:26870946

  1. Risk of Spina Bifida and Maternal Cigarette, Alcohol, and Coffee Use during the First Month of Pregnancy

    PubMed Central

    Benedum, Corey M.; Yazdy, Mahsa M.; Mitchell, Allen A.; Werler, Martha M.

    2013-01-01

    This study was conducted to assess the association between the risks of spina bifida (SB) in relation to cigarette, alcohol, and caffeine consumption by women during the first month of pregnancy. Between 1988–2012, this multi-center case-control study interviewed mothers of 776 SB cases and 8,756 controls about pregnancy events and exposures. We evaluated cigarette smoking, frequency of alcohol drinking, and caffeine intake during the first lunar month of pregnancy in relation to SB risk. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. Levels of cigarette smoking (1–9 and ≥10/day), alcohol intake (average ≥4 drinks/day) and caffeine intake (<1, 1, and ≥2 cups/day) were not likely to be associated with increased risk of SB. Further, results were similar among women who ingested less than the recommended amount of folic acid (400 μg/day). PMID:23917813

  2. Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls.

    PubMed

    Kovacs, M; Krol, R S; Voti, L

    1994-01-01

    An existing longitudinal data set was used to investigate the hypothesis that a depressive disorder in childhood increases the risk of an adolescent pregnancy. Depression is characterized by low self-esteem, lowered concern about one's personal welfare, passivity, and impaired motivation--all of which may prevent teenage girls from taking steps to protect themselves from pregnancy. The 83 subjects had been referred to a child psychiatric clinic (86%) or a general medical facility (12%) in Pittsburgh, Pennsylvania, between the ages of 8-13 years (average age at intake, 11.5 years). They underwent 4 clinical assessments in the first year of study participation and 2 assessments in each subsequent year. 65 girls experienced 1 or more DSM-III-R defined depressive episodes during the study period; the rest, who served as psychopathologic controls, had conduct disorders. 25 of the 83 subjects (30%, compared to the national average of 24%) had documented pregnancies by the age of 18 years. 28% of the pregnant teens had a history of early onset depression compared with 66% of their nonpregnant counterparts. On the other hand, 76% of the pregnant teens had been diagnosed with a conduct disorder by the age of 18 compared with 24% of the nonpregnant girls. Preliminary analysis further indicated that teenage pregnancy was associated with having been born out of wedlock or to a mother aged 18 years or younger; living in an intact family at time of study enrollment and socioeconomic status were not significant correlates. In the multivariate analysis, however, only two factors retained significance: a conduct disorder diagnosis in childhood (mean time to first pregnancy was 17.3 years compared to 18.7 years among remaining subjects) and race (Blacks tended to become pregnant by 17.4 years compared to an average of 18.7 years for Whites). No significant interaction was detected between a conduct disorder and race. These findings suggest that educational interventions aimed at

  3. Elective amniocentesis in low-risk pregnancies: decision making in the era of information and uncertainty.

    PubMed Central

    Lesser, Y; Rabinowitz, J

    2001-01-01

    OBJECTIVES: Rational choice theory was applied to explain women's use of amniocentesis. Variables included knowledge about prenatal diagnostics, attitudes, and emotional preferences. METHODS: Using structured instruments at 9 to 14 and at 29 to 34 weeks' gestation, we interviewed 232 Israeli women who had low-risk pregnancies. RESULTS: Women who had elective amniocentesis (n = 39) were more knowledgeable about prenatal diagnostics, risks of invasive procedures, and probability of fetal abnormality in high maternal age; had fewer children; and had less favorable attitudes toward parenthood than those who had medically indicated amniocentesis (n = 57) and those who did not have amniocentesis (n = 136). CONCLUSIONS: The use and possible overuse of amniocentesis were associated with having more information about prenatal diagnostics and definite emotional preferences. PMID:11291381

  4. Exposure to electromagnetic fields during pregnancy and associated risks for intrauterine growth retardation and spontaneous abortion. Final report

    SciTech Connect

    Bracken, M.B.

    1995-12-01

    This joint EPRI/National Institutes of Health study is the largest epidemiological study ever undertaken to examine the relationship between exposure to electric and magnetic fields (EMF) during pregnancy and reproductive outcomes. Overall, the study concludes that EMF exposure during pregnancy is unrelated to pregnancy outcome. In specific, the study reveals no association between electromagnetic field exposure from electrically heated beds and intrauterine growth retardation or spontaneous abortion. Among the many strengths of this study are clearly specified hypotheses; prospective design; randomized assignment to exposure monitoring; very large sample size; detailed assessment of potential confounding by known risk factors for adverse pregnancy outcomes; and comprehensive statistical analyses. The study also featured extensive exposure assessment, including measurements of EMF from a variety of sources, personal monitoring, and wire coding information.

  5. Intimate partner abuse before and during pregnancy as risk factors for postpartum mental health problems

    PubMed Central

    2014-01-01

    Background Although research has established the profound effects that intimate partner abuse can have on postpartum mental health, little is known regarding how this association may change as a function of the timing and type of abuse. This study examined associations of psychological, physical and sexual abuse experienced as adults before and during pregnancy with symptoms of postpartum mental health problems in a non-clinical sample of women. Methods English-speaking mothers aged 18 years and older in the metropolitan area of a large, Western Canadian city were recruited to participate in a study of women’s health after pregnancy. The study was advertised in hospitals, local newspapers, community venues, and relevant websites. One-hundred women completed standardized, self-report questionnaires during semi-structured interviews conducted by female research assistants at approximately 2 months postpartum. In addition to questions about their general health and well-being, participants answered questions about their experiences of intimate partner abuse and about their mental health during the postpartum period. Results Almost two-thirds (61.0%) of women reported postpartum mental health symptoms above normal levels, with 47.0% reporting symptoms at moderate or higher levels. The majority reported some form of intimate partner abuse before pregnancy (84.0%) and more than two-thirds (70.0%), during pregnancy; however, the abuse was typically minor in nature. Multivariate models revealed that women who experienced intimate partner abuse—whether before or during pregnancy—reported higher levels of postpartum mental health problems; however, associations differed as a function of the timing and type of abuse, as well as specific mental health symptoms. Multivariate models also showed that as the number of types of intimate partner abuse experienced increased, so did the negative effects on postpartum mental health. Conclusions Results of this study provide

  6. Associations of Pregnancy Complications with Calculated CVD Risk and Cardiovascular Risk Factors in Middle Age: The Avon Longitudinal Study of Parents and Children

    PubMed Central

    Fraser, Abigail; Nelson, Scott M.; Macdonald-Wallis, Corrie; Cherry, Lynne; Butler, Elaine; Sattar, Naveed; Lawlor, Debbie A.

    2012-01-01

    Background The nature and contribution of different pregnancy related complications to future cardiovascular disease (CVD) and its risk factors, as well as mechanisms underlying these associations remain unclear. Methods and Results We studied associations of pregnancy diabetes, hypertensive disorders of pregnancy (HDP), preterm delivery and size for gestational age with calculated 10 year CVD risk (based on the Framingham score) and a wide range of cardiovascular risk factors measured 18 years after pregnancy (mean age at outcome assessment: 48 years) in a prospective cohort of 3,416 women. Gestational diabetes (GDM) was positively associated with fasting glucose and insulin, even after adjusting for potential confounders whilst HDP were associated with BMI, waist circumference, blood pressure, lipids and insulin. Large for gestational age (LGA) was associated with greater waist circumference and glucose concentrations, whilst small for gestational age (SGA) and preterm delivery were associated with higher blood pressure. The association with the calculated 10 year CVD risk based on the Framingham prediction score was OR=1.31 (95%CI: 1.11, 1.53) for preeclampsia and 1.26 (0.95, 1.68) for GDM compared to women without preeclampsia and GDM respectively. Conclusions HDP and pregnancy diabetes are independently associated with an increased calculated 10 year CVD risk. Preeclampsia may be the better predictor of future CVD since it was associated with a wider range of cardiovascular risk factors. Our results suggest that pregnancy may be an important opportunity for early identification of women at increased risk of CVD later in life. PMID:22344039

  7. Pesticides and Pregnancy

    MedlinePlus

    Pesticides and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having ... risk. This sheet talks about whether exposure to pesticides may increase the risk for birth defects over ...

  8. Marijuana and Pregnancy

    MedlinePlus

    Marijuana and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having ... risk. This sheet talks about whether exposure to marijuana may increase the risk for birth defects over ...

  9. Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study

    PubMed Central

    Meng, Chun-Xia; Ping, Hua; Qin, Guo-Juan; Cao, Shu-Jun; Xi, Xiaowei; Zhu, Qian; Li, Xiao-Cui; Zhang, Jian

    2014-01-01

    Objective To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle. Methods A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs). Results Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48–2.37]; AOR2 = 1.84 [1.49–2.27]), and the risk increased with the duration of previous use (P1 for trend <10−4, P2 for trend <10−4). The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03–0.05]; withdrawal method: AOR = 0.10 [0.07–0.13]; calendar rhythm method: AOR = 0.54 [0.40–0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02–0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16–0.30]; IUDs: AOR = 0.01 [0.005–0.012]; tubal sterilization: AOR = 0.01 [0.001–0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04–0.06]; withdrawal method: AOR1 = 0.13 [0.09–0.19]; calendar rhythm method: AOR1 = 0.66 [0.48–0.91]; OCPs: AOR1 = 0.14 [0.07–0.26]; IUDs: AOR1 = 0.17 [0.13–0.22]; tubal sterilization: AOR1 = 0.04 [0.02–0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64–10.07]), LNG-EC (AOR2 = 4.87 [3.88–6.10]), IUDs (AOR2 = 21.08 [13.44–33.07]), and tubal sterilization (AOR2 = 7.68 [1.69–34.80]) increased the risk of EP compared

  10. Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies

    PubMed Central

    Wei, Jun; Liu, Cai-Xia; Gong, Ting-Ting; Wu, Qi-Jun; Wu, Lang

    2015-01-01

    Although evidence from epidemiological studies evaluating the association between cigarette smoking during pregnancy and preeclampsia risk has been systematically reviewed, the findings have been out of date. To further clarify the relationship, we conducted this comprehensive meta-analysis of prospective studies. We searched PubMed and Web of Science up to August 2015 to identify prospective studies that evaluated the association between cigarette smoking during pregnancy and preeclampsia risk. Random-effects models were used to estimate summarized relative risk (RR) and 95% confidence intervals (CIs). Seventeen prospective studies involving 62,089 preeclampsia patients from a total of approximately 1.8 million subjects were included. Overall, there was a significant negative association between smoking during pregnancy and incidence of preeclampsia (RR = 0.67, 95% CI: 0.60–0.75), with significant heterogeneity (I2 = 91.7%). Such an inverse association was also detected in strata of subgroup analyses according to study location, study sample size, parity of populations, singleton pregnancy, and adjustment for potential confounders including maternal age, diabetes mellitus, chronic hypertension, body mass index, and gender of infant. In summary, this meta-analysis suggests that smoking during pregnancy is inversely associated with incidence of preeclampsia. Further large scale multi-center prospective studies are warranted to validate our findings. PMID:26498356

  11. Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births - Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008.

    PubMed

    2012-01-20

    Approximately 400,000 teens aged 15-19 years give birth every year in the United States (1), and the teen birth rate remains the highest in the developed world. Teen childbearing is a public health concern because teen mothers are more likely to experience negative social outcomes, including school dropout. In addition, infants of teen mothers are more likely to be low birth weight and have lower academic achievement, and daughters of teen mothers are more likely to become teen mothers themselves. To learn why teens wishing to avoid pregnancy become pregnant, CDC analyzed data from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS). This report describes estimated rates of self-reported prepregnancy contraceptive use among white, black, and Hispanic teen females aged 15-19 years with unintended pregnancies resulting in live births. Approximately one half (50.1%) of these teens were not using any method of birth control when they got pregnant, and of these, nearly one third (31.4%) believed they could not get pregnant at the time; 21.0% used a highly effective contraceptive method (although less than 1% used one of the most effective methods, such as an intrauterine device [IUD]); 24.2% used the moderately effective method of condoms; and 5.1% used the least effective methods, such as rhythm and withdrawal. To decrease teen birth rates, efforts are needed to reduce or delay the onset of sexual activity, provide factual information about the conditions under which pregnancy can occur, increase teens' motivation and negotiation skills for pregnancy prevention, improve access to contraceptives, and encourage use of more effective contraceptive methods. PMID:22258415

  12. Maternal mental disorders in pregnancy and the puerperium and risks to infant health

    PubMed Central

    Pereira, Priscila Krauss; Lima, Lúcia Abelha; Legay, Letícia Fortes; de Cintra Santos, Jacqueline Fernandes; Lovisi, Giovanni Marcos

    2012-01-01

    Prenatal and postnatal period presents the highest prevalence of mental disorders in women’s lives and depression is the most frequent one, affecting approximately one in every five mothers. The aggravating factor here is that during this period psychiatric symptoms affect not only women’s health and well-being but may also interfere in the infant’s intra and extra-uterine development. Although the causes of the relationship between maternal mental disorders and possible risks to a child’s health and development remain unknown, it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy, to substance abuse and the mother’s lifestyle. Moreover, after delivery, maternal mental disorders may also impair the ties of affection (bonding) with the newborn and the maternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition, impaired child growth that is expressed in low weight and height for age, and even behavioral problems and vulnerability to presenting mental disorders in adulthood. Generally speaking, research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight, whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality. Therefore, the success of infant growth care programs also depends on the mother’s mental well being. Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers. However, more research is necessary so as to confirm the association between all factors with

  13. Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms.

    PubMed

    Spradley, Frank T; Palei, Ana C; Granger, Joey P

    2015-12-01

    Preeclampsia (PE) is a pregnancy-specific disorder typically presenting as new-onset hypertension and proteinuria. While numerous epidemiological studies have demonstrated that obesity increases the risk of PE, the mechanisms have yet to be fully elucidated. Growing evidence from animal and human studies implicate placental ischemia in the etiology of this maternal syndrome. It is thought that placental ischemia is brought about by dysfunctional cytotrophoblast migration and invasion into the uterus and subsequent lack of spiral arteriole widening and placental perfusion. Placental ischemia/hypoxia stimulates the release of soluble placental factors into the maternal circulation where they cause endothelial dysfunction, particularly in the kidney, to elicit the clinical manifestations of PE. The most recognized of these factors are the anti-angiogenic sFlt-1 and pro-inflammatory TNF-α and AT1-AA, which promote endothelial dysfunction by reducing levels of the provasodilator nitric oxide and stimulating production of the potent vasoconstrictor endothelin-1 and reactive oxygen species. We hypothesize that obesity-related metabolic factors increase the risk for developing PE by impacting various stages in the pathogenesis of PE, namely, 1) cytotrophoblast migration and placental ischemia; 2) release of soluble placental factors into the maternal circulation; and 3) maternal endothelial and vascular dysfunction. This review will summarize the current experimental evidence supporting the concept that obesity and metabolic factors like lipids, insulin, glucose, and leptin affect placental function and increase the risk for developing hypertension in pregnancy by reducing placental perfusion; enhancing placental release of soluble factors; and by increasing the sensitivity of the maternal vasculature to placental ischemia-induced soluble factors. PMID:26447211

  14. Outcomes associated with planned place of birth among women with low-risk pregnancies

    PubMed Central

    Hutton, Eileen K.; Cappelletti, Adriana; Reitsma, Angela H.; Simioni, Julia; Horne, Jordyn; McGregor, Caroline; Ahmed, Rashid J.

    2016-01-01

    Background: Previous studies have shown that planned home birth is associated with a decreased likelihood of intrapartum intervention with no difference in neonatal outcomes compared with planned hospital birth. The purpose of our study was to evaluate different birth settings by comparing neonatal mortality, morbidity and rates of birth interventions between planned home and planned hospital births in Ontario, Canada. Methods: We used a provincial database of all midwifery-booked pregnancies between 2006 and 2009 to compare women who planned home birth at the onset of labour to a matched cohort of women with low-risk pregnancies who had planned hospital births attended by midwives. We conducted subgroup analyses by parity. Our primary outcome was stillbirth, neonatal death (< 28 d) or serious morbidity (Apgar score < 4 at 5 min or resuscitation with positive pressure ventilation and cardiac compressions). Results: We compared 11 493 planned home births and 11 493 planned hospital births. The risk of our primary outcome did not differ significantly by planned place of birth (relative risk [RR] 1.03, 95% confidence interval [CI] 0.68–1.55). These findings held true for both nulliparous (RR 1.04, 95% CI 0.62–1.73) and multiparous women (RR 1.00, 95% CI 0.49–2.05). All intrapartum interventions were lower among planned home births. Interpretation: Compared with planned hospital birth, planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions. PMID:26696622

  15. Treatment with anthelminthics during pregnancy: what gains and what risks for the mother and child?

    PubMed

    Elliott, Alison M; Ndibazza, Juliet; Mpairwe, Harriet; Muhangi, Lawrence; Webb, Emily L; Kizito, Dennison; Mawa, Patrice; Tweyongyere, Robert; Muwanga, Moses

    2011-10-01

    In 1994 and 2002, respectively, the World Health Organisation proposed that treatment for hookworm and schistosomiasis could be provided during pregnancy. It was hoped that this might have benefits for maternal anaemia, fetal growth and perinatal mortality; a beneficial effect on the infant response to immunisation was also hypothesised. Three trials have now been conducted. Two have examined the effects of benzimidazoles; one (the Entebbe Mother and Baby Study) the effects of albendazole and praziquantel. All three were conducted in settings of high prevalence but low intensity helminth infection. Results suggest that, in such settings and given adequate provision of haematinics, the benefit of routine anthelminthics during pregnancy for maternal anaemia may be small; none of the other expected benefits has yet been demonstrated. The Entebbe Mother and Baby Study found a significant adverse effect of albendazole on the incidence of infantile eczema in the whole study population, and of praziquantel on the incidence of eczema among infants of mothers with Schistosoma mansoni. Further studies are required in settings that differ in helminth species and infection intensities. Further research is required to determine whether increased rates of infantile eczema translate to long-term susceptibility to allergy, and to explore the underlying mechanisms of these effects. The risks and benefits of routine anthelminthic treatment in antenatal clinics may need to be reconsidered. PMID:21810307

  16. Apheresis in high risk antiphospholipid syndrome pregnancy and autoimmune congenital heart block.

    PubMed

    Ruffatti, Amelia; Favaro, Maria; Brucato, Antonio; Ramoni, Veronique; Facchinetti, Myriam; Tonello, Marta; Del Ross, Teresa; Calligaro, Antonia; Hoxha, Ariela; Grava, Chiara; De Silvestro, Giustina

    2015-12-01

    In the first part a prospective cohort study was reported to evaluate the efficacy and safety of a treatment protocol including plasma exchange (PE) or PE plus intravenous immunoglobulins (IVIG) or immunoadsorption (IA) plus IVIG administered in addition to conventional therapy to 22 pregnant women with high-risk APS. The results indicate that PE or IA treatments administered along with IVIG and conventional antithrombotic therapy could be a valuable and safe therapeutic option in pregnant APS women with triple antiphospholipid antibody positivity along with a history of thrombosis and/or one or more severe pregnancy complications. In the second part the efficacy and safety of PE combined with IVIG and steroids were evaluated for the treatment of 10 patients with autoimmune congenital heart block (CHB) by comparing maternal features, pregnancy outcome and side effects with those of 24 CHB patients treated with steroids only. The patients treated with the combined therapy showed a statistically significant regression of 2nd degree blocks, an increase in heart rate at birth and a significantly lower prevalence of pacing in the first year of life. Moreover, no side effects were observed except for a few steroid-related events. If these results are confirmed by large-scale studies, the apheretic procedures could lead to improved outcomes in the treatment of these devastating diseases. PMID:26626966

  17. Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study

    PubMed Central

    Li, D-K; Ferber, J R; Odouli, R

    2015-01-01

    Background/Objectives: In-utero exposures through adverse fetal programming are emerging as an important contributing factor to the epidemic of childhood obesity. This study examines the impact of in-utero exposure to caffeine on the risk of childhood obesity in offspring. Subjects/Methods: A prospective study of pregnant women with 15 years follow-up of their offspring was conducted to examine the impact of in-utero exposure to caffeine on the risk of childhood obesity. Maternal caffeine intake was prospectively ascertained during pregnancy and outcome measures (body mass index (BMI)) were ascertained from medical charts, with 17 BMI measurements per child, on average, during the follow-up period. Potential confounders including known perinatal risk factors for childhood obesity were adjusted for using the generalized estimating equations model with repeated measurements. Results: After controlling for potential confounders, compared with those without caffeine exposure, in-utero exposure to caffeine overall is associated with 87% increased risk of childhood obesity: odds ratio (OR) =1.87, 95% confidence interval (CI): 1.12–3.12. This association demonstrated a dose–response relationship: OR=1.77 (1.05–3.00) for maternal daily caffeine intake <150 mg per day, OR=2.37 (1.24–4.52) for caffeine intake ⩾150 mg per day during pregnancy, respectively. We also observed a linear relationship: every one unit increase (log10 scale) in the amount of maternal caffeine intake was associated with 23% increased risk of obesity in offspring. The dose–response relationship appears stronger for persistent obesity than for transitory obesity (occasional high BMI), and for girls than for boys. Conclusions: We observed an association of in-utero exposure to caffeine with increased risk of childhood obesity. If this observation is further replicated in other studies, the finding will contribute to the understanding of fetal programming of childhood diseases and

  18. Exposure to partner, family, and community violence: gang-affiliated Latina women and risk of unintended pregnancy.

    PubMed

    Miller, Elizabeth; Levenson, Rebecca; Herrera, Lili; Kurek, Laura; Stofflet, Marney; Marin, Leni

    2012-02-01

    While teen pregnancy rates appear to be declining in the U.S.A. overall, the rate of decline among young Latinas has been less than other ethnic groups. Among the myriad factors associated with elevated pregnancy rates, for Latina girls living in the inner city, exposure to gang and community violence may be a critical context for increased pregnancy risk. This study explores the relationship between gang involvement and reproductive health, and the pathways through which childhood, family, and relationship violence exposure may lead to unintended pregnancy. Interviews of 20 young adult Latinas with known gang involvement in Los Angeles County were audiotaped, transcribed, and coded for key themes related to violence exposure and reproductive health. Limited access to reproductive health care compounded by male partner sexual and pregnancy coercion, as well as physical and sexual violence, emerged in the interviews. Exposures to interparental domestic violence, childhood physical and sexual abuse, and gang violence were prominent and closely associated with unhealthy and abusive intimate relationships. Adverse childhood experiences and exposure to partner, family, and community violence impact the reproductive lives and choices of young Latina women in gangs. These findings may guide targeted pregnancy prevention efforts among urban gang-affiliated Latinas as well as encourage the integration of sexual violence prevention and reproductive health promotion within gang violence intervention programs. PMID:22160445

  19. β-endorphin neuronal transplantation into the hypothalamus alters anxiety-like behaviors in prenatal alcohol exposed rats and non-preferring and preferring rats

    PubMed Central

    Logan, Ryan; Wynne, Olivia; Maglakelidze, George; Zhang, Changqing; O’Connell, Stephanie; Boyadjieva, Nadka I.; Sarkar, Dipak K.

    2015-01-01

    Background Alcohol exposure has adverse effects on stress physiology and behavioral reactivity. This is suggested to be due, in part, to the effect of alcohol on β-endorphin (β-EP) producing neurons in the hypothalamus. In response to stress, β-EP normally provides negative feedback to the HPA axis and interacts with other neurotransmitter systems in the amygdala to regulate behavior. We examined whether β-EP neuronal function in the hypothalamus reduces the corticosterone response to acute stress, attenuates anxiety-like behaviors, and modulates alcohol drinking in rats. Methods To determine if β-EP neuronal transplants modulate the stress response, anxiety behavior and alcohol drinking, we implanted differentiated β-EP neurons into the paraventricular nucleus of the hypothalamus (PVN) of normal, prenatal alcohol exposed, and alcohol-preferring (P) and non-preferring (NP) rats. We then assessed corticosterone levels in response to acute restraint stress and other markers of stress response in the brain, and anxiety-like behaviors in the elevated plus maze and open-field assays. Results We showed that β-EP neuronal transplants into the PVN reduced the peripheral corticosterone response to acute stress and attenuated anxiety-like behaviors. Similar transplants completely reduced the hyper-corticosterone response and elevated anxiety behaviors in prenatal alcohol exposed adult rats. Moreover, we showed that β-EP reduced anxiety behavior in P rats with minimal effects on alcohol drinking during and following restraint stress. Conclusions These data further establish a role of β-EP neurons in the hypothalamus for regulating physiological stress response and anxiety behavior, and resembles a potential novel therapy for treating stress-related psychiatric disorders in prenatal alcohol exposed children and those genetically predisposed to increased alcohol consumption. PMID:25623413

  20. 'Love Hormone' Levels in Pregnancy May Point to Risk for Postpartum Depression

    MedlinePlus

    ... their oxytocin levels in the third trimester of pregnancy and their depression symptoms six weeks after they gave birth. Among the 13 women with a history of depression before pregnancy, the higher their oxytocin levels, the more depression ...

  1. Identifying Risk for Onset of Major Depressive Episodes in Low-Income Latinas during Pregnancy and Postpartum

    ERIC Educational Resources Information Center

    Le, Huynh-Nhu; Munoz, Ricardo F.; Soto, Jose A.; Delucchi, Kevin L.; Ippen, Chandra Ghosh

    2004-01-01

    This study aimed to identify subgroups of pregnant women at imminent (1 year) risk for major depressive episodes. Participants were 84 low-income, predominantly Mexican women using public sector obstetrics services who participated in monthly interviews during pregnancy and up to 6 months postpartum. Participants were designated a priori as "more…

  2. Corrigendum: The Associations Between Maternal Factors During Pregnancy and the Risk of Childhood Acute Lymphoblastic Leukemia: A Meta-Analysis.

    PubMed

    Yan, Kangkang; Xu, Xuejing; Liu, Xiaodong; Wang, Xikui; Hua, Shucheng; Wang, Chunpeng; Liu, Xin

    2016-05-01

    Because of the erroneous application of multiple publications, the conclusions of our recent paper (Pediatr Blood Cancer 2015;62:1162-70) were not reliable. The corrected results show that coffee drinking during pregnancy was risk factor for childhood acute lymphoblastic leukemia (OR = 1.44, 95% confidence interval = 1.07-1.92). PMID:26999072

  3. African-American Adolescent Females in the Southeastern United States: Associations among Risk Factors for Teen Pregnancy

    ERIC Educational Resources Information Center

    Killebrew, Alyssa E.; Smith, Michelle L.; Nevels, Robert M.; Weiss, Nicole H.; Gontkovsky, Samuel T.

    2014-01-01

    This study examined the associations among three external variables (Peer Substance Use Before Sex, Peer Number of Children, and Parental Influence and Substance Use Before Sex and History of Pregnancy) identified on the Youth Risk Behavior Surveillance Survey and a demographic survey, using Bandura's Social Learning Theory as an interpretive…

  4. Iron metabolism in African American women during the 2nd and 3rd trimester of a high-risk pregnancy

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objective: To examine iron metabolism during the 2nd and 3rd trimester in African American women classified as a high-risk pregnancy. Design: Longitudinal. Setting: Large, university-based, urban Midwestern medical center. Participants: Convenience sample of 47 African American women classified a...

  5. Use of Nurse-Client Contracting to Reduce Risk of Unintended Pregnancy in an Adolescent Population.

    ERIC Educational Resources Information Center

    Van Dover, Leslie J.

    Unintended pregnancies occur among young people who are sexually active and who do not take sufficient precautions to prevent pregnancy. Two major factors identified as contributing to unintended pregnancy are the lack of knowledge and skill in family planning and inconsistency in use of contraceptives. A pretest-posttest experiment was conducted…

  6. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.

    PubMed

    Marchi, J; Berg, M; Dencker, A; Olander, E K; Begley, C

    2015-08-01

    Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy. PMID:26016557

  7. Does palm oil vitamin E reduce the risk of pregnancy induced hypertension?

    PubMed

    Mahdy, Zaleha Abdullah; Siraj, Harlina Halizah; Khaza'ai, Huzwah; Mutalib, Mohd Sokhini Abdul; Azwar, Muhammad Hatta; Wahab, Marianah Abdul; Dali, Ahmad Zailani Hatta Md; Jaafar, Rohana; Ismail, Nor Azlin Mohd; Jamil, Muhammad Abdul; Adeeb, Nafisah

    2013-01-01

    In view of the high anti-oxidative potential oftocotrienol, the role of the tocotrienol-rich fraction (TRF) of palm oil in preventing pregnancy induced hypertension (PIH) was explored in a randomized double-blind placebo-controlled clinical trial in an urban teaching hospital. Healthy primigravidae were randomized to receive either oral TRF 100 mg daily or placebo, from early second trimester until delivery. Out of 299 women, 151 were randomized into the TRF arm and 148 into the placebo arm. A total of 15 (5.0%) developed PIH. Although there was no statistically significant difference in the incidence of PIH (4/151 or 2.6% in the TRF arm vs. 11/148 or 7.4% in the placebo arm, p = 0.058) between the two arms, there was a tendency towards a lower incidence of PIH in the TRF arm compared to the placebo arm. With TRF supplementation, the relative risk (RR) of PIH was 0.36 (95% CI 0.12-1.09). In conclusion, although TRF from palm oil does not statistically significantly reduce the risk of development of PIH in the population studied, the 64% reduction in incidence of PIH is substantial. The findings warrant further clinical trials, particularly in high risk populations. PMID:24592747

  8. Desire for pregnancy and risk behavior in young HIV-positive women.

    PubMed

    Finger, Julie L; Clum, Gretchen A; Trent, Maria E; Ellen, Jonathan M

    2012-03-01

    This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling. PMID:22482121

  9. Risk of Spontaneous Preterm Birth in Relation to Maternal Exposure to Intimate Partner Violence During Pregnancy in Peru

    PubMed Central

    Sanchez, Sixto E.; Alva, Andrea V.; Chang, Guillermo Diez; Qiu, Chungfang; Yanez, David; Gelaye, Bizu; Williams, Michelle A.

    2012-01-01

    Objective Intimate partner violence (IPV) is increasingly recognized as an important cause of maternal and perinatal morbidity. We assessed the relation between IPV and risk of spontaneous preterm birth (PTB) among Peruvian women. Methods The study was conducted among 479 pregnant women who delivered a preterm singleton infant (<37 weeks gestation) and 480 controls (≥37 weeks gestation). Participants’ exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (aOR) and 95% confidence intervals (CI) were estimated from logistic regression models. Results The prevalence of any IPV during pregnancy was 52.2% among cases and 34.6% among controls. Compared with those reporting no exposure to IPV during pregnancy, women reporting any exposure had a 2.1-fold increased risk of PTB (95% CI 1.59–2.68). The association was attenuated slightly after adjusting for maternal age, pre-pregnancy weight, and other covariates (OR=1.99; 95% CI: 1.52–2.61). Emotional abuse in the absence of physical violence was associated with a 1.6-fold (95% CI 1.21–2.15) increased risk of PTB. Emotional and physical abuse during pregnancy was associated with a 4.7-fold increased risk of PTB (95% CI 2.74–7.92). Associations of similar directions and magnitudes were observed when PTB were sub-categorized according to clinical presentation or severity. Conclusion IPV among pregnant women is common and is associated with an increased risk of PTB. Our findings and those of others support recent calls for coordinated global health efforts to prevent violence against women. PMID:22527763

  10. Are Women With Uterine Fibroids at Increased Risk for Adverse Pregnancy Outcome?

    PubMed

    Ezzedine, Dima; Norwitz, Errol R

    2016-03-01

    Uterine fibroids (leiomyomas) are common in reproductive age women. Most women with fibroids have uneventful pregnancies. The most common complication is painful degeneration. Are fibroids associated with adverse pregnancy outcomes? If so, can we predict which fibroids are most likely to cause complications? And is there anything that can be done to prevent these complications, such as performing a myomectomy before pregnancy? Here we review the published literature looking at the impact of uterine fibroids on adverse pregnancy events, such as miscarriage, preterm labor, placental abruption, fetal growth restriction, and fetal malpresentation. A series of clinical recommendations for the management of pregnancy in women with uterine fibroids are included. PMID:26670833

  11. Pregnancy Incidence and Risk Factors among Women Participating in Vaginal Microbicide Trials for HIV Prevention: Systematic Review and Meta-Analysis

    PubMed Central

    Musekiwa, Alfred; Muchiri, Evans; Manda, Samuel O. M.; Mwambi, Henry G.

    2013-01-01

    Introduction Pregnancy is contraindicated in vaginal microbicide trials for the prevention of HIV infection in women due to the unknown maternal and fetal safety of the microbicides. Women who become pregnant are taken off the microbicide during pregnancy period but this result in reduction of the power of the trials. Strategies to reduce the pregnancy rates require an understanding of the incidence and associated risk factors of pregnancy in microbicide trials. This systematic review estimates the overall incidence rate of pregnancy in microbicide trials and describes the associated risk factors. Methods A comprehensive literature search was carried out to identify eligible studies from electronic databases and other sources. Two review authors independently selected studies and extracted relevant data from included studies. Meta-analysis of incidence rates of pregnancy was carried out and risk factors of pregnancy were reported narratively. Results Fifteen studies reporting data from 10 microbicide trials (N=27,384 participants) were included. A total of 4,107 participants (15.0%) fell pregnant and a meta-analysis of incidence rates of pregnancy from 8 microbicide trials (N=25,551) yielded an overall incidence rate of 23.37 (95%CI: 17.78 to 28.96) pregnancies per 100 woman-years. However, significant heterogeneity was detected. Hormonal injectable, intra-uterine device (IUD) or implants or sterilization, older age, more years of education and condom use were associated with lower pregnancy. On the other hand, living with a man, history of pregnancy, self and partner desire for future baby, oral contraceptive use, increased number of unprotected sexual acts and inconsistent use of condoms were associated with higher pregnancy. Conclusions The incidence rate of pregnancy in microbicide trials is high and strategies for its reduction are urgently required in order to improve the sample size and power of these trials. PMID:24130827

  12. Early pregnancy IGF-I and placental GH and risk of epithelial ovarian cancer: A nested case-control study

    PubMed Central

    Schock, Helena; Fortner, Renée T; Surcel, Heljä-Marja; Grankvist, Kjell; Pukkala, Eero; Lehtinen, Matti; Lundin, Eva

    2014-01-01

    Insulin-like growth factor-I (IGF-I) signaling may promote ovarian tumor development by exerting mitotic, anti-apoptotic, and pro-angiogenic effects. During pregnancy, maternal production of IGF-I is regulated by placental growth hormone (GH). Parity is an established protective factor for ovarian cancer, however, no prior study has evaluated placental GH and IGF-I in pregnancy and epithelial ovarian cancer (EOC). Prior prospective studies on the association between IGF-I and EOC in non-pregnant populations were inconclusive and did not address associations in subtypes of EOC. Among members of the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort we identified 1,045 EOC cases, diagnosed after recruitment (1975-2008) and before March 2011, and 2,658 individually matched controls. Placental GH and IGF-I were measured in serum from the last pregnancy before EOC diagnosis or selection as control. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals [CI] for tertiles and a doubling of hormone concentrations. Higher IGFI was associated with a non-significant decrease in risk for invasive (ORT3 vs. T1: 0.79 [0.62-1.02]; ptrend=0.07) and endometrioid tumors (ORT3 vs. T1: 0.55 [0.28-1.07]; ptrend=0.07). The protective association between higher IGF-I levels and risk of invasive EOC was stronger in analyses limited to women aged <55 years at diagnosis (ORT3 vs. T1: 0.74 [0.57-0.96]; ptrend=0.03). Our study provides the first data on placental GH and IGF-I in pregnancy and EOC risk overall and by subtype. Our data suggest higher IGF-I levels in pregnancy may be associated with lower risk of invasive and endometrioid EOC. PMID:25516257

  13. Effect of Meconium-Stained Amniotic Fluid on Perinatal Complications in Low-Risk Pregnancies at Term.

    PubMed

    Hiersch, Liran; Krispin, Eyal; Aviram, Amir; Wiznitzer, Arnon; Yogev, Yariv; Ashwal, Eran

    2016-03-01

    Objective This study aims to determine the impact of meconium-stained amniotic fluid (MSAF) in low-risk pregnancies at term on pregnancy outcome. Study Design A retrospective cohort study of women with MSAF during labor who delivered in a tertiary hospital at 37 to 41(+6) weeks of gestation (2007-2013). Exclusion criteria included: multiple gestations, noncephalic presentation, fetal structural/chromosomal anomalies, hypertensive disorders, diabetes, oligohydramnios, or small for gestational age. Pregnancy outcome of women with MSAF (N = 4,893) was compared with a control group of women without MSAF (N = 39,651). Neonatal respiratory morbidity was defined as the presence of any of the following: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, or need for ventilatory support. Results Overall, 10.9% of low-risk pregnancies at term were diagnosed with MSAF. Compared with the controls, women with MSAF had higher rates of nulliparity, gestational age at delivery ≥ 41 weeks, induction of labor, nonreassuring fetal heart rate, and operative deliveries. In multivariate analysis MSAF was associated with operative delivery (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.63-2.09; p < 0.001), cesarean section (OR, 1.48; 95% CI, 1.31-1.69; p < 0.001), respiratory morbidity (OR, 4.74; 95% CI, 3.87-5.82; p < 0.001), and increased risk for short-term neonatal morbidity. Conclusions MSAF is associated with a higher rate of adverse perinatal outcome even in low-risk pregnancies at term. PMID:26479168

  14. Early pregnancy IGF-I and placental GH and risk of epithelial ovarian cancer: A nested case-control study.

    PubMed

    Schock, Helena; Fortner, Renée T; Surcel, Heljä-Marja; Grankvist, Kjell; Pukkala, Eero; Lehtinen, Matti; Lundin, Eva

    2015-07-15

    Insulin-like growth factor-I (IGF-I) signaling may promote ovarian tumor development by exerting mitotic, antiapoptotic and proangiogenic effects. During pregnancy, maternal production of IGF-I is regulated by placental growth hormone (GH). Parity is an established protective factor for ovarian cancer, however, no prior study has evaluated placental GH and IGF-I in pregnancy and epithelial ovarian cancer (EOC). Prior prospective studies on the association between IGF-I and EOC in nonpregnant populations were inconclusive and did not address associations in subtypes of EOC. Among members of the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort, we identified 1,045 EOC cases, diagnosed after recruitment (1975-2008) and before March 2011 and 2,658 individually matched controls. Placental GH and IGF-I were measured in serum from the last pregnancy before EOC diagnosis or selection as control. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for tertiles and a doubling of hormone concentrations. Higher IGF-I was associated with a nonsignificant decrease in risk for invasive [ORT3 vs. T1 : 0.79 (0.62-1.02); ptrend  = 0.07] and endometrioid tumors [ORT3 vs. T1 : 0.55 (0.28-1.07); ptrend  = 0.07]. The protective association between higher IGF-I levels and risk of invasive EOC was stronger in analyses limited to women aged <55 years at diagnosis [ORT3 vs. T1 : 0.74 (0.57-0.96); ptrend  = 0.03]. Our study provides the first data on placental GH and IGF-I in pregnancy and EOC risk overall and by subtype. Our data suggest higher IGF-I levels in pregnancy may be associated with lower risk of invasive and endometrioid EOC. PMID:25516257

  15. Defensive Projection, Superimposed on Simplistic Object Relations, Erodes Patient-Provider Relationships in High-Risk Pregnancy: An Empirical Investigation

    PubMed Central

    Shahar, Golan; Porcerelli, John H.; Kamoo, Ray; Epperson, C. Neill; Czarkowski, Kathryn A.; Magriples, Urania; Mayes, Linda C.

    2014-01-01

    In an attempt to illustrate the relevance of psychoanalytic theory and research to behavior medicine, an empirical investigation was conducted of females treated at a high-risk pregnancy specialty clinic (N = 58). Drawing from psychoanalytic object relations theory, it was hypothesized and confirmed that use of projection as a defense mechanism during pregnancy, superimposed on simplistic object relations, predicted an erosion of patient-provider relationships during the pregnancy/postdelivery period. Findings are interpreted through the perspective of mentalization, pertaining to individuals' ability to understand the mental states of self and others, specifically under significant stress. Implications for psychoanalytically oriented assessment and treatment, and for the rift between psychoanalysis and research, are discussed. PMID:21156840

  16. Early pregnancy sex steroids and maternal risk of epithelial ovarian cancer

    PubMed Central

    Schock, Helena; Surcel, Heljä-Marja; Zeleniuch-Jacquotte, Anne; Grankvist, Kjell; Lakso, Hans-Åke; Fortner, Renée Turzanski; Kaaks, Rudolf; Pukkala, Eero; Lehtinen, Matti; Toniolo, Paolo; Lundin, Eva

    2014-01-01

    Well-established associations between reproductive characteristics and epithelial ovarian cancer (EOC) support an involvement of sex steroid hormones in the etiology of EOC. Limited prior studies have evaluated circulating androgens and risk of EOC, and estrogens and progesterone have been investigated in only one prior study. Further, there is little data on potential heterogeneity in the association between circulating hormones and EOC by histologic subgroup. Therefore, we conducted a nested case-control study within the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort to investigate the associations between circulating pre-diagnostic sex steroid concentrations with the histologic subtypes of EOC. We identified 1,052 EOC cases among cohort members diagnosed after recruitment (1975-2008) and before March 2011. Up to three controls were individually matched to each case (n=2,694). Testosterone, androstenedione, 17-hydroxyprogesterone (17-OHP), progesterone, estradiol, and sex hormone-binding globulin were measured in serum samples collected during the last pregnancy before EOC diagnosis. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals [CI]. Associations between hormones and EOC differed by tumor histology and invasiveness. Sex steroid concentrations were not associated with invasive serous tumors, however, doubling of testosterone and 17-OHP concentration was associated with ~40% increased risk of borderline serous tumors. A doubling of androgen concentrations was associated with a 50% risk increase for mucinous tumors. Risk of endometrioid tumors increased with higher estradiol concentrations (OR: 1.89 [1.20-2.98]). This large prospective study in pregnant women supports a role of sex steroid hormones in the etiology of EOC arising in the ovaries. PMID:25270324

  17. Maternal mid-pregnancy glucose levels and risk of congenital heart disease in offspring

    PubMed Central

    Priest, James R; Yang, Wei; Reaven, Gerald; Knowles, Joshua W.; Shaw, Gary M.

    2016-01-01

    Importance There is a well-described association between maternal diabetes and risk of congenital heart disease (CHD) in offspring. Though the clinical diagnoses of Type 2 diabetes or gestational diabetes are strong risk factors for CHD, sub-clinical abnormalities of glucose and insulin metabolism are common within the general population and could also confer risk for CHD. Objective We explored the potential association of two different CHD phenotypes in offspring with midpregnancy measures of glucose and insulin. Design, Setting, and Participants This is a case-control study from a cohort of 277 pregnant women in southern and central California carrying infants with tetralogy of Fallot (ToF) (n=55), d-transposition of the great arteries (dTGA) (n=42), or normal infants without CHD (n=180), Exposures Measurement of blood analytes related to maternal glucose metabolism taken from random non-fasting second trimester blood samples. Main Outcome and Measures We hypothesize that continuous measures of blood analytes related to maternal diabetes are related to odds of cardiac malformations. We measured serum insulin by a validated radioimmunoassay and glucose levels. Multivariable logistic regression models estimated the association between these levels and case status. Results Relative to maternal blood glucose levels of infants without cardiac malformations, we observed that maternal blood glucose levels in models including insulin were strongly associated with odds of ToF (adjusted Odds Ratio 7.54, 95%CI 2.30–24.69), but not with dTGA (adjusted OR 1.16, 95%CI 0.28–4.79). Conclusions & Relevance These results represent a direct correlation of glucose as a continuous variable to odds of specific cardiac malformations. The association between serum glucose and odds of ToF indicates the need for additional epidemiological and mechanistic investigations into the risk conferred by insulin signaling and glucose metabolism during early pregnancy. PMID:26457543

  18. Combination of Thrombophilic Gene Polymorphisms as a Cause of Increased the Risk of Recurrent Pregnancy Loss

    PubMed Central

    Torabi, Raheleh; Zarei, Saeed; Zeraati, Hojjat; Zarnani, Amir Hassan; Akhondi, Mohammad Mehdi; Hadavi, Reza; Shiraz, Elham Savadi; Jeddi-Tehrani, Mahmood

    2012-01-01

    Background Recurrent pregnancy loss is (RPL) a heterogeneous condition. While the role of acquired thrombophilia has been accepted as an etiology for RPL, the contribution of specific inherited thrombophilic gene polymorphisms to the disorder has been remained controversial. Methods One hundred women with a history of two or more consecutive abortions and 100 women with at least two live births and no miscarriages were included in the study and evaluated for the presence of 11 thrombophilic gene polymorphisms (Factor V LEIDEN, Factor V 4070 A/G, Factor V 5279 A/G, Factor XIII 103 G/T, Factor XIII 614 A/T, Factor XIII 1694 C/T, PAI-1 -675 4G/5G, ITGB3 1565 T/C, β-Fibrinogen -455G/A, MTHFR 677 C/T, MTHFR 1298 A/C) using PCR-RFLP technique. The data were statistically analyzed using Mann-Whitney test and logistic regression model. Results There was no relation between factor XIII 103G/T gene polymorphism with increased risk of RPL. However, the other 10 gene polymorphisms were found to be associated with increased/decreased risk of RPL. Multiple logistic regression model for analyzing the simultaneous effects of these polymorphisms on the risk of RPL showed that six of these 11 polymorphisms (Factor V 1691G/A, Factor V 5279A/G, Factor XIII 614A/T, β-Fibrinogen -455G/A, ITGB3 1565T/C, and MTHFR 1298A/ C) were associated with RPL. Conclusion It is possible to calculate the risk of abortion in a patient with RPL by determining only six of the 10 polymorphisms that are individually associated with RPL. PMID:23926530

  19. Hypertensive disorders of pregnancy and risk of diabetes in Indian women: a cross-sectional study

    PubMed Central

    Agrawal, Sutapa; Fledderjohann, Jasmine

    2016-01-01

    Background Epidemiological data from high-income countries suggest that women with hypertensive disorders of pregnancy (HDP) are more likely to develop diabetes later in life. Objective We investigated the association between pre-eclampsia and eclampsia (PE&E) during pregnancy and the risk of diabetes in Indian women. Design Cross-sectional study. Setting India. Methods Data from India's third National Family Health Survey (NFHS-3, 2005–2006), a cross-sectional survey of women aged 15–49 years, are used. Self-reported symptoms suggestive of PE&E were obtained from 39 657 women who had a live birth in the 5 years preceding the survey. The association between PE&E and self-reported diabetes status was assessed using multivariable logistic regression models adjusting for dietary intake, body mass index (BMI), tobacco smoking, alcohol drinking, frequency of TV watching, sociodemographic characteristics and geographic region. Results The prevalence of symptoms suggestive of PE&E in women with diabetes was 1.8% (n=207; 95% CI 1.5 to 2.0; p<0.0001) and 2.1% (n=85; 95% CI 1.8 to 2.3; p<0.0001), respectively, compared with 1.1% (n=304; 95% CI 1.0 to 1.4) and 1.2% (n=426; 95% CI 1.1 to 1.5) in women who did not report any PE&E symptoms. In the multivariable analysis, PE&E was associated with 1.6 times (OR=1.59; 95% CI 1.31 to 1.94; p<0.0001) and 1.4 times (OR=1.36; 95% CI 1.05 to 1.77; p=0.001) higher risk for self-reported diabetes even after controlling for dietary intake, BMI and sociodemographic characteristics. Conclusions HDP is strongly associated with the risk of diabetes in a large nationally representative sample of Indian women. These findings are important for a country which is already tackling the burden of young onset of diabetes in the population. However, longitudinal medical histories and a clinical measurement of diabetes are needed in this low-resource setting. PMID:27496230

  20. Risk Factors and Mediators of the Vascular Dysfunction Associated with Hypertension in Pregnancy

    PubMed Central

    Sheppard, Stephanie J.; Khalil, Raouf A.

    2010-01-01

    Normal pregnancy is associated with significant hemodynamic changes and vasodilation in the uterine and systemic circulation in order to meet the metabolic demands of the mother and developing fetus. Hypertension in pregnancy (HTN-Preg) and preeclampsia (PE) are major complications and life-threatening conditions to both the mother and fetus. PE is precipitated by various genetic, dietary and environmental factors. Although the initiating events of PE are unclear, inadequate invasion of cytotrophoblasts into the uterine artery is thought to reduce uteroplacental perfusion pressure and lead to placental ischemia/hypoxia. Placental hypoxia induces the release of biologically active factors such as growth factor inhibitors, anti-angiogenic proteins, inflammatory cytokines, reactive oxygen species, hypoxia-inducible factors, and antibodies to vascular angiotensin II receptor. These bioactive factors affect the production/activity of various vascular mediators in the endothelium, smooth muscle and extracellular matrix, leading to severe vasoconstriction and HTN. As an endothelial cell disorder, PE is associated with decreased vasodilator mediators such as nitric oxide, prostacyclin and hyperpolarizing factor and increased vasoconstrictor mediators such as endothelin, angiotensin II and thromboxane A2. PE also involves enhanced mechanisms of vascular smooth muscle contraction including intracellular free Ca2+ concentration ([Ca2+]i), and [Ca2+]i sensitization pathways such as protein kinase C, Rho-kinase and mitogen-activated protein kinase. Changes in extracellular matrix composition and matrix metalloproteases activity also promote vascular remodeling and further vasoconstriction in the uterine and systemic circulation. Characterization of the predisposing risk factors, the biologically active factors, and the vascular mediators associated with PE holds the promise for early detection, and should help design specific genetic and pharmacological tools for the management

  1. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study

    PubMed Central

    Li, De-Kun; Liu, Liyan; Odouli, Roxana

    2003-01-01

    Objective To evaluate whether prenatal use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of miscarriage. Design Population based cohort study. Prenatal use of NSAIDs, aspirin, and paracetamol (acetaminophen) ascertained by in-person interview. Setting Kaiser Permanente Medical Care Program, a healthcare delivery system, in the San Francisco area of the United States. Participants 1055 pregnant women recruited and interviewed immediately after their positive pregnancy test. Median gestational age at entry to the study was 40 days. Main outcome measures Pregnancy outcomes up to 20 weeks of gestation. Results 53 women (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage (adjusted hazard ratio 1.8 (95% confidence interval 1.0 to 3.2)). The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week. Prenatal aspirin use was similarly associated with an increased risk of miscarriage. However, prenatal use of paracetamol, pharmacologically different from NSAIDs and aspirin, was not associated with increased risk of miscarriage regardless of timing and duration of use. Conclusion Prenatal use of NSAIDs and aspirin increased the risk of miscarriage. These findings need confirmation in studies designed specifically to examine the apparent association. PMID:12919986

  2. Use of Decongestants During Pregnancy and the Risk of Birth Defects

    PubMed Central

    Yau, Wai-Ping; Mitchell, Allen A.; Lin, Kueiyu Joshua; Werler, Martha M.; Hernández-Díaz, Sonia

    2013-01-01

    Previous studies suggested that early pregnancy exposure to specific oral decongestants increases the risks of several birth defects. Using January 1993–January 2010 data from the Slone Epidemiology Center Birth Defects Study, we tested those hypotheses among 12,734 infants with malformations (cases) and 7,606 nonmalformed control infants in the United States and Canada. Adjusted odds ratios and 95% confidence intervals were estimated for specific birth defects, with controlling for potential confounders. Findings did not replicate several hypotheses but did support 3 previously reported associations: phenylephrine and endocardial cushion defect (odds ratio = 8.0; 95% confidence interval: 2.5, 25.3; 4 exposed cases), phenylpropanolamine and ear defects (odds ratio = 7.8; 95% confidence interval: 2.2, 27.2; 4 exposed cases), and phenylpropanolamine and pyloric stenosis (odds ratio = 3.2; 95% confidence interval: 1.1, 8.8; 6 exposed cases). Hypothesis-generating analyses involving multiple comparisons identified a small number of associations with oral and intranasal decongestants. Accumulating evidence supports associations between first-trimester use of specific oral and possibly intranasal decongestants and the risk of some infrequent specific birth defects. PMID:23825167

  3. Arousal Loss Related to Safer Sex and Risk of Pregnancy: Implications for Women’s and Men’s Sexual Health

    PubMed Central

    Higgins, Jenny A.; Tanner, Amanda E.; Janssen, Erick

    2010-01-01

    CONTEXT Few studies have examined arousal loss associated with safer-sex practices or the perceived risk of unintended pregnancy, let alone its associations with sexual risk practices. METHODS An Internet survey conducted in 2004–2006 among 2,399 men and 3,210 women asked respondents about arousal loss related to the use of condoms or other safer-sex products and perceived unintended pregnancy risk. Regression analyses gauged associations between arousal profiles, unprotected sex in the last year and lifetime experience of unintended pregnancy. RESULTS Many respondents reported arousal loss related to the use of safer-sex products (34%) or the risk of unintended pregnancy (46%). Participants who strongly agreed that use of safer-sex products can lessen their arousal were significantly more likely to have had unprotected sex in the last year than were those who strongly disagreed (odds ratios, 1.8 for men and 3.7 for women); those who strongly disagreed that pregnancy risk can lessen their arousal were significantly more likely to have been involved in an unintended pregnancy than were those who strongly agreed (2.0 for men and 1.4 for women). Arousal loss related to safer-sex practices was more strongly associated with unprotected sex among women than among men, whereas arousal loss related to pregnancy risk was more strongly associated with unintended pregnancy among men than among women. CONCLUSIONS Some men and women are turned off by safer-sex practices or by pregnancy risk. Given arousal profiles’ potential contributions to unintended pregnancies and STD transmission, they should be integrated into sexual health behavioral models, research and programming. PMID:19740232

  4. Maternal Benzene Exposure during Pregnancy and Risk of Childhood Acute Lymphoblastic Leukemia: A Meta-Analysis of Epidemiologic Studies

    PubMed Central

    Li, Zhen; Zhu, Jie; Bi, Yongyi; Bai, YuE; Wang, Hong

    2014-01-01

    Background The prevalence of childhood leukemia is increasing rapidly all over the world. However, studies on maternal benzene exposure during pregnancy and childhood acute lymphoblastic leukemia (ALL) have not been systematically assessed. Therefore, we performed a meta-analysis to investigate the association between maternal solvent, paint, petroleum exposure, and smoking during pregnancy and risk of childhood ALL. Methods Relevant studies up to September 1st, 2013 were identified by searching the PubMed, EMBASE, Cochrane library and the Web of Science databases. The effects were pooled using either fixed or random effect models based on the heterogeneity of the studies. Results Twenty-eight case-control studies and one cohort study were included for analysis, with a total of 16,695 cases and 1,472,786 controls involved. Pooled odds ratio (OR) with 95% confidence interval (CI) for ALL was 1.25 (1.09, 1.45) for solvent, 1.23 (1.02, 1.47) for paint, 1.42 (1.10, 1.84) for petroleum exposure, and 0.99 (0.93, 1.06) for maternal smoking during pregnancy. No publication bias was found in this meta-analysis and consistent results were observed for subgroup and sensitivity analyses. Conclusions Childhood ALL was associated with maternal solvent, paint, and petroleum exposure during pregnancy. No association was found between ALL and maternal smoking during pregnancy. Avoidance of maternal occupational and environmental benzene exposure during pregnancy could contribute to a decrease in the risk of childhood ALL. PMID:25333868

  5. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

    PubMed Central

    Sävervall, Christine; Sand, Freja Lærke; Thomsen, Simon Francis

    2015-01-01

    Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy. PMID:26609305

  6. Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study.

    PubMed

    Zerbo, O; Traglia, M; Yoshida, C; Heuer, L S; Ashwood, P; Delorenze, G N; Hansen, R L; Kharrazi, M; Van de Water, J; Yolken, R H; Weiss, L A; Croen, L A

    2016-01-01

    Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case-control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15-19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified. PMID:27093065

  7. Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study

    PubMed Central

    Zerbo, O; Traglia, M; Yoshida, C; Heuer, L S; Ashwood, P; Delorenze, G N; Hansen, R L; Kharrazi, M; Van de Water, J; Yolken, R H; Weiss, L A; Croen, L A

    2016-01-01

    Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case–control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15–19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified. PMID:27093065

  8. Prevalence and sex-related risk factors of premarital pregnancy and reproductive tract infections among female undergraduates in Wuhan, China.

    PubMed

    Cao, Yue; Xiao, Han; Yan, Hong; Li, Jingjing; Li, Shiyue

    2015-03-01

    In China, more and more female college students engage in premarital sex. Few seek reproductive health services, increasing their risk for unintended pregnancy and reproductive tract infections (RTIs). The present study aims to explore the prevalence and sex-related risk factors of premarital pregnancy and RTIs among female undergraduates in China. A total of 4769 females were recruited using randomized cluster sampling and anonymously completed questionnaires. Of the 4,769 females, 863 (18.1%) reported ever having sexual intercourse, 17.5% of which had become pregnant, and 22.7% had contracted RTIs. Younger age or not using a condom at first sex and having multiple sex partners contributed to premarital pregnancy. Majoring in arts, being from less-developed regions of China, having multiple partners, and self-reported pregnancy contributed to RTIs. Findings suggest importance of sexual health education among undergraduates, especially women from less-developed regions of China and/or majoring in arts. PMID:25675953

  9. Milk consumption during pregnancy increases birth weight, a risk factor for the development of diseases of civilization.

    PubMed

    Melnik, Bodo C; John, Swen Malte; Schmitz, Gerd

    2015-01-01

    Antenatal dietary lifestyle intervention and nutrition during pregnancy and early postnatal life are important for appropriate lifelong metabolic programming. Epidemiological evidence underlines the crucial role of increased birth weight as a risk factor for the development of chronic diseases of civilization such as obesity, diabetes and cancer. Obstetricians and general practitioners usually recommend milk consumption during pregnancy as a nutrient enriched in valuable proteins and calcium for bone growth. However, milk is not just a simple nutrient, but has been recognized to function as an endocrine signaling system promoting anabolism and postnatal growth by activating the nutrient-sensitive kinase mTORC1. Moreover, pasteurized cow's milk transfers biologically active exosomal microRNAs into the systemic circulation of the milk consumer apparently affecting more than 11,000 human genes including the mTORC1-signaling pathway. This review provides literature evidence and evidence derived from translational research that milk consumption during pregnancy increases gestational, placental, fetal and birth weight. Increased birth weight is a risk factor for the development of diseases of civilization thus involving key disciplines of medicine. With regard to the presented evidence we suggest that dietary recommendations promoting milk consumption during pregnancy have to be re-evaluated. PMID:25592553

  10. Clinical cardiovascular risk during young adulthood in offspring of hypertensive pregnancies: insights from a 20-year prospective follow-up birth cohort

    PubMed Central

    Davis, Esther F; Lewandowski, Adam J; Aye, Christina; Williamson, Wilby; Boardman, Henry; Huang, Rae-Chi; Mori, Trevor A; Newnham, John; Beilin, Lawrence J; Leeson, Paul

    2015-01-01

    Objectives Offspring of hypertensive pregnancies have increased cardiovascular risk factors during childhood. We hypothesised that offspring of hypertensive pregnancies would demonstrate increased clinical levels of hypertension by young adult life, which would be proportional to the severity of the pregnancy complication. Design Prospective birth cohort study Setting Tertiary obstetric hospital. Participants 2868 young adult offspring of women enrolled during pregnancy into the Western Australia Pregnancy Cohort (Raine) Study. Main outcome measures Cardiovascular risk, including incidence of hypertension and metabolic disease, in those born to hypertensive compared to normotensive pregnancies. Results Young adult offspring of hypertensive pregnancies were 2.5 times (95% CI 1.32 to 4.56, p=0.004) more likely to have global lifetime risk (QRISK) scores above the 75th centile. Thirty per cent of 20 year olds with hypertensive blood pressures were born following a hypertensive pregnancy. Pre-eclampsia or hypertension resulting in preterm birth associated with a threefold (95% CI 1.3 to 7.0, p=0.01) greater risk of being hypertensive by age 20 years, with no differences in body mass index. Whereas pregnancy-induced hypertension associated with a smaller 3±1 mm Hg blood pressure rise (p=0.001) and a twofold (95% CI 1.5 to 2.8, p=0.001) greater risk of being obese or overweight. Risk factor associations were consistent throughout early life and independent of other birth-factors. Conclusions Incidence of offspring hypertension was significantly increased in those whose mothers had a more complicated pregnancy history, including preterm birth and pre-eclampsia. PMID:26105032

  11. Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors: A Prospective Cohort Study.

    PubMed

    Lei, Qiong; Zhou, Xin; Zhou, Yu-Heng; Mai, Cai-Yuan; Hou, Ming-Min; Lv, Li-Juan; Duan, Dong-Mei; Wen, Ji-Ying; Lin, Xiao-Hong; Wang, Peizhong P; Ling, Xuefeng B; Li, Yu-Ming; Niu, Jian-Min

    2016-08-01

    The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120-139/80-89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11(+0) to 13(+6) weeks' gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37(+0) and 26(+0) weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79-23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674-0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women. PMID:27354425

  12. [Adolescent pregnancy].

    PubMed

    Fatichi, B

    1991-10-01

    This exploration of adolescent pregnancy focuses on adolescents whose pregnancies are undesired. The physical and psychic transformations of puberty and adolescence may be experienced differently in different social contexts. The prolongation of school attendance in Western societies means that most adolescents remain financially dependent on their parents. But greater sexual freedom in the society at large has been reflected in an increase in early sexual activity among adolescents. Wider use of contraception has not completely eliminated prenatal pregnancy among adolescents. Adolescent pregnancies have actually declined in France as a proportion of all pregnancies carried to term, from 4% to 1.5-2% in the past 10 or 15 years. But in 1986, 42.5% of all induced abortions were performed on adolescents. Among causes of unwanted pregnancy in adolescents are their frequent inability to believe that they may be at risk of pregnancy, or that pregnancy can result from the 1st sexual intercourse. The episodic nature of sexual relations, the lack of ready availability of contraception, and specific shortcomings of different methods are factors in the frequent failure of adolescents to protect themselves against undesired pregnancy. Adolescents may become pregnant out of loneliness or to prove that they are women, or as a result of incest or prostitution. Adolescents who seek abortions are those who have discovered and acknowledged their pregnancies before the 12th week and had the courage to inform their parents and obtain legal permission for the abortion. Pregnancy terminations are more frequent in more advantaged societal sectors with more structured family life. The moral shock and sense of failure associated with abortion are often deeply felt by adolescents. Their experience is greatly influenced by the attitudes of those around them. Adolescents who carry their pregnancies to term are those who have not sought abortion in the 1st 12 weeks. Often they refuse to admit

  13. Exposure to folic acid antagonists during the first trimester of pregnancy and the risk of major malformations

    PubMed Central

    Matok, Ilan; Gorodischer, Rafael; Koren, Gideon; Landau, Daniella; Wiznitzer, Arnon; Levy, Amalia

    2009-01-01

    AIM To investigate the safety of folic acid antagonists during the first trimester of pregnancy in a large cohort. METHODS Computerized databases for medications dispensed from 1998 to 2007 to women registered in ‘Clalit’ HMO, Israel southern district, was linked with maternal and infant hospitalization records, and to therapeutics abortions data. The risk for adverse pregnancy outcomes of folic acid antagonists exposure was assessed by adjusting for known confounders. RESULTS Eighty-four thousand, eight hundred and twenty-three infants were born and 998 therapeutic abortions took place; 571 fetuses and infants were exposed to one or more folic acid antagonists in the first trimester of pregnancy. Exposure was associated with an overall increased risk of congenital malformations [odds ratio (OR) 2.43, 95% confidence interval (CI) 1.92, 3.08], due mainly to increased risk for neural tube (adjusted OR 6.5, 95% CI 4.34, 9.15) and cardiovascular defects (OR 1.76, CI 1.05, 2.95). CONCLUSION First-trimester exposure to folic acid antagonists is associated with increased risk of congenital malformations. PMID:20002091

  14. Factors Associated with Monozygosity in Assisted Reproductive Technology (ART) Pregnancies And Risk of Recurrence Using Linked Cycles

    PubMed Central

    Luke, Barbara; Brown, Morton B.; Wantman, Ethan; Stern, Judy E.

    2014-01-01

    Objective To evaluate factors associated with monozygosity (number of fetal heartbeats on early ultrasound greater than number of embryos transferred) and the risk of recurrence in subsequent pregnancies using a national ART database Design Historical cohort study Setting Clinic-based data Patients 197,327 pregnancies (including 2,824 with evidence of monozygosity) from cycles reported to SART CORS between 2004 and 2010. Adjusted odds ratios and their 95% confidence intervals were computed from logistic regression models. Interventions None Main Outcome Measures Evidence of monozygosity. Results In the univariate analysis, the risk of MZ was increased with ovulation disorders, donor oocytes, GnRHA suppression, assisted hatching (AZH), and day 5–6 transfer, and decreased with higher FSH doses (≥3,000 IU). In the multivariate analysis, the risk of MZ was increased with GnRHA suppression, AZH, and decreased with ICSI and higher FSH dose. The interaction showed that although MZ was more likely with day 5–6 embryos, AZH had a minimal nonsignificant effect, whereas in day 2–3 embryos, AZH had a substantial significant effect. Only one woman had a recurrence of monozygosity in a subsequent ART pregnancy, which is consistent with randomness. Conclusions The risk of MZ was higher with fresh day 5–6 embryos, donor oocytes, GnRHA suppression, lower FSH doses, and AZH (particularly with day 2–3 embryos). PMID:24388206

  15. Inhaled Corticosteroids Use Is Not Associated With an Increased Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus

    PubMed Central

    Lee, Chang-Hoon; Kim, Jimin; Jang, Eun Jin; Lee, Joon-Ho; Kim, Yun Jung; Choi, Seongmi; Kim, Deog Kyeom; Yim, Jae-Joon; Yoon, Ho Il

    2016-01-01

    Abstract There have been concerns that systemic corticosteroid use is associated with pregnancy-induced hypertension (PIH) and diabetes mellitus. However, the relationship between inhaled corticosteroids (ICSs) and the risk of PIH has not been fully examined, and there was no study investigating the association between ICS use and the development of gestational diabetes mellitus (GDM). The aims of the study are to determine whether the use of ICSs during pregnancy increases the risk of PIH and GDM in women. We conducted 2 nested case-control studies utilizing the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea), in which 1,306,281 pregnant women who delivered between January 1, 2009 and December 31, 2011 were included. Among them, PIH cases and GDM cases were identified and matched controls were included. Conditional logistic regression analyses adjusted by other concomitant drugs use during and before pregnancy and confounding covariates including comorbidities were performed. Total 43,908 PIH cases and 219,534 controls, and 34,190 GDM cases and 170,934 control subjects were identified. When other concomitant drugs use during pregnancy was adjusted, ICS use was associated with an increased rate of PIH (adjusted odds ratio, 1.40 [95% CI, 1.05–1.87]). ICS medication possession ratios and cumulative doses were associated with an increased risk of PIH. However, the statistical significance was not found in other models. In both unadjusted and adjusted multivariable models, ICSs use was not associated with increase in the risk of GDM. ICSs use is not associated with an increased risk of PIH and GDM. PMID:27258493

  16. Prevalence of domestic violence during pregnancy and related risk factors: a cross-sectional study in southern Sweden

    PubMed Central

    2014-01-01

    Background Domestic violence during pregnancy is a serious public health issue which threatens maternal and foetal health outcomes. The aim of the study was to explore prevalence of domestic violence among pregnant women in southern Sweden (Scania) and to explore associations with background factors, as symptoms of depression and sense of coherence. Methods This study has a cross-sectional design and is the first part of a longitudinal, cohort study. Inclusion criteria were women ≥ 18 years, registered at antenatal care when pregnant and who understand and write Swedish or English. Questionnaires were collected prospectively at seventeen antenatal care receptions situated in the two cities and six smaller municipalities in Scania. Statistical analyses were done using descriptive statistics, chi-square tests, bivariate logistic regression and multiple regression with Odds ratios (OR) and 95% confidence intervals (95% CI). Results Study sample included 1939 women. History of violence was reported by 39.5% (n =761) women. Significant differences were obtained between the groups with or without history of violence regarding being single/living apart, unemployment, financial distress, smoking/snuffing, unintended pregnancy as well as history of miscarriage/legalised abortion (p < 0.001). Experience of domestic violence during pregnancy regardless of type or level of abuse was 1.0% (n = 18); history of physical abuse by actual intimate partner was 2.2% (n = 42). History of violence was the strongest risk factor associated with domestic violence during pregnancy, where all women (n = 18) exposed reported history of violence (p < 0.001). Several symptoms of depression (adjusted for low socio-economic status, miscarriage/abortion, single/living apart, lack of sleep, unemployment, age and parity) were associated with a 7.0 fold risk of domestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3). Conclusions The reported prevalence of domestic

  17. Pregnancy and IC

    MedlinePlus

    ... risk of deformities and premature labor. Fitness and Physical Therapy to Keep You Comfortable Along with diet, a ... and relaxation, IC and pregnancy-friendly exercise, and physical therapy. During pregnancy, there’s a lot of weight on ...

  18. Ibuprofen and Pregnancy

    MedlinePlus

    ... possible association with the use of NSAIDs in early pregnancy and a low risk for certain birth defects. ... a few studies looking at NSAID prescriptions in early pregnancy. However, the reason the NSAID was prescribed was ...

  19. Diabetes and Pregnancy

    MedlinePlus

    ... check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test ... to your baby during the first weeks of pregnancy - even before you know you are pregnant. To ...

  20. Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension

    PubMed Central

    Lin, Li-Te; Tsui, Kuan-Hao; Cheng, Jiin-Tsuey; Cheng, Jin-Shiung; Huang, Wei-Chun; Liou, Wen-Shiung; Tang, Pei-Ling

    2016-01-01

    Abstract Pregnancy-induced hypertension (PIH) may be a major predictor of pregnancy-associated intracranial hemorrhage (ICH). However, the relationship between PIH and long-term ICH risk is unknown. The objective of the study was to determine the association between PIH and ICH and to identify the predictive risk factors. Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database. PIH patients were divided into gestational hypertension (GH) and preeclampsia groups. The 2 groups were separately compared with matched cohorts of patients without PIH based on age and date of delivery. The occurrence of ICH was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013. Among the 23.3 million individuals registered in the National Health Insurance Research Database, 28,346 PIH patients, including 7390 with GH and 20,956 with preeclampsia, were identified. The incidences of ICH were increased in both groups (incidence rate ratio [IRR] = 3.72 in the GH group, 95% confidence interval [CI] 3.63–3.81, P < 0.0001 and IRR = 8.21 in the preeclampsia group, 95% CI 8.12–8.31, P < 0.0001, respectively). In addition, according to the results of stratification of follow-up years, both groups were associated with a highest risk of ICH at 1 to 5 years of follow-up (IRR = 11.99, 95% CI 11.16–12.88, P < 0.0001 and IRR = 21.83, 95% CI 21.24–22.44, P < 0.0001, respectively). After adjusting for age, parity, severity of PIH, number of PIH occurrences, gestational age, and comorbidities in the multivariate survival analysis using Cox regression model, age ≥30 years (hazard ratio [HR] 1.99, 95% CI 1.27–3.10, P = 0.0026), patients with preeclampsia (HR 2.18, 95% CI 1.22–3.90, P = 0.0089), multiple PIH occurrences (HR 4.08, 95% CI 1.85–9.01, P = 0.0005), hypertension (HR 4.51, 95% CI 1.89–10.74, P = 0.0007), and obesity (HR 7.21, 95

  1. Risk of congenital cytomegalovirus infection among HIV-exposed uninfected infants is not decreased by maternal nelfinavir use during pregnancy

    PubMed Central

    Gantt, Soren; Leister, Erin; Jacobson, Denise L.; Boucoiran, Isabelle; Huang, Meei-Li; Jerome, Keith R.; Jourdain, Gonzague; Ngo-Giang-Huong, Nicole; Burchett, Sandra; Frenkel, Lisa

    2016-01-01

    Background Congenital cytomegalovirus (cCMV) infection is common among infants born to HIV-infected women. Nelfinavir (NFV), an antiretroviral drug that is safe during pregnancy, inhibits CMV replication in vitro at concentrations that standard doses achieve in plasma. We hypothesized that infants born to women receiving NFV for prevention of mother-to-child transmission of HIV (PMTCT) would have a reduced prevalence of cCMV infection. Methods The prevalence of cCMV infection was compared among HIV-uninfected infants whose HIV-infected mothers either received NFV for ≥4 weeks during pregnancy (NFV-exposed) or did not receive any NFV in pregnancy (NFV-unexposed). CMV PCR was performed on infant blood samples collected at <3 weeks from birth. Results Of the 1,255 women included, 314 received NFV for ≥4 weeks during pregnancy and 941 did not receive any NFV during pregnancy. The overall prevalence of cCMV infection in the infants was 2.2%, which did not differ by maternal NFV use. Maternal CD4 T cell counts were inversely correlated with risk of cCMV infection, independent of the time NFV was initiated during gestation. Infants with cCMV infection were born 0.7 weeks earlier (p=0.010) and weighed 170 grams less (p=0.009) than uninfected infants. Conclusion Among HIV-exposed uninfected infants, cCMV infection was associated with adverse perinatal outcomes. NFV use in pregnancy was not associated with protection against cCMV. Safe and effective strategies to prevent cCMV infection are needed. PMID:26519647

  2. Risks of spontaneously and IVF-conceived singleton and twin pregnancies differ, requiring reassessment of statistical premises favoring elective single embryo transfer (eSET).

    PubMed

    Gleicher, Norbert; Kushnir, Vitally A; Barad, David H

    2016-01-01

    A published review of the literature by Dutch investigators in 2004 suggested significant outcome differences between spontaneously - and in vitro fertilization (IVF) - conceived singleton and twin pregnancies. Here we review whether later studies between 2004-2015 confirmed these findings. Though methodologies of here reviewed studies varied, and all were retrospective, they overall confirmed results of the 2004 review, and supported significant outcome variances between spontaneously- and IVF-conceived pregnancies: IVF singletons demonstrate significantly poorer and IVF twins significantly better perinatal outcomes than spontaneously conceived singletons and twins, with differences stable over time, and with overall obstetrical outcomes significantly improved. Exaggerations of severe IVF twin risks are likely in the 50 % range, while exaggerations of milder perinatal risks are approximately in 25 % range. Though elective single embryo transfers (eSET) have been confirmed to reduce pregnancy chances, they are, nevertheless, increasingly utilized. eSET, equally unquestionably, however, reduces twin pregnancies. Because twin pregnancies have been alleged to increase outcome risks in comparison to singleton pregnancies, here reported findings should affect the ongoing discussion whether increased twin risks are factual. With no risk excess, eSET significantly reduces IVF pregnancy chances without compensatory benefits and, therefore, is not advisable in IVF, unless patients do not wish to conceive twins or have medical contraindications to conceiving twins. PMID:27142226

  3. Are female orphans at risk for early marriage, early sexual debut, and teen pregnancy? Evidence from sub-Saharan Africa.

    PubMed

    Palermo, Tia; Peterman, Amber

    2009-06-01

    Female orphans are widely cited as being at risk for early marriage, early childbearing, and risky sexual behavior; however, to date no studies have examined these linkages using population-level data across multiple countries. This study draws from recent Demographic and Health Surveys from ten sub-Saharan African countries to examine the relationship between orphanhood status and measures of early marriage, early sexual debut, and teen pregnancy among adolescent girls aged 15 to 17. Results indicate that, overall, little association is found between orphanhood and early marriage or teen pregnancy, whereas evidence from seven countries supports associations between orphanhood and early sexual debut. Findings are sensitive to the use of multivariate models, type of orphan, and country setting. Orphanhood status alone may not be a sufficient targeting mechanism for addressing these outcomes in many countries; a broader, multidimensional targeting scheme including orphan type, schooling, and poverty measures would be more robust in identifying and aiding young women at risk. PMID:19662802

  4. Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making.

    PubMed

    Dalke, Katharine Baratz; Wenzel, Amy; Kim, Deborah R

    2016-06-01

    Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making. PMID:27091646

  5. Omega-6 fatty acids and greater likelihood of suicide risk and major depression in early pregnancy

    PubMed Central

    Vaz, Juliana S.; Kac, Gilberto; Nardi, Antonio E.; Hibbeln, Joseph R.

    2014-01-01

    Objective To estimate the prevalence of suicide risk (SR) and major depressive episode (MDE) in early pregnancy, and the relationship of fatty acids serum status to these outcomes. Method Cross-sectional analyses of 234 pregnant women enrolled in a prospective cohort study in Rio de Janeiro/Brazil were performed. SR and MDE were defined according to MINI International Neuropsychiatric Interview. Fatty acids compositions were determined in serum samples obtained between the 6th and 13th gestational week. Statistical analyses included univariate and multiple logistic regressions. Fatty acids data were expressed both as percent of total fatty acids and converted to Z scores then entered as continuous variable into regression models. Results The prevalence of SR was 19.6% and MDE was 17.0%. Higher likelihood of SR was observed among women with higher arachidonic acid [AA (20:4n-6): OR=1.45, 95% CI 1.02-2.07] and adrenic acid [AdA (22:4 n-6): OR=1.43, 95% CI 1.01-2.04], and for MDE: AA [OR=1.47, 95% CI 1.03-2.10], and AdA [OR=1.59, 95% CI 1.09-2.32], per standard deviation of fatty acid, in adjusted logistic regressions. Conclusion Higher serum status of AA and AdA, two omega-6 fatty acids, were associated with greater likelihood of SR and MDE among pregnant Brazilian women independently of confounding variables. PMID:23726775

  6. Circadian System and Melatonin Hormone: Risk Factors for Complications during Pregnancy

    PubMed Central

    Valenzuela, F. J.; Vera, J.; Venegas, C.; Pino, F.; Lagunas, C.

    2015-01-01

    Pregnancy is a complex and well-regulated temporal event in which several steps are finely orchestrated including implantation, decidualization, placentation, and partum and any temporary alteration has serious effects on fetal and maternal health. Interestingly, alterations of circadian rhythms (i.e., shiftwork) have been correlated with increased risk of preterm delivery, intrauterine growth restriction, and preeclampsia. In the last few years evidence is accumulating that the placenta may have a functional circadian system and express the clock genes Bmal1, Per1-2, and Clock. On the other hand, there is evidence that the human placenta synthesizes melatonin, hormone involved in the regulation of the circadian system in other tissues. Moreover, is unknown the role of this local production of melatonin and whether this production have a circadian pattern. Available information indicates that melatonin induces in placenta the expression of antioxidant enzymes catalase and superoxide dismutase, prevents the injury produced by oxidative stress, and inhibits the expression of vascular endothelial growth factor (VEGF) a gene that in other tissues is controlled by clock genes. In this review we aim to analyze available information regarding clock genes and clock genes controlled genes such as VEGF and the possible role of melatonin synthesis in the placenta. PMID:25821470

  7. Ultrasound evaluation of fetal movements in pregnancies at risk for severe spinal muscular atrophy.

    PubMed

    Parra, Juan; Martínez-Hernández, Rebeca; Also-Rallo, Eva; Alias, Laura; Barceló, María Jesús; Amenedo, María; Medina, Carmen; Senosiain, Raquel; Calaf, Joaquim; Baiget, Montserrat; Bernal, Sara; Tizzano, Eduardo F

    2011-02-01

    We studied spinal muscular atrophy (SMA) during human development to identify possible delays or alterations in fetal movements detectable by ultrasound. We evaluated 29 pregnancies at risk for severe SMA performing 2D-ultrasound around 11-14 weeks, prior to prenatal molecular testing of the SMN1 gene. We charted the occurrence of generalized body movements, isolated movements of arms and legs, head movements, startle and hiccup. Fetuses were diagnosed as healthy (n=12), carriers (n=10) or affected (n=7) according to the SMN1 molecular testing results obtained. SMN2 copies were also tested in the seven affected fetuses, six of whom showed two SMN2 copies and one a unique SMN2 copy. The movements under study were observed in all recordings, regardless of group and the SMN2 copies. At the gestational age examined, we did not observe a qualitative early limitation of movements in fetuses with SMA, even in cases predicted to develop a severe neonatal form. PMID:21194946

  8. Determinants of contraceptive method among young women at risk for unintended pregnancy and sexually transmitted infections.

    PubMed

    Raine, Tina; Minnis, Alexandra M; Padian, Nancy S

    2003-07-01

    The objective of this study was to examine the relationship between contraceptive method choice, sexual risk and various demographic and social factors. Data were collected on 378, 15- to 24-year-old women, recruited from health clinics and through community outreach in Northern California. Logistic regression analysis was used to estimate the association of predictors with contraceptive method used at last sex. Asian and Latina women were less likely to use any method. Women who were raised with a religion, or thought they were infertile, were also less likely to use any method. Women with multiple partners were generally less likely to use any method, but were more likely to use barrier methods when they did use one. Few women (7%) were dual method users. Women appear to act in a rational fashion within their own social context and may use no methods at all or use methods that are less effective for pregnancy prevention but offer more protection from sexually transmitted infections. PMID:12878282

  9. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study.

    PubMed

    Zhang, Jian; Li, Cheng; Zhao, Wei-Hong; Xi, Xiaowei; Cao, Shu-Jun; Ping, Hua; Qin, Guo-Juan; Cheng, Linan; Huang, He-Feng

    2015-01-01

    Cases of ectopic pregnancy (EP) following levonorgestrel emergency contraception (LNG-EC) failure have been reported continuously, but whether there is an association between EP risk and LNG-EC is unclear. We concluded a case-control study to explore this association by recruiting 2,411 EP patients as case group, and 2,416 women with intrauterine pregnancy and 2,419 non-pregnant women as control groups. Odds ratios (ORs) and their 95% confidential intervals (CIs) were calculated and adjusted for potential confounding factors. Previous use of LNG-EC was not correlated with the EP. Compared to women who did not use contraceptives, current use of LNG-EC reduced the risk for intrauterine pregnancy (Adjusted OR [AOR] = 0.20, 95%CI: 0.14-0.27), but did not increase the risk for EP (AOR2 = 1.04, 95%CI: 0.76-1.42). Furthermore, compared to women who did not have further act of intercourse, women with unprotected further act of intercourse were at a higher risk of EP (AOR1 = 2.35, 95%CI: 1.17-4.71), and women with repeated use of LNG-EC for further intercourse during the same cycle was also associated with a higher risk for EP (AOR1 = 3.08, 95%CI: 1.09-8.71; AOR2 = 2.49, 95%CI: 1.00-6.19). A better understanding of the risk of EP following LNG-EC failure can optimize LNG-EC use and thus reduce the risk of EP. PMID:25674909

  10. Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort

    PubMed Central

    Nykjaer, Camilla; Alwan, Nisreen A; Greenwood, Darren C; Simpson, Nigel A B; Hay, Alastair W M; White, Kay L M; Cade, Janet E

    2014-01-01

    Background Evidence is conflicting regarding the relationship between low maternal alcohol consumption and birth outcomes. This paper aimed to investigate the association between alcohol intake before and during pregnancy with birth weight and gestational age and to examine the effect of timing of exposure. Methods A prospective cohort in Leeds, UK, of 1303 pregnant women aged 18–45 years. Questionnaires assessed alcohol consumption before pregnancy and for the three trimesters separately. Categories of alcohol consumption were divided into ≤2 units/week and >2 units/week with a non-drinking category as referent. This was related to size at birth and preterm delivery, adjusting for confounders including salivary cotinine as a biomarker of smoking status. Results Nearly two-thirds of women before pregnancy and over half in the first trimester reported alcohol intakes above the Department of Health (UK) guidelines of ≤2 units/week. Associations with birth outcomes were strongest for intakes >2 units/week before pregnancy and in trimesters 1 and 2 compared to non-drinkers. Even women adhering to the guidelines in the first trimester were at significantly higher risk of having babies with lower birth weight, lower birth centile and preterm birth compared to non-drinkers, after adjusting for confounders (p<0.05). Conclusions We found the first trimester to be the period most sensitive to the effect of alcohol on the developing fetus. Women adhering to guidelines in this period were still at increased risk of adverse birth outcomes. Our findings suggest that women should be advised to abstain from alcohol when planning to conceive and throughout pregnancy. PMID:24616351

  11. Annexin A5 Promoter Haplotype M2 Is Not a Risk Factor for Recurrent Pregnancy Loss in Northern Europe

    PubMed Central

    Rull, Kristiina; Christiansen, Ole B.; Nielsen, Henriette S.; Laan, Maris

    2015-01-01

    Introduction Annexin A5 is an essential component of placental integrity that may potentially mediate susceptibility to phenotypes of compromised pregnancy. A promoter haplotype termed M2 of the coding gene ANXA5 has been implicated in various pregnancy complications such as preeclampsia and recurrent pregnancy loss (RPL), however with inconclusive results. Study subjects and methods A retrospective case-control study combining resequencing and restriction fragment length polymorphism (RFLP) analysis was undertaken in 313 women with unexplained RPL and 214 fertile women from Estonia and Denmark to estimate the RPL disease risk of the M2 haplotype in Northern Europe. Comparative prevalence of the studied ANXA5 genetic variants in human populations was estimated based on the 1000 Genomes Project (n = 675, whole-genome sequencing data) and the KORA S3 500K dataset of South German samples (n = 1644, genome-wide genotyping data). Results Minor allele frequency of common polymorphisms in ANXA5 promoter was up to two-fold lower among Estonian RPL subjects than fertile controls. The M2 haplotype was not associated with RPL and a trend for decreased prevalence was observed among RPL patients compared to controls both in Estonia (8.1% vs 15.2%, respectively) and Denmark (9.7% vs 12.6%). The high M2 prevalence in fertile controls was consistent with estimations for European and East Asian populations (9.6%-16.0%). Conclusions This study cautions to consider the M2 haplotype as a deterministic factor in early pregnancy success because: i) no RPL disease risk was associated with the haplotype in two clinically well-characterized RPL case-control study samples, ii) high prevalence of the haplotype among fertile controls and world-wide populations is inconsistent with the previously proposed severe impact on early pregnancy success, iii) weak impact of M2 haplotype on the production of ANXA5 protein has been established by others. PMID:26135579

  12. Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study

    PubMed Central

    2013-01-01

    Background Health authorities in numerous countries recommend periconceptional folic acid to pregnant women to prevent neural tube defects. The objective of this study was to examine the association of folic acid supplementation during different periods of pregnancy and of dietary folate intake with the risk of spontaneous preterm delivery (PTD). Methods The Norwegian Mother and Child Cohort Study is a population-based prospective cohort study. A total of 65,668 women with singleton pregnancies resulting in live births in 1999–2009 were included. Folic acid supplementation was self-reported from 26 weeks before pregnancy until week 24 during pregnancy. At gestational week 22, the women completed a food frequency questionnaire, which allowed the calculation of their average total folate intake from foods and supplements for the first 4–5 months of pregnancy. Spontaneous PTD was defined as the spontaneous onset of delivery between weeks 22+0 and 36+6 (n = 1,628). Results The median total folate intake was 266 μg/d (interquartile range IQR 154–543) in the overall population and 540 μg/d (IQR 369–651) in the supplement users. Eighty-three percent reported any folic acid supplementation from <8 weeks before to 24 weeks after conception while 42% initiated folic acid supplementation before their pregnancy. Cox regression analysis showed that the amount of folate intake from the diet (hazard ratio HR 1.16; confidence interval CI 0.65-2.08) and from the folic acid supplements (HR 1.04; CI 0.95-1.13) was not significantly associated with the risk of PTD. The initiation of folic acid supplementation more than 8 weeks before conception was associated with an increased risk for PTD (HR 1.19; CI 1.05-1.34) compared to no folic acid supplementation pre-conception. There was no significant association with PTD when supplementation was initiated within 8 weeks pre-conception (HR 1.01; CI 0.88-1.16). All analyses were adjusted for maternal characteristics and

  13. [Pregnancy-specific dermatoses].

    PubMed

    Soutou, B; Aractingi, S

    2015-03-01

    Pregnancy-specific dermatoses include polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Intrahepatic cholestasis of pregnancy and impetigo herpetiformis are not real pregnancy-specific dermatoses but they are important to know considering the fetal and maternal risks. Polymorphic eruption of pregnancy is a pruritic disease that usually occurs in primiparous women during the last trimester of pregnancy. Atopic eczema of pregnancy is still controversial as an entity covering conditions with eczematous lesions, prurigo, or folliculitis, and inconstantly associated with a personal history of atopy. Skin biopsy with direct immunofluorescence or search for serum anti-BPAg1 (180kD) NC16a antibodies is mandatory in pruritic dermatoses of pregnancy in order to rule out pemphigoid gestationis. Serum bile salts levels should be tested whenever a generalized pruritus develops during pregnancy in order to rule out intrahepatic cholestasis. PMID:25194221

  14. Preimplantation genetic diagnosis for couples at high risk of Down syndrome pregnancy owing to parental translocation or mosaicism

    PubMed Central

    Conn, C.; Cozzi, J.; Harper, J.; Winston, R.; Delhanty, J.

    1999-01-01

    The population risk for trisomy 21 is 1 in 700 births but some couples are at a much higher risk owing to parental translocation or mosaicism. We report on the first attempt to carry out preimplantation genetic diagnosis for two such couples using cleavage stage embryo biopsy and dual colour FISH analysis. Each couple underwent two treatment cycles. Couple 1 (suspected gonadal mosaicism for trisomy 21) had two embryos normal for chromosome 21 transferred, but no pregnancy resulted; 64% (7/11) unfertilised oocytes/embryos showed chromosome 21 aneuploidy. Couple 2 (46,XX,t(6;21)(q13;q22.3)) had a single embryo transferred resulting in a biochemical pregnancy; 91% (10/11) oocytes/embryos showed chromosome 21 imbalance, most resulting from 3:1 segregation of this translocation at gametogenesis. The opportunity to test embryos before implantation enables the outcome of female meiosis to be studied for the first time and the recurrence risk for a Down syndrome pregnancy to be assessed.


Keywords: preimplantation genetic diagnosis; Down syndrome; reciprocal translocation; gonadal mosaicism PMID:9950365

  15. Korean-Specific Parameter Models for Calculating the Risk of Down Syndrome in the Second Trimester of Pregnancy

    PubMed Central

    Kwon, Ji Young; Park, In Yang; Park, Yong Gue; Lee, Young; Lee, Guisera

    2011-01-01

    The purpose of the current study was to propose a Korean-specific parameter set for calculating the risk of Down syndrome in the second trimester of pregnancy and to determine the screening performances of triple and quadruple tests in Korean women. Using the data on triple or quadruple screening from three hospitals in Korea during 7 yr, we re-converted the concentrations of four serum markers to multiple of median values according to gestational age and maternal weight. After re-calculating the risk of Down syndrome in each pregnancy by multiplying maternal age-specific risk by the likelihood ratio values for the serum markers, screening performances and optimal cut-off values of triple and quadruple tests were analyzed. Among 16,077 pregnancies, 23 cases had Down syndrome (1.4/1,000 deliveries). Compared to the previous program, the tests with new parameters had improved screening performance. The triple and quadruple tests had detection rates of 65.2% and 72.7%, respectively, at a false-positive rate of 5%. The optimal cut-off value for the quadruple and triple tests was 1:250. We have presented a Korean-specific parameter set for Down syndrome screening. The proposed screening test using this parameter set may improve the performance of Down syndrome screening for Korean women. PMID:22148000

  16. Risk of Vaginal Infections at Early Gestation in Patients with Diabetic Conditions during Pregnancy: A Retrospective Cohort Study

    PubMed Central

    Marschalek, Julian; Farr, Alex; Kiss, Herbert; Hagmann, Michael; Göbl, Christian S; Trofaier, Marie-Louise; Kueronya, Verena; Petricevic, Ljubomir

    2016-01-01

    Pregnant women with gestational diabetes mellitus (GDM) are reported to be at increased risk for infections of the genital tract. This study aimed to compare the prevalence of asymptomatic bacterial vaginosis (BV) and Candida colonization at early gestation between pregnant women with and without diabetic conditions during pregnancy. We included data from 8, 486 singleton pregnancies that underwent an antenatal infection screen-and-treat programme at our department. All women with GDM or pre-existing diabetes were retrospectively assigned to the diabetic group (DIAB), whereas non-diabetic women served as controls (CON). Prevalence for BV and Candida colonization was 9% and 14% in the DIAB group, and 9% and 13% in the CON group, respectively (n.s.). No significant difference regarding stillbirth and preterm delivery (PTD), defined as a delivery earlier than 37 + 0 (37 weeks plus 0 days) weeks of gestation was found. We could not find an increased risk of colonization with vaginal pathogens at early gestation in pregnant women with diabetes, compared to non-diabetic women. Large prospective studies are needed to evaluate the long-term risk of colonization with vaginal pathogens during the course of pregnancy in these women. PMID:27167850

  17. Pregnancies, breast-feeding, and breast cancer risk in the International BRCA1/2 Carrier Cohort Study (IBCCS)

    PubMed Central

    Andrieu, Nadine; Goldgar, David E.; Easton, Douglas F.; Rookus, Matti; Brohet, Richard; Antoniou, Antonis C.; Peock, Susan; Evans, Gareth; Eccles, Diana; Douglas, Fiona; Noguès, Catherine; Gauthier-Villars, Marion; Chompret, Agnès; Van Leeuwen, Flora E.; Kluijt, Irma; Benitez, Javier; Arver, Brita; Olah, Edith; Chang-Claude, Jenny

    2006-01-01

    Background Multiparity, young age at first childbirth, and breastfeeding are associated with a reduced risk of breast cancer in the general population. The breast cancer predisposition gene, BRCA1, has been shown to have a central role in regulating normal cell differentiation. Reproductive factors may thus have an influence on breast cancer risk in BRCA1/2 carriers since mammary gland cells undergo cell division and differentiation during pregnancy. Methods We performed a retrospective cohort study of 1601 women who carried a mutation in BRCA1 or BRCA2. Information on reproductive factors was obtained from a questionnaire completed subsequent to genetic counseling. At censoring, 853 subjects were affected with breast cancer. Data analysis was performed using a weighted cohort approach. All statistical tests were two-sided. Results There was no statistically significant difference in the risk of breast cancer between parous and nulliparous women. Among parous women, an increasing number of full-term pregnancies was associated with a statistically significant decrease in the risk of breast cancer (Ptrend = .008); risk was reduced by 14% (95% confidence interval [CI]= 6% to 22%) for each additional birth. This association was the same for carriers of mutations in either BRCA1 or BRCA2 and was restricted to women older than 40 years. In BRCA2 mutation carriers, first childbirth at later ages was associated with a increased risk of breast cancer compared with first childbirth before age 20 years (20–24 years, HR = 2.33 [95% CI = 0.93 to 5.83], 25–29 years, HR = 2.68 [95% CI = 1.02 to 7.07], 30 or later, HR = 1.97 [95% CI = 0.67 to 5.81]), whereas in BRCA1 mutation carriers, first childbirth at age 30 or later was associated with a reduced risk compared with first childbirth before age 20 (HR = 0.58 [95% CI = 0.36 to 0.94]). Neither history of interrupted pregnancies nor history of breastfeeding was statistically significant associated with the risk of breast cancer

  18. MicroRNA Cargo of Extracellular Vesicles from Alcohol-exposed Monocytes Signals Naive Monocytes to Differentiate into M2 Macrophages.

    PubMed

    Saha, Banishree; Momen-Heravi, Fatemeh; Kodys, Karen; Szabo, Gyongyi

    2016-01-01

    Membrane-coated extracellular vesicles (EVs) released by cells can serve as vehicles for delivery of biological materials and signals. Recently, we demonstrated that alcohol-treated hepatocytes cross-talk with immune cells via exosomes containing microRNA (miRNAs). Here, we hypothesized that alcohol-exposed monocytes can communicate with naive monocytes via EVs. We observed increased numbers of EVs, mostly exosomes, secreted by primary human monocytes and THP-1 monocytic cells in the presence of alcohol in a concentration- and time-dependent manner. EVs derived from alcohol-treated monocytes stimulated naive monocytes to polarize into M2 macrophages as indicated by increased surface expression of CD68 (macrophage marker), M2 markers (CD206 (mannose receptor) and CD163 (scavenger receptor)), secretion of IL-10, and TGFβ and increased phagocytic activity. miRNA profiling of the EVs derived from alcohol-treated THP-1 monocytes revealed high expression of the M2-polarizing miRNA, miR-27a. Treatment of naive monocytes with control EVs overexpressing miR-27a reproduced the effect of EVs from alcohol-treated monocytes on naive monocytes and induced M2 polarization, suggesting that the effect of alcohol EVs was mediated by miR-27a. We found that miR-27a modulated the process of phagocytosis by targeting CD206 expression on monocytes. Importantly, analysis of circulating EVs from plasma of alcoholic hepatitis patients revealed increased numbers of EVs that contained high levels of miR-27a as compared with healthy controls. Our results demonstrate the following: first, alcohol increases EV production in monocytes; second, alcohol-exposed monocytes communicate with naive monocytes via EVs; and third, miR-27a cargo in monocyte-derived EVs can program naive monocytes to polarize into M2 macrophages. PMID:26527689

  19. Ectopic Pregnancy

    MedlinePlus

    ... Education & Events Advocacy For Patients About ACOG Ectopic Pregnancy Home For Patients Search FAQs Ectopic Pregnancy Page ... Ectopic Pregnancy FAQ155, August 2011 PDF Format Ectopic Pregnancy Pregnancy What is an ectopic pregnancy? Who is ...

  20. Mild Air Pollution of Concern in Pregnancy

    MedlinePlus

    ... nih.gov/medlineplus/news/fullstory_158558.html Mild Air Pollution of Concern in Pregnancy Study found risk for ... Being exposed to just a small amount of air pollution during pregnancy ups the risk of a pregnancy ...

  1. Mild Air Pollution of Concern in Pregnancy

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_158558.html Mild Air Pollution of Concern in Pregnancy Study found risk for ... Being exposed to just a small amount of air pollution during pregnancy ups the risk of a pregnancy ...

  2. Prevalence of Metabolic Syndrome One Year after Delivery in Finnish Women at Increased Risk for Gestational Diabetes Mellitus during Pregnancy

    PubMed Central

    Puhkala, Jatta; Kinnunen, Tarja I.; Vasankari, Tommi; Kukkonen-Harjula, Katriina; Raitanen, Jani

    2013-01-01

    Background. Women with a history of gestational diabetes mellitus (GDM) are at increased risk for metabolic syndrome (MeS) after delivery. We studied the prevalence of MeS at one year postpartum among Finnish women who in early pregnancy were at increased risk of developing GDM. Methods. This follow-up study is a part of a GDM prevention trial. At one year postpartum, 150 women (mean age 33.1 years, BMI 27.2 kg/m2) were evaluated for MeS. Results. The prevalence of MeS was 18% according tothe International Diabetes Federation (IDF) criteria and 16% according toNational Cholestrol Education Program (NCEP) criteria. Of MeS components, 74% of participants had an increased waist circumference (≥80 cm). Twenty-seven percent had elevated fasting plasma glucose (≥5.6 mmol/L), and 29% had reduced HDL cholesterol (≤1.3 mmol/L). The odds ratio for the occurrence of MeS at one year postpartum was 3.0 (95% CI 1.0–9.2) in those who were overweight before pregnancy compared to normal weight women. Conclusions. Nearly one-fifth of the women with an increased risk of GDM in early pregnancy fulfilled the criteria of MeS at one year postpartum. The most important factor associated with MeS was prepregnancy overweight. Weight management before and during pregnancy is important for preventing MeS after delivery. PMID:23577256

  3. Maternal exposure to air pollutant PM2.5 and PM10 during pregnancy and risk of congenital heart defects.

    PubMed

    Zhang, Bin; Liang, Shengwen; Zhao, Jinzhu; Qian, Zhengmin; Bassig, Bryan A; Yang, Rong; Zhang, Yiming; Hu, Ke; Xu, Shunqing; Zheng, Tongzhang; Yang, Shaoping

    2016-06-01

    Maternal exposure to ambient air pollution has increasingly been linked to congenital heart defects (CHDs). The objective of this study was to evaluate whether high levels of maternal exposure to PM2.5 and PM10 are related to increased risk of CHDs in Wuhan, China. We conducted a cohort study with a total of 105,988 live-born infants, stillbirths, and fetal deaths. The study included mothers living in the urban district of Wuhan during pregnancy over the 2-year period from 10 June 2011 to 9 June 2013. For each study participant, we assigned 1-month and 1-week averages of PM10 and PM2.5 exposure based on measurements obtained from the nearest exposure monitor to the living residence of mothers during their early pregnancy period. Logistic regression analyses were conducted to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the association between exposure to these ambient air pollutants during early pregnancy and CHDs. We observed an increased risk of CHDs, particularly ventricular septal defect (VSD), with increasing PM2.5 exposure. Using 1-week averages, we also observed significant monotonically increasing associations between PM2.5 exposure during weeks 7-10 of pregnancy and risk of VSD, with aORs ranging from 1.11 to 1.17 (95% CI: 1.02-1.20, 1.03-1.22, 1.05-1.24, and 1.08-1.26 separately) per a 10 μg/m(3) change in PM2.5 concentration. Our study contributes to the small body of knowledge regarding the association between in utero exposure to air pollution and CHDs, but confirmation of these associations will be needed in future studies. PMID:26883477

  4. Maternal exposure to air pollutant PM2.5 and PM10 during pregnancy and risk of congenital heart defects

    PubMed Central

    Zhang, Bin; Liang, Shengwen; Zhao, Jinzhu; Qian, Zhengmin; Bassig, Bryan A; Yang, Rong; Zhang, Yiming; Hu, Ke; Xu, Shunqing; Zheng, Tongzhang; Yang, Shaoping

    2016-01-01

    Maternal exposure to ambient air pollution has increasingly been linked to congenital heart defects (CHDs). The objective of this study was to evaluate whether high levels of maternal exposure to PM2.5 and PM10 are related to increased risk of CHDs in Wuhan, China. We conducted a cohort study with a total of 105,988 live-born infants, stillbirths, and fetal deaths. The study included mothers living in the urban district of Wuhan during pregnancy over the 2-year period from 10 June 2011 to 9 June 2013. For each study participant, we assigned 1-month and 1-week averages of PM10 and PM2.5 exposure based on measurements obtained from the nearest exposure monitor to the living residence of mothers during their early pregnancy period. Logistic regression analyses were conducted to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CI) for the association between exposure to these ambient air pollutants during early pregnancy and CHDs. We observed an increased risk of CHDs, particularly ventricular septal defect (VSD), with increasing PM2.5 exposure. Using 1-week averages, we also observed significant monotonically increasing associations between PM2.5 exposure during weeks 7–10 of pregnancy and risk of VSD, with aORs ranging from 1.11 to 1.17 (95% CI: 1.02–1.20, 1.03–1.22, 1.05–1.24, and 1.08–1.26 separately) per a 10 μg/m3 change in PM2.5 concentration. Our study contributes to the small body of knowledge regarding the association between in utero exposure to air pollution and CHDs, but confirmation of these associations will be needed in future studies. PMID:26883477

  5. Healthy Pre-Pregnancy Diet and Exercise May Reduce Risk of Gestational Diabetes

    MedlinePlus

    ... A Patient’s Guide to a Healthy Pregnancy Related Science Advances Healthy Diet May Fend Off Type 2 Diabetes After Gestational Diabetes (featured on NICHD website) Physical Activity May Stave Off Diabetes for Women At ...

  6. Timing of Zika Infection in Pregnancy May Be Key to Birth Defect Risk

    MedlinePlus

    ... medlineplus.gov/news/fullstory_159383.html Timing of Zika Infection in Pregnancy May Be Key to Birth ... June 15, 2016 (HealthDay News) -- The danger of Zika-related birth defects may be confined to maternal ...

  7. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States.

    PubMed

    Fejzo, Marlena S; MacGibbon, Kimber W; Mullin, Patrick M

    2016-07-01

    This is an analysis of fetal outcome in pregnancies exposed to ondansetron to treat Hyperemesis Gravidarum (HG). In this retrospective cohort study, U.S. data on outcome were collected on 1070 pregnancies exposed to ondansetron and compared to outcomes in two control groups: 771 pregnancies in women with a history of HG with no ondansetron exposure and 1555 pregnancies with neither a history of HG nor ondansetron exposure. Ventricular septal defects were reported in 2/952 of infants in the HG/Ondansetron-exposure group and 4/1286 in the No HG/No Ondansetron-exposure group. Cleft palate was reported in 1/952 live births in the HG/Ondansetron and 2/1286 in the No HG/No Ondansetron-exposure groups. Women with a history of HG who took ondansetron reported less miscarriages and terminations, and higher live birth rates. The overall results do not support evidence of teratogenicity of ondansetron. PMID:27151373

  8. Effects of Yoga on Utero-Fetal-Placental Circulation in High-Risk Pregnancy: A Randomized Controlled Trial

    PubMed Central

    Nagarathna, Raghuram; Mhaskar, Rita; Mhaskar, Arun; Thomas, Annamma; Gunasheela, Sulochana

    2015-01-01

    Introduction. Impaired placentation and inadequate trophoblast invasion have been associated with the etiology of many pregnancy complications and have been correlated with the first trimester uterine artery resistance. Previous studies have shown the benefits of yoga in improving pregnancy outcomes and those of yogic visualization in revitalizing the human tissues. Methods. 59 high-risk pregnant women were randomized into yoga (n = 27) and control (n = 32) groups. The yoga group received standard care plus yoga sessions (1 hour/day, 3 times/week), from 12th to 28th week of gestation. The control group received standard care plus conventional antenatal exercises (walking). Measurements were assessed at 12th, 20th, and 28th weeks of gestation. Results. RM-ANOVA showed significantly higher values in the yoga group (28th week) for biparietal diameter (P = 0.001), head circumference (P = 0.002), femur length (P = 0.005), and estimated fetal weight (P = 0.019). The resistance index in the right uterine artery (P = 0.01), umbilical artery (P = 0.011), and fetal middle cerebral artery (P = 0.048) showed significantly lower impedance in the yoga group. Conclusion. The results of this first randomized study of yoga in high-risk pregnancy suggest that guided yogic practices and visualization can improve the intrauterine fetal growth and the utero-fetal-placental circulation. PMID:25688304

  9. Physical activity during pregnancy: predictors of change, perceived support and barriers among women at increased risk of gestational diabetes.

    PubMed

    Leppänen, Marja; Aittasalo, Minna; Raitanen, Jani; Kinnunen, Tarja I; Kujala, Urho M; Luoto, Riitta

    2014-11-01

    The aim of this study was to examine the predictors of change in intensity-specific leisure-time physical activity (LTPA) during pregnancy, and the perceived support and barriers of LTPA in Finnish pregnant women at increased risk of gestational diabetes. The study population consisted of 399 pregnant women who participated in a randomized controlled trial aiming to prevent gestational diabetes. Evaluation of LTPA was based on a self-report at baseline, 26-28, and 36-37 weeks' gestation. Data on predictors of change, perceived support and barriers were collected with questionnaires and from the maternity cards. Multinomial logistic regression was used to assess associations between the variables. The average weekly minutes of light-intensity LTPA were 179 at baseline, 161 at 26-28 weeks' gestation, and 179 at 36-37 weeks' gestation. The corresponding minutes of moderate-to-vigorous-intensity LTPA were 187, 133 and 99. At 26-28 weeks' gestation, the strongest predictors for light-intensity LTPA were meeting the PA recommendations prior to pregnancy, having polytechnic education and working part-time, while having a physically active spouse prior to pregnancy was the strongest predictor for moderate-to-vigorous-intensity LTPA. The people and/or factors that encouraged women to LTPA the most were the spouse, a child, other family members and weather, whereas tiredness, nausea, perceived health, work and lack of time restricted their LTPA the most. The strongest predictors for maintaining LTPA during pregnancy were pre-pregnancy LTPA, education, working part-time and a spouse's LTPA. Most common barriers were perceived health, work and lack of time. PMID:24615354

  10. Non-occupational exposure to paint fumes during pregnancy and risk of congenital anomalies: a cohort study

    PubMed Central

    2012-01-01

    Background Occupational exposure to organic solvents during the 1st trimester of pregnancy has been associated with congenital anomalies. Organic solvents are also used in the home environments in paint products, but no study has investigated the effect of such exposure in a general population. Methods We studied associations between residential exposure to paint fumes during the 1st trimester of pregnancy and predefined subgroups of congenital anomalies, using data from the Danish National Birth Cohort (DNBC). During 2001 and 2003, a total of 20 103 pregnant women, enrolled in the DNBC, were interviewed in the 30th week of gestation about the use of paint in their residence during pregnancy. By the end of first trimester, information about smoking habits, alcohol consumption and occupation were collected. Information on congenital anomalies was obtained from national registers. Associations were examined by estimating odds ratios (OR) using logistic regression. Results In total 1404 women (7%) had been exposed to paint fumes during the 1st trimester of pregnancy and 1086 children were diagnosed with congenital anomalies; 73 children with congenital anomalies had been exposed to paint fumes in utero. Exposure to paint fumes seemed positively associated with congenital anomalies of the nervous system (OR 2.19, 95% confidence interval (CI) 0.76 to 6.32), ear, face and neck (OR 2.15, 95% CI 0.84 to 5.55) and the renal system (OR 2.16, 95% CI 1.02 to 4.58) after adjustment for maternal age, smoking, alcohol consumption and occupational solvent exposure. Congenital anomalies in the remaining subgroups were not associated with the exposure. Conclusions Our results suggest that in the general population, exposure to paint fumes during the 1st trimester of pregnancy may increase the risk of some types of congenital anomalies, but the findings need to be confirmed. PMID:22892023

  11. Predictors of incident herpes simplex virus type 2 infections in young women at risk for unintended pregnancy in San Francisco

    PubMed Central

    Moss, Nicholas J; Harper, Cynthia C; Ahrens, Katherine; Scott, Katherine; Kao, Susan; Padian, Nancy; Raine, Tina; Klausner, Jeffrey D

    2007-01-01

    Background Young women receiving family planning services are at risk for both unintended pregnancy and herpes simplex virus type 2 (HSV-2) infection. Methods We performed a secondary analysis using data from a previously published randomized controlled trial evaluating access to emergency contraception on reproductive health outcomes. Women aged 15 to 24 years were recruited from two Planned Parenthood clinics and two community health clinics in San Francisco. Demographic information and sexual history were obtained by interview. HSV-2 seropositivity was determined by fingerstick blood test. New pregnancies were measured by self-report, urine testing and medical chart review. Subjects were evaluated for incident HSV-2 infection and pregnancy at a 6-month follow-up appointment. Women who were pregnant or intending to become pregnant at enrolment were excluded. Results At enrolment 2,104 women were screened for HSV-2 and 170 (8.1%) were seropositive. Eighty-seven percent of initially seronegative women completed the study (n = 1,672) and 73 (4.4%) became HSV-2 seropositive. HSV-2 seroincidence was 7.8 cases per 100 person-years. One hundred and seventeen women (7%) became pregnant and 7 (6%) of these had a seroincident HSV-2 infection during the study. After adjustment for confounders, predictors of incident HSV-2 infection were African American race and having multiple partners in the last six months. Condom use at last sexual encounter was protective. Conclusion HSV-2 seroincidence and the unintended pregnancy rate in young women were high. Providers who counsel women on contraceptive services and sexually transmitted infection prevention could play an expanded role in counselling women about HSV-2 prevention given the potential sequelae in pregnancy. The potential benefit of targeted screening and future vaccination against HSV-2 needs to be assessed in this population. PMID:17897466

  12. MATERNAL OCCUPATIONAL EXPOSURE TO POLYCYCLIC AROMATIC HYDROCARBONS AND RISK OF ORAL CLEFT-AFFECTED PREGNANCIES

    PubMed Central

    Langlois, Peter H; Hoyt, Adrienne T; Lupo, Philip J; Lawson, Christina C; Waters, Martha A; Desrosiers, Tania A; Shaw, Gary M; Romitti, Paul A; Lammer, Edward J

    2014-01-01

    Objective Evaluate whether there is an association between maternal occupational exposure to polycyclic aromatic hydrocarbons (PAHs) and oral cleftsin offspring. This is the first human study of PAHs and clefts of which the authors are aware. Design Case-control study. Setting, Participants Data for 1997–2002 from the National Birth Defects Prevention Study, a large population-based case-control study in the US, were analyzed. Maternal telephone interviews yielded information on jobs held in the month before through three months after conception. Two industrial hygienists independently assessed occupational exposure to PAHs ; all jobs rated as exposed or with rating difficulty were reviewed with a third industrial hygienist to reach consensus on all exposure parameters. Logistic regression estimated crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cleft lip with or without cleft palate (CL±P) and cleft palate alone (CP). Results There were 2989 controls( 3.5% exposed), 805 cases of CL±P (5.8% exposed) and 439 cases of CP (4.6% exposed). The odds of maternal occupational exposure to PAH (any vs none) during pregnancy was increased for CL±P cases as compared with controls (OR 1.69, 95% CI 1.18–2.40); the OR was 1.47 (95% CI 1.02–2.12) adjusted for maternal education. There was a statistically significant adjusted exposure-response relationship for CL±P (ptrend = 0.02). ORs for CP were not statistically significant. Conclusions Maternal occupational exposure to PAHs was associated with increased risk of cleft lip with or without cleft palate in offspring. PMID:23136939

  13. Methamphetamine/Dextroamphetamine and Pregnancy

    MedlinePlus

    Methamphetamine/Dextroamphetamine and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of ... risk. This sheet talks about whether exposure to methamphetamine or dextroamphetamine may increase the risk for birth ...

  14. Pruritus in pregnancy

    PubMed Central

    Bergman, Hagit; Melamed, Nir; Koren, Gideon

    2013-01-01

    Abstract Question Some of my pregnant patients complain about pruritus. Are there conditions in pregnancy that present with pruritus that might put the mother or fetus at risk? Answer Although most cases of pruritus can be attributed to itchy dry skin, there are conditions unique to pregnancy that involve pruritus as a leading symptom. These include pemphigoid gestationis, pruritic urticarial papules and plaques of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. These conditions are associated with severe pruritus and some might be associated with adverse fetal outcomes. Clinical history and physical examination are the most important diagnostic clues when evaluating pruritus in pregnancy. PMID:24336540

  15. First-trimester bleeding characteristics associate with increased risk of preterm birth: data from a prospective pregnancy cohort

    PubMed Central

    Velez Edwards, D.R.; Baird, D.D.; Hasan, R.; Savitz, D.A.; Hartmann, K.E.

    2012-01-01

    BACKGROUND Prior evidence linking first-trimester bleeding with preterm birth (PTB, <37 weeks gestation) risk has been inconsistent and may be biased by subject selection and/or incomplete documentation of bleeding episodes for all participants. Prior studies have not carefully examined the role of bleeding characteristics in PTB risk. In the present study, we estimate the association between first-trimester bleeding and PTB in a non-clinical prospective cohort and test whether bleeding characteristics better predict risk. METHODS Women were enrolled in Right from the Start (2000–2009), a prospective pregnancy cohort. Data about bleeding and bleeding characteristics were examined with logistic regression to assess association with PTB. RESULTS Among 3978 pregnancies 344 were PTB and 3634 term. Bleeding was reported by 986 (26%) participants. After screening candidate confounders, only multiple gestations remained in the model. Bleeding associated with PTB [odds ratio (OR)adjusted = 1.40, 95% confidence interval (CI) 1.09–1.80]. Risk did not vary by race/ethnicity. Compared with non-bleeders, PTB risk was higher for bleeding with red color (ORadjusted = 1.92, 95% CI, 1.32–2.82), for heavy episodes (ORadjusted = 2.40, 95% CI 1.18–4.88) and long duration (ORadjusted = 1.67, 95% CI 1.17–2.38). CONCLUSIONS Bleeding associated with PTB was not confounded by common risk factors for bleeding or PTB. PTB risk was greatest for women with heavy bleeding episodes with long duration and red color and would suggest that combining women with different bleeding characteristics may affect the accuracy of risk assessment. These data suggest a candidate etiologic pathway for PTB and warrant further investigation of the biologic mechanisms. PMID:22052384

  16. Cross-sectional study of serum parathyroid hormone level in high-risk pregnancies as compared to nonpregnant control

    PubMed Central

    Sharma, J. B.; Sharma, Subhadra; Usha, B. R.; Yadav, Manisha; Kumar, Sunesh; Mukhopadhyay, A. K.

    2016-01-01

    Objectives: To note the value of serum parathyroid hormone (PTH) levels in normal and high-risk pregnancies (HRP) in patients attending antenatal visits at All India Institute of Medical Sciences (AIIMS). Materials and Methods: This is a cross-sectional study where a total of 282 patients attending Gynecology Outpatient Department at AIIMS, New Delhi were recruited. Among the 282 subjects, 251 were pregnant, and 31 were controls. The serum was tested for serum PTH levels using Beckman coulter access 2 immunoassay. Results: The median value of PTH level in pregnant women was 31.6 pg/ml with range being 0.8–505.5 pg/ml in contrast to 45.9 pg/ml with range being 19–102.7 pg/ml in nonpregnant female. This difference was statistically significant (P = 0.0012). There was no significant difference in median level of PTH in different age group. Although the median PTH levels were lower in second trimester (25.25 pg/ml) than in first trimester (35.5 pg/ml) and in third trimester (32.4 pg/ml), the difference was not statistically significant. There was no significant difference in PTH level in HRP (median value – 31.6 pg/ml) as compared to low-risk pregnancies (31.5 pg/ml). Conclusion: Serum PTH levels are significantly lower during pregnancy as compared to nonpregnant state. However, age, parity, and HRP did not alter PTH level during pregnancy. PMID:26904475

  17. Maternal dietary fatty acid intake during pregnancy and the risk of preclinical and clinical type 1 diabetes in the offspring.

    PubMed

    Niinistö, Sari; Takkinen, Hanna-Mari; Uusitalo, Liisa; Rautanen, Jenna; Nevalainen, Jaakko; Kenward, Michael G; Lumia, Mirka; Simell, Olli; Veijola, Riitta; Ilonen, Jorma; Knip, Mikael; Virtanen, Suvi M

    2014-03-14

    The aim of the present study was to examine the associations between the maternal intake of fatty acids during pregnancy and the risk of preclinical and clinical type 1 diabetes in the offspring. The study included 4887 children with human leucocyte antigen (HLA)-conferred type 1 diabetes susceptibility born during the years 1997-2004 from the Finnish Type 1 Diabetes Prediction and Prevention Study. Maternal diet was assessed with a validated FFQ. The offspring were observed at 3- to 12-month intervals for the appearance of type 1 diabetes-associated autoantibodies and development of clinical type 1 diabetes (average follow-up period: 4·6 years (range 0·5-11·5 years)). Altogether, 240 children developed preclinical type 1 diabetes and 112 children developed clinical type 1 diabetes. Piecewise linear log-hazard survival model and Cox proportional-hazards regression were used for statistical analyses. The maternal intake of palmitic acid (hazard ratio (HR) 0·82, 95 % CI 0·67, 0·99) and high consumption of cheese during pregnancy (highest quarter v. intermediate half HR 0·52, 95 % CI 0·31, 0·87) were associated with a decreased risk of clinical type 1 diabetes. The consumption of sour milk products (HR 1·14, 95 % CI 1·02, 1·28), intake of protein from sour milk (HR 1·15, 95 % CI 1·02, 1·29) and intake of fat from fresh milk (HR 1·43, 95 % CI 1·04, 1·96) were associated with an increased risk of preclinical type 1 diabetes, and the intake of low-fat margarines (HR 0·67, 95 % CI 0·49, 0·92) was associated with a decreased risk. No conclusive associations between maternal fatty acid intake or food consumption during pregnancy and the development of type 1 diabetes in the offspring were detected. PMID:24589042

  18. Young adolescent girls are at high risk for adverse pregnancy outcomes in sub-Saharan Africa: an observational multicountry study

    PubMed Central

    Mombo-Ngoma, Ghyslain; Mackanga, Jean Rodolphe; González, Raquel; Ouedraogo, Smaila; Kakolwa, Mwaka A; Manego, Rella Zoleko; Basra, Arti; Rupérez, María; Cot, Michel; Kabanywany, Abdunoor M; Matsiegui, Pierre-Blaise; Agnandji, Seldiji T; Vala, Anifa; Massougbodji, Achille; Abdulla, Salim; Adegnika, Ayôla A; Sevene, Esperança; Macete, Eusebio; Yazdanbakhsh, Maria; Kremsner, Peter G; Aponte, John J; Menéndez, Clara; Ramharter, Michael

    2016-01-01

    Objectives One of Africa's most important challenges is to improve maternal and neonatal health. The identification of groups at highest risk for adverse pregnancy outcomes is important for developing and implementing targeted prevention programmes. This study assessed whether young adolescent girls constitute a group at increased risk for adverse birth outcomes among pregnant women in sub-Saharan Africa. Setting Data were collected prospectively as part of a large randomised controlled clinical trial evaluating intermittent preventive treatment of malaria in pregnancy (NCT00811421—Clinical Trials.gov), conducted between September 2009 and December 2013 in Benin, Gabon, Mozambique and Tanzania. Participants Of 4749 participants, pregnancy outcomes were collected for 4388 deliveries with 4183 live births including 83 multiple gestations. Of 4100 mothers with a singleton live birth delivery, 24% (975/4100) were adolescents (≤19 years of age) and 6% (248/4100) were aged ≤16 years. Primary and secondary outcome measures Primary outcomes of this predefined analysis were preterm delivery and low birth weight. Results The overall prevalence of low birthweight infants and preterm delivery was 10% (371/3851) and 4% (159/3862), respectively. Mothers aged ≤16 years showed higher risk for the delivery of a low birthweight infant (OR: 1.96; 95% CI 1.35 to 2.83). Similarly, preterm delivery was associated with young maternal age (≤16 years; OR: 2.62; 95% CI 1.59 to 4.30). In a subanalysis restricted to primiparous women: preterm delivery, OR 4.28; 95% CI 2.05 to 8.93; low birth weight, OR: 1.29; 95% CI 0.82 to 2.01. Conclusions Young maternal age increases the risk for adverse pregnancy outcomes and it is a stronger predictor for low birth weight and preterm delivery than other established risk factors in sub-Saharan Africa. This finding highlights the need to improve adolescent reproductive health in sub-Saharan Africa. Trial registration number NCT00811421

  19. Carotid artery elasticity decreases during pregnancy - the Cardiovascular Risk in Young Finns study

    PubMed Central

    2014-01-01

    Background The aims were to evaluate the effect of pregnancy on carotid artery elasticity and determine the associations between maternal lipids, endothelial function and arterial elasticity during pregnancy. Methods We examined 99 pregnant and 99 matched non-pregnant control women as part of a population-based prospective cohort study. Carotid artery elasticity indexes; carotid artery distensibility (CAD), Young’s elastic modulus (YEM) and stiffness index (SI) as well as brachial artery flow-mediated dilation (FMD) were assessed using ultrasound; serum lipid levels were also determined. Results SI was 57% and YEM 75% higher and CAD 36% lower in the third trimester group than the corresponding values in the first trimester group. Serum cholesterol and triglyceride levels were significantly higher in women at the end of the pregnancy than at the beginning of pregnancy (P < 0.001) and in controls (P < 0.001). In multivariate analysis, gestational age was the only independent correlate of arterial elasticity in pregnant women. In controls, age (P ≤ 0.001) and common carotid diameter (P = 0.001-0.029) were associated with SI, YEM and CAD. Conclusions The present study revealed that carotid artery elasticity declined towards the end of the pregnancy; this neither is straight correlating with maternal hyperlipidemia or the diameter of the carotid artery nor is it associated with changes in endothelial function. PMID:24602149

  20. [Teenage pregnancy].

    PubMed

    Mora-Cancino, María; Hernández-Valencia, Varcelino

    2015-05-01

    In Mexico, 20% of the annual births are presented in women younger than 20 years old. Pregnancy in adolescents puts at risk mother and child health. This risk is major while the woman is younger, especially when the social and economic conditions are not favorable, which is decisive in later psychosocial development. It has been pointed out that the youths with low education, with minor academic and laboral expectations, with low self-esteem and assertiveness, tend to begin early their active sexual life, to use less frequently contraceptives, and in the case of younger women, to be pregnant, with the risk of abortion because they cannot to make the best decision. It is important to take into account the social context and the special characteristics of the family to understand situation of adolescent at risk of pregnancy. PMID:26233975

  1. Tobacco and alcohol use during pregnancy and risk of oral clefts. Occupational Exposure and Congenital Malformation Working Group.

    PubMed Central

    Lorente, C; Cordier, S; Goujard, J; Aymé, S; Bianchi, F; Calzolari, E; De Walle, H E; Knill-Jones, R

    2000-01-01

    OBJECTIVES: This study examined the relationship between maternal tobacco and alcohol consumption during the first trimester of pregnancy and oral clefts. METHODS: Data were derived from a European multicenter case-control study including 161 infants with oral clefts and 1134 control infants. RESULTS: Multivariate analyses showed an increased risk of cleft lip with or without cleft palate associated with smoking (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.07, 3.04) and an increased risk of cleft palate associated with alcohol consumption (OR = 2.28, 95% CI = 1.02, 5.09). The former risk increased with the number of cigarettes smoked. CONCLUSIONS: This study provides further evidence of the possible role of prevalent environmental exposures such as tobacco and alcohol in the etiology of oral clefts. PMID:10705862

  2. Ectopic Pregnancy

    MedlinePlus

    ... 5 Things to Know About Zika & Pregnancy Ectopic Pregnancy KidsHealth > For Parents > Ectopic Pregnancy Print A A ... lower back pain continue What Causes an Ectopic Pregnancy? An ectopic pregnancy usually happens because a fertilized ...

  3. Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities 1

    PubMed Central

    Trindade-Suedam, Ivy Kiemle; von Kostrisch, Lília Maria; Pimenta, Luiz André Freire; Negrato, Carlos Antônio; Franzolin, Solange Braga; Trindade, Alceu Sergio

    2016-01-01

    Abstract Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized. PMID:27508899

  4. Use of Amniotic Fluid for Determining Pregnancies at Risk of Preterm Birth and for Studying Diseases of Potential Environmental Etiology

    PubMed Central

    Geer, Laura A.; Pycke, Benny F. G.; Sherer, David M.; Abulafia, Ovadia; Halden, Rolf U.

    2014-01-01

    Amniotic fluid (AF) is a biological medium uniquely suited for the study of early exposure of the human fetus to environmental contaminants acquired by the mother before and during pregnancy. Traditional diagnostic applications of AF have focused almost exclusively on the diagnosis of genetic aberrations such as Trisomy-21 and on heritable diseases in high-risk pregnancies. Since more than 50 anthropogenic compounds have been detected in AF, there is considerable potential in utilizing fetal protein biomarkers as indicators of prenatal exposure-related health effects. Here, we focus on preterm birth (PTB) to illustrate opportunities and limitations of using AF as a diagnostic matrix. Representing a pervasive public health challenge worldwide, PTB cannot be managed simply by improving hygiene and broadening access to healthcare. This is illustrated by 15-year increases of PTB in the U.S. from 1989-2004. AF is uniquely suited as a matrix for early detection of the association between fetal exposures and PTB due to its fetal origin and the fact that it is sampled from women who are at higher risk of PTB. This critical review shows the occurrence in AF of a number of xenobiotics, including endocrine-disrupting compounds (EDCs), which are known or may reasonably be expected to shorten fetal gestation. It is not yet known whether EDCs, including bisphenol A, phytoestrogens, and polychlorinated biphenyls (PCBs), can affect the expression of proteins considered viable or potential biomarkers for the onset of PTB. As such, the diagnostic value of AF is broad and has not yet been fully explored for prenatal diagnosis of pregnancies at risk from toxic, environmental exposures and for the elucidation of mechanisms underlying important public health challenges including PTB. PMID:25460669

  5. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain

    PubMed Central

    Tennfjord, Merete Kolberg; Hilde, Gunvor; Ellström-Engh, Marie; Bø, Kari

    2016-01-01

    Background/aim Diastasis recti abdominis (DRA) is defined as a separation of the 2 muscle bellies of rectus abdominis. To date there is scant knowledge on prevalence, risk factors, and consequences of the condition. The present study aimed to investigate the prevalence of DRA during pregnancy and post partum, presence of possible risk factors, and the occurrence of lumbopelvic pain among women with and without DRA. Methods This prospective cohort study followed 300 first-time pregnant women from pregnancy till 12 months post partum. Data were collected by electronic questionnaire and clinical examinations. DRA was defined as a palpated separation of ≥2 fingerbreadths either 4.5 cm above, at or 4.5 cm below the umbilicus. Women with and without DRA were compared with independent samples Student's t-test and χ2/Fisher exact test, and OR with significance level >0.05. Results Prevalence of DRA was 33.1%, 60.0%, 45.4%, and 32.6% at gestation week 21, 6 weeks, 6 months and 12 months post partum, respectively. No difference in risk factors was found when comparing women with and without DRA. OR showed a greater likelihood for DRA among women reporting heavy lifting ≥20 times weekly (OR 2.18 95% CI 1.05 to 4.52). There was no difference in reported lumbopelvic pain (p=0.10) in women with and without DRA. Conclusions Prevalence of mild DRA was high both during pregnancy and after childbirth. Women with and without DRA reported the same amount of lumbopelvic pain 12 months post partum. PMID:27324871

  6. Rising School Enrollment and Declining HIV and Pregnancy Risk Among Adolescents in Rakai District, Uganda, 1994-2013

    PubMed Central

    Santelli, John; Mathur, Sanyukta; Song, Xiaoyu; Huang, Tzu Jung; Wei, Ying; Lutalo, Tom; Nalugoda, Fred; Gray, Ron H.; Serwadda, David M.

    2015-01-01

    Background Poverty, family stability, and social policies influence the ability of adolescents to attend school. Likewise, being enrolled in school may shape an adolescent's risk for HIV and pregnancy. We identified trends in school enrollment, factors predicting school enrollment (antecedents), and health risks associated with staying in or leaving school (consequences). Methods Data from the Rakai Community Cohort Study (RCCS) were examined for adolescents 15-19 years (n=21,735 person-rounds) from 1994 to 2013. Trends, antecedents, and consequences were assessed using logistic and linear regression with robust variance estimation. Qualitative data were used to explore school leaving among HIV+ and HIV- youth (15-24 years). Results School enrollment and socioeconomic status (SES) rose steadily from 1994 to 2013 among adolescents; orphanhood declined after availability of antiretroviral therapy. Antecedent factors associated with school enrollment included age, SES, orphanhood, marriage, family size, and the percent of family members <20 years. In qualitative interviews, youth reported lack of money, death of parents, and pregnancy as primary reasons for school dropout. Among adolescents, consequences associated with school enrollment included lower HIV prevalence, prevalence of sexual experience, and rates of alcohol use and increases in consistent condom use. Young women in school were more likely to report use of modern contraception and never being pregnant. Young men in school reported fewer recent sexual partners and lower rates of sexual concurrency. Conclusions Rising SES and declining orphanhood were associated with rising school enrollment in Rakai. Increasing school enrollment was associated with declining risk for HIV and pregnancy. PMID:26075159

  7. A two-period assessment of changes in specialist contact in a high-risk pregnancy telemedical program.

    PubMed

    Britt, David W; Norton, Jonathan D; Hubanks, Amanda S; Navidad, Susan A; Perkins, Rosalyn J; Lowery, Curtis L

    2006-02-01

    The purpose was to examine the organizational impact of a state-wide high-risk pregnancy telemedical system, Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), after the first year of its roll out. The focus is on several aspects of system organization, including the volume and diversity of patient-based telemedical consultations and weekly telemedical case discussions, telephone consultations, and changes in the pattern of birth-related patient transports. Individual data on patient transports and associated hospital days, provider-specialist telephone calls, and telemedical consultations were collected for two time periods: December 2002-May 2003 (prior to initiation of ANGELS), and December 2003-May 2004 (postinitiation of ANGELS). Different statistical tests were constructed to compare the two periods as appropriate. Significant increases were observed in the volume and geographic diversity of telemedical consultations and the volume of telephone consultations. There was a moderate, but nonsignificant decrease in the number of maternal transports to University of Arkansas School of Medical Sciences (UAMS), and the average length of stay decreased. The type of specialist-provider and specialist-patient contact has changed as the ANGELS high-risk pregnancy telemedical system has evolved over the first year. We conclude that the rollout of the ANGELS program is changing the shape of high-risk patient care in Arkansas, and we attribute that to an evolving collegial network between specialists and generalists. PMID:16478411

  8. Antidepressant Use During Pregnancy and the Risk of Preterm Delivery and Fetal Growth Restriction

    PubMed Central

    Toh, Sengwee; Mitchell, Allen A.; Louik, Carol; Werler, Martha M.; Chambers, Christina D.; Hernández-Díaz, Sonia

    2011-01-01

    Objective The associations between prenatal exposure to antidepressants and preterm delivery and fetal growth restriction are controversial and poorly understood. We studied the relation between antidepressant use and these outcomes. Methods Analysis included women with nonmalformed infants interviewed in the Slone Epidemiology Center Birth Defects Study between 1998 and 2008. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for premature and small-for–gestational age (SGA) offsprings, adjusting for sociodemographic, lifestyle, medical, and reproductive factors. Results The frequencies of preterm delivery were 7.3% among the 5710 nonusers (reference), 8.9% among the 192 selective serotonin reuptake inhibitor (SSRI) users (OR, 1.1; 95% CI, 0.6–2.0), and 15.3% among the 59 non-SSRI antidepressant users (OR, 2.2; 95% CI, 1.0–4.9); the respective frequencies of delivering an SGA offspring were 7.2%, 10.9% (OR, 1.7; 95% CI, 1.0–2.7), and 13.6% (OR, 2.2; 95% CI, 1.0–4.9). Compared with nonusers, the frequencies of preterm delivery (7.6%) and SGA offspring (5.7%) were not increased among the 106 women who discontinued SSRIs before the end of the first trimester. Among women who continued SSRIs beyond the first trimester, 10.5% delivered a preterm infant (OR, 1.3; 95% CI, 0.6–2.8) and 17.4% had an SGA offspring (OR, 3.0; 95% CI, 1.7–5.5). Conclusions Women treated with SSRIs late in pregnancy had a higher frequency of delivering SGA infants, and women receiving non-SSRI antidepressants were more likely to deliver premature and SGA offsprings. The findings suggest an effect of underlying mood disorder or an effect common to both drug classes. In any case, prenatal antidepressant use may help identify women at elevated risks of delivering preterm and SGA infants. PMID:19910720

  9. [Serial determinations of serum oxytocinase and ultrasonic biparietal cephalometry in normal and high-risk pregnancies].

    PubMed

    Mansani, F E; Serventi, G; Verrelli, D; Condemi, V; Ferrari, F

    1975-01-01

    The value of sonor biparietal cephalometry and serum oxytocinase that we have obtained with weekly simultaneous determinations in 14 females with normal pregnancy and in 5 with pathological pregnancy, from 24th to 39th week, show a statical positive relation. Serum oxitocinase determination against hormonal tests of the phetoplancental function (urinary oestriol, pregnandiol, serum HCS, ecc.) give advantages: it is the easyer, faster and less espandove determination. Therefore we think that it is helpful to determin togheter serial values of sonar biparietal cephalometry and serum oxytocinase to anticipate the endouterine fetal growth retardation. PMID:1212272

  10. Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study

    PubMed Central

    Johansson, Stefan; Cnattingius, Sven

    2016-01-01

    Background Maternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI]) over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term. Methods and Findings This study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk) infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012. We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0–6) at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs) were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (<25 versus ≥25 kg/m2) in the first pregnancy. Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of −1 to <1 kg/m2), the adjusted OR for a low Apgar score in the offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12–1.58). The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00–2.02) and 1.78 (95% CI 1.19–2.68), respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI < 25 kg/m2 in the first pregnancy. A study limitation was the lack of data on the effects of obstetric

  11. Maternal dietary folate, folic acid and vitamin D intakes during pregnancy and lactation and the risk of cows' milk allergy in the offspring.

    PubMed

    Tuokkola, Jetta; Luukkainen, Päivi; Kaila, Minna; Takkinen, Hanna-Mari; Niinistö, Sari; Veijola, Riitta; Virta, Lauri J; Knip, Mikael; Simell, Olli; Ilonen, Jorma; Virtanen, Suvi M

    2016-08-01

    Maternal nutrient intake during pregnancy and lactation potentially influences the development of allergic diseases. Cows' milk allergy (CMA) is often the first manifestation of atopic diseases, but the impact of early nutritional influences on CMA has not been explored. The associations between maternal intakes of folate, folic acid and vitamin D during pregnancy and lactation were addressed in a prospective, population-based birth cohort within the Finnish Type 1 Diabetes Prediction and Prevention Study. Mothers of 4921 children during pregnancy and 2940 children during lactation provided information on maternal dietary intake during the 8th month of pregnancy and the 3rd month of lactation using a detailed, validated FFQ. Information on diagnosed CMA in the offspring was obtained from a medical registry as well as queried from the parents. The Finnish food composition database was used to calculate nutrient intake. Logistic regression was applied for statistical analyses. Folate intake and folic acid and vitamin D supplement use were associated with an increased risk of CMA in the offspring, whereas vitamin D intake from foods during pregnancy was associated with a decreased risk of CMA. Thus, maternal nutrient intake during pregnancy and lactation may affect the development of CMA in offspring. Supplementation with folic acid may not be beneficial in terms of CMA development, especially in children of allergic mothers. The association between dietary supplement use and CMA risk can at least partly be explained by increased health-seeking behaviour among more educated mothers who also use more dietary supplements. PMID:27350011

  12. Maternal Caffeine Consumption during Pregnancy and Risk of Low Birth Weight: A Dose-Response Meta-Analysis of Observational Studies

    PubMed Central

    Rhee, Jongeun; Kim, Rockli; Kim, Yongjoo; Tam, Melanie; Lai, Yizhen; Keum, NaNa; Oldenburg, Catherine Elizabeth

    2015-01-01

    Epidemiologic studies have shown inconsistent conclusions about the effect of caffeine intake during pregnancy on the risk of low birth weight (LBW). We performed a meta-analysis and linear-dose response analysis examining the association between caffeine consumption during pregnancy and risk of LBW. PubMed and EMBASE were searched for relevant articles published up to March 2014. Eight cohort and four case-control studies met all inclusion criteria. Using a random-effects model of the twelve studies, the pooled odds ratio (OR) for the risk of LBW comparing the highest versus lowest level of caffeine intake during pregnancy was 1.38 (95% CI: 1.10, 1.73). Linear dose-response analysis showed that every additional 100 mg of caffeine intake (1 cup of coffee or 2 cups of tea) per day during pregnancy was associated with a 3.0% increase in OR for LBW. There was a moderate level of overall heterogeneity with an I-squared value of 55% (95% CI: 13, 76%), and no evidence of publication bias based on Egger’s test (P = 0.20) and the funnel plot. Thus, high caffeine intake during pregnancy is associated with a significant increase in the risk of LBW, and this risk appears to increase linearly as caffeine intake increases. PMID:26193706

  13. Prolonged pregnancy.

    PubMed

    Hollis, Brian

    2002-04-01

    Prolonged pregnancy is defined as any pregnancy that lasts 294 days or more. It is now well recognized that prolonged pregnancy is associated with an increased risk of perinatal mortality and morbidity. It is these complications of pregnancy that have led obstetricians to adopt a policy of induction of labour before the onset of the post-term period. The induction of labour between 41 and 42 weeks is, however, a very crude strategy for reducing term and post-term stillbirth rates. Although the risk of fetal death is increased after 42 weeks, many more fetuses die in utero between 37 and 42 weeks than die in the post-term period. It appears that smaller term fetuses run a greater risk than their larger counterparts, and that current methods of antepartum assessment of the term fetus are still inadequate. It behoves us as obstetricians to improve our capabilities in identifying the compromised fetus at term. This review puts into perspective the most recent publications and highlights areas requiring further study. PMID:11914699

  14. Orphaned and Abused Youth Are Vulnerable to Pregnancy and Suicide Risk

    ERIC Educational Resources Information Center

    Zapata, Lauren B.; Kissin, Dmitry M.; Bogoliubova, Olga; Yorick, Roman V.; Kraft, Joan Marie; Jamieson, Denise J.; Marchbanks, Polly A.; Hillis, Susan D.

    2013-01-01

    Objective: Little is known about the magnitude and consequences of violence against children for those living outside family care. We sought to estimate the frequency of childhood abuse and examine its association with lifetime pregnancy involvement (LPI) and past year suicide ideation among orphaned youth. Methods: We analyzed data collected via…

  15. Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State

    ERIC Educational Resources Information Center

    Oman, Roy F.; Merritt, Breanca T.; Fluhr, Janene; Williams, Jean M.

    2015-01-01

    Background: The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. Methods: Pre- and…

  16. Smoking during Pregnancy Is a Risk Factor for Executive Function Deficits in Preschool-aged Children

    PubMed Central

    Daseking, M.; Petermann, F.; Tischler, T.; Waldmann, H.-C.

    2015-01-01

    Introduction: Maternal nicotine use during pregnancy has a negative impact on the child. Numerous studies have demonstrated an association between smoking during pregnancy and psychological deficits. This study looks at deficits in executive functioning in preschool-aged children. Methods: The executive functioning of preschool children was assessed by asking parents to complete the parental form of the Behavior Rating Inventory of Executive Functions – Preschool Version (BRIEF-P, German version). The results for preschool children whose mothers had smoked during pregnancy (n = 71) were compared with those of a control group. In a subsample, parental assessments of children of smokers (n = 42) and non-smokers (n = 27) were complemented by the teacher form of the BRIEF-P (German version), which allowed inter-rater agreement (parents vs. preschool teachers) to be assessed. Results: An increased incidence of executive function deficits was noted in the children of smokers, based on parental assessment. Clinically relevant deficits were particularly evident with regard to inhibition, with inhibitory deficits in children of smokers found to be almost four times higher than in the control group (p = 0.006). Inhibitory deficits were reported both by parents and by preschool teachers. Discussion: The increased percentage of executive function deficits described here, particularly the increased inhibitory deficits, confirms the current state of research on smoking during pregnancy. Poor inhibition or impulse control is a key symptom of ADHD. PMID:25684788

  17. The Younger Siblings of Teenage Mothers: A Follow-up of Their Pregnancy Risk.

    ERIC Educational Resources Information Center

    East, Patricia L.; Jacobson, Leanne J.

    2001-01-01

    Followed for 1.5 years younger siblings of parenting and nonparenting teenagers. Found that relative to other youths, sisters of parenting teens exhibited a sharp increase in drug and alcohol use and partying behavior across time and had the highest pregnancy rate at Time 2. For girls, many hours spent caring for their sisters' children related to…

  18. Mother's pre-pregnancy BMI is an important determinant of adverse cardiometabolic risk in childhood

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Maternal adiposity is associated with poor offspring cardiometabolic health. We aimed to evaluate the relationship of maternal pre-pregnancy body mass index (BMI) on the BMI, body composition and cardiometabolic characteristics of the offspring. Forty offspring of overweight/obese mothers (O-OW) and...

  19. Sexually Transmitted Infections and Unintended Pregnancy: A Longitudinal Analysis of Risk Transmission through Friends and Attitudes

    ERIC Educational Resources Information Center

    Henry, David B.; Deptula, Daneen P.; Schoeny, Michael E.

    2012-01-01

    Data from 1,087 adolescent participants in three waves of the National Longitudinal Study of Adolescent Health were used to examine the effects of peer selection and socialization processes in adolescence on later reports of sexually transmitted infections (STI) and unintended pregnancies. Friends' attitudes and behavior were assessed with…

  20. Maternal Exercise During Pregnancy Reduces Risk of Mammary Tumorigenesis In Rat Offspring

    PubMed Central

    Camarillo, Ignacio; Clah, Leon; Zheng, Wei; Zhou, Xuanzhu; Larrick, Brienna; Blaize, Nicole; Breslin, Emily; Patel, Neal; Johnson, Diamond; Teegarden, Dorothy; Donkin, Shawn S.; Gavin, Timothy P.; Newcomer, Sean

    2015-01-01

    Breast cancer is the most common cancer among women. Emerging research indicates that modifying lifestyle factors during pregnancy may convey long-term health benefits to offspring. This study was designed to determine whether maternal exercise during pregnancy leads to reduced mammary tumorigenesis in female offspring. Pregnant rats were randomly assigned to exercised and sedentary groups, with the exercised group having free access to a running wheel and the sedentary group housed with a locked wheel during pregnancy. Female pups from exercised or sedentary dams were weaned at 21 days of age and fed a high fat diet without access to a running wheel. At 6 weeks, all pups were injected with the carcinogen N-methyl-N-nitrosourea (MNU). Mammary tumor development in all pups was monitored for 15 weeks. Pups from exercised dams had a substantially lower tumor incidence (42.9%) compared to pups from sedentary dams (100%). Neither tumor latency nor histological grade differed between the two groups. These data are the first to demonstrate that exercise during pregnancy potentiates reduced tumorigenesis in offspring. This study provides an important foundation towards developing more effective modes of behavior modification for cancer prevention. PMID:24950432

  1. Maternal exercise during pregnancy reduces risk of mammary tumorigenesis in rat offspring.

    PubMed

    Camarillo, Ignacio G; Clah, Leon; Zheng, Wei; Zhou, Xuanzhu; Larrick, Brienna; Blaize, Nicole; Breslin, Emily; Patel, Neal; Johnson, Diamond; Teegarden, Dorothy; Donkin, Shawn S; Gavin, Timothy P; Newcomer, Sean

    2014-11-01

    Breast cancer is the most common cancer among women. Emerging research indicates that modifying lifestyle factors during pregnancy may convey long-term health benefits to offspring. This study was designed to determine whether maternal exercise during pregnancy leads to reduced mammary tumorigenesis in female offspring. Pregnant rats were randomly assigned to exercised and sedentary groups, with the exercised group having free access to a running wheel and the sedentary group housed with a locked wheel during pregnancy. Female pups from exercised or sedentary dams were weaned at 21 days of age and fed a high fat diet without access to a running wheel. At 6 weeks, all pups were injected with the carcinogen N-methyl-N-nitrosourea. Mammary tumor development in all pups was monitored for 15 weeks. Pups from exercised dams had a substantially lower tumor incidence (42.9%) compared with pups from sedentary dams (100%). Neither tumor latency nor histological grade differed between the two groups. These data are the first to demonstrate that exercise during pregnancy potentiates reduced tumorigenesis in offspring. This study provides an important foundation towards developing more effective modes of behavior modification for cancer prevention. PMID:24950432

  2. Alternative versus standard packages of antenatal care for low-risk pregnancy

    PubMed Central

    Dowswell, Therese; Carroli, Guillermo; Duley, Lelia; Gates, Simon; Gülmezoglu, A Metin; Khan-Neelofur, Dina; Piaggio, Gilda GP

    2014-01-01

    Background The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. Objectives To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (April 2010), reference lists of articles and contacted researchers in the field. Selection criteria Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care. Data collection and analysis Two authors assessed trial quality and extracted data independently. Main results We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more ‘goal oriented’. Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1

  3. Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women

    PubMed Central

    Kilembe, William; Haddad, Lisa; Vwalika, Bellington; Lakhi, Shabir; Khu, Naw Htee; Brill, Ilene; Chomba, Elwyn; Mulenga, Joseph; Tichacek, Amanda; Allen, Susan

    2016-01-01

    Background: Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression. Methods: From 1994 to 2012, HIV discordant couples recruited at couples' voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly. Multivariate survival analyses explored associations between time-varying contraception, pregnancy, and breastfeeding and 2 outcomes among HIV-positive women: (1) time to death and (2) time to antiretroviral treatment (ART) initiation. Results: Among 1656 female seropositive, male seronegative couples followed for 3359 person-years (PY), 224 women died [6.7/100 PY; 95% confidence interval (CI): 5.8 to 7.6]. After 2003, 290 women initiated ART (14.5/100 PY; 95% CI: 12.9 to 16.2). In a multivariate model of time to death, hormonal implant [adjusted hazard ratio (aHR) = 0.30; 95% CI: 0.10 to 0.98] and injectable (aHR = 0.59; 95% CI: 0.36 to 0.97) were significantly protective relative to nonhormonal method use, whereas oral contraceptive pill (OCP) use was not (aHR = 1.08; 95% CI: 0.74 to 1.57) controlling for baseline HIV disease stage, time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In a multivariate model of time-to-ART initiation, implant was significantly protective (aHR = 0.54; 95% CI: 0.31 to 0.95), whereas OCP (aHR = 0.70; 95% CI: 0.44 to 1.10) and injectable (aHR = 0.85; 95% CI: 0.55 to 1.32) were not relative to nonhormonal method use controlling for variables above, woman's age, and literacy. Pregnancy was not significantly associated with death (aHR = 1.07; 95% CI: 0.68 to 1.66) or ART initiation (aHR = 1.24; 95% CI: 0.83 to 1.86), whereas breastfeeding was protective for death (aHR = 0.34; 95% CI: 0.19 to 0.62) and ART initiation (aHR = 0.49; 95% CI: 0.29 to 0.85). Conclusions: Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with

  4. Pregnancy loss.

    PubMed

    Robinson, Gail Erlick

    2014-01-01

    Women who lose desired pregnancies by miscarriage, stillbirth, or genetic termination are at risk of suffering from grief, anxiety, guilt and self-blame that may even present in subsequent pregnancies. It is important to find effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging the parents to view and hold the baby. This approach has been questioned as possibly causing persistent anxiety and post-traumatic stress disorder. Women who miscarry are currently encouraged to find ways to memorialise the lost fetus. Couples who decide to terminate a pregnancy after discovering a defect may deal not only with sadness but also guilt. Immediate crisis intervention and follow-up care should be available, recognising that individual women may experience different reactions and their specific post-loss needs must be assessed. PMID:24047642

  5. Teenage pregnancy.

    PubMed

    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. PMID:22846537

  6. Pregnancy Intentions and Teenage Pregnancy Among Latinas: A Mediation Analysis

    PubMed Central

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

    2010-01-01

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

  7. Thrombosis and embolism in pregnancy and the puerperium, reducing the risk: what proportion of patients reach the threshold for thromboprophylaxis?

    PubMed Central

    Revell, Bethany J; Smith, Richard P

    2011-01-01

    In November 2009 the Royal College of Obstetricians and Gynaecologists published an updated guideline, ‘Reducing the risk of thrombosis and embolism during pregnancy and the puerperium’. This includes a clear and simple score-based risk assessment tool, designed for antenatal and postnatal patients. Thresholds are given at which thromboprophylaxis should be offered. However the proportion of patients who reach the threshold is not estimated in the guideline, and we are not aware of any published data regarding this. In this cross-sectional study, we studied the case-notes of all 109 deliveries conducted over a one-week period, including elective caesarean sections. Of those, 7% met the threshold for antenatal thromboprophylaxis and 41% met the threshold for postnatal thromboprophylaxis.

  8. Skin disease in pregnancy.

    PubMed

    Soutou, Boutros; Aractingi, Sélim

    2015-07-01

    Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases. PMID:25862358

  9. Asthma and Pregnancy

    MedlinePlus

    ... best live chat Live Help Fact Sheets Share Asthma and Pregnancy Saturday, 01 August 2015 In every ... her background risk. This sheet talks about whether asthma may increase the risk for birth defects over ...

  10. Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women

    PubMed Central

    Christofides, Nicola J.; Jewkes, Rachel K.; Dunkle, Kristin L.; McCarty, Frances; Shai, Nwabisa Jama; Nduna, Mzikazi; Sterk, Claire

    2014-01-01

    Background Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Objective Teenage girls, aged 15–18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Results Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21–0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05–2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07–0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58–0.83 and OR 0.78; 95% CI 0.64–0.96). Believing that the teenage girl

  11. Vitamin D exposure during pregnancy, but not early childhood, is associated with risk of childhood wheezing.

    PubMed

    Anderson, L N; Chen, Y; Omand, J A; Birken, C S; Parkin, P C; To, T; Maguire, J L

    2015-08-01

    The association between vitamin D and wheezing in early childhood is unclear. The primary objective of this study was to evaluate the association between vitamin D exposure, during both pregnancy and childhood, and early childhood wheezing. Secondary objectives were to evaluate the associations between vitamin D exposures and asthma and wheezing severity. We conducted a cohort study of children (0-5 years) recruited from 2008 to 2013 through the TARGet Kids! primary-care research network. Vitamin D exposures included maternal vitamin D supplement use during pregnancy, child vitamin D supplementation and children's 25-hydroxyvitamin D (25(OH)D) concentrations. The outcomes measured were parent-reported childhood wheezing, diagnosed asthma and wheezing severity. Vitamin D supplement and wheezing data were available for 2478 children, and blood samples were available for 1275 children. Adjusted odds ratios (aOR) were estimated using logistic regression adjusted for age, sex, ethnicity, body mass index, birth weight, outdoor play, breastfeeding duration, daycare status, parental smoking and family history of asthma. Vitamin D supplementation during pregnancy was associated with lower odds of childhood wheezing (aOR=0.65; 95% CI: 0.46-0.93). In early childhood, neither 25(OH)D (aOR per 10 nmol/l=1.01; 95% CI: 0.96-1.06) nor vitamin D supplementation (aOR=1.00; 95% CI: 0.81-1.23) was associated with wheezing. No significant associations were observed with diagnosed asthma or wheezing severity. Vitamin D supplementation during pregnancy was associated with reduced odds of wheezing, but child vitamin D supplementation and childhood 25(OH)D were not associated with reduced wheezing. The timing of exposure may be important in understanding the association between vitamin D and childhood wheezing. PMID:25885931

  12. Zinc erythrocyte protoporphyrin as marker of malaria risk in pregnancy - a retrospective cross-sectional and longitudinal study

    PubMed Central

    2012-01-01

    Background The effects of iron interventions and host iron status on infection risk have been a recurrent clinical concern, although there has been little research on this interaction in pregnant women. Methods Cross-sectional and longitudinal analyses were undertaken to determine the association of whole blood zinc erythrocyte protoporphyrin (ZPP) with malaria parasitaemia in pregnant women attending antenatal and delivery care at Montfort and Chikwawa Hospitals, Shire Valley, Malawi. Prevalence of antenatal, delivery and placental malaria was assessed in relation to maternal ZPP levels. The main outcome measures were prevalence of peripheral and placental Plasmodium falciparum parasitaemia and odds ratios of malaria risk. Results A total of 4,103 women were evaluated at first antenatal visit, of whom at delivery 1327 were screened for peripheral and 1285 for placental parasitaemia. Risk of malaria at delivery (peripheral or placental) was higher in primigravidae (p < 0.001), and lower (peripheral) with use of intermittent preventive anti-malarials during pregnancy (p < 0.001). HIV infection was associated with increased malaria parasitaemia (p < 0.02, peripheral or placental). Parasitaemia prevalence was lower in women with normal ZPP levels compared to those with raised concentrations at both first antenatal visit (all gravidae, p = 0.048, and at delivery (all gravidae, p < 0.001; primigravidae, p = 0.056). Between first antenatal visit and delivery women who transitioned from raised (at first antenatal visit) to normal ZPP values (at delivery) had lower peripheral parasitaemia prevalence at delivery compared to those who maintained normal ZPP values at both these visits (all gravidae: 0.70, 95%CI 0.4-1.1; primigravidae: 0.3, 0.1-0.8). In regression analysis this difference was lost with inclusion of HIV infection in the model. Conclusions Raised ZPP concentrations in pregnancy were positively associated with P. falciparum parasitaemia

  13. Pregnancy hypertensive disease and risk of dementia and cardiovascular disease in women aged 65 years or older: a cohort study

    PubMed Central

    Cnattingius, S; Åkerud, H; Wikström, J; Pedersen, N L; Wikström, A-K

    2016-01-01

    Objective The primary aim was to study pregnancy hypertensive disease and subsequent risk of dementia. The second aim was to study if the increased risks of cardiovascular disease (CVD) and stroke after pregnancy hypertensive disease persist in an elderly population. Design Cohort study. Setting Sweden. Population or sample 3232 women 65 years or older (mean 71 years) at inclusion. Methods Cox proportional hazards regression analyses were used to calculate risks of dementia, CVD and/or stroke for women exposed to pregnancy hypertensive disease. Exposure data were collected from an interview at inclusion during the years 1998–2002. Outcome data were collected from the National Patient Register and Cause of Death Register from the year of inclusion until the end of 2010. Age at inclusion was set as a time-dependent variable, and adjustments were made for body mass index, education and smoking. Main outcome measures Dementia, CVD, stroke. Results During the years of follow-up, 7.6% of the women exposed to pregnancy hypertensive disease received a diagnosis of dementia, compared with 7.4% among unexposed women (HR 1.19; 95% CI 0.79 to 1.73). The corresponding rates for CVD were 22.9% for exposed women and 19.0% for unexposed women (HR 1.29; 95% CI 1.02 to 1.61), and for stroke 13.4% for exposed women and 10.7% for unexposed women (HR 1.36; 95% CI 1.00 to 1.81). Conclusions There was no increased risk of dementia after self-reported pregnancy hypertensive disease in our cohort. We found that the previously reported increased risk of CVD and stroke after pregnancy hypertensive disease persists in an older population. PMID:26801467

  14. Variability in urinary phthalate metabolite levels across pregnancy and sensitive windows of exposure for the risk of preterm birth

    PubMed Central

    Ferguson, Kelly K.; McElrath, Thomas F.; Ko, Yi-An; Mukherjee, Bhramar; Meeker, John D.

    2014-01-01

    Background Preterm birth is a significant public health problem, affecting over 1 in 10 live births and contributing largely to infant mortality and morbidity. Everyday exposure to environmental chemicals such as phthalates could contribute, and may be modifiable. In the present study we examine variability in phthalate exposure across gestation and identify windows of susceptibility for the relationship with preterm birth. Methods Women were recruited early in pregnancy as part of a prospective, longitudinal birth cohort at the Brigham and Women’s Hospital in Boston, Massachusetts. Urine samples were collected at up to 4 time points during gestation for phthalate measurement, and birth outcomes were recorded at delivery. From this population we selected all 130 cases of preterm birth, defined as delivery before 37 weeks completed gestation, as well as 352 random controls. Results Urinary phthalate metabolite levels were moderately variable over pregnancy, but levels measured at multiple time points were associated with increased odds of preterm birth. Adjusted odds ratios (aOR) for spontaneous preterm birth were strongest in association with phthalate metabolite concentrations measured at the beginning of the third trimester (aOR for summed di-2-ethylhexyl phthalate metabolites [∑DEHP]=1.33, 95% confidence interval [CI]=1.02, 1.73). Odds ratios for placental preterm birth, defined as delivery with presentation of preeclampsia or intrauterine growth restriction, were slightly elevated in the first trimester for DEHP metabolites (aOR for ∑DEHP=1.33, 95% CI=0.99, 1.78). Conclusions Pregnant women with exposure to phthalates both early and late in pregnancy are at increased risk of delivering preterm, but mechanisms may differ based on etiology. PMID:24934852

  15. Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancy

    PubMed Central

    Hamama, Lydia; Rauch, Sheila A. M.; Sperlich, Mickey; Defever, Erin; Seng, Julia S.

    2010-01-01

    This paper examines the impact of elective and spontaneous abortion (EAB/SAB) on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n = 1,581). Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, pregnancy wantedness, and religiosity. Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been “a hard time” (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n=51), the rate of depression was 16.8% (n=68), and 5.4% (n=22) met criteria for both disorders. History of sexual trauma predicted appraising the experience of EAB or SAB as “a hard time”. Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. PMID:20577979

  16. Prednisone/Prednisolone and Pregnancy

    MedlinePlus

    Prednisone/Prednisolone and Pregnancy In every pregnancy, a woman starts out with a 3-5% chance of having a ... talks about whether exposure to oral prednisone or prednisolone may increase the risk for birth defects over ...

  17. Efficacy of Enhanced HIV Counseling for Risk Reduction during Pregnancy and in the Postpartum Period: A Randomized Controlled Trial

    PubMed Central

    Maman, Suzanne; Moodley, Dhayendre; McNaughton-Reyes, Heathe Luz; Groves, Allison K.; Kagee, Ashraf; Moodley, Prashini

    2014-01-01

    Introduction Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants. Methods Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n = 733) and control arms (n = 747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum. Results There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0.71–1.44) or HIV-positive participants (aRR 0.86, 95% CI 0.61–1.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59–0.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67–1.75). Discussion An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women. Trial Registration ClinicalTrials.gov NCT01683461 PMID:24824050

  18. Neuroinfectious diseases in pregnancy.

    PubMed

    Baldwin, Kelly Jo; Roos, Karen L

    2011-09-01

    Pregnancy is associated with impaired T-cell-mediated immunity putting the woman at risk for infectious diseases not typically seen in immunocompetent individuals. When maternal infection is severe, and when a primary herpesvirus infection is acquired during pregnancy, there is a risk of fetal loss, maternal death, neonatal death, or congenital abnormalities from intrauterine infection. In this review, the authors emphasize specific neurologic infectious diseases that occur in pregnancy, the safety of the antimicrobial therapy of these diseases during pregnancy, as well as the congenital and neonatal sequelae of infection. PMID:22113513

  19. Pregnancy and Skin

    PubMed Central

    Vora, Rita V.; Gupta, Rajat; Mehta, Malay J.; Chaudhari, Arvind H.; Pilani, Abhishek P.; Patel, Nidhi

    2014-01-01

    Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management. PMID:25657937

  20. Ectopic pregnancy

    MedlinePlus

    Tubal pregnancy; Cervical pregnancy; Tubal ligation-ectopic pregnancy ... In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg ...

  1. Family risk factors associated with adolescent pregnancy: study of a group of adolescent girls and their families in Ecuador.

    PubMed

    Guijarro, S; Naranjo, J; Padilla, M; Gutiérez, R; Lammers, C; Blum, R W

    1999-08-01

    This paper presents the study on the family risk factors associated with adolescent pregnancy among adolescent girls and their families in Quito, Ecuador. The study aimed to identify characteristics within the family associated with adolescent pregnancy. A total of 135 female adolescents (aged 12-19 years) and their families were separately interviewed. 47 were pregnant and attending prenatal care at an inner city hospital in Quito, and 88 were nonpregnant students from schools located within the same geographical area. Results showed that when compared to their pregnant peers, more nonpregnant adolescents lived with their biological parents (p 0.002); they showed higher school performance (p 0.001); and more values and religiosity (p 0.0001). Pregnant adolescents reported lower mother-daughter and father-daughter communication (p 0.02), lesser life satisfaction in general, and more school and economic difficulties (p 0.001). Moreover, they were less likely to find support for their problems in or outside the family (p 0.0001) and showed higher levels of depression (68.8%) and sexual abuse (14.9%). Parental education was higher in the families of nonpregnant adolescents and both parents worked to provide financial support for the family. PMID:10447044

  2. Viremia during pregnancy and risk of childhood leukemia and lymphomas in the offspring: Nested case-control study.

    PubMed

    Bzhalava, Davit; Hultin, Emilie; Arroyo Mühr, Laila Sara; Ekström, Johanna; Lehtinen, Matti; de Villiers, Ethel-Michele; Dillner, Joakim

    2016-05-01

    A possible role for infections of the pregnant mother in the development of childhood acute leukemias and lymphomas has been suggested. However, no specific infectious agent has been identified. Offspring of 74,000 mothers who had serum samples taken during pregnancy and stored in a large-scale biobank were followed up to the age of 15 years (750,000 person years) through over-generation linkages between the biobank files, the Swedish national population and cancer registers to identify incident leukemia/lymphoma cases in the offspring. First-trimester sera from mothers of 47 cases and 47 matched controls were retrieved and analyzed using next generation sequencing. Anelloviruses were the most common viruses detected, found in 37/47 cases and in 40/47 controls, respectively (OR: 0.6, 95% CI: 0.2-1.9). None of the detected viruses was associated with leukemia/lymphoma in the offspring. Viremia during pregnancy was common, but no association with leukemia/lymphoma risk in the offspring was found. PMID:26132655

  3. Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy

    PubMed Central

    Hsieh, Vivian Chia-Rong; Liu, Chin-Chen; Hsiao, Yu-Chen; Wu, Trong-Neng

    2016-01-01

    Purpose Despite links between maternal and child health status, evidence on the association between gum infection in pregnant mothers and childhood allergies is scarce. We aim to evaluate the risk of developing allergy in children born to periodontal mothers in a nationwide study. Methods We conducted a 9-year population-based, retrospective cohort study using Taiwan’s National Health Insurance database. A study cohort of 42,217 newborns born to mothers with periodontal disease during pregnancy was identified in 2001 and matched with 42,334 babies born to mothers without any infection (control) by mother’s age at delivery and baby sex. With a follow-up period from 2001 to 2010, we observed the incidence of allergic rhinitis (AR), allergic conjunctivitis (AC), and eczema in these children. Cox proportional hazards regression models were performed with premature deaths as competing risk for the estimation of allergic disease risks. Results Nine-year cumulative incidences were the highest among children born to periodontal mothers; they reached 46.8%, 24.2%, and 40.4% (vs. 39.5%, 18.3% and 34.8% in control) for AR, AC, and eczema, respectively. Our results showed moderately increased risks for the allergies in children born to periodontal mothers relative to their matched non-inflammatory control (adjusted HRs: 1.17, 95% CI: 1.15–1.20; 1.27, 1.24–1.31; 1.14, 1.12–1.17, respectively). Because the impact of food consumption and living environment cannot be considered using insurance data, we attempted to control it by adjusting for parental income and mother’s residential area. Conclusions Overall cumulative incidence and risks of children born to periodontal mothers for AR, AC, and eczema are significantly higher than those born to non-inflammatory mothers. Gum infection in women during pregnancy is an independent risk factor for allergic diseases in children, thus its intergenerational consequences should be considered in gestational care. PMID:27224053

  4. Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries

    PubMed Central

    2011-01-01

    Background Hypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries. Methods A literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data were extracted into a standardized excel sheet. Identified studies were graded based on strengths and limitations of studies. All the included studies were from developing countries. Meta-analyses were generated where data were available from more than one study for an outcome. Primary outcomes were maternal mortality, eclampsia, pre-eclampsia, and severe preeclampsia. Neonatal outcomes like neonatal mortality, preterm birth, small for gestational age and low birth weight were also evaluated. We followed standardized guidelines of Child Health Epidemiology Reference Group (CHERG) to generate estimates of effectiveness of calcium supplementation during pregnancy in reducing maternal and neonatal mortality in developing countries, for inclusion in the Lives Saved Tool (LiST). Results Data from 10 randomized controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy was associated with a significant reduction of 45% in risk of gestational hypertension [Relative risk (RR) 0.55; 95 % confidence interval (CI) 0.36-0.85] and 59% in the risk of pre-eclampsia [RR 0.41; 95 % CI 0.24-0.69] in developing countries. Calcium supplementation during pregnancy was also associated with a significant reduction in neonatal mortality

  5. Hematological Problems of Pregnancy

    PubMed Central

    Ballem, P.J.

    1988-01-01

    Hematologic complications are relatively common in pregnancy. Furthermore, many chronic hematologic disorders require special surveillance and intervention in pregnancy. In this brief review, the author discusses common nutritional anemias in pregnancy. She reviews the disorders of hemoglobin synthesis and the need for early genetic counselling and prenatal diagnosis, as well as the special requirements and problems affected patients encounter in pregnancy. An overview of the frequent causes of thrombocytopenia in pregnancy is given and an approach suggested to the management of both the mother and the fetus. An approach is also presented to the management of women at risk for thrombosis in pregnancy, a particularly vexing and controversial problem. The risks of the various forms of anticoagulation are reviewed. Finally, a brief review of obstetrical hemorrhage is presented along with some guidelines useful in its management. PMID:21253125

  6. Gynecologic malignancy in pregnancy

    PubMed Central

    Ji, Yong Il

    2013-01-01

    Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence. PMID:24328018

  7. Prevalence and Risk Factors of Maternal Anxiety in Late Pregnancy in China

    PubMed Central

    Kang, Yu-ting; Yao, Yan; Dou, Jing; Guo, Xin; Li, Shu-yue; Zhao, Cai-ning; Han, Hong-zhi; Li, Bo

    2016-01-01

    Objective: A large number of studies have shown the adverse neonatal outcomes of maternal psychological ill health. Given the potentially high prevalence of antenatal anxiety and few studies performed among Chinese people, the authors wanted to investigate the prevalence of antenatal anxiety and associated factors among pregnant women and to provide scientific basis to reduce prenatal anxiety effectively. Methods: A cross-sectional study was carried out at the Changchun Gynecology and Obstetrics Hospital from January 2015 to march 2015, with 467 participants of at least 38 weeks’ gestation enrolled. Antenatal anxiety was measured using the Self-Rating Anxiety Scale (SAS). χ2 test and logistic regression analysis were performed to evaluate the association of related factors of antenatal anxiety. Results: Among the 467 participants, the prevalence of antenatal anxiety was 20.6% (96 of 467). After adjustment for women’s socio-demographic characteristics (e.g., area, age, household income), multivariate logistical regression analysis revealed that antenatal anxiety showed significant relationship with education level lower than middle school (years ≤ 9), expected natural delivery, anemia during pregnancy, pregnancy-induced hypertension syndrome, disharmony in family relationship and life satisfaction. Conclusions: It is important to prevent or reduce antenatal anxiety from occurring by improving the health status of pregnant women and strengthening prenatal-related education and mental intervention. PMID:27153080

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

    PubMed Central

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

    2015-01-01

    Background 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. Methods and Findings 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

  9. Nurse versus community health worker identification of psychosocial risks in pregnancy through a structured interview.

    PubMed

    Godecker, Amy L; Harrison, Patricia A; Sidebottom, Abbey C

    2013-11-01

    A structured psychosocial risk screening interview, the Prenatal Risk Overview, was administered to 733 women in prenatal care. Either a community health worker (CHW) or a registered nurse (RN) conducted the interview based on day of the week. A comparison of identified risk factors found no significant differences between study samples for six of 13 domains. For CHW interviews, significantly more participants were classified as Moderate/ High Risk for Depression, Lack of Telephone Access, Food Insecurity, and Housing Instability, and as High Risk for Lack of Social Support, Lack of Transportation Access, and Housing Instability. For RN interviews, significantly more participants were classified as High Risk for Alcohol Use. Community health workers successfully conducted psychosocial screening and elicited more self-reported risk than RNs, especially lack of basic needs. Comparing the hourly salary/ wage, the cost for CHWs was 56% lower than for RNs. Preliminary findings support use of paraprofessionals for structured screening interviews. PMID:24185153

  10. Enhancement of "Reducing the Risk" for the 21st Century: Improvement to a Curriculum Developed to Prevent Teen Pregnancy and STI Transmission

    ERIC Educational Resources Information Center

    Langley, Cheri; Barbee, Anita P.; Antle, Becky; Christensen, Dana; Archuleta, Adrian; Sar, Bibhuti K.; Karam, Eli; van Zyl, Riaan; Cunningham, Michael R.; Borders, Kevin

    2015-01-01

    To ensure that "Reducing the Risk," a successful teen pregnancy prevention education curriculum, remains relevant for today's youth, covers all information youth need to know in order to make better choices, and is delivered in a standardized way, adaptations were made and enhancements were added. This article describes results of a…

  11. The Influence of Pregnancy, Sexually Transmitted Diseases, and Human Immunodeficiency Virus Perceived Susceptibility Patterns on Sexual Risk Reduction for Adolescent Females

    ERIC Educational Resources Information Center

    Kershaw, Trace S.; Ethier, Kathleen A.; Milan, Stephanie; Lewis, Jessica B.; Niccolai, Linda M.; Meade, Christina; Ickovics, Jeannette R.

    2005-01-01

    Risky sexual behavior can lead to pregnancy, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV). Our study of 300 adolescent females takes an integrative approach by incorporating these multiple outcomes to assess the influence of risk perceptions on sexual behavior by (1) identifying subgroups of perceived susceptibility…

  12. Pregnancy after cardiac transplantation.

    PubMed

    Cowan, Scott W; Davison, John M; Doria, Cataldo; Moritz, Michael J; Armenti, Vincent T

    2012-08-01

    More women are reporting pregnancy following heart transplantation. Although successful outcomes have been reported for the mother, transplanted heart, and newborn, such pregnancies should be considered high risk. Hypertension, preeclampsia, and infection should be treated. Vaginal delivery is recommended unless cesarean section is obstetrically necessary. Most outcomes are live births, and long-term follow-up of children show most are healthy and developing well. Maternal survival, independent of pregnancy-related events, should be part of prepregnancy counseling. PMID:22813369

  13. Assessing the risk of birth defects associated with exposure to fixed-dose combined antituberculous agents during pregnancy in rats.

    PubMed

    Awodele, O; Patrick, E B; Oluwatoyin Agbaje, Esther; Oremosu, A A; Gbotolorun, S C

    2012-01-01

    Due to the risks of disease progression and transmission to the newborn, treatment of tuberculosis is often pursued during pregnancy and fixed-dose combined antituberculous agents have been found to be beneficial. Unfortunately, there is paucity of data on the safety of the fixed-dose combined antituberculous drugs during pregnancy. This study intends to assess the teratogenic effect of fixed-dose combined antituberculous drugs on the organogenesis stage of fetal development and also investigate the possible roles of vitamin C in modulating the teratogenic effects of these agents on the fetus using animal model. Pregnant rats were divided into 3 groups with 12 animals per group: group 1 received distilled water (10 mL/kg) orally; group 2 received 51.4 mg/kg/day of fixed-dose combined antituberculous agents orally; group 3 received 51.4 mg/kg/day of fixed-dose combined antituberculous agents plus vitamin C (10 mg/kg/day) orally. Six rats in each group were randomly selected and sacrificed on day 20 by cervical dislocation prior to day 21 of gestation, and the foetuses were harvested through abdominal incision for physical examination. Blood samples were collected from the 1st filial rats of the remaining six animals for biochemical and hematological examination. The liver, kidney, heart, and brain of all the sacrificed animals were used for histopathological examination. There were significant (P ≤ 0.05) low birth weights of the foetuses of the animals that were treated with fixed-dose combined antituberculous agents. The haematological parameters also revealed a reduction in the platelets counts and neutrophiles at the first filial generation. Significant (P ≤ 0.05) elevations in the levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in the foetuses of the animals treated with fixed-dose combined antituberculous agents were also observed. However, the combination of vitamin C with fixed-dose combined antituberculous agents significantly

  14. The Influence of High School Dropout and School Disengagement on the Risk of School-Age Pregnancy.

    ERIC Educational Resources Information Center

    Manlove, Jennifer

    1998-01-01

    Used recent longitudinal cohort of eighth graders to examine whether measures of school engagement predicted school-age pregnancy among white, black, and Hispanic teens. Found that high student engagement was associated with postponing pregnancy. Among white and Hispanic teens, dropouts were more likely than others to have school-age pregnancies.…

  15. Maternal Continuing Folic Acid Supplementation after the First Trimester of Pregnancy Increased the Risk of Large-for-Gestational-Age Birth: A Population-Based Birth Cohort Study

    PubMed Central

    Wang, Sufang; Ge, Xing; Zhu, Beibei; Xuan, Yujie; Huang, Kun; Rutayisire, Erigene; Mao, Leijing; Huang, Sanhuan; Yan, Shuangqin; Tao, Fangbiao

    2016-01-01

    Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma’anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma’anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were <10th percentile of birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn’s gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these

  16. Maternal Continuing Folic Acid Supplementation after the First Trimester of Pregnancy Increased the Risk of Large-for-Gestational-Age Birth: A Population-Based Birth Cohort Study.

    PubMed

    Wang, Sufang; Ge, Xing; Zhu, Beibei; Xuan, Yujie; Huang, Kun; Rutayisire, Erigene; Mao, Leijing; Huang, Sanhuan; Yan, Shuangqin; Tao, Fangbiao

    2016-01-01

    Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma'anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma'anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were <10th percentile of birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn's gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these

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

    PubMed

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

    2016-07-01

    Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK's Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26-28 weeks' gestation at the Bradford Royal Infirmary (2007-2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (<37 weeks' gestation) and SGA (<10th customised centile). Results After adjustment for socio-demographic and medical factors, financial strain was associated with a 45 % increase in PTB (OR 1.45: 95 % CI 1.06-1.98). Contrary to expectation, maternal distress in Pakistani women was negatively associated with SGA (OR 0.65: CI 0.48-0.88). Obesity in White British women was protective for PTB (OR 0.67: CI 0.45-0.98). Previously recognized risk factors, such as smoking in pregnancy and hypertension, were confirmed. Conclusions This study confirms known risk factors for PTB and SGA, along with a new variable of interest, financial strain. It also reveals a difference in the risk factors between ethnicities. In order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required. PMID:26983444

  18. Maternal folate, alcohol and energy metabolism-related gene polymorphisms and the risk of recurrent pregnancy loss.

    PubMed

    Sata, F; Yamada, H; Kishi, R; Minakami, H

    2012-10-01

    Epidemiological studies have suggested that the condition of recurrent pregnancy loss (RPL) may be multifactorial, with both genetic predisposition and environmental factors potentially involved in its pathogenesis. The aim of this study is to elucidate the associations between maternal folate, alcohol and energy metabolism-related gene polymorphisms and the risk of RPL. This case-control study, which involved 116 cases with two or more instances of RPL and 306 fertile controls, was performed in the city of Sapporo, Japan. The associations between eight single nucleotide polymorphisms of folate, alcohol and energy metabolism-related genes [methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR), alcohol dehydrogenase 1B (ADH1B), aldehyde dehydrogenase 2 (ALDH2), beta-3-adrenergic receptor (ADRB3) and peroxisome proliferator-activated receptor gamma (PPARG)], and RPL were assessed. Without consideration of cigarette smoking or alcohol use, the risk of RPL significantly decreased in women with the MTHFR rs1801133 TT, MTR rs1805087 AG or ALDH2 rs671 AA genotype (P < 0.05). The risk of RPL associated with cigarette smoking and alcohol use decreased significantly in women carrying the MTHFR rs1801133 T allele [odds ratio (OR), 0.51; 95% confidence interval (CI), 0.27-0.95]. Similarly, the risk of RPL significantly decreased in women carrying the MTR rs1805087 G allele (OR, 0.44; 95% CI, 0.23-0.85). Our findings suggest that maternal gene polymorphisms related to folate metabolism may decrease the risk of RPL. Molecular epidemiological studies are needed to unequivocally elucidate the multifactorial effects of both genetic and environmental factors on human fecundity. PMID:25102261

  19. Clinical application of Medical Resonance Therapy Music in high-risk pregnancies.

    PubMed

    Sidorenko, V N

    2000-01-01

    Music is an ancient method for healing. In the year 550 B.C., Pythagoras from Greece developed a concept for the use of music in medicine, esteeming music higher than many other medical treatments. The Medical Resonance Therapy Music (MRT-Music) of the German classical composer and musicologist Peter Huebner is built on this concept of Pythagorean music medicine. Its therapeutic effect may be best explained by the natural phenomenon of resonance between the harmony laws of the microcosm of music and the biological laws of the body. Results received after application of MRT-Music indicate multiple positive effects on the organism of pregnant women both with a healthy pregnancy as with a pathologic one, reducing the rate of premature births very effectively. Furthermore, MRT-Music came out to be an effective method in the complex therapy of late gestoses and a nearly irreplaceable method for preoperative preparation of pregnant woman for caesarean section. It demonstrated a powerful anti-stress effect and allowed to reduce the amount of administered pain-killers to pregnant women by the factor 1.5 to 2.0, thus reducing the negative pharmacological load to the foetus. It furthermore reduced labour time and shortened hospital stay. It helped to create optimal conditions for the course of pregnancy and heightened pain sensitivity threshold by means of improving the functional, hormonal, and psycho-emotional conditions of pregnant and lying-in women. Thus, the labour process became more natural, the delivery non-traumatic, and motherhood more happy and safe. PMID:11286372

  20. Interrupting the Inter-Generational Cycle in High Risk Adolescent Pregnancy.

    ERIC Educational Resources Information Center

    Stirtzinger, Ruth; McDermid, Stephanie; Grusec, Joan; Bernardini, Silvia; Quinlan, Kathy; Marshall, Michelle

    2002-01-01

    Describes the creation of a parenting course for high-risk adolescent mothers. This study supports direction away from 'knowledge-only' prevention/interventions with high risk adolescents and advocates the integration of this type of mental health/education parenting course with secondary school health class curricula using selected, trained…

  1. Birth outcome and risk of neonatal hypoglycaemia following in utero exposure to pivmecillinam: a population-based cohort study with 414 exposed pregnancies.

    PubMed

    Larsen, H; Nielsen, G L; Møller, M; Ebbesen, F; Schønheyder, H C; Sørensen, H T

    2001-01-01

    Concerns have been raised as to the safety of using pivaloyl-conjugated beta-lactam antibiotics during pregnancy as they cause carnitine depletion. Restrictions have been recommended in some Scandinavian countries as drug-induced carnitine depletion could constitute a risk to the developing foetus. One of these drugs, pivmecillinam, is widely used against urinary tract infections but few data exist concerning its safety in pregnancy. In a cohort study, we compared the prevalences of congenital abnormalities, pre-term delivery, low birth weight, low Apgar score and neonatal hypoglycaemia in the offspring of 414 women who had at least 1 prescription for pivmecillinam redeemed during pregnancy with those of the offspring of 7472 pregnant women for whom no drugs were prescribed during pregnancy. The prevalence of congenital abnormalities was 1.7% among 119 infants exposed in the first trimester and 3.7% among the reference group [odds ratio (OR) 0.46; 95% confidence interval (CI) 0.11-1.86]. We found no significantly increased risks in either pre-term delivery (OR 0.91, 95% CI 0.11-1.86), low birth weight (OR 0.57, 95%, CI 0.23-1.41), low Apgar score (OR 2.32, 95% CI 0.30-18.16) or hypoglycaemia (OR 0.73, 95% CI 0.18-3.00) that were induced by carnitine depletion. No significantly increased risk in adverse birth outcome was therefore found in women treated with pivmecillinam. PMID:11450863

  2. A Prospective Study of Pre-pregnancy Serum Concentrations of Perfluorochemicals and the Risk of Gestational Diabetes

    PubMed Central

    Zhang, Cuilin; Sundaram, Rajeshwari; Maisog, José; Calafat, Antonia M.; Barr, Dana Boyd; Buck Louis, Germaine M.

    2014-01-01

    OBJECTIVE To examine preconception serum concentrations of perfluorooctanoic acid (PFOA) and six other PFCs in relation to gestational diabetes (GDM) risk. DESIGN Prospective cohort with longitudinal follow-up. SETTING 16 counties in Michigan and Texas, 2005-2009. PATIENT(S) Among 501 women recruited upon discontinuing contraception for purposes of becoming pregnant, 258 (51%) became pregnant and were eligible for the study of which 28 (11%) women reported having physician-diagnosed GDM during followup. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The odds ratios (ORs) and 95% confidence intervals (CIs) of GDM associated with each standard deviation (SD) increment of preconception serum PFOA concentrations (ng/mL, log-transformed) and six other PFCs were estimated using logistic regression after adjusting for age, pre-pregnancy body mass index, smoking, and parity conditional on gravidity. RESULT(S) Preconception geometric mean (95% CI) PFOA concentrations (in ng/ml) were higher for women with than without GDM (3.94 (3.15-4.93) vs. 3.07 (2.83-3.12), respectively). Each SD increment in PFOA was associated with a 1.87 fold increased GDM risk (adjusted OR (95% CI): 1.86 (1.14, 3.02)). A slightly increased risk associated with each SD increment for the six other PFCs was observed as well (all ORs >1.0; range 1.06-1.27), although the associations were not statistically significant. CONCLUSIONS Our findings suggested that higher environmentally relevant concentrations of PFOA were significantly associated with an increased GDM risk. If corroborated, these findings may be suggestive of a possible environmental etiology for GDM. PMID:25450302

  3. The legal aspects of the termination of unwanted pregnancies and the risks faced by the medical doctor: a UK perspective.

    PubMed

    Gibson, C

    2003-03-01

    Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence. PMID:14556349

  4. PREGNANCY NUTRITION SURVEILLANCE SYSTEM (PNSS)

    EPA Science Inventory

    The Pregnancy Nutrition Surveillance System (PNSS) is a program based surveillance system developed in order to assist health professionals in achieving of the goals of identifying and reducing pregnancy-related health risks that contribute to adverse pregnancy outcomes. Its purp...

  5. Maternal dietary intake of folate and vitamins B6 and B12 during pregnancy and risk of childhood brain tumors.

    PubMed

    Greenop, Kathryn R; Miller, Margaret; de Klerk, Nicholas H; Scott, Rodney J; Attia, John; Ashton, Lesley J; Dalla-Pozza, Luciano; Bower, Carol; Armstrong, Bruce K; Milne, Elizabeth

    2014-01-01

    Childhood brain tumors (CBT) are the second most common childhood cancers, yet their etiology is largely unknown. We investigated whether maternal gestational intake of folate and vitamins B6 and B12 was associated with CBT risk in a nationwide case-control study conducted 2005-2010. Case children 0-14 years were recruited from all 10 Australian pediatric oncology centers. Control children were recruited by national random digit dialing, frequency matched to cases on age, sex, and state of residence. Dietary intake was ascertained using food frequency questionnaires and adjusted for total energy intake. Data from 293 case and 726 control mothers were analyzed using unconditional logistic regression. The odds ratio (OR) for the highest versus lowest tertile of folate intake was 0.70 [95% confidence interval (CI): 0.48, 1.02]. The ORs appeared lower in mothers who drank alcohol during pregnancy (OR = 0.45, 95% CI: 0.22, 0.93), mothers who took folic acid (OR = 0.67, 95% CI: 0.42, 1.06) or B6/B12 supplements (OR = 0.51, 95% CI: 0.25, 1.06) and in children younger than 5 years (OR = 0.50, 95% CI: 0.27, 0.93). These findings are consistent with folate's crucial role in maintenance of genomic integrity and DNA methylation. Dietary intake of B6 and B12 was not associated with risk of CBT. PMID:24897174

  6. Association between World Health Organization categories of body mass index and relative risks for weight-related pregnancy outcomes: a retrospective cohort study

    PubMed Central

    Zaballa, Katrina; Liu, Anthony; Peek, Michael John; Mongelli, Max; Nanan, Ralph

    2012-01-01

    Objective To analyse the dose-dependent effect of body mass index (BMI) categories for common pregnancy outcomes. Methods A retrospective cohort study of all deliveries that occurred between 1 January 2005 and 31 December 2009 in a tertiary maternity centre, in Sydney Australia. Common pregnancy outcomes were analysed against World Health Organization (WHO) BMI categories using multiple logistic regression analysis. Results From a total of 18,304 pregnancies, 9087 singleton pregnancies with complete data-sets were identified. Of these pregnancies, 4000 (44%) had a normal BMI, 470 (5.2%) were underweight, 2293 (25.2%) were overweight, 1316 (14.5%) were obese class I, 630 (6.9%) were obese class II and 378 (4.2%) were obese class III. Using the normal BMI category as the reference, there was a clear dose effect of BMI categories for hypertension (P < 0.001), pre-eclampsia (P < 0.001), caesarean section (P < 0.001), macrosomia (P < 0.001), large for gestational age (P < 0.001), small for gestational age (P < 0.001) and neonatal respiratory distress (P = 0.039). In contrast, despite a significant association with BMI (P < 0.001), a dose-dependent effect was not found for gestational diabetes. Conclusion The results of our study have important clinical significance as the data, using WHO BMI categories, more accurately help stratify risk assessment in a clinically relevant dose-dependent relationship.

  7. Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension: A nationwide population-based retrospective cohort study.

    PubMed

    Lin, Li-Te; Wang, Peng-Hui; Tsui, Kuan-Hao; Cheng, Jiin-Tsuey; Cheng, Jin-Shiung; Huang, Wei-Chun; Tang, Pei-Ling; Hu, Li-Yu

    2016-07-01

    Dysregulation of the immune system plays a role in the pathogenesis of both, pregnancy-induced hypertension (PIH) and systemic lupus erythematosus (SLE). It is well known that SLE predisposes to be complicated with PIH. However, few studies have attempted to investigate whether PIH increased subsequent SLE risk.The objectives of this study were to assess the association between PIH and subsequent SLE risk and identify predictive risk factors.Patients with newly diagnosed PIH were selected from the Taiwan National Health Insurance Research Database (NHIRD) and compared with a matched cohort without PIH based on age and the year of delivery. The incidence of new-onset SLE was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013.Among the 23.3 million individuals registered in the NHIRD, 29,091 patients with PIH and 116,364 matched controls were identified. The incidence of SLE was higher among patients with PIH than in the matched controls (incidence rate ratio [IRR] = 4.02, 95% confidence interval [CI] 3.98-4.05, P < 0.0001). The IRR for subsequent SLE development remained significantly higher in all stratifications during the follow-up years. The multivariate Cox regression model was performed and the results showed that PIH may be an independent risk factors for the development of subsequent SLE (hazard ratio [HR] = 2.87, 95% CI 2.07-3.98, P < 0.0001). Moreover, multivariate Cox regression model was used again among the PIH cohort only in order to identify the possible risk factors for subsequent SLE in the population with PIH.Patients with PIH may have higher risk of developing newly diagnosed SLE than those without PIH. In addition, among individuals who have experienced PIH, those younger than 30 years, having experienced preeclampsia/eclampsia, single parity, preterm birth, or chronic kidney disease, may display an increased subsequent risk of SLE. PMID:27472738

  8. Fish Oil Supplementation does not Reduce Risks of Gestational Diabetes Mellitus, Pregnancy-Induced Hypertension, or Pre-Eclampsia: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Chen, Bing; Ji, Xinran; Zhang, Lei; Hou, Zhaohui; Li, Chundong; Tong, Ying

    2015-01-01

    Background The effects of gestational supplementation with fish oil on risks for gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), and pre-eclampsia (PE) have not been confirmed. In this study, a meta-analysis was performed to evaluate the effect of fish oil supplementation on these gestational complications. Material/Methods Randomized controlled human trials that investigated the effects of fish oil supplementation in pregnant women were identified by a systematic search of Medline, Embase, and Cochrane’s Library, and references of related reviews and studies up to December 2014. Relative risks (RRs) for GDM, PIH, and PE were the outcomes of interest. Fixed-effects or random-effects models were applied according to the heterogeneity. Results Thirteen comparisons from 11 published articles, including more than 5000 participants, were included. The results showed that fish oil supplementation was not associated with reduced risks for GDM (RR=1.06, 95% confidence interval [CI]: 0.85–1.32, p=0.60), PIH (RR=1.03, 95% CI: 0.89–1.20, p=0.66), or PE (RR=0.93, 95% CI: 0.74–1.16, p=0.51). No statistically significant heterogeneity was detected for the comparison of each outcome. The effects of fish oil on these gestational complications were consistent between women with low-risk and high-risk pregnancies. Conclusions Gestational supplementation with fish oil during the second or third trimester of pregnancy is not associated with reduced risks for GDM, PIH, or PE. Other possible benefits of fish oil supplementation during pregnancy warrant further evaluation. PMID:26256041

  9. Use of selective serotonin reuptake inhibitor antidepressants in pregnancy does carry risks, but the risks are small.

    PubMed

    Casper, Regina C

    2015-03-01

    The paper by Robinson posits that risks from prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants are not different from the risks encountered in the general population and that untoward effects of SSRIs are difficult to distinguish from those of the mood disorder. Indeed, maternal depression and anxiety can have negative consequences for fetal and postnatal development. Fortunately, experimental evidence suggests that mood and anxiety disorder symptoms often respond to psychosocial interventions. If pharmacotherapy becomes necessary, it is, however, important to know that even if SSRI drugs have been shown to be safe overall, research has shown that fetal development can be adversely affected by in utero exposure to SSRIs in a subgroup of neonates. Examples would be the transient neonatal adaptation syndrome, an increased risk of persistent pulmonary hypertension of the newborn, and small, albeit measurable, changes in motor and social adaptability in infancy and childhood. PMID:25714254

  10. Exercise in Pregnancy: Guidelines.

    PubMed

    Artal, Raul

    2016-09-01

    In recent years it has been recognized that in all phases of life, including pregnancy, physical activity promotes health benefits and precludes comorbidities, the scientific evidence is indisputable. Several organizations around the world have updated in recent years the guidelines and recommendations for exercise in pregnancy. The December 2015, updated guidelines of the American College of Obstetricians and Gynecologists emphasize that physical activity in pregnancy has minimal risk. Although recommending exercise in pregnancy, the anatomic/physiological changes, absolute and relative contraindications should be considered. Women who exercised regularly before pregnancy, in the absence of contraindications, can continue and engage in moderate to strenuous activities, although information on strenuous activities in pregnancy is still limited. This review summarizes the most recent published and recommended guidelines. PMID:27398880

  11. [Cardiovascular disease in pregnancy].

    PubMed

    Hilfiker-Kleiner, Denise; Bauersachs, Johann

    2016-01-01

    Cardiovascular diseases are among the most frequent complications in pregnancies. Among them preexisting heart diseases including congenital heart disease, genetic cardiomyopathies, myocardial infarction and chemotherapy-induced cardiomyopathies display a special challenge for the mother and her physicians. Moreover, the incidence of cardiovascular disease induced by or associated with pregnancy, i.e. hypertensive disorders and peripartum cardiomyopathies, has increased over the past decades. In the present overview we explain why pregnancy is a stress model for the maternal heart and summarize the current knowledge on the influence of pregnancy on preexisting cardiomyopathies. We highlight recent advances in research with regard to hypertensive complications in pregnancy and peripartum cardiomyopathy (PPCM). Moreover, we summarize etiologies, risk factors, pathomechanisms, diagnosis, treatment, management and prognosis. Finally, interdisciplinarity between different clinical fields and basic science is a key requirement to avoid longterm damage to the cardiovascular system induced by pregnancy associated impacts and with this improve women's health in general. PMID:26800071

  12. Sleep disorders in pregnancy

    PubMed Central

    Bourjeily, Ghada

    2009-01-01

    Sleep complaints are a common occurrence in pregnancy that are in part due to pregnancy-associated anatomic and physiological changes but may also be due to pathological causes. In the non-pregnant population, sleep deprivation has been associated with physical and cognitive issues; poor sleep may even be associated with adverse maternal outcomes. Maternal obesity, one of the most prevalent risk factors in obstetric practices, together with physiologic changes of pregnancy predispose to the development of sleep disordered breathing. Symptoms of sleep disordered breathing have also been associated with poor maternal outcomes. Management options of restless legs syndrome and narcolepsy pose a challenge in pregnancy; benefits of therapy need to be weighed against the potential harm to the fetus. This article briefly reviews the normal changes in pregnancy affecting sleep, gives an overview of certain sleep disorders occurring in pregnancy, and suggests management options specific for this population.

  13. Malaria in pregnancy in rural Gabon: a cross-sectional survey on the impact of seasonality in high-risk groups

    PubMed Central

    2013-01-01

    Background Malaria remains one of the most important infectious diseases in pregnancy in sub-Saharan Africa. Whereas seasonal malaria chemoprevention is advocated as public health intervention for children in certain areas of highly seasonal malaria transmission, the impact of seasonality on malaria in pregnancy has not yet been investigated for stable, hyper-endemic transmission settings of Equatorial Africa. The aim of this study was to investigate the influence of seasonality on the prevalence of malaria in pregnancy in Gabon. Methods The study was conducted at a rural district hospital in Gabon between January 2008 and December 2011. At first antenatal care visits demographic data, parity, age, and gestational age of pregnant women were documented and thick blood smears were performed for the diagnosis of malaria. Seasonality and established risk factors were evaluated in univariate and multivariate analysis for their association with Plasmodium falciparum infection. Results 1,661 pregnant women were enrolled in this study. Participants presenting during high transmission seasons were at significantly higher risk for P. falciparum infection compared to low transmission seasons (adjusted odds ratio [AOR] 1.91, 95% confidence interval [CI] 1.39-2.63, p < 0.001). Established risk factors including parity (AOR 0.45, CI 0.30-0.69, p < 0.001 for multipara versus paucipara) and age (AOR, CI and p-value for women aged 13–17, 18–22, 23–27 and ≥28 years, respectively: AOR 0.59, CI 0.40-0.88; AOR 0.57, CI 0.34-0.97; AOR 0.51, CI 0.29-0.91) were significant risk factors for P. falciparum infection. High-risk groups including nulli- and primipara and younger women aged 13–17 years showed a disproportionately increased risk for malaria in high transmission seasons from 17% to 64% prevalence in low and high transmission periods, respectively. Conclusion Seasonal variations lead to important differences in the risk for P. falciparum infection in pregnancy

  14. Perinatal mortality in rural India with special reference to high risk pregnancies.

    PubMed

    Misra, P K; Thakur, S; Kumar, A; Tandon, S

    1993-02-01

    One-thousand-and-sixty-five pregnant mothers among a rural population of 30,000 in Uttar Pradesh were followed for 1 year. A still birth rate of 26.1 and perinatal mortality rate of 121.1 per thousand births were registered. Early neonatal mortality rate was found to be 97.4 per thousand live births. Twenty per cent of the women were identified with high risk factors. Inadequate or no antenatal care, bad obstetric history, and prolonged labour attributed to 13, 20, and 27 per cent of the risk, respectively, with a respective relative risk of 2.23, 3.1, and 4.09 times. These three factors were found to be the major and significant contributors to high perinatal mortality amongst the 'high risk' group. Selective extension of comprehensive M.C.H. Care to this group using the high risk approach is expected to lower perinatal mortality in rural community where M.C.H. services are far from optimum. PMID:8445688

  15. "The More the Better" Paradox of Antenatal Ultrasound Examinations in Low-Risk Pregnancy.

    PubMed

    Chiossi, Giuseppe; Palomba, Stefano; Balduzzi, Sara; Costantine, Maged M; Falbo, Angela I; La Sala, Giovanni B

    2016-06-01

    Objective To investigate whether different antenatal care models could account for differences in operative delivery rates and adverse neonatal outcomes among low-risk pregnant women, and to identify independent variables associated with delivery modes and adverse neonatal outcomes. Study design Retrospective cohort from a single center of singleton, term, live births between January 2012 and June 2014. Rates of cesarean deliveries, operative vaginal deliveries, and neonatal morbidities were analyzed among women followed by private obstetrician-gynecologists versus national health system providers (certified nurse midwifes supervised by obstetrician-gynecologists), and adjusted for potential confounders. Results Among the 2,831 women in our cohort, obstetric and neonatal outcomes were independent of obstetric providers. After we controlled for confounders, private patients having more than four antenatal ultrasound examinations were more likely to undergo cesarean delivery than public patients with four or fewer sonographic assessments (five to eight prenatal scans: relative risk ratio, 3.3; 95% confidence interval [CI] 1.4-8; nine or more prenatal scans: relative risk ratio, 4.1; 95% CI 1.2-14). Conclusions Multiple prenatal ultrasound examinations in low-risk obstetric populations appear to be an independent and potentially modifiable risk factor for cesarean deliveries. PMID:26862726

  16. [Inflammatory bowel disease and pregnancy].

    PubMed

    Parfenov, A I

    2012-01-01

    Inflammatory bowel disease (IBD) in pregnant women in their characteristics do not differ from general population, unless they had operations on the pelvic organs. Women with a first pregnancy, regardless of the activity of IBD have an increased risk of adverse pregnancy and high risk births. Most treatment methods are compatible with pregnancy and breastfeeding. Women affected by IBD should discuss their plans for pregnancy with the doctor first in order to know the possible dangers. Every patient in the IBD during pregnancy must be observed by a gastroenterologist, accoucheur and pediatrician to ensure peace of mother and child. PMID:22830229

  17. Stroke in pregnancy.

    PubMed

    Feske, Steven K

    2007-11-01

    Although pregnancy-associated stroke is uncommon, the risk of stroke is greatly increased above the low baseline rate in young patients during late pregnancy and, even more so, during the puerperium. Stroke is a major contributor to the serious morbidity and mortality of pregnancy. The physiological hormonally mediated changes in circulation, vascular tissue structure, and coagulability, and the pathological state of pre-eclampsia-eclampsia contribute to this increased risk of stroke. Pregnancy-associated strokes are roughly evenly divided among hemorrhagic strokes, mainly from rupture of aneurysms and arteriovenous malformations (AVMs); ischemic strokes, mainly from late pregnancy and postpartum cerebral venous thrombosis; and strokes associated with pre-eclampsia-eclampsia, with a contribution from cardioembolism, especially in populations at risk from a high rate of underlying rheumatic valvular heart disease. Awareness of the types of stroke to expect during pregnancy will facilitate early diagnosis. This article discusses the pathogenesis of pregnancy-associated stroke, its epidemiology, and some diagnostic and therapeutic issues unique to pregnancy. PMID:17940923

  18. Sleep disordered breathing in pregnancy

    PubMed Central

    2015-01-01

    Key points Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses. Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy. SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy. Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations. There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. Educational aims To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population. To inform readers about risk factors for SDB in pregnancy. To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes. To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. 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

  19. Exercise during Pregnancy

    MedlinePlus

    ... or more) with risk factors for preterm labor • Placenta previa after 26 weeks of pregnancy • Preterm labor ... A gas that is necessary to sustain life. Placenta Previa: A condition in which the placenta lies ...

  20. Microangiopathy and pregnancy.

    PubMed

    Azzoug, Said; Chentli, Farida

    2016-09-01

    Diabetic microangiopathy is a frequent complication of longstanding diabetes mellitus. Micro vascular lesions may have severe implications for both maternal and foetal health. Patients with advanced underlying lesions are at increased risk of progression during pregnancy. Severe retinal lesions can progress during pregnancy and one year after delivery. Poor glycaemic control prior to conception and rapid improvement during pregnancy are other risk factors of progression. Treatment of lesions with high risk of progression and progressive blood glucose lowering in the preconception period can improve the prognosis. Diabetic nephropathy predisposes to preeclampsia, premature delivery, intrauterine growth retardation and perinatal mortality. Patients with elevated creatinine levels are at increased risk of permanent impairment of kidney function. These patients should be closely monitored and their blood pressure tightly controlled. Gastroparesis may be aggravated by pregnancy hyper emesis. Autonomic neuropathy may result in erratic maternal glucose control, foetus growth retardation and foetal loss. PMID:27582154

  1. Docusate Sodium and Pregnancy

    MedlinePlus

    ... live chat Live Help Fact Sheets Share Docusate Sodium Friday, 01 April 2016 In every pregnancy, a ... This sheet talks about whether exposure to docusate sodium may increase the risk for birth defects over ...

  2. Ectopic Pregnancy

    MedlinePlus

    ... and how far into the pregnancy she is: Methotrexate Methotrexate is a medicine that stops an ectopic pregnancy ... of ectopic pregnancies can be successfully treated with methotrexate if detected early enough. The rest will require ...

  3. Pregnancy test

    MedlinePlus

    HCG level rises rapidly during the first trimester of pregnancy and then slightly declines. ... hours in the beginning of a pregnancy. HCG level that does not rise appropriately may indicate a problem with your pregnancy. ...

  4. Prenatal diagnosis of Sanfilippo A syndrome: experience in 35 pregnancies at risk and the use of a new fluorogenic substrate for the heparin sulphamidase assay.

    PubMed

    Kleijer, W J; Karpova, E A; Geilen, G C; Keulemans, J L; Huijmans, J G; Tsvetkova, I V; Voznyi YaV; van Diggelen, O P

    1996-09-01

    We have investigated the use of a 4-methylumbelliferone (MU)-derived artificial substrate, MU-alpha-D-N-sulphoglucosaminide, for the sulphamidase assay in chorionic villi and amniotic fluid cells. In the new two-step enzyme assay, fluorescent MU is released by the successive action of endogenous sulphamidase and an added yeast enzyme preparation which hydrolyses the MU-alpha-glucosaminide intermediate. Optimal conditions for a sensitive, accurate, and convenient procedure for use in the prenatal diagnosis of Sanfilippo A syndrome are described. Previously, prenatal diagnosis of Sanfilippo A syndrome has been achieved by a radioactive sulphamidase assay in chorionic villi or in cultured amniocytes and by two-dimensional electrophoresis of glycosaminoglycans in amniotic fluid. Our experience using these methods in 35 pregnancies at risk is reported. The feasibility of the new fluorogenic assay was evaluated by retrospective testing of stored homogenates of chorionic villi and amniotic fluid cells from 22 pregnancies at risk. Unequivocal assignment of the fetal status in five affected pregnancies and 17 pregnancies with a normal outcome confirms the reliability of the new sulphamidase assay, which is in every respect more convenient than the conventional method using 35S-radiolabelled heparin. PMID:8905897

  5. Risk of Preterm or Small-for-Gestational-Age Birth After Influenza Vaccination During Pregnancy: Caveats When Conducting Retrospective Observational Studies.

    PubMed

    Vazquez-Benitez, Gabriela; Kharbanda, Elyse O; Naleway, Allison L; Lipkind, Heather; Sukumaran, Lakshmi; McCarthy, Natalie L; Omer, Saad B; Qian, Lei; Xu, Stanley; Jackson, Michael L; Vijayadev, Vinutha; Klein, Nicola P; Nordin, James D

    2016-08-01

    Vaccines are increasingly targeted toward women of reproductive age, and vaccines to prevent influenza and pertussis are recommended during pregnancy. Prelicensure clinical trials typically have not included pregnant women, and when they are included, trials cannot detect rare events. Thus, postmarketing vaccine safety assessments are necessary. However, analysis of observational data requires detailed assessment of potential biases. Using data from 8 Vaccine Safety Datalink sites in the United States, we analyzed the association of monovalent H1N1 influenza vaccine (MIV) during pregnancy with preterm birth (<37 weeks) and small-for-gestational-age birth (birth weight < 10th percentile). The cohort included 46,549 pregnancies during 2009-2010 (40% of participants received the MIV). We found potential biases in the vaccine-birth outcome association that might occur due to variable access to vaccines, the time-dependent nature of exposure to vaccination within pregnancy (immortal time bias), and confounding from baseline differences between vaccinated and unvaccinated women. We found a strong protective effect of vaccination on preterm birth (relative risk = 0.79, 95% confidence interval: 0.74, 0.85) when we ignored potential biases and no effect when accounted for them (relative risk = 0.91; 95% confidence interval: 0.83, 1.0). In contrast, we found no important biases in the association of MIV with small-for-gestational-age birth. Investigators conducting studies to evaluate birth outcomes after maternal vaccination should use statistical approaches to minimize potential biases. PMID:27449414

  6. An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anaemia and perinatal mortality in Burkina Faso

    PubMed Central

    2012-01-01

    Background A prospective study aiming at assessing the effect of adding a third dose sulphadoxine-pyrimethamine (SP) to the standard two-dose intermittent preventive treatment for pregnant women was carried out in Hounde, Burkina Faso, between March 2006 and July 2008. Pregnant women were identified as earlier as possible during pregnancy through a network of home visitors, referred to the health facilities for inclusion and followed up until delivery. Methods Study participants were enrolled at antenatal care (ANC) visits and randomized to receive either two or three doses of SP at the appropriate time. Women were visited daily and a blood slide was collected when there was fever (body temperature > 37.5°C) or history of fever. Women were encouraged to attend ANC and deliver in the health centre, where the new-born was examined and weighed. The timing and frequency of malaria infection was analysed in relation to the risk of low birth weight, maternal anaemia and perinatal mortality. Results Data on birth weight and haemoglobin were available for 1,034 women. The incidence of malaria infections was significantly lower in women having received three instead of two doses of SP. Occurrence of first malaria infection during the first or second trimester was associated with a higher risk of low birth weight: incidence rate ratios of 3.56 (p < 0.001) and 1.72 (p = 0.034), respectively. After adjusting for possible confounding factors, the risk remained significantly higher for the infection in the first trimester of pregnancy (adjusted incidence rate ratio = 2.07, p = 0.002). The risk of maternal anaemia and perinatal mortality was not associated with the timing of first malaria infection. Conclusion Malaria infection during first trimester of pregnancy is associated to a higher risk of low birth weight. Women should be encouraged to use long-lasting insecticidal nets before and throughout their pregnancy. PMID:22433778

  7. Inhaled Corticosteroids Use Is Not Associated With an Increased Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus: Two Nested Case-Control Studies.

    PubMed

    Lee, Chang-Hoon; Kim, Jimin; Jang, Eun Jin; Lee, Joon-Ho; Kim, Yun Jung; Choi, Seongmi; Kim, Deog Kyeom; Yim, Jae-Joon; Yoon, Ho Il

    2016-05-01

    There have been concerns that systemic corticosteroid use is associated with pregnancy-induced hypertension (PIH) and diabetes mellitus. However, the relationship between inhaled corticosteroids (ICSs) and the risk of PIH has not been fully examined, and there was no study investigating the association between ICS use and the development of gestational diabetes mellitus (GDM). The aims of the study are to determine whether the use of ICSs during pregnancy increases the risk of PIH and GDM in women.We conducted 2 nested case-control studies utilizing the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea), in which 1,306,281 pregnant women who delivered between January 1, 2009 and December 31, 2011 were included. Among them, PIH cases and GDM cases were identified and matched controls were included. Conditional logistic regression analyses adjusted by other concomitant drugs use during and before pregnancy and confounding covariates including comorbidities were performed.Total 43,908 PIH cases and 219,534 controls, and 34,190 GDM cases and 170,934 control subjects were identified. When other concomitant drugs use during pregnancy was adjusted, ICS use was associated with an increased rate of PIH (adjusted odds ratio, 1.40 [95% CI, 1.05-1.87]). ICS medication possession ratios and cumulative doses were associated with an increased risk of PIH. However, the statistical significance was not found in other models. In both unadjusted and adjusted multivariable models, ICSs use was not associated with increase in the risk of GDM.ICSs use is not associated with an increased risk of PIH and GDM. PMID:27258493

  8. Maternal Adjustment and Infant Outcome in Medically Defined High-Risk Pregnancy.

    ERIC Educational Resources Information Center

    Levy-Shiff, Rachel; Lerman, Maya; Har-Even, Dov; Hod, Moshe

    2002-01-01

    Explored relation of biological and psychosocial risk factors to infant development among pregnant women who had pregestational diabetes, gestational diabetes, or were nondiabetic. Found that infants of diabetic mothers scored lower on the Bayley Scales at 1 year and revealed fewer positive and more negative behaviors than infants of nondiabetic…

  9. Measurement and Associations of Pregnancy Risk Factors with Genetic Influences, Postnatal Environmental Influences, and Toddler Behavior

    ERIC Educational Resources Information Center

    Marceau, Kristine; Hajal, Nastassia; Leve, Leslie D.; Reiss, David; Shaw, Daniel S.; Ganiban, Jody M.; Mayes, Linda C.; Neiderhiser, Jenae M.

    2013-01-01

    This study demonstrates the unique contributions of perinatal risk and genetic and environmental influences on child behavior using data from 561 domestic US adoption triads (birth mothers, adopted child, and adoptive parents). Findings show distinct patterns of associations among genetic (birth mother psychopathology), prenatal (six maternal…

  10. Strategies for Managing the Dual Risk of Sexually Transmitted Infections and Unintended Pregnancy Among Puerto Rican and African American Young Adults

    PubMed Central

    Hock-Long, Linda; Kraft, Joan Marie; Henry-Moss, Dare; Hatfield-Timajchy, Kendra; Singer, Merrill

    2012-01-01

    Although young adults in the United States are at increased risk for sexually transmitted infections (STIs) and unintended pregnancy, they do not report high rates of dual-method use (condoms plus other contraception) for prevention. We used prospective qualitative data from 69 urban Puerto Rican and African American individuals aged 18 to 25 years to determine how they managed these risks in their heterosexual relationships during a 4- to 8-week period. Hormonal or long-acting contraceptive use, condoms, and withdrawal were the most common unintended pregnancy prevention strategies; condoms, STI testing, and perceived fidelity were dominant among STI prevention strategies. We need to shift the focus from dual-method use toward a broader concept of dual protection to be more responsive to young adults’ concerns, perceptions, and priorities. PMID:22390507

  11. A case-control study to examine the association between breastfeeding during late pregnancy and risk of a small-for-gestational-age birth in Lima, Peru.

    PubMed

    Pareja, Rossina G; Marquis, Grace S; Penny, Mary E; Dixon, Philip M

    2015-04-01

    Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥ 28 weeks) and the risk of having a small-for-gestational-age (SGA) newborn, using a matched case-control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non-SGA controls: 50th percentile risk of SGA were assessed by their adjusted odds ratios (aOR) from conditional logistic regression. Exposure to an overlap of breastfeeding during late pregnancy was not associated with an increased risk of having a SGA newborn [aOR=0.58, 95% confidence interval (CI): 0.10-3.30]. However, increased risk was associated with having a previous low-birthweight birth (aOR=6.53; 95% CI: 1.43-29.70) and a low intake of animal source foods (<25th percentile; aOR=2.26; 95% CI: 1.01-5.04), and tended to be associated with being short (<150 cm; aOR=2.05; 95% CI: 0.92-4.54). This study found no evidence to support the hypothesis that breastfeeding during late pregnancy increases the risk for SGA; however, studies with greater statistical power are needed to definitively examine this possible association and clarify whether there are other risks to the new baby, the toddler and the pregnant woman. PMID:23020780

  12. Influence of Perinatal Depression on Labor-Associated Fear and Emotional Attachment to the Child in High-Risk Pregnancies and the First Days After Delivery

    PubMed Central

    Koss, Joanna; Bidzan, Mariola; Smutek, Jerzy; Bidzan, Leszek

    2016-01-01

    Background The aim of this study was to analyze the influence of the level of perinatal depression on the labor-associated fear and emotional attachment of children born to women during high-risk pregnancies and in the first days after delivery. Material/Methods 133 women aged between 16 and 45 years took part in the study. The first group included 63 pregnant women (mean age=28.59, SD=5.578) with a high-risk pregnancy (of maternal origin, for example, cardiologic disorders and diabetes). The second group included 70 women (mean age=27.94, SD=5.164) who were in the first days post-partum. Research methods included: Analysis of medical documentation; Clinical interview; the Edinburgh Postnatal Depression Scale (EPDS); the Questionnaire of Labor-Associated Anxiety (KLP), the Maternal-Fetal Attachment Scale (MFAS). Results Women after delivery displayed a higher level of concern for the child’s health and life when compared to the high-risk pregnancy group. The results indicated the appearance of a postnatal fear, the level of which is connected with the perception of the role of the mother. This fear is lower in women prior to childbirth than it is after. There has also been noted a statistically significant relationship between the appearance of depression and attachment to the child. Those women with depression show less attachment to their child than is the case for those who do not suffer from depression. Conclusions The appearance of a high level of depression amongst women from the high-risk pregnancy group during the first days post childbirth was accompanied by perinatal depression and a weaker attachment to the child. PMID:27023735

  13. Malaria Risk Factors in Women on Intermittent Preventive Treatment at Delivery and Their Effects on Pregnancy Outcome in Sanaga-Maritime, Cameroon

    PubMed Central

    Tonga, Calvin; Kimbi, Helen Kuokuo; Anchang-Kimbi, Judith Kuoh; Nyabeyeu, Hervé Nyabeyeu; Bissemou, Zacharie Bissemou; Lehman, Léopold G.

    2013-01-01

    Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP) used for intermittent preventive treatment (IPT) is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPTp-SP) at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively). Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001). Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007). Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPTp-SP (p<0.0001 and p = 0.018 respectively). Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome. PMID:23762446

  14. Influence of Perinatal Depression on Labor-Associated Fear and Emotional Attachment to the Child in High-Risk Pregnancies and the First Days After Delivery.

    PubMed

    Koss, Joanna; Bidzan, Mariola; Smutek, Jerzy; Bidzan, Leszek

    2016-01-01

    BACKGROUND The aim of this study was to analyze the influence of the level of perinatal depression on the labor-associated fear and emotional attachment of children born to women during high-risk pregnancies and in the first days after delivery. MATERIAL AND METHODS 133 women aged between 16 and 45 years took part in the study. The first group included 63 pregnant women (mean age=28.59, SD=5.578) with a high-risk pregnancy (of maternal origin, for example, cardiologic disorders and diabetes). The second group included 70 women (mean age=27.94, SD=5.164) who were in the first days post-partum. Research methods included: Analysis of medical documentation; Clinical interview; the Edinburgh Postnatal Depression Scale (EPDS); the Questionnaire of Labor-Associated Anxiety (KLP), the Maternal-Fetal Attachment Scale (MFAS). RESULTS Women after delivery displayed a higher level of concern for the child's health and life when compared to the high-risk pregnancy group. The results indicated the appearance of a postnatal fear, the level of which is connected with the perception of the role of the mother. This fear is lower in women prior to childbirth than it is after. There has also been noted a statistically significant relationship between the appearance of depression and attachment to the child. Those women with depression show less attachment to their child than is the case for those who do not suffer from depression. CONCLUSIONS The appearance of a high level of depression amongst women from the high-risk pregnancy group during the first days post childbirth was accompanied by perinatal depression and a weaker attachment to the child. PMID:27023735

  15. Primary aldosteronism and pregnancy.

    PubMed

    Landau, Ester; Amar, Laurence

    2016-06-01

    Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases. PMID:27156905

  16. Cardiac arrhythmias in pregnancy.

    PubMed

    Knotts, Robert J; Garan, Hasan

    2014-08-01

    As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias. PMID:25037518

  17. Methylenetetrahydrofolate Reductase C677T Polymorphism and Recurrent Pregnancy Loss Risk in Asian Population: A Meta-analysis.

    PubMed

    Rai, Vandana

    2016-10-01

    The C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene was implicated to be associated with thrombophilia due to its role in catalyzing the formation of 5-methylenetetrahydrofolate, a co-substrate for the conversion of homocysteine to methionine. Several case-control studies were investigated MTHFR C677T polymorphism as risk for recurrent pregnancy loss (RPL). These studies rendered contradictory results, some indicating that the polymorphism is associated with the risk of RPL whereas others concluded there is no association. To shed light on these inconclusive findings, a meta-analysis of all available studies published from Asian population relating the C677T polymorphism to the risk of RPL was conducted. The following electronic databases were searched without language restrictions: PubMed, Google Scholars, Elsevier and Springer Link up to December, 2015. Meta-analysis was performed using MetaAnalyst and Mix version 1.7. Meta-analysis results suggested that MTHFR C677T polymorphism contributed to the increased RPL risk in Asian population using all five genetic models (for T vs. C: OR 1.35, 95 % CI 1.09-1.68, p = 0.009; for TT + CT vs. CC: OR 1.44, 95 % CI 1.14-1.82, p = 0.006; for CT vs. CC: OR 1.39, 95 % CI 1.07-1.8, p = 0.01; for TT vs. CC: OR 1.79, 95 % CI 1.23.2.6, p = 0.007; for TT vs. CT + CC: OR 1.61, 95 % CI 1.02-2.56, p = 0.04). In conclusion, this meta-analysis demonstrates a strong association between the MTHFR C677T variant and RPL in Asian population and raising the importance of the use of folate in its treatment and prevention. PMID:27605737

  18. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

    PubMed Central

    Bartsch, Emily; Medcalf, Karyn E; Park, Alison L

    2016-01-01

    Objective To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design Systematic review and meta-analysis of cohort studies. Data sources PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy. PMID:27094586

  19. Thrombophilia and early pregnancy loss.

    PubMed

    McNamee, Kelly; Dawood, Feroza; Farquharson, Roy G

    2012-02-01

    Early pregnancy loss is the most common pregnancy complication. About 15% of pregnancies result in pregnancy loss and 1% of women experience recurrent miscarriage (more than three consecutive miscarriages). The influence of thrombophilia in pregnancy is a popular research topic in recurrent miscarriage. Both acquired and inherited thrombophilia are associated with a risk of pregnancy failure. Antiphospholipid syndrome is the only thrombophilia known to have a direct adverse effect on pregnancy. Historically, clinical research studying thrombophilia treatment in recurrent miscarriage has been of limited value owing to small participant numbers, poor study design and heterogeneity. The debate on the efficacy of aspirin and heparin has advanced with recently published randomised-controlled trials. Multi-centre collaboration is required to ascertain the effect of thrombophilia on early pregnancy loss and to establish an evidence-based treatment protocol. PMID:22079389

  20. The treatment of epilepsy in pregnancy: The neurodevelopmental risks associated with exposure to antiepileptic drugs.

    PubMed

    Bromley, R

    2016-09-01

    A number of antiepileptic drugs (AEDs) have been confirmed as teratogens due to their association with an increased malformation rate. The majority of research to date does not find an association between prenatal exposure to monotherapy carbamazepine, lamotrigine or phenytoin and neurodevelopmental outcome in comparison to control children and noted higher abilities in comparison to children exposed to valproate; but further work is needed before conclusions can be drawn. Data for levetiracetam was limited to one study, as was the evidence for topiramate. Sodium valproate exposure appeared to carry a dose dependent risk to the developing brain, with evidence of reduced levels of IQ, poorer verbal abilities and increased rate of autistic spectrum disorder both in comparison to control children and children exposed to other AEDs. The severity of the neurodevelopmental deficits associated with prenatal exposure to valproate highlight the critical need to consider neurodevelopmental outcomes as a central aspect of teratological research. PMID:27312074

  1. Bringing life course home: a pilot to reduce pregnancy risk through housing access and family support.

    PubMed

    Allen, Deborah; Feinberg, Emily; Mitchell, Heavenly

    2014-02-01

    Proponents of life course comment that while the theory is persuasive, translating theory to practice is daunting. This paper speaks to the challenges and possibilities of intervention based on life course theory. It describes Healthy Start in Housing (HSiH), a partnership between the Boston Public Health Commission (BPHC) and the Boston Housing Authority (BHA) to reduce stress due to housing insecurity among low-income, pregnant women. HSiH seeks improved birth outcomes and long term health of mothers and infants. BHA goals are improved quality of life for participants, greater public housing stability and enhanced impact of housing on community well-being. HSiH is a 1 year pilot offering 75 housing units to pregnant women at risk of adverse birth outcomes and homelessness. BHA provides housing and expedites processing of HSiH applications; BPHC staff oversee enrollment, guide women through the application process, and provide enhanced, long-term case management. Of 130 women referred to HSiH to date, 53 were ineligible, 59 have submitted applications, 13 are preparing applications and 5 dropped out. Nineteen women have been housed. Among eligible women, 58 % had medical conditions, 56 % mental health conditions, and 14 % prior adverse outcomes; 30 % had multiple risks. Standardized assessments reflected high levels of depressive symptoms; 41 % had symptoms consistent with post-traumatic stress disorder. Life course theory provides both the framework and the rationale for HSiH. HSiH experience confirms the salience of daily social experience to women's health and the importance of addressing stressors and stress in women's lives. PMID:23820672

  2. [Hypertensive Disorders in Pregnancy].

    PubMed

    Middeke, Martin

    2016-09-01

    In pregnancy, both mother and fetus benefit from blood pressure in normal ranges. There is discrepancy in the normenclature and thresholds for classification of hypertension in pregnancy and for initiation of antihypertensive treatment in different international guidelines. Systolic and diastolic blood pressure values that are associated with normal outcome are notably lower than any recommended treatment threshold in pregnancy. Tight blood pressure control under 85 mmHg diastolic is save and significantly prevents severe maternal hypertension as could be demonstrated in CHIPS. Close blood pressure monitoring comprising modern methods and devices including telemonitoring allows early recognition of risk developments and optimal guidance of antihypertensive therapy starting early in pregnancy. Only a few pharmacological substances are suitable for antihypertensive treatment in pregnancy. PMID:27598915

  3. Parent–Adolescent Relationship Education (PARE): Program Delivery to Reduce Risks for Adolescent Pregnancy and STDs

    PubMed Central

    Lederman, Regina P.; Chan, Wenyaw; Roberts-Gray, Cynthia

    2008-01-01

    The first author recruited parent–adolescent dyads (N = 192) into after-school prevention education groups at middle schools in southeast Texas. This author placed participants in either (1) an Interactive Program (IP) in which they role-played, practiced resistance skills, and held parent–child discussions or (2) an Attention Control Program (ACP) that used the same curriculum but was delivered in a traditional, didactic format. Questionnaires administered at the beginning and end of the 4-session program and again after booster sessions in 3 subsequent semesters provided measures of social controls (eg, communication with parents) and self controls (eg, protection against risk) on the youths' sexual health behaviors. Linear mixed models adjusted for gender, age, and ethnicity showed that the IP, in comparison with the ACP, achieved significant gains in social control by increasing parental rules about having sex and other risky behaviors and also enhanced students' self-control by increasing their knowledge about prevention and enhancing resistance responses when pressured to have sex. PMID:18316271

  4. [Pregnancy and antiphospholipid syndrome].

    PubMed

    Costedoat-Chalumeau, N; Guettrot-Imbert, G; Leguern, V; Leroux, G; Le Thi Huong, D; Wechsler, B; Morel, N; Vauthier-Brouzes, D; Dommergues, M; Cornet, A; Aumaître, O; Pourrat, O; Piette, J-C; Nizard, J

    2012-04-01

    Antiphospholipid syndrome (APS) is associated with a risk of obstetrical complications, affecting both the mother and the fetus. Obstetrical APS is defined by a history of three consecutive spontaneous miscarriages before 10 weeks of gestation (WG), an intra-uterine fetal death after 10 WG, or a premature birth before 34 WG because of severe pre-eclampsia, eclampsia or placental adverse outcomes (intrauterine growth retardation, oligohydramnios). Pregnancy in women with a diagnosis of obstetric APS is at increased risk for placental abruption, HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome and thrombosis that may be part of a catastrophic antiphospholipid syndrome (CAPS). A previous thrombosis and the presence of a lupus anticoagulant are risk factors for pregnancy failure. A multidisciplinary approach, associating the internist, the anesthesiologist and the obstetrician, is recommended for these high-risk pregnancies. Preconception counseling is proposed to identify pregnancy contraindications, and to define and adapt the treatment prior and during the upcoming pregnancy. Heparin and low-dose aspirin are the main treatments. The choice between therapeutic or prophylactic doses of heparin will depend on the patient's medical history. The anticoagulant therapeutic window for delivery should be as narrow as possible and adapted to maternal thrombotic risk. There is a persistent maternal risk in the postpartum period (thrombosis, HELLP syndrome, CAPS) justifying an antithrombotic coverage during this period. We suggest a monthly clinical and biological monitoring which can be more frequent towards the end of pregnancy. The persistence of notches at the Doppler-ultrasound evaluation seems to be the best predictor for a higher risk of placental vascular complications. Treatment optimization and multidisciplinary antenatal care improve the prognosis of pregnancies in women with obstetric APS, leading to a favorable outcome most of the time. PMID

  5. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

    PubMed Central

    Samanta, Sukhen; Jain, Kajal; Bhardwaj, Neerja; Jain, Vanita; Samanta, Sujay; Saha, Rini

    2016-01-01

    Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia. PMID:27013750

  6. Antihypertensive Medication Use During Pregnancy and the Risk of Cardiovascular Malformations

    PubMed Central

    Caton, Alissa R.; Bell, Erin M.; Druschel, Charlotte M.; Werler, Martha M.; Lin, Angela E.; Browne, Marilyn L.; McNutt, Louise-Anne; Romitti, Paul A.; Mitchell, Allen A.; Olney, Richard S.; Correa, Adolfo

    2016-01-01

    We used data from the National Birth Defects Prevention Study, a population-based, case-control study, to examine whether previously reported associations between antihypertensive medications and cardiovascular malformations could be confirmed and to explore whether new associations might be identified. Cases (n=5021) were ascertained through birth defects surveillance systems from 1997 through 2003 in 10 US states. Controls (n=4796) were live births without birth defects selected randomly from birth certificates or hospital discharge listings in the same geographic regions. Logistic regression was used to examine the relationship between antihypertensive medication treatment and the occurrence of cardiovascular malformations while controlling for confounding variables. First-trimester treatment with antihypertensive medication was associated with pulmonary valve stenosis (odds ratio [OR]: 2.6; 95% CI: 1.3 to 5.4), Ebstein malformation (crude OR: 11.4; exact 95% CI: 2.8 to 34.1), coarctation of the aorta (OR: 3.0; 95% CI: 1.3 to 6.6), and secundum atrial septal defects (OR: 2.4; 95% CI: 1.3 to 4.4). Treatment initiated after the first trimester was associated with pulmonary valve stenosis (OR: 2.4; 95% CI: 1.1 to 5.4), perimembranous ventricular septal defects (OR: 2.3; 95% CI: 1.2 to 4.6), and secundum atrial septal defects (OR: 2.4; 95% CI: 1.3 to 4.4). Untreated hypertension was associated with Ebstein malformation (OR: 2.1; 95% CI: 1.0 to 4.3) and secundum atrial septal defects (OR: 1.3; 95% CI: 1.0 to 1.6). Antihypertensive medication use and/or the underlying hypertension might increase the risk of having an infant with specific left and right obstructive and septal defects. Additional studies with adequate power will be needed to confirm these findings. PMID:19433779

  7. Lupus and pregnancy.

    PubMed

    Baer, Alan N; Witter, Frank R; Petri, Michelle

    2011-10-01

    Systemic lupus erythematosus (SLE) disproportionately affects women in their reproductive age years. Pregnancy in this systemic autoimmune disease has long been associated with poor obstetric outcomes. However, the frequency of pregnancy loss in lupus has dropped to a level commensurate with that of the general US population. The outcomes of lupus pregnancies are better if conception is delayed until the disease has been inactive for at least 6 months, and the medication regimen has been adjusted in advance. Pregnancy in lupus is prone to complications, including flares of disease activity during pregnancy or in the postpartum period, preeclampsia, miscarriage, stillbirth, intrauterine growth retardation, and preterm birth. Active lupus nephritis poses the greatest risk. The recognition of a lupus flare during pregnancy may be difficult because the signs and symptoms may mimic those of normal pregnancy. Monitoring should include baseline and monthly laboratory tests, serial ultrasonography, fetal surveillance tests, and fetal m-mode echocardiography for mothers with SS-A (Ro) or SS-B (La) antibodies. In the absence of any signs or symptoms of active SLE, affected patients require no specific treatment during pregnancy. If hydroxychloroquine was in use before conception, it should be maintained throughout pregnancy. If a woman with SLE has antiphospholipid antibodies, prophylactic treatment with aspirin and/or low-molecular weight heparin is indicated to prevent fetal loss. Lupus flares during pregnancy are generally treated with hydroxychloroquine, low-dose prednisone, pulse intravenous methylprednisolone, and azathioprine. High-dose prednisone and cyclophosphamide are reserved for severe lupus complications but are associated with significant pregnancy-related complications and poor obstetrical outcomes. PMID:22112525

  8. The Predictive Effects of Early Pregnancy Lipid Profiles and Fasting Glucose on the Risk of Gestational Diabetes Mellitus Stratified by Body Mass Index

    PubMed Central

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

    2016-01-01

    This study aimed at evaluating the predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus (GDM) in patients stratified by prepregnancy body mass index (p-BMI) and to determine the optimal cut-off values of each indicator for different p-BMI ranges. A retrospective system cluster sampling survey was conducted in Beijing during 2013 and a total of 5,265 singleton pregnancies without prepregnancy diabetes were included. The information for each participant was collected individually using questionnaires and medical records. Logistic regression analysis and receiver operator characteristics analysis were used in the analysis. Outcomes showed that potential markers for the prediction of GDM include early pregnancy lipid profiles (cholesterol, triacylglycerols, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios [LDL-C/HDL-C], and triglyceride to high-density lipoprotein cholesterol ratios [TG/HDL-C]) and fasting glucose, of which fasting glucose level was the most accurate indicator. Furthermore, the predictive effects and cut-off values for these factors varied according to p-BMI. Thus, p-BMI should be a consideration for the risk assessment of pregnant patients for GDM development. PMID:26981541

  9. Maternal Antioxidant Levels in Pregnancy and Risk of Preeclampsia and Small for Gestational Age Birth: A Systematic Review and Meta-Analysis

    PubMed Central

    Cohen, Jacqueline M.; Beddaoui, Margaret; Kramer, Michael S.; Platt, Robert W.; Basso, Olga; Kahn, Susan R.

    2015-01-01

    Background Oxidative stress in preeclampsia and small for gestational age (SGA) birth suggests antioxidant supplementation could prevent these conditions. However, it remains unclear whether maternal antioxidant levels are systematically lower in these pregnancies. Objective To conduct a systematic review of the association between maternal antioxidant levels during pregnancy and preeclampsia or SGA. Methods We searched PubMed, Embase, and several other databases from 1970–2013 for observational studies that measured maternal blood levels of non-enzymatic antioxidants (vitamins A, C, E, and carotenoids) during pregnancy or within 72 hours of delivery. The entire review process was done in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale and additional questions. We pooled the standardized mean difference (SMD) across studies, stratified by outcome and pregnancy trimester, and investigated heterogeneity using meta-regression. Results We reviewed 1,882 unique citations and 64 studies were included. Most studies were small with important risk of bias. Among studies that addressed preeclampsia (n = 58) and SGA (n = 9), 16% and 66%, respectively, measured levels prior to diagnosis. The SMDs for vitamins A, C, and E were significantly negative for overall preeclampsia, but not for mild or severe preeclampsia subtypes. Significant heterogeneity was observed in all meta-analyses and most could not be explained. Evidence for lower carotenoid antioxidants in preeclampsia and SGA was limited and inconclusive. Publication bias appears likely. Conclusions Small, low-quality studies limit conclusions that can be drawn from the available literature. Observational studies inconsistently show that vitamins C and E or other antioxidants are lower in women who develop preeclampsia or SGA. Reverse causality remains a possible explanation for associations observed. New clinical trials are not warranted in light of this evidence; however, additional rigorous

  10. Placental Fatty Acid Ethyl Esters Are Elevated with Maternal Alcohol Use in Pregnancies Complicated by Prematurity

    PubMed Central

    Gauthier, Theresa W.; Mohan, Sowmya S.; Gross, Teresa S.; Harris, Frank L.; Guidot, David M.; Brown, Lou Ann S.

    2015-01-01

    The accumulation of fatty acid ethyl esters (FAEEs) in meconium of term newborns has been described as one potential biomarker of maternal alcohol use during pregnancy. FAEEs accumulate in multiple alcohol-exposed fetal tissues and in the placenta. Limited research has focused on the identification of the premature newborn exposed to alcohol in utero. We hypothesized that maternal alcohol use occurs in a significant proportion of premature deliveries and that this exposure can be detected as elevated placental FAEEs. The goals of this study were to 1) determine the prevalence of maternal alcohol use in the premature newborn and 2) investigate whether placental FAEEs could identify those newborns with fetal alcohol exposure. This prospective observational study evaluated 80 placentas from 80 women after premature delivery. Subjects were interviewed for alcohol intake and placental FAEEs were quantified via GC/MS. Receiver Operator Characteristic (ROC) Curves were generated to evaluate the ability of placental FAEEs to predict maternal drinking during pregnancy. Adjusted ROC curves were generated to adjust for gestational age, maternal smoking, and illicit drug use. 30% of the subjects admitted to drinking alcohol during pregnancy and approximately 14% answered questions indicative of problem drinking (designated AUDIT+). The specific FAEEs ethyl stearate and linoleate, as well as combinations of oleate + linoleate + linolenate (OLL) and of OLL + stearate, were significantly (p<0.05) elevated in placentas from AUDIT+ pregnancies. Adjusted ROC Curves generated areas under the curve ranging from 88–93% with negative predictive values of 97% for AUDIT+ pregnancies. We conclude that nearly one third of premature pregnancies were alcohol-exposed, and that elevated placental FAEEs hold great promise to accurately determine maternal alcohol use, particularly heavy use, in pregnancies complicated by premature delivery. PMID:25978403

  11. Assessing the Validity and Reliability of Three Indicators Self-Reported on the Pregnancy Risk Assessment Monitoring System Survey

    PubMed Central

    Helms, Kristen; Morrow, Brian

    2013-01-01

    Objectives We investigated the reliability and validity of three self-reported indicators from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods We used 2008 PRAMS (n=15,646) data from 12 states that had implemented the 2003 revised U.S. Certificate of Live Birth. We estimated reliability by kappa coefficient and validity by sensitivity and specificity using the birth certificate data as the reference for the following: prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid payment for delivery; and breastfeeding initiation. These indicators were examined across several demographic subgroups. Results The reliability was high for all three measures: 0.81 for WIC participation, 0.67 for Medicaid payment of delivery, and 0.72 for breastfeeding initiation. The validity of PRAMS indicators was also high: WIC participation (sensitivity = 90.8%, specificity = 90.6%), Medicaid payment for delivery (sensitivity = 82.4%, specificity = 85.6%), and breastfeeding initiation (sensitivity = 94.3%, specificity = 76.0%). The prevalence estimates were higher on PRAMS than the birth certificate for each of the indicators except Medicaid-paid delivery among non-Hispanic black women. Kappa values within most subgroups remained in the moderate range (0.40–0.80). Sensitivity and specificity values were lower for Hispanic women who responded to the PRAMS survey in Spanish and for breastfeeding initiation among women who delivered very low birthweight and very preterm infants. Conclusion The validity and reliability of the PRAMS data for measures assessed were high. Our findings support the use of PRAMS data for epidemiological surveillance, research, and planning. PMID:24179264

  12. Prolactinomas, cabergoline, and pregnancy.

    PubMed

    Glezer, Andrea; Bronstein, Marcello D

    2014-09-01

    Hyperprolactinemia, frequently caused by a prolactinoma, is an important cause of infertility among young women. Dopamine agonists (DA) are the treatment of choice. Although cabergoline (CAB) is currently considered the gold standard DA, bromocriptine (BRC) remains the drug of choice for women desiring pregnancy, as it was proven to be safe in more than 6,000 pregnancies. The purpose of this review is to perform a critical evaluation of CAB safety in pregnancy, as it is used by most patients harboring prolactinomas. Although the number of CAB-induced pregnancies (about 800) is still reduced as compared with those under BRC treatment, data in the literature do not point to increase risk of preterm delivery or fetal malformations, comparing to pregnancies induced by BRC and those in the general population. Moreover, CAB use throughout pregnancy was reported in about ten cases, without evidence of any harm to fetal development. Therefore, even though BRC still remains the recommended DA drug for pregnancy induction or use during pregnancy in women with prolactinomas, increasing evidences point to the safety of CAB for this purpose. PMID:24985062

  13. Young Adult Outcomes Associated with Teen Pregnancy Among High-Risk Girls in an RCT of Multidimensional Treatment Foster Care.

    PubMed

    Leve, Leslie D; Kerr, David C R; Harold, Gordon T

    2013-09-01

    Teen pregnancy is associated with a host of deleterious outcomes for girls such as drug use and poor parenting. Thus, reducing teen pregnancy rates could improve long-term developmental outcomes for girls, improving adjustment during young adulthood. Based on the positive effects of Multidimensional Treatment Foster Care (MTFC) relative to group care (GC) in a study of adolescent girls-significantly fewer pregnancies reported in the 2-year follow-up for MTFC girls-the present study followed this sample into young adulthood (approximately 7 years postbaseline) to examine the effects of adolescent pregnancy on young adult substance use and pregnancy-related outcomes. All participants were randomly assigned to MTFC (n = 81) or GC (n = 85) as adolescents as part of two RCTs. Results from logistic regression analyses indicated that becoming pregnant during the 2-year follow-up was significantly related to illicit drug use, miscarriage from a new pregnancy, and child welfare involvement at 7 years postbaseline. In addition, baseline marijuana use predicted marijuana use at 7 years postbaseline. PMID:24453470

  14. Managing Prolactinomas during Pregnancy.

    PubMed

    Almalki, Mussa Hussain; Alzahrani, Saad; Alshahrani, Fahad; Alsherbeni, Safia; Almoharib, Ohoud; Aljohani, Naji; Almagamsi, Abdurahman

    2015-01-01

    Prolactinomas are the most prevalent functional benign pituitary tumors due to a pituitary micro- or macroadenoma. The majority of patients presents with infertility and gonadal dysfunction. A dopamine agonist (DA) (bromocriptine or cabergoline) is the treatment of choice that can normalize prolactin levels, reduce tumor size, and restore ovulation and fertility. Cabergoline generally preferred over bromocriptine because of its higher efficacy and tolerability. Managing prolactinomas during pregnancy may be challenging. During pregnancy, the pituitary gland undergoes global hyperplasia due to a progressive increase in serum estrogens level that may lead to increase of the tumor volume with potential mass effect and visual loss. The risk of tumor enlargement may occur in 3% of those with microadenomas, 32% in those with macroadenomas that were not previously operated on, and 4.8% of those with macroadenomas with prior ablative treatment. Though both drugs appear to be safe during pregnancy, the data on fetal exposure to DAs during pregnancy have been reported with bromocriptine far exceeds that of cabergoline with no association of increased risk of pregnancy loss and premature delivery. It is advisable to stop the use of DAs immediately once pregnancy is confirmed, except in the case of women with invasive macroprolactinomas or pressure symptoms. This review outlines the therapeutic approach to prolactinoma during pregnancy, with emphasis on the safety of available DA therapy. PMID:26074878

  15. Managing Prolactinomas during Pregnancy

    PubMed Central

    Almalki, Mussa Hussain; Alzahrani, Saad; Alshahrani, Fahad; Alsherbeni, Safia; Almoharib, Ohoud; Aljohani, Naji; Almagamsi, Abdurahman

    2015-01-01

    Prolactinomas are the most prevalent functional benign pituitary tumors due to a pituitary micro- or macroadenoma. The majority of patients presents with infertility and gonadal dysfunction. A dopamine agonist (DA) (bromocriptine or cabergoline) is the treatment of choice that can normalize prolactin levels, reduce tumor size, and restore ovulation and fertility. Cabergoline generally preferred over bromocriptine because of its higher efficacy and tolerability. Managing prolactinomas during pregnancy may be challenging. During pregnancy, the pituitary gland undergoes global hyperplasia due to a progressive increase in serum estrogens level that may lead to increase of the tumor volume with potential mass effect and visual loss. The risk of tumor enlargement may occur in 3% of those with microadenomas, 32% in those with macroadenomas that were not previously operated on, and 4.8% of those with macroadenomas with prior ablative treatment. Though both drugs appear to be safe during pregnancy, the data on fetal exposure to DAs during pregnancy have been reported with bromocriptine far exceeds that of cabergoline with no association of increased risk of pregnancy loss and premature delivery. It is advisable to stop the use of DAs immediately once pregnancy is confirmed, except in the case of women with invasive macroprolactinomas or pressure symptoms. This review outlines the therapeutic approach to prolactinoma during pregnancy, with emphasis on the safety of available DA therapy. PMID:26074878

  16. Isotretinoin and Other Retinoids During Pregnancy

    MedlinePlus

    ... virus and pregnancy Microcephaly Medicine safety and pregnancy Birth defects prevention Learn how to help reduce your risk ... the body from infection. How can you prevent birth defects from isotretinoin? Because isotretinoin can be so harmful ...

  17. Challenges of Twin Pregnancy

    PubMed Central

    Wilson, Lynn M.; Hose, Patricia M.

    1991-01-01

    Family physicians have an important role in the diagnosis and management of twin pregnancies. Optimal antepartum management begins with early detection. Provision of patient education about the risks of the pregnancy is important. Intrapartum management is dependent on gestation age, placentation, fetal presentation, and fetal well-being. Anticipatory guidance and ongoing support should be provided for postpartum issues, such as breast-feeding and family adjustment. PMID:21229108

  18. Early pregnancy assessment in multiple pregnancies.

    PubMed

    D'Antonio, Francesco; Bhide, Amar

    2014-02-01

    Early ultrasound assessment and accurate determination of chorionicity is crucial so that appropriate care of multiple pregnancy can be provided. It is best achieved in the first trimester of pregnancy using the Lambda 'λ' and 'T' signs. Accurate labelling of the twins is needed to ensure that the same individual fetus is measured through the pregnancy so that the longitudinal growth pattern can be correctly assessed. Discrepancy in crown-rump length indicates a possibility for future development of selective intrauterine growth restriction. Careful early ultrasound assessment is needed to identify structural and chromosomal anomalies, as twin pregnancies are at increased risk. Twin-to-twin transfusion syndrome, selective intrauterine growth restriction and congenital abnormalities represent the major determinants of perinatal loss in monochorionic pregnancies, and diagnosis and prognosis are discussed in detail. Treatment of twin reverse arterial perfusion sequence is more effective in early pregnancy, so early identification is needed. Outcome of conjoined twins is guarded, and is dependent on the extent of fusion, degree of sharing of organs, associated anomalies, and presence of cardiac failure in utero. PMID:24355992

  19. Migraine in pregnancy and lactation.

    PubMed

    David, Paru S; Kling, Juliana M; Starling, Amaal J

    2014-04-01

    Migraine headache is a significant health problem affecting women more than men. In women, the hormonal fluctuations seen during pregnancy and lactation can affect migraine frequency and magnitude. Understanding the evaluation of headache in pregnancy is important, especially given the increased risk of secondary headache conditions. Pregnancy and lactation can complicate treatment options for women with migraine because of the risk of certain medications to the fetus. This review includes details of the workup and then provides treatment options for migraine during pregnancy and lactation. PMID:24604057

  20. Maternal total caffeine intake, mainly from Japanese and Chinese tea, during pregnancy was associated with risk of preterm birth: the Osaka Maternal and Child Health Study.

    PubMed

    Okubo, Hitomi; Miyake, Yoshihiro; Tanaka, Keiko; Sasaki, Satoshi; Hirota, Yoshio

    2015-04-01

    The relation of maternal caffeine intake with birth outcomes is still inconclusive and has not been examined in Japan, where the sources of caffeine intake are different from those in Western countries. We hypothesized that maternal consumption of total caffeine and culture-specific major sources of caffeine would be associated with birth outcomes among Japanese pregnant. The study subjects were 858 Japanese women who delivered singleton infants. Maternal diet during pregnancy was assessed using a validated, self-administered diet history questionnaire. Birth outcomes considered were low birth weight (LBW; <2500 g), preterm birth (PTB; <37 weeks of gestation), and small for gestational age (SGA; <10th percentile). The main caffeine sources were Japanese and Chinese tea (73.5%), coffee (14.3%), black tea (6.6%), and soft drinks (3.5%). After controlling for confounders, maternal total caffeine intake during pregnancy was significantly associated with an increased risk of PTB (odds ratio per 100 mg/d caffeine increase, 1.28; 95% confidence interval, 1.03-1.58; P for trend = .03). However, no evident relationships were observed between total caffeine intake and risk of LBW or SGA. As for caffeine sources, higher Japanese and Chinese tea consumption was associated with an increased risk of PTB (odds ratio per 1 cup/d increase, 1.14; 95% confidence interval, 1.00-1.30; P for trend = .04), but not LBW or SGA. There were no associations between consumption of the other beverages examined and birth outcomes. In conclusion, this prospective birth cohort in Japan suggests that higher maternal total caffeine intake, mainly in the form of Japanese and Chinese tea, during pregnancy is associated with a greater risk of PTB. PMID:25773355

  1. Health Problems in Pregnancy

    MedlinePlus

    Every pregnancy has some risk of problems. The causes can be conditions you already have or conditions you develop. They also include being pregnant with ... health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, ...

  2. Pregnancy with Portal Hypertension

    PubMed Central

    Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

    2014-01-01

    Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

  3. [Pregnancy following bariatric surgery requires special attention].

    PubMed

    Renault, Kristina; Andersen, Lise Lotte; Kjær, Mette Mandrup; Lauenborg, Jeanette; Gjerris, Anne Cathrine; Berlac, Janne Foss; Jensen, Dorte Møller; Damm, Peter

    2012-04-16

    In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women. PMID:22510546

  4. Does Use of Low-Molecular-Weight Heparin during Pregnancy Influence the Risk of Prolonged Labor: A Population-Based Cohort Study

    PubMed Central

    Sandström, Anna; Cnattingius, Sven; Wikström, Anna-Karin

    2015-01-01

    Background The use of low-molecular-weight heparins (LMWHs) during pregnancy is increasing. In vitro studies and small clinical studies support the hypothesis that LMWH treatment during pregnancy may reduce duration of labor. The aim of this study was to investigate if use of LMWH is associated with a reduced risk of diagnosis of prolonged labor, after taking maternal, fetal and other delivery characteristics into account. Methods and Findings A population-based cohort study from the Swedish Medical Birth Register from April 2006 through December 2011. We identified 514 875 term (≥37 weeks) deliveries of live singleton infants in cephalic presentation with spontaneous or induced onsets of labor. The Birth Register was linked to the Prescribed Drug Register to retrieve information on dispensed LMWH during pregnancy and to the Patient Register for information on underlying diagnosis for use of LMWH. Diagnosis of prolonged labor in the Birth Register was retrieved from diagnosis at discharge from the delivery hospital. The risk of diagnosis of prolonged labor in relation to treatment with LMWH was assessed using logistic regression analysis to estimate unadjusted and adjusted odds ratios. A total of 5 275 (1.0%) of the pregnant women used LMWH. The absolute risk of diagnosis of prolonged labor for nulliparous women was 19.9% among women using LMWH in third trimester, and 21.2% in women without use of LMWH. For parous women the corresponding absolute risks were 4.3% and 4.7%, respectively. Compared to nulliparous women without use of LMWH, nulliparous women with LMWH during third trimester had an odds ratio (OR) of 0.92 (95% CI 0.81–1.05, p-value: 0.051) for diagnosis of prolonged labor in unadjusted analyses and after adjustments for maternal characteristics, gestational age and epidural analgesia the OR was 1.00 (95% CI 0.87–1.15, p-value: 0.673). Parous women treated with LMWH in third trimester presented the same pattern, unadjusted OR for diagnosis of

  5. Pregnancy care

    MedlinePlus

    ... pregnancy ( gestational diabetes ) High blood pressure during pregnancy ( preeclampsia ). Your doctor will talk with you about how to care for yourself if you have preeclampsia . Premature or preterm changes in the cervix Problems ...

  6. Ectopic Pregnancy

    MedlinePlus

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

  7. Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment - A review of epidemiological studies.

    PubMed

    Polańska, Kinga; Jurewicz, Joanna; Hanke, Wojciech

    2015-01-01

    Maternal active and passive smoking and low or moderate alcohol drinking during pregnancy, taking into account the level of exposure and developmental or behavioral outcomes, are recognized as a significant issue from both a clinical and a public health perspective. The article aims at evaluating the impact of prenatal exposure to tobacco smoke constituents and low or moderate alcohol drinking during pregnancy on children neurodevelopment by reviewing the most recently published literature. Relevant studies were identified by searching the Pubmed, Medline and Ebsco literature databases. This review is restricted to 29 human studies published in English in peer reviewed journals since 2006. The studies published recently continued to show some relationship between tobacco smoke exposure, from active and passive maternal smoking during pregnancy, and children's psychomotor development independent of other variables, but this relationship is not straightforward. The association is mostly consistent for measures of academic achievements and behavioral problems which require further attention. The results of the studies on low or moderate exposure to alcohol are not fully conclusive, but some of them suggest that consumption of alcohol during pregnancy may adversely affect children's intelligence quotient (IQ), mental health, memory and verbal or visual performance. As the reviewed studies indicate, maternal lifestyle during pregnancy like alcohol drinking or smoking may affect children neurodevelopment. All effort should be taken to eliminate such exposure to ensure appropriate children's development. PMID:26190723

  8. Acute respiratory failure in pregnancy.

    PubMed

    Lapinsky, Stephen E

    2015-09-01

    Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient. Endotracheal intubation in pregnancy carries an increased risk, due to airway edema and rapid oxygen desaturation following apnea. Few data are available to direct prolonged mechanical ventilation in pregnancy. Chest wall compliance is reduced, perhaps permitting slightly higher airway pressures. Optimizing oxygenation is important, but data on the use of permissive hypercapnia are limited. Delivery of the fetus does not always improve maternal respiratory function, but should be considered if benefit to the fetus is anticipated. PMID:27512467

  9. Babies born after diabetes in pregnancy: what are the short- and long-term risks and how can we minimise them?

    PubMed

    Hawdon, J M

    2011-02-01

    Despite improvements in services for people with diabetes and an increased focus on care of diabetes in pregnancy, there has been no significant reduction in neonatal complications after pregnancy complicated by maternal diabetes. Some complications are severe and life threatening or lead to long-term difficulties, whilst others are transient and are unlikely to lead to long-term harm, if managed according to standard guidelines. Most neonatal complications are, in theory, avoidable by optimal diabetes care, those that arise directly as a result of poor control of diabetes in pregnancy or as a result of obstetric interventions related to maternal diabetes control. Of greater concern are iatrogenic complications that arise from decisions which have no clear rationale (e.g., 'routine' admission of a baby to a neonatal unit). Planning for neonatal management must take into account known risks and the likelihood of occurrence, start in advance of delivery, involve all relevant groups of professionals and be centred on the needs of the mother and baby and not upon historical organisational policies. PMID:21237719

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

    PubMed

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

    2012-07-01

    Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case-control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case-control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case-control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review. PMID:21739194

  11. Prenatal Ultrasound Screening for Fetal Anomalies and Outcomes in High-Risk Pregnancies due to Maternal HIV Infection: A Retrospective Study

    PubMed Central

    Reitter, A.; Stücker, A. U.; Buxmann, H.; Herrmann, E.; Haberl, A. E.; Schlößer, R.; Louwen, F.

    2013-01-01

    Objective. To assess the prevalence of prenatal screening and of adverse outcome in high-risk pregnancies due to maternal HIV infection. Study Design. The prevalence of prenatal screening in 330 pregnancies of HIV-positive women attending the department for prenatal screening and/or during labour between January 1, 2002 and December 31, 2012, was recorded. Screening results were compared with the postnatal outcome and maternal morbidity, and mother-to-child transmission (MTCT) was evaluated. Results. One hundred of 330 women (30.5%) had an early anomaly scan, 252 (74.5%) had a detailed scan at 20–22 weeks, 18 (5.5%) had a detailed scan prior to birth, and three (0.9%) had an amniocentesis. In seven cases (2.12%), a fetal anomaly was detected prenatally and confirmed postnatally, while in eight (2.42%) an anomaly was only detected postnatally, even though a prenatal scan was performed. There were no anomalies in the unscreened group. MTCT occurred in three cases (0.9%) and seven fetal and neonatal deaths (2.1%) were reported. Conclusion. The overall prevalence of prenatal ultrasound screening in our cohort is 74.5%, but often the opportunity for prenatal ultrasonography in the first trimester is missed. In general, the aim should be to offer prenatal ultrasonography in the first trimester in all pregnancies. This allows early reassurance or if fetal disease is suspected, further steps can be taken. PMID:24194633

  12. Folic acid alone or multivitamin containing folic acid intake during pregnancy and the risk of gestational hypertension and preeclampsia through meta-analyses

    PubMed Central

    Shim, Sang-Min; Yun, Yeo-Ul

    2016-01-01

    Objective The objective of this study was to assess the effect of folic acid and multivitamin use during pregnancy on the risk of developing of hypertensive disorder of pregnancy. Methods Two reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, placebo-controlled, randomized clinical trial published using PubMed Medline database, KERIS (Korea Education and Research Information Service), Scopus, and the Cochrane Central Register of controlled trials comparing before conception throughout pregnancy intake oral multivitamin containing folic acid or folic acid alone. Meta-analyses were estimated with odds ratios and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. Results Data from six effect sizes from six studies involving 201,661 patients were enrolled. These meta-analyses showed multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence (odds ratio, 0.91; 95% CI, 0.81 to 1.03) than the placebo. And the difference of effective sizes of preeclampsia and gestational hypertension according to two dependent variables, multivitamin and folic acid were not significant, respectively (point estimate, 0.66; 95% CI, 0.46 to 0.96). Conclusion These meta-analyses demonstrate multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence. PMID:27004201

  13. Pregnancy - health risks

    MedlinePlus

    ... of folic acid (also known as folate or vitamin B9) a day. If you have any chronic medical problems (such as high blood pressure , kidney problems, or diabetes ), talk to your provider before trying to get ...

  14. High-Risk Pregnancy

    MedlinePlus

    ... with questions about grants, contracts & research areas Training, Education & Career Development Support for Training at Universities & Other Institutions Extramural training, fellowships & career development opportunities Training at ...

  15. Sexually-transmitted Infections and Unintended Pregnancy: A Longitudinal Analysis of Risk Transmission through Friends and Attitudes

    PubMed Central

    Henry, David B.; Deptula, Daneen P.; Schoeny, Michael E.

    2011-01-01

    Data from 1087 adolescent participants in three waves of the National Longitudinal Study of Adolescent Health was used to examine the effects of peer selection and socialization processes in adolescence on later reports of sexually-transmitted infections (STI) and unintended pregnancies. Friends’ attitudes and behavior were assessed with friends’ reports. Among males, there was evidence for selection effects on STI diagnoses and socialization effects on reports of unintended pregnancy, both involving friends’ attitudes. Among females, there was evidence for long-term effects of both socialization and selection processes involving same-sex friends’ attitudes. Discussion focuses on the importance of peer and individual attitudes as potential intervention targets. PMID:22563148

  16. Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: randomised controlled trial

    PubMed Central

    Perichart-Perera, Otilia; Espino, Salvador; Avila-Vergara, Marco Antonio; Ibarra, Isabel; Ahued, Roberto; Godines, Myrna; Parry, Samuel; Macones, George; Strauss, Jerome F

    2011-01-01

    Objective To test the hypothesis that a relative deficiency in L-arginine, the substrate for synthesis of the vasodilatory gas nitric oxide, may be associated with the development of pre-eclampsia in a population at high risk. Design Randomised, blinded, placebo controlled clinical trial. Setting Tertiary public hospital in Mexico City. Participants Pregnant women with a history of a previous pregnancy complicated by pre-eclampsia, or pre-eclampsia in a first degree relative, and deemed to be at increased risk of recurrence of the disease were studied from week 14-32 of gestation and followed until delivery. Interventions Supplementation with a medical food—bars containing L-arginine plus antioxidant vitamins, antioxidant vitamins alone, or placebo—during pregnancy. Main outcome measure Development of pre-eclampsia/eclampsia. Results 222 women were allocated to the placebo group, 228 received L-arginine plus antioxidant vitamins, and 222 received antioxidant vitamins alone. Women had 4-8 prenatal visits while receiving the bars. The incidence of pre-eclampsia was reduced significantly (χ2=19.41; P<0.001) in women randomised to L-arginine plus antioxidant vitamins compared with placebo (absolute risk reduction 0.17 (95% confidence interval 0.12 to 0.21). Antioxidant vitamins alone showed an observed benefit, but this effect was not statistically significant compared with placebo (χ2=3.76; P=0.052; absolute risk reduction 0.07, 0.005 to 0.15). L-arginine plus antioxidant vitamins compared with antioxidant vitamins alone resulted in a significant effect (P=0.004; absolute risk reduction 0.09, 0.05 to 0.14). Conclusions Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia. Supplementation with L-arginine plus antioxidant vitamins needs to be

  17. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study

    PubMed Central

    Lundgren, Maria; Brandt, Lena; Reutfors, Johan; Andersen, Morten; Kieler, Helle

    2012-01-01

    Objective To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. Design Population based cohort study using data from national health registers. Setting Sweden. Participants 332 137 women with a last menstrual period anytime after 1 July 2005 and giving birth anytime before the end of 31 December 2009. Women with a record of at least two bipolar diagnoses were identified and grouped as treated (n=320)—those who had filled a prescription for mood stabilisers (lithium, antipsychotics, or anticonvulsants) during pregnancy—or untreated (n=554). Both groups were compared with all other women giving birth (n=331 263). Main outcome measures Preterm birth, mode of labour initiation, gestational diabetes, infants born small or large for gestational age, neonatal morbidity, and congenital malformations. Results Of the untreated women, 30.9% (n=171) were induced or had a planned caesarean delivery compared with 20.7% (n=68 533) without bipolar disorder (odds ratio 1.57, 95% confidence interval 1.30 to 1.90). The corresponding values for the treated women were 37.5% (n=120) (2.12, 1.68 to 2.67). The risks of preterm birth in both treated and untreated women were increased by 50%. Of the untreated women, 3.9% (n=542) had a microcephalic infant compared with 2.3% (324 844) of the women without bipolar disorder (1.68, 1.07 to 2.62). The corresponding values for the treated women were 3.3% (n=311) (1.26, 0.67 to 2.37). Similar trends were observed for risks of infants being small for gestational age infants for weight and length. Among infants of untreated women, 4.3% (n=24) had neonatal hypoglycaemia compared with 2.5% (n=8302) among infants of women without bipolar disorder (1.51, 1.04 to 2.43), and 3.4% (n=11) of the treated women (1.18, 0.64 to 2.16). The analyses of variation in outcomes did not support any significant differences between treated and untreated women. Conclusions Bipolar

  18. Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women. The CARDIA Study. Coronary Artery Risk Development in Young Adults.

    PubMed

    Lewis, C E; Funkhouser, E; Raczynski, J M; Sidney, S; Bild, D E; Howard, B V

    1996-08-01

    The authors analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study in order to examine associations between parity and lipoproteins. Of 2,787 women recruited in 1985-1986, 2,534 (91%) returned in 1987-1988 and 2,393 (86%) returned in 1990-1991 for repeat evaluations. Two-year change (1987-1988 to 1985-1986) in high density lipoprotein (HDL) cholesterol was significantly different among the parity groups. HDL cholesterol decreased in women who had their first pregnancy of at least 28 weeks duration during follow-up (mean +/- standard error, -3.5 +/- 1.2 mg/dl), and this change was significantly different from the increase in women parous at baseline who had no further pregnancies (2.5 +/- 0.3 mg/dl) and in nullipara (2.4 +/- 0.3 mg/dl). There was a nonsignificant trend for a greater decrease in HDL2 cholesterol fraction in the primipara compared with the other groups. The HDL cholesterol decrease remained significant after controlling for race, age, education, oral contraceptive use, and changes in body mass index, waist-hip ratio, physical activity, smoking status, and alcohol intake. Change in HDL cholesterol was also significantly different among the parity groups in analyses of pregnancies that occurred during the subsequent 3 years of follow-up. There were no differences for change in LDL cholesterol or triglycerides. Potential mechanisms for a detrimental effect of pregnancy on HDL cholesterol include hormonal, body composition, or life-style/behavioral changes. PMID:8686693

  19. Thrombophilia and Pregnancy Complications

    PubMed Central

    Simcox, Louise E.; Ormesher, Laura; Tower, Clare; Greer, Ian A.

    2015-01-01

    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. PMID:26633369

  20. [Gaucher's disease and pregnancy].

    PubMed

    Tordjeman, N; Monnier, J C; Hautefeuille, P; Ducloy, J C; Dufour, P; Jean-Lechner, P; Janin, A

    1991-01-01

    Gaucher's disease is rare in association with pregnancy (we have only found 53 cases of women with this disease who had at least one pregnancy since 1945). A review of literature on this subject and this one case confirms that it is unlikely that the disease will progress as far as the symptomatology is concerned and that there are unlikely to be obstetric or fetal complications. All the same there are certain complications that can occur as the haematological state is concerned (thrombocytopenia, coagulation defects such as bleeding, particularly post-partum from the genital organs). Mechanical difficulties may occur because of the greatly enlarged spleen. Pregnancy is not contra-indicated but it is a high risk pregnancy that has to watched very carefully with ultrasound and great attention to the obstetric and biological condition. PMID:1822493

  1. Risk Factors for Pregnancy and Childbearing in Single Young Women: Evidence from the Australian Longitudinal Study on Women's Health

    ERIC Educational Resources Information Center

    Miller-Lewis, Lauren R.; Wade, Tracey D.; Lee, Christina

    2005-01-01

    This study investigated psychosocial predictors of early pregnancy and childbearing in single young women, consistent with the Eriksonian developmental perspective. Two mail-out surveys assessing reproductive behaviour and sociodemographic, education/competence, psychosocial well-being, and aspiration factors were completed 4 years apart by 2635…

  2. Immune Thrombocytopenia in Pregnancy

    PubMed Central

    Stavrou, Evi; McCrae, Keith R.

    2009-01-01

    SYNOPSIS Management of ITP in pregnancy can be a complex and challenging task, and may be complicated by fetal/neonatal thrombocytopenia. Though fetal intracranial hemorrhage is a rare complication of ITP in pregnancy, invasive studies designed to determine the fetal platelet count before delivery are associated with greater risk than that of fetal intracranial hemorrhage, and therefore are discouraged. Moreover, the risk of neonatal bleeding complications does not correlate with the mode of delivery, and thus cesarean section should be reserved for obstetric indications only. PMID:19932435

  3. The effect of timing and frequency of Plasmodium falciparum infection during pregnancy on the risk of low birth weight and maternal anemia

    PubMed Central

    Kalilani, Linda; Mofolo, Innocent; Chaponda, Marjorie; Rogerson, Stephen J.; Meshnick, Steven R.

    2016-01-01

    Plasmodium falciparum infection during pregnancy causes maternal anemia and low birth weight (LBW), but the effect of frequency and timing of infection on the severity of these adverse effects is unknown. We conducted a cohort study recruiting 2462 pregnant women in Malawi. Microscopy was used to diagnose malaria at enrollment, follow-up and delivery. Birth weight and maternal hemoglobin were measured at delivery. The association between timing and frequency of infection and LBW and maternal anemia was analyzed using a binomial regression model. Compared with uninfected women, (i) the risk of LBW increased with the number of malaria episodes [one episode: prevalence ratio (PR) 1.62 (95% CI 1.07–2.46); two episodes: PR 2.41 (95% CI 1.39–4.18)]; (ii) the risk for maternal anemia increased with the number of malaria episodes [one episode: PR 1.15 (95% CI 0.86–1.54); two episodes: PR 1.82 (95% CI 1.28–2.62)]; and (iii) the risk of LBW was higher with infection in the second (PR 1.71; 95% CI 1.06–2.74) than third trimester or at delivery (PR 1.55; 95% CI 0.88–2.75). The timing and frequency of P. falciparum infection during pregnancy affected the risk of LBW but only frequency of infection had an effect on the risk of maternal anemia. Identification of gestational periods when malaria causes most adverse outcomes will facilitate effective targeting of interventions. PMID:20207387

  4. Nutrition in pregnancy and lactation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Optimal maternal health during pregnancy reduces the risk of suboptimal fetal development. Obesity prevalence is increasing among women of childbearing age in both developed and developing countries. Although teenage pregnancies remain common in some countries, generally women are getting pregnant a...

  5. PREGNANCY AND RENAL TRANSPLANTATION.

    PubMed

    Atallah, David; El Kassis, Nadine; Salameh, Charbel; Safi, Joelle; Bejjani, Lina; Lutfallah, Fouad; Ghaname, Wadih; Moukarzel, Maroun

    2015-01-01

    Pregnancy is common nowadays in kidney transplant female patients because of medical and surgical advances. However, pregnancy is a high risk one in these patients. Fertility is rapidly restored after the transplantation; thus, contraception is a good option in the first year. Adding to that, pregnancy can endanger the allograft function in the presence of hypertension, a moderate to severe kidney disease and proteinuria. Medical complications are more prevalent in kidney transplant population, such as infections, gestational hypertension and diabetes and anemia. Low birth weight infants and premature delivery are two other major concerns in this population. Acute rejection of the allograft is another major complication that can be avoided with close monitoring of the graft and convenient immunosuppression. Immunosuppressive drugs must be continued during pregnancy except for mycophenolic acid and sirolimus that can be teratogen. Delivery of kidney transplant patients should be vaginal and spontaneous. Cesarean section should be reserved for obstetrical indications. Prophylactic antibiotics should be administered for every invasive procedure. Patients treated with corticosteroids can breastfeed their babies. Kidney donating women can have a safe pregnancy but with a slight risk of gestational diabetes and hypertension. In summary, a multidisciplinary medical team should follow pregnant kidney transplant patients in a tertiary center. International and national registries are a must to collect data concerning this particular high-risk population in order to solve unanswered questions. PMID:26591192

  6. Household Air Pollution from Solid Fuel Use and Risk of Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis of the Empirical Evidence

    PubMed Central

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

    2014-01-01

    Background 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. Methods 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). Results 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. Conclusion 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. PMID:25463771

  7. [The proteins of fast phase of inflammation in prognosis of condition of newborn in case of pregnancy complicated by hydramnion and under the risk of intrauterine infection].

    PubMed

    Botvin'eva, I A; Renge, L V; Zorina, R M; Bazhenova, L G; zorina, V N

    2012-06-01

    The content of alpha-macroglobulin associated with pregnancy, alpha2-glycoprotein, alpha1-antitripsin, and lactolerrin in blood serum of pregnant women and umbilical serum under hydramnion and risk of development of intrauterine infection of fetus is investigated. It is demonstrated that in case ofpresence in blood of pregnant woman of G-antibodies to C. trachomatis under low titers (1:20, 1:40) the increase of levels of alpha-macroglobulin, alpha2-glycoprotein, al-antitripsin and especially of lactoferrin in serum of pregnant women testifies the high risk of presence of intrauterine infection of fetus and probability of birth of child with low values on Apgar scale. PMID:22946221

  8. Valve disease in pregnancy.

    PubMed

    Pessel, Cara; Bonanno, Clarissa

    2014-08-01

    Maternal cardiac disease is a major cause of non-obstetric morbidity and accounts for 10-25% of maternal mortality. Valvular heart disease may result from congenital abnormalities or acquired lesions, some of which may involve more than one valve. Maternal and fetal risks in pregnant patients with valve disease vary according to the type and severity of the valve lesion along with resulting abnormalities of functional capacity, left ventricular function, and pulmonary artery pressure. Certain high-risk conditions are considered contraindications to pregnancy, while others may be successfully managed with observation, medications, and, in refractory cases, surgical intervention. Communication between the patient׳s obstetrician, maternal-fetal medicine specialist, obstetrical anesthesiologist, and cardiologist is critical in managing a pregnancy with underlying maternal cardiac disease. The management of the various types of valve diseases in pregnancy will be reviewed here, along with a discussion of related complications including mechanical prosthetic valves and infective endocarditis. PMID:25037517

  9. Prepregnancy Nutrition and Early Pregnancy Outcomes

    PubMed Central

    Gaskins, Audrey J.; Toth, Thomas L.; Chavarro, Jorge E.

    2015-01-01

    Implantation failure and pregnancy loss are estimated to affect up to 75% of fertilized ova; however as of yet there is limited empirical evidence, particularly at the population level, for understanding the environmental determinants of these losses. The purpose of this review is to summarize the current knowledge on prepregnancy nutrition and early pregnancy outcomes with particular focus on the outcome of spontaneous abortion among pregnancies conceived naturally and early pregnancy end points among pregnancies conceived through in vitro fertilization. To date, there is limited evidence to support associations of prepregnancy vitamin D and caffeine intake with pregnancy loss. There is suggestive data supporting a link between a healthy diet and lower risk of pregnancy loss. High folate and minimal to no alcohol intake prior to conception have the most consistent evidence supporting an association with lower risk of pregnancy loss. PMID:26457232

  10. Medical management of abnormal pregnancy.

    PubMed

    Ratnam, S S; Prasad, R N

    1990-06-01

    Medical termination of abnormal pregnancy requires specific techniques since some conditions make therapy more effective, e.g., missed abortion intrauterine death and molar pregnancy, and others less so, e.g. anencephalic pregnancy. In all cases it is best to terminate the pregnancy as soon as possible to reduce anguish and risks of complications such as consumptive coagulopathy. Oxytocin is not consistently effective, but intraamniotic rivanol has oxytocic properties, and prostaglandins (PGs) are effective by several routes. Surgical methods are more popular in Japan and the US. A diagnostic flow chart is included and described. For missed abortion and fetal death vacuum aspiration or dilatation and evacuation are appropriate for early pregnancy, or PGs are used for later pregnancy, unless there are medical contraindications. Anencephalic pregnancy, usually diagnoses in 2nd or 3rd trimester, is resistant to medical therapy and must often be terminated by cesarean section. Molar pregnancy can be managed with vacuum aspiration at any length of gestation, but must be completed by curettage. Intraamniotic PGs are not advised for mole or fetal death. PG analogs can be administered intramuscularly, or vaginally in gel form. Other types of abnormal pregnancy that can be managed with PGs are spina bifida, hydrocephalus, hydrops fetalis, Dandy-Walker syndrome and Down's syndrome. Tubal pregnancy can be evacuated with intratubally administered PGs under laparoscopic control, thereby preserving tubal integrity. PMID:2225605

  11. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications.

    PubMed

    Leemaqz, Shalem Y; Dekker, Gustaaf A; McCowan, Lesley M; Kenny, Louise C; Myers, Jenny E; Simpson, Nigel A B; Poston, Lucilla; Roberts, Claire T

    2016-07-01

    Widespread legalisation of marijuana raises safety concerns for its use in pregnancy. This study investigated the association of marijuana use prior to and during pregnancy with pregnancy outcomes in a prospective cohort of 5588 nulliparous women from the international SCOPE study. Women were assessed at 15±1 and 20±1 weeks' gestation. Cases [278 Preeclampsia, 470 gestational hypertension, 633 small-for-gestational-age, 236 spontaneous preterm births (SPTB), 143 gestational diabetes] were compared separately with 4114 non-cases. Although the numbers are small, continued maternal marijuana use at 20 weeks' gestation was associated with SPTB independent of cigarette smoking status [adj OR 2.28 (95% CI:1.45-3.59)] and socioeconomic index (SEI) [adj OR 2.17 (95% CI:1.41-3.34)]. When adjusted for maternal age, cigarette smoking, alcohol and SEI, continued maternal marijuana use at 20 weeks' gestation had a greater effect size [adj OR 5.44 (95% CI 2.44-12.11)]. Our data indicate that increasing use of marijuana among young women of reproductive age is a major public health concern. PMID:27142189

  12. Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study.

    PubMed

    Castro, V M; Kong, S W; Clements, C C; Brady, R; Kaimal, A J; Doyle, A E; Robinson, E B; Churchill, S E; Kohane, I S; Perlis, R H

    2016-01-01

    Multiple studies have examined the risk of prenatal antidepressant exposure and risk for autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD), with inconsistent results. Precisely estimating such risk, if any, is of great importance in light of the need to balance such risk with the benefit of depression and anxiety treatment. We developed a method to integrate data from multiple New England health systems, matching offspring and maternal health data in electronic health records to characterize diagnoses and medication exposure. Children with ASD or ADHD were matched 1:3 with children without neurodevelopmental disorders. Association between maternal antidepressant exposure and ASD or ADHD liability was examined using logistic regression, adjusting for potential sociodemographic and psychiatric confounding variables. In new cohorts of 1245 ASD cases and 1701 ADHD cases, along with age-, sex- and socioeconomic status matched controls, neither disorder was significantly associated with prenatal antidepressant exposure in crude or adjusted models (adjusted odds ratio 0.90, 95% confidence interval 0.50-1.54 for ASD; 0.97, 95% confidence interval 0.53-1.69 for ADHD). Pre-pregnancy antidepressant exposure significantly increased risk for both disorders. These results suggest that prior reports of association between prenatal antidepressant exposure and neurodevelopmental disease are likely to represent a false-positive finding, which may arise in part through confounding by indication. They further demonstrate the potential to integrate data across electronic health records studies spanning multiple health systems to enable efficient pharmacovigilance investigation. PMID:26731445

  13. Stillbirth in the pregnancy complicated by diabetes.

    PubMed

    Starikov, Roman; Dudley, Donald; Reddy, Uma M

    2015-03-01

    Pregestational diabetes currently complicates 4% of pregnancies, while gestational diabetes complicates approximately 8% of pregnancies. Increased risk of stillbirth in diabetic pregnancies has been a well-known and recognized complication for decades. While stillbirth rates for diabetic pregnancies have decreased due to screening, treatment, and antenatal surveillance of these patients, about 4% of all stillbirths remain attributable to diabetes, and diabetic pregnancies continue to be at increased risk for perinatal mortality. The purpose of this article is to review the literature on the epidemiology, pathophysiology, and prevention, as well as future research, of diabetes-associated perinatal mortality. PMID:25667005

  14. Parasuicide in pregnancy.

    PubMed

    Marishane, T; Moodley, J

    2005-06-01

    Parasuicide is a significant risk factor for completed suicide. Furthermore, suicide is emerging as an important cause of maternal death, especially among young mothers. There are no published reports of parasuicide in pregnancy from poor countries. Three cases are reported to highlight this issue and to demonstrate management options available to health professionals working in the field of women's health. PMID:15919394

  15. Venlafaxine (Effexor) and Pregnancy

    MedlinePlus

    ... health care providers. Studies have shown that when depression is left untreated during pregnancy, there may be increased risks for miscarriage, preeclampsia (dangerous rise in maternal blood pressure), preterm delivery, low birth weight, postpartum mood disorders and other harmful effects (see the ...

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

    PubMed

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

    2016-07-01

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

  17. Managing asthma in pregnancy

    PubMed Central

    2015-01-01

    during pregnancy as for other adults. Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy. Educational aims To identify the goals of and steps associated with effective asthma management in pregnancy. To understand the maternal and perinatal risks associated with asthma during pregnancy. To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma. PMID:27066119

  18. Chest pain syndromes in pregnancy.

    PubMed

    Sahni, Gagan

    2012-08-01

    Chest pain syndromes in pregnancy include numerous catastrophic cardiovascular events. Acute myocardial infarction, aortic dissection, pulmonary embolism, and amniotic fluid embolism are the most important causes of nonobstetric mortality and morbidity in pregnancy. Each of these could result in poor maternal and fetal outcomes if not diagnosed and treated in a timely fashion. However, their diagnosis and management is limited by fetal risks of diagnostic procedures, dangers of pharmacotherapy and interventions that have neither been widely studied nor validated. This article reviews the current literature on epidemiology, risk factors, pathogenesis, diagnosis, and management of 4 potentially lethal chest pain syndromes in pregnancy. PMID:22813362

  19. Sickle Cell Disease in Pregnancy.

    PubMed

    Hathaway, Amanda Redden

    2016-09-01

    Sickle cell disease (SCD) is the most common hereditary disorder and affects 30 million people worldwide. Advances in science have improved overall survival in patients with SCD and as such, more patients are reaching reproductive age and are becoming pregnant. SCD in pregnancy leads to multiple complications that put both the mother and fetus at risk, and patients with SCD have six times the mortality during pregnancy as compared with patients without SCD. This review summarizes the maternal and fetal risks of patients with SCD and makes recommendations on how best to care for these patients throughout all stages of pregnancy. PMID:27598360

  20. Pregnancy Weight Gain Calculator

    MedlinePlus

    ... Newsroom Dietary Guidelines Communicator’s Guide Pregnancy Weight Gain Calculator You are here Home / Online Tools Pregnancy Weight Gain Calculator Print Share Pregnancy Weight Gain Calculator Pregnancy Weight Gain Calculator Pregnancy Weight Gain Intro ...

  1. Teenage Pregnancy.

    ERIC Educational Resources Information Center

    McClellan, Mary C.

    1987-01-01

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

  2. [Ictus, pregnancy and contraception].

    PubMed

    Pareja, A; Láinez, J M

    1995-01-01

    Ictus is a severe complication of pregnancy and the puerperium and a significant cause of maternal mortality. The risk of ictus increases by 3-13 times during pregnancy because of a tendency toward hypercoagulability, hemodynamic alterations related to increased blood volume, and severe arterial hypertension. This work outlines the incidence, etiology, diagnosis, and treatment of ischemic cerebrovascular pathology, cerebral venous thrombosis, and hemorrhagic cerebrovascular pathology occurring during pregnancy. Risk factors are indicated. The role of oral contraceptives (OCs) as a risk factor for cerebrovascular pathology is then discussed. Various prospective and retrospective studies to establish the causal or casual relationship between OC use and ictus have been published since 1962. Two important studies published in 1969 found a statistically significant increased relative risk of ischemic cerebrovascular accident in OC users. The Collaborative Group for the Study of Stroke in Young Women included hemorrhagic ictus in a retrospective study for the first time in 1973, finding that the risk of thrombotic and hemorrhagic cerebrovascular accident was significantly greater in OC users. In 1975, using the same sample, the group found a positive relation between increased blood pressure and risk of ischemic and hemorrhagic events in OC users. The largest prospective study, begun by the Royal College of General Practitioners in England in 1968, found an increased risk of mortality from circulatory diseases in OC users, with mortality risks for coronary ischemia and subarachnoid hemorrhage statistically significant. The study found that the use of OCs increased the risk of fatal subarachnoid hemorrhage, especially in women over 35 who smoked. Other prospective studies found an increased incidence of nonfatal cerebrovascular accident, with relative risks for all cerebrovascular accidents ranging from 5 to 6.5. A recent continuation of the Royal College Study found that

  3. Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A register study

    PubMed Central

    Reis, Margareta; Källén, Bengt

    2013-01-01

    Objectives To investigate the proposed synergistic teratogenic effect of use of selective serotonin receptor inhibitors (SSRI) together with sedatives or hypnotics, primarily benzodiazepines, during pregnancy. Design Cohort study of congenital malformations after maternal use of SSRI, sedatives/hypnotics or the combination of the two drug categories. Setting Swedish national health registers. Participants A total of 10 511 infants born of women who had used SSRI drugs but no other central nervous system (CNS)-active drug, 1000 infants born of women who had used benzodiazepines and no other CNS-active drug, and 406 infants whose mothers had used both SSRI and benzodiazepines but no other CNS-active drug. Results None of the three groups showed a higher risk for any relatively severe congenital malformation or any cardiac defect when comparison was made with the general population risk (adjusted risk ratio (RR) for the combination of SSRI and benzodiazepines and a relatively severe malformation=1.17 (95% CI 0.70 to 1.73). Similar results were obtained for the combination of SSRI with other sedative/hypnotic drugs. Conclusions The previously stated increased risk associated with the combined use of these drug categories, notably for a cardiac defect, could not be replicated. PMID:23427202

  4. Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal

    PubMed Central

    Nisar, Yasir Bin; Dibley, Michael J.; Aguayo, Victor M.

    2016-01-01

    The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77–0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64–0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used. PMID:26828515

  5. Migraine in pregnancy.

    PubMed

    Aubé, M

    1999-01-01

    Migraine does not increase the risk for complications of pregnancy for the mother or for the fetus: the incidences of toxemia, miscarriages, abnormal labour, congenital anomalies, and stillbirths are comparable to those of the general population. Several retrospective studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70% of women either go into remission or improve significantly, mainly during the second and third trimesters. Women with migraine onset at menarche and those with perimenstrual migraine are more likely to go into remission during pregnancy. The migraine type does not seem to be a significant prognostic factor for improvement. However, in the small number of women (4-8%) whose migraines worsen with pregnancy, migraine with aura appears to be overrepresented. In a small number of cases (1.3-16.5%), migraine appears to start with pregnancy, often in the first trimester; these headaches involve a higher proportion of migraine with aura. Management of migraine during pregnancy should first focus on avoiding potential triggers. Consideration should also be given to nonpharmacologic therapies. If pharmacologic treatment becomes necessary, acetaminophen and codeine can be used safely as abortive agents; ASA and NSAIDs (ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester. For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine can be used; metoclopramide should be restricted to the third trimester. According to the United States FDA risk categories, meperidine and morphine show no evidence of risk in humans but should not be used at the end of the third trimester. In some refractory cases, dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g., pro