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Sample records for improve pregnancy outcome

  1. Improving maternal nutrition for better pregnancy outcomes.

    PubMed

    Nnam, N M

    2015-11-01

    Much has been learned during the past several decades about the role of maternal nutrition in the outcome of pregnancy. While the bulk of the data is derived from animal models, human observations are gradually accumulating. There is need to improve maternal nutrition because of the high neonatal mortality rate especially in developing countries. The author used a conceptual framework which took both primary and secondary factors into account when interpreting study findings. Nutrition plays a vital role in reducing some of the health risks associated with pregnancy such as risk of fetal and infant mortality, intra-uterine growth retardation, low birth weight and premature births, decreased birth defects, cretinism, poor brain development and risk of infection. Adequate nutrition is essential for a woman throughout her life cycle to ensure proper development and prepare the reproductive life of the woman. Pregnant women require varied diets and increased nutrient intake to cope with the extra needs during pregnancy. Use of dietary supplements and fortified foods should be encouraged for pregnant women to ensure adequate supply of nutrients for both mother and foetus. The author concludes that nutrition education should be a core component of Mother and Child Health Clinics and every opportunity should be utilised to give nutrition education on appropriate diets for pregnant women.

  2. Systemic lupus erythematosus: strategies to improve pregnancy outcomes

    PubMed Central

    Yamamoto, Yuriko; Aoki, Shigeru

    2016-01-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a high prevalence in females of childbearing age. Thus, reproduction in SLE patients is a major concern for clinicians. In the past, SLE patients were advised to defer pregnancy because of poor pregnancy outcomes and fear of SLE flares during pregnancy. Investigations to date show that maternal and fetal risks are higher in females with SLE than in the general population. However, with appropriate management of the disease, sufferers may have a relatively uncomplicated pregnancy course. Factors such as appropriate preconception counseling and medication adjustment, strict disease control prior to pregnancy, intensive surveillance during and after pregnancy by both the obstetrician and rheumatologist, and appropriate interventions when necessary play a key role. This review describes the strategies to improve pregnancy outcomes in SLE patients at different time points in the reproduction cycle (preconception, during pregnancy, and postpartum period) and also details the neonatal concerns. PMID:27468250

  3. Obesity in pregnancy: addressing risks to improve outcomes.

    PubMed

    Kriebs, Jan M

    2014-01-01

    The rapidly increasing rates of obesity among women of childbearing age, not only in the United States but also across the globe, contribute to increased risks during pregnancy and childbirth. Overweight and obesity are quantified by body mass index (BMI) for clinical purposes. In 2010, 31.9% of U.S. women aged 20 to 39 years met the definition of obesity, a BMI of 30 kg/m or greater. Across the life span, obesity is associated with increased risks of hypertension, cardiovascular disease, diabetes, sleep apnea, and other diseases. During pregnancy, increasing levels of prepregnancy BMI are associated with increases in both maternal and fetal/neonatal risks. This article reviews current knowledge about obesity in pregnancy and health risks related to increased maternal BMI, addresses weight stigma as a barrier to care and interventions that have evidence of benefit, and discusses the development of policies and guidelines to improve care.

  4. Does influenza vaccination improve pregnancy outcome? Methodological issues and research needs.

    PubMed

    Savitz, David A; Fell, Deshayne B; Ortiz, Justin R; Bhat, Niranjan

    2015-11-25

    Evidence that influenza vaccination during pregnancy is safe and effective at preventing influenza disease in women and their children through the first months of life is increasing. Several reports of reduced risk of adverse outcomes associated with influenza vaccination have generated interest in its potential for improving pregnancy outcome. Gavi, the Vaccine Alliance, estimates maternal influenza immunization programs in low-income countries would have a relatively modest impact on mortality compared to other new or under-utilized vaccines, however the impact would be substantially greater if reported vaccine effects on improved pregnancy outcomes were accurate. Here, we examine the available evidence and methodological issues bearing on the relationship between influenza vaccination and pregnancy outcome, particularly preterm birth and fetal growth restriction, and summarize research needs. Evidence for absence of harm associated with vaccination at a point in time is not symmetric with evidence of benefit, given the scenario in which vaccination reduces risk of influenza disease and, in turn, risk of adverse pregnancy outcome. The empirical evidence for vaccination preventing influenza in pregnant women is strong, but the evidence that influenza itself causes adverse pregnancy outcomes is inconsistent and limited in quality. Studies of vaccination and pregnancy outcome have produced mixed evidence of potential benefit but are limited in terms of influenza disease assessment and control of confounding, and their analytic methods often fail to fully address the longitudinal nature of pregnancy and influenza prevalence. We recommend making full use of results of randomized trials, re-analysis of existing observational studies to account for confounding and time-related factors, and quantitative assessment of the potential benefits of vaccination in improving pregnancy outcome, all of which should be informed by the collective engagement of experts in influenza

  5. Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby.

    PubMed

    Fitzpatrick, Alyssa; Mohammadi, Fadak; Jesudason, Shilpanjali

    2016-01-01

    Parenthood is a central focus for women with chronic kidney disease, but raises important fears and uncertainties about risks to their own and their baby's health. Pregnancy in women with background kidney disease, women receiving dialysis, or those with a functioning kidney transplant poses a challenging clinical scenario, associated with high maternal-fetal morbidity and potential impact on maternal renal health. Improvements in care over recent decades have led to a paradigm shift with cautious optimism and growing interest regarding pregnancies in women with chronic kidney disease. In this review, we discuss obstetric and renal outcomes, and practical aspects of management of pregnancy in this complex cohort. PMID:27471410

  6. Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby

    PubMed Central

    Fitzpatrick, Alyssa; Mohammadi, Fadak; Jesudason, Shilpanjali

    2016-01-01

    Parenthood is a central focus for women with chronic kidney disease, but raises important fears and uncertainties about risks to their own and their baby’s health. Pregnancy in women with background kidney disease, women receiving dialysis, or those with a functioning kidney transplant poses a challenging clinical scenario, associated with high maternal–fetal morbidity and potential impact on maternal renal health. Improvements in care over recent decades have led to a paradigm shift with cautious optimism and growing interest regarding pregnancies in women with chronic kidney disease. In this review, we discuss obstetric and renal outcomes, and practical aspects of management of pregnancy in this complex cohort. PMID:27471410

  7. Methamphetamines and Pregnancy Outcomes

    PubMed Central

    Wright, Tricia E.; Schuetter, Renee; Tellei, Jacqueline; Sauvage, Lynnae

    2014-01-01

    during pregnancy. Stopping MA use at any time during pregnancy improves birth outcomes, thus resources should be directed towards providing treatment and prenatal care. PMID:25599434

  8. Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome?

    PubMed

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

    2015-01-01

    The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome. Hydroxychloroquine is widely used in patients with various autoimmune diseases, particularly SLE. Antimalarials have many anti-inflammatory, anti-aggregant and immune-regulatory properties: they inhibit phospholipase activity, stabilize lysosomal membranes, block the production of several pro-inflammatory cytokines and, in addition, impair complement-dependent antigen-antibody reactions. There is ample evidence of protective effects of hydroxychloroquine in OAPS similar to the situation in SLE arising from in vitro studies of pathophysiological working mechanism of hydroxychloroquine. However, the clinical data on the use of hydroxychloroquine in primary APS are lacking and prospective studies are necessary.

  9. The Complement System and Adverse Pregnancy Outcomes

    PubMed Central

    Regal, Jean F.; Gilbert, Jeffrey S.; Burwick, Richard M.

    2015-01-01

    Adverse pregnancy outcomes significantly contribute to morbidity and mortality for mother and child, with lifelong health consequences for both. The innate and adaptive immune system must be regulated to insure survival of the feta allograft, and the complement system is no exception. An intact complement system optimizes placental development and function and is essential to maintain host defense and fetal survival. Complement regulation is apparent at the placental interface from early pregnancy with some degree of complement activation occurring normally throughout gestation. However, a number of pregnancy complications including early pregnancy loss, fetal growth restriction, hypertensive disorders of pregnancy and preterm birth are associated with excessive or misdirected complement activation, and are more frequent in women with inherited or acquired complement system disorders or complement gene mutations. Clinical studies employing complement biomarkers in plasma and urine implicate dysregulated complement activation in components of each of the adverse pregnancy outcomes. In addition, mechanistic studies in rat and mouse models of adverse pregnancy outcomes address the complement pathways or activation products of importance and allow critical analysis of the pathophysiology. Targeted complement therapeutics are already in use to control adverse pregnancy outcomes in select situations. A clearer understanding of the role of the complement system in both normal pregnancy and complicated or failed pregnancy will allow a rational approach to future therapeutic strategies for manipulating complement with the goal of mitigating adverse pregnancy outcomes, preserving host defense, and improving long term outcomes for both mother and child. PMID:25802092

  10. The complement system and adverse pregnancy outcomes.

    PubMed

    Regal, Jean F; Gilbert, Jeffrey S; Burwick, Richard M

    2015-09-01

    Adverse pregnancy outcomes significantly contribute to morbidity and mortality for mother and child, with lifelong health consequences for both. The innate and adaptive immune system must be regulated to insure survival of the fetal allograft, and the complement system is no exception. An intact complement system optimizes placental development and function and is essential to maintain host defense and fetal survival. Complement regulation is apparent at the placental interface from early pregnancy with some degree of complement activation occurring normally throughout gestation. However, a number of pregnancy complications including early pregnancy loss, fetal growth restriction, hypertensive disorders of pregnancy and preterm birth are associated with excessive or misdirected complement activation, and are more frequent in women with inherited or acquired complement system disorders or complement gene mutations. Clinical studies employing complement biomarkers in plasma and urine implicate dysregulated complement activation in components of each of the adverse pregnancy outcomes. In addition, mechanistic studies in rat and mouse models of adverse pregnancy outcomes address the complement pathways or activation products of importance and allow critical analysis of the pathophysiology. Targeted complement therapeutics are already in use to control adverse pregnancy outcomes in select situations. A clearer understanding of the role of the complement system in both normal pregnancy and complicated or failed pregnancy will allow a rational approach to future therapeutic strategies for manipulating complement with the goal of mitigating adverse pregnancy outcomes, preserving host defense, and improving long term outcomes for both mother and child.

  11. Interstitial pregnancy management and subsequent pregnancy outcome.

    PubMed

    Sagiv, Ron; Debby, Abraham; Keidar, Ran; Kerner, Ram; Golan, Abraham

    2013-11-01

    We report on management and subsequent fertility outcome of interstitial pregnancy in a retrospective cohort study (Canadian Task Force classification II-3) at a university affiliated teaching hospital. Of 706 women with extrauterine pregnancy, 14 consecutive women with interstitial pregnancy were treated by methotrexate, laparotomy or laparoscopy between 1997 and 2007. The first four women, with significant hemoperitoneum, were treated by laparotomy. Of the next 10 women, four were selected for medical treatment with methotrexate. Only one case was treated successfully. The other six women had laparoscopic treatment. Of nine laparoscopies, one was converted to laparotomy due to excessive blood loss during the procedure. Of nine women desiring a child, three were infertile, whereas six conceived with an intrauterine pregnancy. A change from diagnosis later in pregnancy and laparotomy to more conservative treatment, mainly by laparoscopy, suggests a possibly better subsequent pregnancy rate.

  12. Dietary L-glutamine supplementation improves pregnancy outcome in mice infected with type-2 porcine circovirus.

    PubMed

    Ren, Wenkai; Luo, Wei; Wu, Miaomiao; Liu, Gang; Yu, Xinglong; Fang, Jun; Li, Teijun; Yin, Yulong; Wu, Guoyao

    2013-09-01

    Porcine circovirus type 2 (PCV2) causes reproductive failure in swine. As glutamine can enhance immune function in animals, this study was conducted with mice to test the hypothesis that dietary glutamine supplementation will improve pregnancy outcome in PCV2-infected dams. Beginning on day 0 of gestation, mice were fed a standard diet supplemented with 1.0% L-glutamine or 1.22% L-alanine (isonitrogenous control). All mice were infected with PCV2 (2000 TCID50) on day 10 of gestation. On day 17 of gestation, six mice from each group were euthanized to obtain maternal tissues and fetuses for hematology and histopathology tests. The remaining mice continued to receive their respective diets supplemented with 1.0% L-glutamine or 1.22% L-alanine through lactation. The PCV2 virus was present in maternal samples (serum and lung) of most mice in the control group but was not detected in the glutamine-supplemented mice. Dietary glutamine supplementation reduced abortion, decreased fetal deaths, and enhanced neonatal survival. The glutamine treatment also reduced concentrations of interleukin-6, while increasing concentrations of tumor necrosis factor-α and C-reactive protein, in the maternal serum of mice. Furthermore, glutamine supplementation attenuated microscopic lesions in maternal tissues (lung, spleen, and liver). Collectively, these results indicate that dietary glutamine supplementation is beneficial for ameliorating reproductive failure in virus-infected mice. The findings support the notion that gestating dams require adequate amounts of dietary glutamine for the optimal survival and growth of embryos, fetuses, and neonates, and have important implications for nutritional support of mammals (including swine and humans) during gestation and lactation.

  13. Traditional birth attendant training for improving health behaviours and pregnancy outcomes

    PubMed Central

    Sibley, Lynn M; Sipe, Theresa Ann; Barry, Danika

    2014-01-01

    Background Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training is limited but promising for some mortality outcomes. Objectives To assess the effects of TBA training on health behaviours and pregnancy outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (18 June 2012), citation alerts from our work and reference lists of studies identified in the search. Selection criteria Published and unpublished randomised controlled trials (RCT), comparing trained versus untrained TBAs, additionally trained versus trained TBAs, or women cared for/living in areas served by TBAs. Data collection and analysis Three authors independently assessed study quality and extracted data in the original and first update review. Three authors and one external reviewer independently assessed study quality and two extracted data in this second update. Main results Six studies involving over 1345 TBAs, more than 32,000 women and approximately 57,000 births that examined the effects of TBA training for trained versus untrained TBAs (one study) and additionally trained TBA training versus trained TBAs (five studies) are included in this review. These studies consist of individual randomised trials (two studies) and cluster-randomised trials (four studies). The primary outcomes across the sample of studies were perinatal deaths, stillbirths and neonatal deaths (early, late and overall). Trained TBAs versus untrained TBAs: one cluster-randomised trial found a significantly lower perinatal death rate in the trained versus untrained TBA clusters (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.59 to 0.83), lower stillbirth rate (adjusted OR 0.69, 95% CI 0.57 to 0.83) and lower neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82). This study also found the maternal death

  14. A multi-centre phase IIa clinical study of predictive testing for preeclampsia: improved pregnancy outcomes via early detection (IMPROvED)

    PubMed Central

    2013-01-01

    Background 5% of first time pregnancies are complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful screening test exists; consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROvED Consortium members have pioneered a personalised medicine approach to identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The key objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia. Methods/Design We report the design of a multicentre, phase IIa clinical study aiming to recruit 5000 low risk primiparous women to assess and refine innovative prototype tests based on emerging metabolomic and proteomic technologies. Participation involves maternal phlebotomy at 15 and 20 weeks’ gestation, with optional testing and biobanking at 11 and 34 weeks. Blood samples will be analysed using two innovative, proprietary prototype platforms; one metabolomic based and one proteomic based, both of which outperform current biomarker based screening tests at comparable gestations. Analytical and clinical data will be collated and analysed via the Copenhagen Trials Unit. Discussion The IMPROvED study is expected to refine proteomic and metabolomic panels, combined with clinical parameters, and evaluate clinical applicability as an early pregnancy predictive test for pre-eclampsia. If ‘at risk’ patients can be identified, this will allow stratified care with personalised fetal and maternal surveillance, early diagnosis, timely intervention, and significant health economic savings. The IMPROvED biobank will be accessible to the European scientific community for high quality research into the cause and prevention of adverse pregnancy outcome. Trial registration Trial registration number NCT01891240 The IMPROvED project is funded by the seventh framework

  15. First look: a cluster-randomized trial of ultrasound to improve pregnancy outcomes in low income country settings

    PubMed Central

    2014-01-01

    Background In high-resource settings, obstetric ultrasound is a standard component of prenatal care used to identify pregnancy complications and to establish an accurate gestational age in order to improve obstetric care. Whether or not ultrasound use will improve care and ultimately pregnancy outcomes in low-resource settings is unknown. Methods/Design This multi-country cluster randomized trial will assess the impact of antenatal ultrasound screening performed by health care staff on a composite outcome consisting of maternal mortality and maternal near-miss, stillbirth and neonatal mortality in low-resource community settings. The trial will utilize an existing research infrastructure, the Global Network for Women’s and Children’s Health Research with sites in Pakistan, Kenya, Zambia, Democratic Republic of Congo and Guatemala. A maternal and newborn health registry in defined geographic areas which documents all pregnancies and their outcomes to 6 weeks post-delivery will provide population-based rates of maternal mortality and morbidity, stillbirth, neonatal mortality and morbidity, and health care utilization for study clusters. A total of 58 study clusters each with a health center and about 500 births per year will be randomized (29 intervention and 29 control). The intervention includes training of health workers (e.g., nurses, midwives, clinical officers) to perform ultrasound examinations during antenatal care, generally at 18–22 and at 32–36 weeks for each subject. Women who are identified as having a complication of pregnancy will be referred to a hospital for appropriate care. Finally, the intervention includes community sensitization activities to inform women and their families of the availability of ultrasound at the antenatal care clinic and training in emergency obstetric and neonatal care at referral facilities. Discussion In summary, our trial will evaluate whether introduction of ultrasound during antenatal care improves pregnancy

  16. Physical violence during pregnancy and pregnancy outcomes in Ghana

    PubMed Central

    2014-01-01

    Background In pregnancy, violence can have serious health consequences that could affect both mother and child. In Ghana there are limited data on this subject. We sought to assess the relationship between physical violence during pregnancy and pregnancy outcomes (early pregnancy loss, perinatal mortality and neonatal mortality) in Ghana. Method The 2008 Ghana Demographic and Health Survey data were used. For the domestic violence module, 2563 women were approached of whom 2442 women completed the module. After excluding missing values and applying the weight factor, 1745 women remained. Logistic regression analysis was performed to assess the relationship between physical violence in pregnancy and adverse pregnancy outcomes with adjustments for potential confounders. Results About five percent of the women experienced violence during their pregnancy. Physical violence in pregnancy was positively associated with perinatal mortality and neonatal mortality, but not with early pregnancy loss. The differences remained largely unchanged after adjustment for age, parity, education level, wealth status, marital status and place of residence: adjusted odds ratios were 2.32; 95% CI: 1.34-4.01 for perinatal mortality, 1.86; 95% CI: 1.05-3.30 for neonatal mortality and 1.16; 95% CI: 0.60-2.24 for early pregnancy loss. Conclusion Our findings suggest that violence during pregnancy is related to adverse pregnancy outcomes in Ghana. Major efforts are needed to tackle violence during pregnancy. This can be achieved through measures that are directed towards the right target groups. Measures should include education, empowerment and improving socio-economic status of women. PMID:24528555

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

    PubMed Central

    2012-01-01

    Background Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes. Methods A systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented. Results Thirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n

  18. Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population.

    PubMed

    Ezeanochie, M C; Ande, A B; Olagbuji, B N

    2011-12-01

    Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.

  19. Pregnancy outcome and uterine fibroids.

    PubMed

    Parazzini, Fabio; Tozzi, Luca; Bianchi, Stefano

    2016-07-01

    Myomas are observed in about 3-12% of pregnant women. Uterine fibroids may affect the outcome of pregnancy. The presence of myomas - in particular of myomas that distort the uterine cavity and larger intramural myomas - has been associated with infertility. In the case of pregnancy, it has been linked to an increased risk of spontaneous abortion, fetal malpresentation, placenta previa, preterm birth, cesarean section, and peripartum hemorrhage. Although fibroids may negatively affect pregnancy outcome, the impact of their treatment, particularly in quantitative terms, is unclear. Hysteroscopic myomectomy is the treatment of choice for submucous fibroids. The comparative efficacy of laparoscopic, laparotomic, or new modalities of treatment of intramural fibroids is not known. Up to date the choice and modalities of treatment of submucous fibroids should not be based on sound evidence but on clinical concerns and the skill of each center. PMID:26723475

  20. Maternal microbiome and pregnancy outcomes.

    PubMed

    Fox, Chelsea; Eichelberger, Kacey

    2015-12-01

    Alterations of the human microbiome are a known characteristic of various inflammatory disease states and have been linked to spontaneous preterm birth and other adverse pregnancy outcomes. Recent advances in metagenomic research have proven that the placenta harbors its own rich diverse microbiome, even in clinically healthy pregnancies, and preterm birth may be a result of hematogenous infection rather than exclusively ascending infection as previously hypothesized. In this review, we describe the microbiome in healthy nongravid and gravid women to contrast it with the alterations of the microbiome associated with spontaneous preterm birth. We also discuss the importance of host gene-environment interactions and the potential for microbiota-specific targeted therapies to reduce the risk of adverse pregnancy outcomes.

  1. Pregnancy outcome and uterine fibroids.

    PubMed

    Parazzini, Fabio; Tozzi, Luca; Bianchi, Stefano

    2016-07-01

    Myomas are observed in about 3-12% of pregnant women. Uterine fibroids may affect the outcome of pregnancy. The presence of myomas - in particular of myomas that distort the uterine cavity and larger intramural myomas - has been associated with infertility. In the case of pregnancy, it has been linked to an increased risk of spontaneous abortion, fetal malpresentation, placenta previa, preterm birth, cesarean section, and peripartum hemorrhage. Although fibroids may negatively affect pregnancy outcome, the impact of their treatment, particularly in quantitative terms, is unclear. Hysteroscopic myomectomy is the treatment of choice for submucous fibroids. The comparative efficacy of laparoscopic, laparotomic, or new modalities of treatment of intramural fibroids is not known. Up to date the choice and modalities of treatment of submucous fibroids should not be based on sound evidence but on clinical concerns and the skill of each center.

  2. Thyroid dysfunction and pregnancy outcomes

    PubMed Central

    Nazarpour, Sima; Ramezani Tehrani, Fahimeh; Simbar, Masoumeh; Azizi, Fereidoun

    2015-01-01

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

  3. Improved pregnancy outcome in a patient with renal allograft nephropathy undergoing temporary hemodialysis.

    PubMed

    Al-Jayyousi, R; Carr, S; Hodgett, S; Scudamore, I; Howarth, E; Singlehurst, A; Brunskill, N

    2003-12-01

    We report a case of a woman with a poorly functioning renal allograft and a positive anti-cardiolipin antibody who was dialysis-independent and conceived 18 months following her transplant. She was electively maintained on hemodialysis during the pregnancy and delivered a live infant at 31 weeks gestation. Her renal function returned to prepregnancy levels post partum and she remained dialysis-independent. PMID:14690260

  4. Personality and adolescent pregnancy outcomes

    PubMed Central

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

    2014-01-01

    Aims To examine the relationship between personality, pregnancy and birth outcomes in adolescents Background Personality has been shown to be a strong predictor of many health outcomes. Adolescents who become pregnant have worse birth outcomes than adults. Design Cross-sectional study using data from the National Longitudinal Study of Adolescent Health (baseline, 1994-1995; follow-up, 2007-2008). Methods The study sample was 6529 girls, 820 of whom reported on pregnancy outcomes for a teenage birth. Personality data was taken from the Mini International Personality Item Pool personality tool, which measures the five-factor personality traits of neuroticism, conscientiousness, intellect/imagination, extraversion and agreeableness. Logistic regression was used to predict teen pregnancy and linear regression was used to predict birth weight and gestational age with adjustment for confounders and stratification by race. Results Agreeableness and intellect/imagination were associated with a reduced likelihood of becoming pregnant as an adolescent, while neuroticism, conscientiousness and extraversion were all associated with an increased likelihood of becoming pregnant. Higher neuroticism was associated with lower birth weight and gestational age among Black girls, but not non-Black. Conscientiousness was associated with lower gestational age among non-Black girls. No relationships were found with extraversion or agreeableness and birth outcomes. Receiving late or no prenatal care was associated with higher intellect/imagination. Conclusions Personality is understudied with respect to pregnancy and birth outcomes compared with other health outcomes. Such research could help professionals and clinicians design and target programs that best fit the characteristics of the population most likely to need them, such as those with high neuroticism. PMID:25040691

  5. Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby

    PubMed Central

    2013-01-01

    Abstract Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide effective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be

  6. Evaluation of a mHealth Data Quality Intervention to Improve Documentation of Pregnancy Outcomes by Health Surveillance Assistants in Malawi: A Cluster Randomized Trial

    PubMed Central

    Joos, Olga; Silva, Romesh; Amouzou, Agbessi; Moulton, Lawrence H.; Perin, Jamie; Bryce, Jennifer; Mullany, Luke C.

    2016-01-01

    Background While community health workers are being recognized as an integral work force with growing responsibilities, increased demands can potentially affect motivation and performance. The ubiquity of mobile phones, even in hard-to-reach communities, has facilitated the pursuit of novel approaches to support community health workers beyond traditional modes of supervision, job aids, in-service training, and material compensation. We tested whether supportive short message services (SMS) could improve reporting of pregnancies and pregnancy outcomes among community health workers (Health Surveillance Assistants, or HSAs) in Malawi. Methods and Findings We designed a set of one-way SMS that were sent to HSAs on a regular basis during a 12-month period. We tested the effectiveness of the cluster-randomized intervention in improving the complete documentation of a pregnancy. We defined complete documentation as a pregnancy for which a specific outcome was recorded. HSAs in the treatment group received motivational and data quality SMS. HSAs in the control group received only motivational SMS. During baseline and intervention periods, we matched reported pregnancies to reported outcomes to determine if reporting of matched pregnancies differed between groups and by period. The trial is registered as ISCTRN24785657. Conclusions Study results show that the mHealth intervention improved the documentation of matched pregnancies in both the treatment (OR 1.31, 95% CI: 1.10–1.55, p<0.01) and control (OR 1.46, 95% CI: 1.11–1.91, p = 0.01) groups relative to the baseline period, despite differences in SMS content between groups. The results should be interpreted with caution given that the study was underpowered. We did not find a statistically significant difference in matched pregnancy documentation between groups during the intervention period (OR 0.94, 95% CI: 0.63–1.38, p = 0.74). mHealth applications have the potential to improve the tracking and data quality of

  7. Cohort analysis of antenatal care and delivery outcomes in pregnancy: a basis for improving maternal health.

    PubMed

    Harries, A D; Jahn, A; Ben-Smith, A; Gadabu, O J; Douglas, G P; Seita, A; Khader, A; Zachariah, R

    2014-06-21

    Cohort analysis has been the cornerstone of tuberculosis (TB) monitoring and evaluation for nearly two decades; these principles have been adapted for patients with the human immunodeficiency virus/acquired immune-deficiency syndrome on antiretroviral treatment and patients with diabetes mellitus and hypertension. We now make the case for using cohort analyses for monitoring pregnant women during antenatal care, up to and including childbirth. We believe that this approach would strengthen the current monitoring and evaluation systems used in antenatal care by providing more precise information at regular time intervals. Accurate real-time data on how many pregnant women are enrolled in antenatal care, their characteristics, the interventions they are receiving and the outcomes for mother and child should provide a solid basis for action to reduce maternal mortality.

  8. 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

  9. Common sleep disorders: management strategies and pregnancy outcomes.

    PubMed

    Nodine, Priscilla M; Matthews, Ellyn E

    2013-01-01

    Sleep disorders, prevalent in industrialized countries, are associated with adverse health outcomes such as hypertension, diabetes, and obesity. Disturbed sleep during pregnancy is frequently overlooked by health care providers, yet recent studies suggest there is an association between sleep disorders and adverse pregnancy outcomes, including preeclampsia, elevated serum glucose, depression, prolonged labor, and cesarean birth. Growing evidence indicates that the recognition and management of prenatal sleep disorders may minimize adverse pregnancy outcomes and improve maternal and fetal well-being. This focused review of prenatal sleep disturbance literature suggests there are 3 main sleep disorders of interest: breathing-related sleep disorders (ie, habitual snoring and obstructive sleep apnea), restless legs syndrome, and insomnia. These sleep disorders are common in pregnancy and have maternal and fetal consequences if left untreated. This article describes sleep disorders of pregnancy, elucidates their relationship with maternal and neonatal outcomes, and presents current evidence regarding diagnostic and management strategies.

  10. Is the Presence of the Father of the Baby during First Prenatal Ultrasound Study Visit Associated with Improved Pregnancy Outcomes in Adolescents and Young Adults?

    PubMed Central

    Lazebnik, Rina; Kuper-Sassé, Margaret

    2016-01-01

    This study examined whether the presence of the father of the baby (FOB) at the first prenatal ultrasound study (US) visit of pregnant adolescents and young adults (AYA) is a marker for improved pregnancy outcomes. Charts of 400 pregnant AYA aged 14–22 years seen at an academic maternity hospital were assessed retrospectively for support persons brought to prenatal US visits. Logistic regression analysis was used to examine the association between FOB presence and gestational age and birth weight. Of 400 charts with support person recorded, 298 charts with first US visit data, singleton birth, and complete gestational data available were analyzed. FOB was present at 30.2% of visits, while the parent of the mother was present at 34.2% of visits. With FOB present, 3.3% of infants were born preterm (gestational age < 37 weeks) compared with 10.5% of infants with FOB absent (p = 0.04). Patients with FOB present also had significantly earlier gestational age at the first US visit (15 weeks) than those who did not (19 weeks; p = 0.02). For AYA, the presence of FOB at initial prenatal US visits is a predictor of improved pregnancy outcome and likely represents increased support during the pregnancy.

  11. Maternal Dietary Patterns and Pregnancy Outcome

    PubMed Central

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

    2016-01-01

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

  12. Occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy

    PubMed Central

    Henry, David; Dormuth, Colin; Winquist, Brandace; Carney, Greg; Bugden, Shawn; Teare, Gary; Lévesque, Linda E.; Bérard, Anick; Paterson, J. Michael; Platt, Robert W.

    2016-01-01

    Background: Isotretinoin, a teratogen, is widely used to treat cystic acne. Although the risks of pregnancy during isotretinoin therapy are well recognized, there are doubts about the level of adherence with the pregnancy prevention program in Canada. Our objective was to evaluate the effectiveness of the Canadian pregnancy prevention program in 4 provinces: British Columbia, Saskatchewan, Manitoba and Ontario. Methods: Using administrative data, we identified 4 historical cohorts of female users of isotretinoin (aged 12–48 yr) for the period 1996 to 2011. We defined pregnancy using International Statistical Classification of Diseases and billing codes. One definition included only cases with documented pregnancy outcomes (high-specificity definition); the other definition also included individuals recorded as receiving prenatal care (high-sensitivity definition). We studied new courses of isotretinoin and detected pregnancies in 2 time windows: during isotretinoin treatment only and up to 42 weeks after treatment. Live births were followed for 1 year to identify congenital malformations. Results: A total of 59 271 female patients received 102 308 courses of isotretinoin. Between 24.3% and 32.9% of participants received prescriptions for oral contraceptives while they were taking isotretinoin, compared with 28.3% to 35.9% in the 12 months before isotretinoin was started. According to the high-specificity definition of pregnancy, there were 186 pregnancies during isotretinoin treatment (3.1/1000 isotretinoin users), compared with 367 (6.2/1000 users) according to the high-sensitivity definition. By 42 weeks after treatment, there were 1473 pregnancies (24.9/1000 users), according to the high-specificity definition. Of these, 1331 (90.4%) terminated spontaneously or were terminated by medical intervention. Among the 118 live births were 11 (9.3%) cases of congenital malformation. Pregnancy rates during isotretinoin treatment remained constant between 1996 and 2011

  13. Major malformation risk, pregnancy outcomes, and neurodevelopmental outcomes associated with metformin use during pregnancy.

    PubMed

    Andrade, Chittaranjan

    2016-04-01

    There are several reasons why metformin treatment may be considered for women in neuropsychiatric practice. These include prevention or attenuation of antipsychotic-associated weight gain, prevention or treatment of gestational diabetes mellitus (GDM), treatment of type 2 diabetes mellitus, and improvement of conception chances and pregnancy outcomes in the presence of polycystic ovarian disease (PCOD). This article examines the benefits and risks associated with metformin use during pregnancy. The available data suggest that metformin exposure during the first trimester is not associated with major congenital malformations; that metformin reduces the risk of early pregnancy loss, preeclampsia, preterm delivery, and GDM in women with PCOD; that metformin is associated with at least comparable benefits relative to insulin treatment in women with mild GDM; and that neurodevelopmental outcomes at age 1.5-2.5 years are comparable after gestational exposure to metformin and insulin. Whereas study designs were not always ideal and sample sizes were mostly small to modest, the study findings are more encouraging than discouraging and can guide shared decision-making in women who are receiving or may need metformin during pregnancy.

  14. Thrombosis in pregnancy and maternal outcomes.

    PubMed

    James, Andra H

    2015-09-01

    Pregnancy increases the risk of thrombosis four- to five-fold. Seventy-five to eighty percent of pregnancy-related thrombotic events are venous and twenty to -twenty-five percent are arterial. The main reason for the increased risk is hypercoagulability. Women are hypercoagulable because they have evolved so that they are protected against the bleeding challenges of pregnancy, miscarriage, or childbirth. Both genetic and acquired risk factors can further increase the risk of thrombosis. The maternal consequences of thrombosis of pregnancy include permanent vascular damage, disability, and death. While the maternal outcomes of thrombosis can be modified by anticoagulation therapy, management of thrombosis during pregnancy is the subject of another paper in this issue (see paper by B. Konkle). This review will focus on the epidemiology, pathophysiology, risk factors, and maternal consequences of thrombosis in pregnancy.

  15. Does the presence of a condition-specific obstetric protocol lead to detectable improvements in pregnancy outcomes?

    PubMed Central

    Bailit, Jennifer L.; Grobman, William; McGee, Paula; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M.; Leveno, Kenneth J.; Iams, Jay D.; Tita, Alan T. N.; Saade, George; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.

    2015-01-01

    Objective To evaluate whether the presence of condition-specific obstetric protocols within a hospital was associated with better maternal and neonatal outcomes. Study Design Cohort study of a random sample of deliveries performed at 25 hospitals over three years. Condition-specific protocols were collected from all hospitals and categorized independently by two authors. Data on maternal and neonatal outcomes, as well as data necessary for risk adjustment were collected. Risk-adjusted outcomes were compared according to whether the patient delivered in a hospital with condition-specific obstetric protocols at the time of delivery. Results Hemorrhage-specific protocols were not associated with a lower rate of postpartum hemorrhage or with fewer cases of EBL >1000cc. Similarly, in the presence of a shoulder dystocia protocol, there were no differences in the frequency of shoulder dystocia or number of shoulder dystocia maneuvers used. Conversely, preeclampsia-specific protocols were associated with fewer ICU admissions (OR 0.28, 95% CI 0.18–0.44) and fewer cases of severe maternal hypertension (OR 0.86, 95% CI 0.77–0.96). Conclusion The presence of condition-specific obstetric protocols was not consistently shown to be associated with improved risk-adjusted outcomes. Our study would suggest that the presence or absence of a protocol does not matter and regulations to require protocols are not fruitful. PMID:25659468

  16. Treatment with hCG 4 or 6 days after TAI to improve pregnancy outcomes in repeat-breeding dairy cows.

    PubMed

    Alnimer, Mufeed A; Shamoun, Ahmad I

    2015-06-01

    A study was conducted to evaluate the effect of human chorionic gonadotropin (hCG) administration 4 or 6 days after timed AI (TAI) on P4 concentration and pregnancy outcomes in repeat breeding dairy cows. All cows were treated by Cosynch protocol before being assigned into 3 groups: CON (n=139): did not receive hormonal treatments; D4 (n=136): received 1500 IU hCG 4 days post TAI; and D6 (n=131): received 1500 IU hCG 6 days post TAI. Plasma P4 concentration was evaluated on Day of hCG and 12 days post TAI. Pregnancies per AI (P/AI) on Day 45 were greater for D6 (38.9%) than CON (30.9%) groups. Pregnancy losses (PL) were lower for D6 (15.0%) and D4 (26.7%) than CON (37.7%) groups. Treatment by season revealed a greater P/AI and lower PL for D6 (30.3% and 18.2%) and D4 (33.3% and 31.0%) than CON (19.2% and 58.3%) groups during summer, while P/AI was greater for D6 (57.1%) than D4 (30.6%) and CON (37.9%) groups during winter. Treatment by parity indicated a greater P/AI for D4 (46.4%) and D6 (31.6%) than CON (15.8%) groups within primiparous cows. Pregnancy losses were lower for D6 (15.1%) than CON (36.5%) groups within multiparous cows while D4 tended to be lower (13.3%) than CON (50.0%) groups. Plasma P4 concentration on Day 12 post TAI was higher for treated than for CON groups. Applying hCG 6 days after TAI was beneficial in improving P/AI either in summer or winter as a result of reducing PL and increasing P4 concentration.

  17. Pregnancy outcomes following the use of thiocolchicoside.

    PubMed

    Ozturk, Zeynep; Olmez, Ercument; Gurpinar, Tugba; Vural, Kamil

    2016-04-01

    Thiocolchicoside is a commonly used muscle relaxant in orthopedic, rheumatologic or musculoskeletal disorders to treat painful muscle spasms. It is contraindicated in pregnancy and lactation. There is no previously published experience with thiocolchicoside exposure during pregnancy. In this observational study, we collected and evaluated 18 pregnancy outcomes of the women referred to our prenatal consultation service for thiocolchicoside exposure between 2007-2012, and offspring were followed up until 2 years of age. There were 16 live births, 1 spontaneous abortion and 1 elective termination of pregnancy. No major birth defect was observed. The mothers and their babies were free of perinatal complications. No growth or developmental abnormalities were found during follow-up period. Our findings add information on inadvertent use of thiocolchicoside in pregnancy. Further large prospective cohort studies are required to investigate this issue. PMID:26876142

  18. Early gonadotropin-releasing hormone antagonist start improves follicular synchronization and pregnancy outcome as compared to the conventional antagonist protocol

    PubMed Central

    Park, Chan Woo; Hwang, Yu Im; Koo, Hwa Seon; Kang, Inn Soo; Yang, Kwang Moon

    2014-01-01

    Objective To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR). Methods A retrospective cohort study. A total of 218 infertile women who underwent IVF between January 2011 and February 2013. The initial cohort (Cohort I) that underwent IVF between January 2011 and March 2012 included a total of 68 attempted IVF cycles. Thirty-four cycles were treated with the conventional GnRH antagonist protocol, and 34 cycles with an early GnRH antagonist start protocol. The second cohort (Cohort II) that underwent IVF between June 2012 and February 2013 included a total of 150 embryo-transfer (ET) cycles. Forty-three cycles were treated with the conventional GnRH antagonist protocol, 34 cycles with the modified early GnRH antagonist start protocol using highly purified human menopause gonadotropin and an addition of GnRH agonist to the luteal phase support, and 73 cycles with the GnRH agonist long protocol. Results The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04). The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%). Conclusion The modified early antagonist start protocol may improve the mature oocyte yield, possibly via enhanced follicular synchronization, while resulting in superior CPR as compared to the conventional antagonist protocol, which needs to be studied further in prospective randomized controlled trials. PMID:25599038

  19. Caffeine Use Affects Pregnancy Outcome

    ERIC Educational Resources Information Center

    Diego, Miguel; Field, Tiffany; Hernandez-Reif, Maria; Vera, Yanexy; Gil, Karla; Gonzalez-Garcia, Adolfo

    2008-01-01

    A sample of 750 women were interviewed during pregnancy on their depression and anxiety symptoms, substance use and demographic variables. A subsample was seen again at the neonatal stage (n = 152), and their infants were observed for sleep-wake behavior. Symptoms of depression and anxiety were related to caffeine use. Mothers who consumed more…

  20. Resistance Exercise in Pregnancy and Outcome.

    PubMed

    Barakat, Ruben; Perales, Maria

    2016-09-01

    As the health benefits of exercise are increasingly recognized, the traditional advice to rest during pregnancy has changed toward a more healthy and active pregnancy, therefore different forms of exercise have been integrated into the life of the pregnant woman. Although the benefits of using a combination of resistance and aerobic exercises are not yet determined, studies about resistance and strengthen training programs are few although no adverse outcomes were reported. PMID:27388962

  1. Pregnancy outcome of early multifetal pregnancy reduction: triplets to twins versus triplets to singletons.

    PubMed

    Haas, Jigal; Hourvitz, Ariel; Dor, Jehoshua; Yinon, Yoav; Elizur, Shai; Mazaki-Tovi, Shali; Barzilay, Eran; Shulman, Adrian

    2014-12-01

    Multifetal pregnancy reduction (MPR) of triplets to twins results in improved pregnancy outcomes compared with triplet gestations managed expectantly. Perinatal outcomes of early transvaginal MPR from triplets to twins were compared with reduction from triplets to singletons. Seventy-four trichorionic triplet pregnancies that underwent early transvaginal MPR at 6-8 weeks gestation were included. Cases were divided into two groups according to the initial procedure: reduction to twin (n = 55) or to singleton (n = 19) gestations. Infants from triplet pregnancies reduced to twins were delivered earlier (36.6 versus 37.9 weeks; P = 0.04) and had lower mean birth weights (2364 g versus 2748 g; P = 0.02) compared with those from triplets reduced to singleton gestations. The rates of pregnancy loss before 24 weeks (3.6% versus 5.3%), as well as of preterm delivery before 32 and 34 weeks of gestation (0% versus 5.3% and 7.3% versus 5.3%, respectively) were similar between the twin and singleton pregnancies. No significant difference was found in the prevalence of gestational diabetes (15.1% versus 5.6%) or gestational hypertension (24.5% versus 16.7%) between the groups. Selective reduction of triplet pregnancies to singleton rather than twin gestations is associated with improved outcomes. PMID:25444505

  2. The impact of dasatinib on pregnancy outcomes.

    PubMed

    Cortes, Jorge E; Abruzzese, Elisabetta; Chelysheva, Ekaterina; Guha, Mausumee; Wallis, Nicola; Apperley, Jane F

    2015-12-01

    Prolonged survival in patients with chronic myeloid leukemia treated with BCR-ABL1-targeted tyrosine kinase inhibitors allows consideration of parenthood for patients on chronic therapy, but there are limited data about the effects of dasatinib on pregnancy. Pregnancy-related outcomes in dasatinib-treated patients or their partners reported to Bristol-Myers Squibb from clinical trials or healthcare providers through December 2013 were reviewed. Outcomes were available in 46/78 dasatinib-treated women (59%) and 33/69 partners of dasatinib-treated men (48%). Fifteen women (33%) delivered a normal infant; 18 (39%) and 8 (17%) had an elective or spontaneous abortion; and 5 (11%) had an abnormal pregnancy. There were 7 reports of fetal/infant abnormalities (encephalocele, renal tract abnormalities, and hydrops fetalis). Thirty of 33 (91%) infants fathered by dasatinib-treated men were reported normal at birth. Also, animal studies evaluated the impact of dasatinib on fertility, embryo-fetal toxicity, and development, suggesting that dasatinib may be a selective developmental toxicant. The outcomes of most pregnancies conceived by men treated with dasatinib were normal, but due to the small number of cases, further monitoring is required. Significant effects on pregnancy outcomes in women treated with dasatinib were found, supporting current recommendations that women avoid becoming pregnant during dasatinib treatment and be informed of fetal risks. PMID:26348106

  3. Pre-pregnancy stress reactivity and pregnancy outcome.

    PubMed

    Harville, Emily W; Gunderson, Erica P; Matthews, Karen A; Lewis, Cora E; Carnethon, Mercedes

    2010-11-01

    Stress has been proposed as a cause of preterm birth (PTB) and small-for-gestational age (SGA), but stress does not have the same effects on all women. It may be that a woman's reaction to stress relates to her pregnancy health, and previous studies indicate that higher reactivity is associated with reduced birthweight and gestational age. The objective of this study was to examine the relationship between pre-pregnancy cardiovascular reactivity to stress and pregnancy outcome. The sample included 917 women in the Coronary Artery Risk Development in Young Adults Study who had cardiovascular reactivity measured in 1987-88 and at least one subsequent singleton livebirth within an 18-year period. Cardiovascular reactivity was measured using a video game, star tracing and cold pressor test. Gestational age and birthweight were based on the women's self-report, with PTB defined as birth <37 weeks' gestation and SGA as weight <10th percentile for gestational age. Linear and Poisson regression and generalised estimating equations were used to model the relationship between reactivity to stress and birth outcomes with control for confounders. Few associations were seen between reactivity and pregnancy outcomes. Higher pre-pregnancy diastolic blood pressure (adjusted relative risk 1.14; 95% confidence interval [CI] 0.98, 1.34) and mean arterial pressure reactivity (1.15; 0.98, 1.36) were associated with risk of PTB at first pregnancy, while SGA was associated with lower systolic blood pressure reactivity (0.76; 0.60, 0.95). No associations were seen with other measures of reactivity. Contrary to hypothesis, the association between heart rate reactivity and PTB in first pregnancy was stronger in whites (adjusted relative risk 1.39; 1.03, 1.88) than in blacks (1.00; 0.83, 1.20; P for interaction = 0.08). Similar results were found for mean arterial pressure. No strong associations were found between higher pre-pregnancy stress reactivity and SGA or PTB, and stress reactivity

  4. Antiepileptic Drugs and Pregnancy Outcomes

    PubMed Central

    Wlodarczyk, Bogdan J.; Palacios, Ana M.; George, Timothy M.; Finnell, Richard H.

    2012-01-01

    The treatment of epilepsy in women of reproductive age remains a clinical challenge. While most women with epilepsy require anticonvulsant drugs for adequate control of their seizures, the teratogenicity associated with some antiepileptic drugs is a risk that needs to be carefully addressed. Antiepileptic medications are also used to treat an ever broadening range of medical conditions such as bipolar disorder, migraine prophylaxis, cancer and neuropathic pain. Despite the fact that the majority of pregnancies of women with epilepsy who are receiving pharmacological treatment are normal, studies have demonstrated that the risk of having a pregnancy complicated by a major congenital malformation is doubled when comparing the risk of untreated pregnancies. Furthermore, when antiepileptic drugs (AEDs) are used in polytherapy regimens, the risk is tripled, especially when valproic acid (VPA) is included. However, it should be noted that the risks are specific for each anticonvulsant drug. Some investigations have suggested that the risk of teratogenicity is increased in a dose-dependent manner. More recent studies have reported that in utero exposure to AEDs can have detrimental effects on the cognitive functions and language skills in later stages of life. In fact, the FDA just issued a safety announcement on the impact of VPA on cognition (Safety Announcement 6-30-2011). The purpose of this document is to review the most commonly used compounds in the treatment of women with epilepsy, and to provide information on the latest experimental and human epidemiological studies of the effects of antiepileptic drugs in the exposed embryos. PMID:22711424

  5. Outcome of Induction of Labour in Prolonged Pregnancy.

    PubMed

    Nasrin, S; Islam, S; Shahida, S M; Begum, R A; Haque, N

    2015-10-01

    This was a hospital based prospective clinical study conducted among women having prolonged pregnancy to assess the outcome of induction of labour in prolonged pregnancy cases. One hundred and thirty nine women having uncomplicated prolonged pregnancy were studied. The study was carried out in Sir Salimullah Medical College & Mitford Hospital, Dhaka from 01 July 2010 to 30 March 2011. In this study 66% of the respondents had vaginal delivery on routine induction of labour and in 34% cases induction failed. Ninety three percent (93%) of the multigravida had vaginal delivery and in primigravida their vaginal delivery rate was 47.5%. Regarding cervical condition for delivery, 75% of the respondents having favourable cervix had vaginal delivery and in case of unfavourable cervix respondents, they had 55% cases of vaginal delivery. About the foetal outcome it was evidenced from this study that the perinatal adverse outcome increases with the increasing age of gestation beyond 40 completed weeks of gestation. This study showed that the use of prostaglandins for cervical ripening and by confirming the diagnosis of prolonged pregnancy, the delivery outcome in prolonged pregnancy can be improved. The study also showed that induction of labour is not associated with any major complications and the routine induction of labour in prolonged pregnancy is beneficial for both mother and the baby.

  6. Fetal growth potential and pregnancy outcome.

    PubMed

    Bukowski, Radek

    2004-02-01

    Although the association of fetal growth restriction and adverse pregnancy outcomes is well known, lack of sensitivity limits its clinical value. To a large extent, this limitation is a result of traditionally used method to define growth restriction by comparing fetal or birth weight to population norms. The use of population norms, by virtue of their inability to fully consider individual variation, results in high false positive and negative rates. An alternative, calculating fetal individually optimal growth potential, based on physiological determinants of individual growth, is superior in predicting adverse outcomes of pregnancy. Impairment of fetal growth potential identifes some adverse pregnancy outcomes that are not associated with growth restrction defined by population norms. When compared with traditional population-based norms, fetal growth potential is a better predictor of several important adverse outcomes of pregnancy which include: stillbirth, neonatal mortality and morbidity, and long-term adverse neonatal outcomes like neonatal encephalopathy, cerebral palsy and cognitive abilities. Impairment of individual growth potential is also strongly associated with spontaneous preterm delivery. Although definitive interventional trials have not been conducted as yet to validate the clinical value of fetal growth potential, many observational studies, conducted in various populations, indicate its significant promise in this respect.

  7. Chronic Endometritis Due to Common Bacteria Is Prevalent in Women With Recurrent Miscarriage as Confirmed by Improved Pregnancy Outcome After Antibiotic Treatment

    PubMed Central

    Matteo, Maria; Tinelli, Raffaele; Pinto, Vincenzo; Marinaccio, Marco; Indraccolo, Ugo; De Ziegler, Dominique; Resta, Leonardo

    2014-01-01

    Recurrent miscarriage (RM) is defined as 3 or more miscarriages before 20 weeks’ pregnancy. In recent years, interest has been focused on chronic endometritis (CE), a subtle inflammation thought to be associated with RM. We aimed to evaluate the relationships between CE and RM. The records of 360 women with unexplained RM were retrospectively analyzed. Data from hysteroscopy, endometrial histology, endometrial culture, and polymerase chain reaction for chlamydia, performed before and after antibiotic treatment for CE, were analyzed. The occurrence of successful pregnancies within 1 year after treatment was also evaluated. Results showed that 208 (57.8%) women with RM showed CE at hysteroscopy; 190 (91.3%), positive at hysteroscopy, were also positive at histology, and 142 (68.3%) had positive cultures. Common bacteria were found in 110 (77.5%) patients. Mycoplasma and Ureaplasma were found in 36 (25.3%) patients and Chlamydia in 18 patients (12.7%). In 102 (71%) women, antibiogram-based antibiotic treatment normalized hysteroscopy, histology, and cultures (group 1); while in 40 (28.2%) patients, CE was still present at hysteroscopy (group 2). In 16 of the 66 patients positive at hysteroscopy, but not at cultures, the hysteroscopy becomes normal (group 3) after a Centers for Disease Control and Prevention-based therapy; while in 50 women, CE was still present (group 4). One year after treatment, group 1 showed a significantly higher number of pregnancies (78.4%) compared to group 2 (17.5%; P < .001) and group 4 (15.3%; P = .005). The CE is frequent in women with RM. Antibiotic treatment seems to be associated with an improved reproductive outcome. PMID:24177713

  8. Pregnancy and neonatal outcome after bariatric surgery.

    PubMed

    Willis, Kent; Lieberman, Nicky; Sheiner, Eyal

    2015-01-01

    The global obesity epidemic is changing the face of maternal-fetal medicine. One in five women is obese at time of conception, and increasing numbers of parturients have undergone bariatric surgery. Recent publication of large, population-based studies and comparison studies of preoperative and post-operative pregnancies have highlighted new risks and benefits to the mother and child. Pregnancy after bariatric surgery appears to effectively reduce the risk of complications such as fetal macrosomia, gestational diabetes mellitus, and hypertensive disorders of pregnancy; however, women who become pregnant after bariatric surgery may constitute a unique obstetric population with an increased risk for preterm and small-for-gestational-age infants. In this article, we provide an overview of the current knowledge of the impact of maternal bariatric surgery on neonatal and pregnancy outcomes.

  9. Arsenic in drinking water and pregnancy outcomes.

    PubMed Central

    Ahmad, S A; Sayed, M H; Barua, S; Khan, M H; Faruquee, M H; Jalil, A; Hadi, S A; Talukder, H K

    2001-01-01

    We studied a group of women of reproductive age (15-49 years) who were chronically exposed to arsenic through drinking water to identify the pregnancy outcomes in terms of live birth, stillbirth, spontaneous abortion, and preterm birth. We compared pregnancy outcomes of exposed respondents with pregnancy outcomes of women of reproductive age (15-49 years) who were not exposed to arsenic-contaminated water. In a cross-sectional study, we matched the women in both exposed and nonexposed groups for age, socioeconomic status, education, and age at marriage. The total sample size was 192, with 96 women in each group (i.e., exposed and nonexposed). Of the respondents in the exposed group, 98% had been drinking water containing [Greater and equal to] 0.10 mg/L arsenic and 43.8% had been drinking arsenic-contaminated water for 5-10 years. Skin manifestation due to chronic arsenic exposure was present in 22.9% of the respondents. Adverse pregnancy outcomes in terms of spontaneous abortion, stillbirth, and preterm birth rates were significantly higher in the exposed group than those in the nonexposed group (p = 0.008, p = 0.046, and p = 0.018, respectively). PMID:11445518

  10. 77 FR 48995 - Draft National Toxicology Program (NTP) Monograph on Developmental Effects and Pregnancy Outcomes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-15

    ... Developmental Effects and Pregnancy Outcomes Associated With Cancer Chemotherapy Use During Pregnancy; Request... Pregnancy Outcomes Associated with Cancer Chemotherapy Use during Pregnancy (available by August 14, 2012... NTP Monograph on Developmental Effects and Pregnancy Outcomes Associated with Cancer Chemotherapy...

  11. 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

  12. [Influence of short interpregnancy interval on pregnancy outcomes].

    PubMed

    Zilberman, Beniamin

    2007-01-01

    Optimal interpregnancy interval (IPI) is an important issue affecting pregnancy results, fetal and maternal morbidity/mortality, and has economic, social and demographic significance. The definition of IPI has not yet been standardized, thereby affecting results and conclusions. It was found that pregnancies conceived 18 to 23 months after previous birth had the lowest risks of fetal complications--low birth weight, preterm birth, and small size for gestational age. Women with shorter IPI have higher risk of maternal mortality, hypertensive disorders of pregnancy, bleeding and anemia. Studies conducted in developing countries suggest longer IPI-3 to 5 years as the optimal IPI. The relation between short interpregnancy intervals and adverse perinatal outcomes has been attributed to maternal nutritional depletion, the competition theory and behavioral risk factors. It was proposed that there is a J-shaped association between IPI and adverse pregnancy outcomes. This is not the effect of other common reproductive risk factors. There is a need to inform women regarding the association between adverse pregnancy outcomes and interpregnancy intervals, as well as the benefits of optimizing that interval. Public health programs could identify women with other risk factors (for example substance abuse, such as tobacco or alcohol, or a young/advanced maternal age) for interventions to improve perinatal outcomes. There is also a need for more studies to define the optimal IPI under local conditions. PMID:17294848

  13. Pregnancy outcomes of women exposed to laninamivir during pregnancy

    PubMed Central

    Minakami, Hisanori; Kubo, Takahiko; Nakai, Akihito; Saito, Shigeru; Unno, Nobuya

    2014-01-01

    Purpose The purpose of this study is to assess pregnancy outcomes of women treated with a novel neuraminidase inhibitor, laninamivir, during pregnancy. Methods A retrospective review of pregnancy outcomes of 112 pregnant women who were given laninamivir for treatment of influenza was performed. Possible adverse events, including miscarriages, preterm birth, foetal malformation and any neonatal morbidity requiring treatment, were assessed. Results Seventeen, 39, 46 and 10 women were administered a single inhaled dose of 20 or 40 mg of laninamivir at gestational week (GW) 3–11, 12–21, 22–36 and 37 or more, respectively. One (1.8%) of 56 women with laninamivir at GW <22 experienced miscarriage at GW <12. The remaining 111 women gave birth to 111 viable infants but at preterm (GW <37) in nine (8.8%) of 102 women with laninamivir at GW <37. Three (2.7%) of the 111 newborns had malformations: forefoot varus deformity, foot polydactyly and cleft lip in one each born to a mother taking laninamivir at GW 6, 17 and 21, respectively. Five neonates (4.5%) were small for gestational age. Eleven (9.9%), five (4.5%) and no neonates required phototherapy for jaundice, transient respiratory supports for respiratory distress syndrome (n = 2) or transient tachypnoea of the newborn (n = 3), and glucose administration for hypoglycaemia, respectively. Conclusions Although this study included a small number of study women and no control women, the results suggested that maternal exposure to laninamivir did not increase the rate of adverse pregnancy and foetal outcomes. PMID:25074683

  14. Impact of environmental factors and poverty on pregnancy outcomes.

    PubMed

    Weck, Rebekah L; Paulose, Tessie; Flaws, Jodi A

    2008-06-01

    Studies have indicated that various societal factors such as toxicant exposure, maternal habits, occupational hazards, psychosocial factors, socioeconomic status, racial disparity, chronic stress, and infection may impact pregnancy outcomes. These outcomes include spontaneous abortion, preterm birth, alterations in the development of the fetus, and long-term health of offspring. Although much is known about individual pregnancy outcomes, little is known about the associations between societal factors and pregnancy outcomes. This manuscript reviews some of the literature available on the effects of the above-mentioned societal factors on pregnancy outcomes and examines some potential remedies for preventing adverse pregnancy outcomes in the future. PMID:18463465

  15. Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes

    PubMed Central

    Wong, Luchin F.; Wilkes, Jacob; Korgenski, Kent; Varner, Michael W.; Manuck, Tracy A.

    2016-01-01

    Objective The objective of this study was to describe pregnancy outcomes, including cervical insufficiency and preterm birth, in the subsequent pregnancy following an intrapartum cervical laceration. Study Design Retrospective cohort of women with their first two consecutive singleton pregnancies carried to ≥ 200/7 weeks' gestation within a tertiary health care system from 2002 to 2012. Cervical laceration cases were identified by ICD9 codes and included if suture repair was required. Results In this study, 55 women were confirmed to have a cervical laceration in the first delivery; 43 lacerations after vaginal delivery (VD) and 12 after cesarean delivery (CD). The median gestational age of the first delivery was 400/7 weeks and the median birth weight 3,545 g; these did not differ between VD and CD. In the second pregnancy, 2 of 55 women (4.6%) had a prophylactic cerclage placed; 1 carried to term and the other delivered at 356/7 weeks. In total, four women (9.3%) delivered the second pregnancy < 37 weeks: three had a prior term VD and one had a prior 34 weeks VD. There was only one case of recurrent cervical laceration, occurring in the setting of vaginal deliveries. Conclusion Obstetric cervical lacerations are uncommon. Complications in the following pregnancy were low, despite lack of additional prophylactic cerclage use. PMID:27621953

  16. Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes

    PubMed Central

    Wong, Luchin F.; Wilkes, Jacob; Korgenski, Kent; Varner, Michael W.; Manuck, Tracy A.

    2016-01-01

    Objective  The objective of this study was to describe pregnancy outcomes, including cervical insufficiency and preterm birth, in the subsequent pregnancy following an intrapartum cervical laceration. Study Design  Retrospective cohort of women with their first two consecutive singleton pregnancies carried to ≥ 200/7 weeks' gestation within a tertiary health care system from 2002 to 2012. Cervical laceration cases were identified by ICD9 codes and included if suture repair was required. Results  In this study, 55 women were confirmed to have a cervical laceration in the first delivery; 43 lacerations after vaginal delivery (VD) and 12 after cesarean delivery (CD). The median gestational age of the first delivery was 400/7 weeks and the median birth weight 3,545 g; these did not differ between VD and CD. In the second pregnancy, 2 of 55 women (4.6%) had a prophylactic cerclage placed; 1 carried to term and the other delivered at 356/7 weeks. In total, four women (9.3%) delivered the second pregnancy < 37 weeks: three had a prior term VD and one had a prior 34 weeks VD. There was only one case of recurrent cervical laceration, occurring in the setting of vaginal deliveries. Conclusion  Obstetric cervical lacerations are uncommon. Complications in the following pregnancy were low, despite lack of additional prophylactic cerclage use. PMID:27621953

  17. Diet during pregnancy, neonatal outcomes and later health.

    PubMed

    Moore, Vivienne M; Davies, Michael J

    2005-01-01

    Renewed interest in nutrition during pregnancy has been generated by the hypothesis that adult disease has origins in early life. Animal experiments clearly show that altering maternal diet before and during pregnancy can induce permanent changes in the offspring's birth size, adult health and lifespan. Among women living in Western societies, cigarette smoking is the most important factor known to reduce fetal growth, followed by low pre-pregnancy weight and low gestational weight gain. Obesity is also associated with pregnancy complications and adverse neonatal outcomes, so inadequate or excessive energy intake is not optimal for the developing fetus. Against a history of inconsistent results, several recent studies suggest that in Western settings the balance of macronutrients in a woman's diet can influence newborn size. Effects appear to be modest, but this relationship may not encapsulate the full significance for health of the child, as there is emerging evidence of associations with long-term metabolic functioning that are independent of birth size. Consequences of inadequate maternal nutrition, for the offspring, may depend on timing during gestation, reflecting critical windows for fetal development. Where women are not malnourished, changing a woman's nutritional plane during pregnancy may be detrimental to the unborn baby, and systematic reviews of the literature on dietary supplementation during pregnancy indicate few benefits and possible risks. In view of this, improved diet before pregnancy deserves greater attention.

  18. An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol

    PubMed Central

    Wendt, Kim; Crilly, Julia; May, Chris; Bates, Kym; Saxena, Rakhee

    2014-01-01

    Background Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011. Methods A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered. Results Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS–EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST). Conclusions The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED. PMID:24136123

  19. Surgery during pregnancy and fetal outcome

    SciTech Connect

    Brodsky, J.B.; Cohen, E.N.; Brown, B.W.; Wu, M.L.; Whitcher, C.

    1988-01-01

    Information was sought on wives of dentists or female dental assistants who underwent surgery during their pregnancies to determine the effects of anesthesia and surgery on fetal outcome. Occupational exposure to inhalation anesthetics either directly (dental assistants) or indirectly (wives of exposed male dentists) was associated with a significant increase in spontaneous abortion rate over a comparison group during both trimesters. Anesthesia for surgery was also associated with increased fetal loss when administered during the first or second trimesters. The number of congenital abormalities in children born to women who had surgery during pregnancy was not increased. For women surgically exposed to anesthetics and occupationally exposed as well, either directly or indirectly, the risk of spontaneous abortion increased almost threefold above control lvels. The authors conclude that elective surgery should be deferred during early pregnanacy to minimize potential fetal loss.

  20. Maternal and neonatal outcomes of macrosomic pregnancies

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Weisz, Boaz; Achiron, Reuven; Dulitzky, Mordechai

    2012-01-01

    Summary Background To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. Material/Methods A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000–4250 g, 4250–4500 g and ≥4500 g). Results The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000–4250 g, 4250–4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000–4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. Conclusions Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500g group. PMID:22936200

  1. Pregnancy outcomes associated with viral hepatitis.

    PubMed

    Reddick, K L B; Jhaveri, R; Gandhi, M; James, A H; Swamy, G K

    2011-07-01

    The aim of this study was to examine the contribution of hepatitis B virus (HBV) and hepatitis C virus (HCV) to pregnancy-related complications including gestational diabetes mellitus (GDM), preterm birth (PTB), intrauterine growth restriction (IUGR), pre-eclampsia, antepartum haemorrhage and cholestasis. The Nationwide Inpatient Sample was queried for all pregnancy-related discharges, pregnancy complications and viral hepatitis from 1995 to 2005. Logistic regression was used to examine the association between HBV, HCV, HBV + HCV and pregnancy-related complications including GDM, PTB, IUGR, pre-eclampsia, antepartum haemorrhage, cholestasis and caesarean delivery. Model covariates included maternal age, race, insurance status, substance use and medical complications including liver complication, hypertension, HIV, anaemia, thrombocytopenia and sexually transmitted infections. Of 297 664 pregnant women data available for analysis, 1446 had a coded diagnosis of HBV, HCV or both. High-risk behaviours, such as smoking, alcohol and substance use were higher in women with either HBV or HCV. Women with HBV had an increased risk for PTB (aOR 1.65, CI [1.3, 2.0]) but a decreased risk for caesarean delivery (aOR 0.686, CI [0.53, 0.88]). Individuals with HCV had an increased risk for GDM (aOR 1.6, CI [1.0, 2.6]). Individuals with both HBV and HCV co-infection had an increased risk for antepartum haemorrhage (aOR 2.82, CI [1.1, 7.2]). There was no association of viral hepatitis with IUGR or pre-eclampsia. Women with hepatitis have an increased risk for complications during pregnancy. Research to determine the efficacy and cost-effectiveness of counselling patients about potential risks for adverse outcomes is warranted. PMID:21692952

  2. Does intrauterine saline infusion by intrauterine insemination (IUI) catheter as endometrial injury during IVF cycles improve pregnancy outcomes among patients with recurrent implantation failure?: An RCT

    PubMed Central

    Salehpour, Saghar; Zamaniyan, Marzieh; Saharkhiz, Nasrin; Zadeh modares, Shahrzad; Hosieni, Sedighe; Seif, Samira; Malih, Narges; Rezapoor, Parinaz; Sohrabi, Mohammad-Reza

    2016-01-01

    Background: Recurrent implantation failure is one of the most issues in IVF cycles. Some researchers found that beneficial effects of endometrial Scratching in women with recurrent implantation failure, while some authors demonstrated contrary results Objective: The present study aimed to investigate the effect of intrauterine. Saline infusion as a form of endometrial injury, during fresh in vitro fertilization-embryo transfer cycle, among patients with recurrent implantation failure. Materials and Methods: In this clinical trial study 63 women undergoing assisted reproductive technology were divided into two groups either local endometrial injury by intrauterine saline infusion during day 3-5 of the ongoing controlled ovarian stimulation cycle, or IVF protocol performed without any other intervention in Taleghani Hospital, Tehran, Iran. The main outcome measure was clinical pregnancy rates. Results: Patients who received intra uterine saline infusion (n=20), had significantly lower clinical pregnancy numbers (1 vs. 9, p<0.05) and implantation rates (4.7% vs. 41.6%, p<0.05), compared to controls (n=39). However, there was no significant difference in miscarriage rates (9.4% vs. 8.7%, p>0.05) and multiple pregnancy numbers (1 vs. 3, p>0.05) between groups. Conclusion: When intrauterine saline infusion as a form of endometrial injury is performed during the ongoing IVF cycles it has negative effect on reproductive outcomes among patients with recurrent implantation failure. PMID:27738660

  3. Steroid contraceptive use and pregnancy outcome.

    PubMed

    Pardthaisong, T; Gray, R H; McDaniel, E B; Chandacham, A

    1988-07-01

    Contraceptive use in relation to pregnancy outcome was studied in 8,816 births in Chiang Mai, northern Thailand, by examination of newborn infants and interviews with their mothers. Four thousand twenty-three women used no contraception before the index pregnancy, 1,229 used the injectable contraceptive Depo Provera (DMPA), and 3,038 used oral contraceptives prior to or during pregnancy. No differences were observed between these groups with respect to still births, multiple pregnancies, and birthweight. Women who used oral contraceptives had unexpectedly low rates of major defects and may have been affected by self-selection bias, whereas the noncontraceptors had rates similar to other populations. There was a significantly increased association of polysyndactyly among infants of DMPA users relative to the other groups, which was most pronounced in offspring of women under age 30 years, and persisted after exclusion of subjects with a family history or infants with multiple abnormalities. However, in five out of the ten polysyndactyly cases, the last injection of DMPA occurred more than 9 months before conception, and only three cases had definite gestational exposure. The association of chromosomal anomalies was also significantly increased in infants of mothers who used DMPA. The unrelated nature of these defects, the lack of confirmation from other studies, the distant preconceptional exposure to DMPA in many cases, and chance effects due to multiple statistical comparisons make a causal association unlikely. Other birth defects that had been previously reported in some publications to be associated with progestational steroid exposure, such as neural tube defects, heart malformations, and limb reduction defects, were not found in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Improving asthma during pregnancy with dietary antioxidants: the current evidence.

    PubMed

    Grieger, Jessica A; Wood, Lisa G; Clifton, Vicki L

    2013-08-14

    The complication of asthma during pregnancy is associated with a number of poor outcomes for the mother and fetus. This may be partially driven by increased oxidative stress induced by the combination of asthma and pregnancy. Asthma is a chronic inflammatory disease of the airways associated with systemic inflammation and oxidative stress, which contributes to worsening asthma symptoms. Pregnancy alone also intensifies oxidative stress through the systemic generation of excess reactive oxidative species (ROS). Antioxidants combat the damaging effects of ROS; yet antioxidant defenses are reduced in asthma. Diet and nutrition have been postulated as potential factors to combat the damaging effects of asthma. In particular, dietary antioxidants may play a role in alleviating the heightened oxidative stress in asthma. Although there are some observational and interventional studies that have shown protective effects of antioxidants in asthma, assessment of antioxidants in pregnancy are limited and there are no antioxidant intervention studies in asthmatic pregnancies on asthma outcomes. The aims of this paper are to (i) review the relationships between oxidative stress and dietary antioxidants in adults with asthma and asthma during pregnancy, and (ii) provide the rationale for which dietary management strategies, specifically increased dietary antioxidants, might positively impact maternal asthma outcomes. Improving asthma control through a holistic antioxidant dietary approach might be valuable in reducing asthma exacerbations and improving asthma management during pregnancy, subsequently impacting perinatal health.

  5. Early Childhood Adversity and Pregnancy Outcomes

    PubMed Central

    Smith, Megan V.; Gotman, Nathan; Yonkers, Kimberly A.

    2016-01-01

    Objectives To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits. Methods Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators. Results Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age. Conclusions ACEs have an enduring effect on maternal reproductive health, as manifested by mothers’ delivery of offspring that were of reduced birth weight and shorter gestational age. PMID:26762511

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

    PubMed Central

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

    2016-01-01

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

  7. Does the severity of diabetic retinopathy predict pregnancy outcome?

    PubMed

    Klein, B E; Klein, R; Meuer, S M; Moss, S E; Dalton, D D

    1988-01-01

    The authors sought to determine whether the severity of diabetic retinopathy is a predictor of subsequent pregnancy outcome. One hundred and seventy-nine pregnant diabetic women were evaluated in their first trimester of pregnancy. Stereoscopic color photographs of the ocular fundus were taken and graded by the Fundus Photography Reading Center. Thirty-nine women had no retinopathy, while 28 had proliferative retinopathy in the worse eye. The women's history and hospital delivery room charts were reviewed with regard to pregnancy outcome. Thirty-three pregnancies terminated with an adverse outcome. A logistic regression analysis was used to evaluate significant predictors of pregnancy outcome. Of maternal age, duration of diabetes, glycosylated hemoglobin, proteinuria, cigarette smoking status, and severity of diabetic retinopathy, only the last variable significantly predicted an adverse outcome. These data suggest that the severity of retinopathy should be considered when counseling a pregnant diabetic woman.

  8. Nausea and Vomiting during Pregnancy and Neurodevelopmental Outcomes in Offspring

    PubMed Central

    Parker, Samantha E.; Starr, Jacqueline R.; Collett, Brent R.; Speltz, Matthew L.; Werler, Martha M.

    2014-01-01

    Background Nausea and vomiting of pregnancy (NVP) is the most common complication of pregnancy. NVP has been associated with improved fetal outcomes, but its association with childhood neurodevelopmental outcomes has rarely been studied. Methods Subjects were children aged 5–12 years (n=560) who were controls in a previously conducted case-control study of prenatal risk factors for craniofacial malformations. Information on NVP, including trimester, duration, and treatment, was collected through a maternal interview conducted within three years of delivery. Neurocognition was assessed using the Peabody Picture Vocabulary Test (PPVT-III) and the Beery-Buktenica Test of Visual Motor Integration (VMI-5). Psychosocial outcomes, including internalizing and externalizing behavior problems, were measured by maternal-report using the Child Behavior Checklist (CBCL) and teacher-report, using the Teacher Report Form (TRF). Linear regression models were used to calculate adjusted mean differences (adjMD) and 95% confidence intervals (CI) on test scores for children exposed and unexposed to NVP in-utero. Differences based on trimester, duration, and treatment were assessed. Results NVP was reported among 63% of women and was most common in early pregnancy. Children exposed to NVP performed worse on the VMI-5 (adjMD:−3.04; CI: −5.02, −1.06), but exhibited few other differences from unexposed children. Durations of NVP ≥4 months were associated with poorer scores on PPVT-III (adjMD: −2.52), VMI-5 (adjMD: −5.41), and CBCL (adjMD:3.38(Internalizing) and adjMD:4.19(Externalizing)). Conclusions Overall there were few differences between children exposed and unexposed to NVP. NVP was associated with slightly worse visual-motor performance, and prolonged NVP and NVP extending late into pregnancy were associated with poorer scores on several neurodevelopmental measures. PMID:25327160

  9. Preconceptual administration of an alphavirus replicon UL83 (pp65 homolog) vaccine induces humoral and cellular immunity and improves pregnancy outcome in the guinea pig model of congenital cytomegalovirus infection.

    PubMed

    Schleiss, Mark R; Lacayo, Juan C; Belkaid, Yasmine; McGregor, Alistair; Stroup, Greg; Rayner, Jon; Alterson, Kimberly; Chulay, Jeffrey D; Smith, Jonathan F

    2007-03-15

    Development of a vaccine against congenital cytomegalovirus (CMV) infection is a major public health priority. We report the use of a propagation-defective, single-cycle, RNA replicon vector system, derived from an attenuated strain of the alphavirus Venezuelan equine encephalitis virus, to produce virus-like replicon particles (VRPs) expressing GP83, the guinea pig CMV (GPCMV) homolog of the human CMV pp65 phosphoprotein. Vaccination with VRP-GP83 induced antibodies and CD4(+) and CD8(+) T cell responses in GPCMV-seronegative female guinea pigs. Guinea pigs immunized with VRP-GP83 vaccine or with a VRP vaccine expressing influenza hemagglutinin (VRP-HA) were bred for pregnancy and subsequent GPCMV challenge during the early third trimester. Dams vaccinated with VRP-GP83 had improved pregnancy outcomes, compared with dams vaccinated with the VRP-HA control. For VRP-GP83-vaccinated dams, there were 28 live pups and 4 dead pups (13% mortality) among 10 evaluable litters, compared with 9 live pups and 12 dead pups (57% mortality) among 8 evaluable litters in the VRP-HA-vaccinated group (P<.001, Fisher's exact test). Improved pregnancy outcome was accompanied by reductions in maternal blood viral load, measured by real-time polymerase chain reaction. These results indicate that cell-mediated immune responses directed against a CMV matrix protein can protect against congenital CMV infection and disease. PMID:17299708

  10. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health.

    PubMed

    Lassi, Zohra S; Mansoor, Tarab; Salam, Rehana A; Das, Jai K; Bhutta, Zulfiqar A

    2014-01-01

    The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period. PMID:25178042

  11. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health

    PubMed Central

    2014-01-01

    The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period. PMID:25178042

  12. Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies.

    PubMed

    Ku, Ming; Guo, Shuiming; Shang, Weifeng; Li, Qing; Zeng, Rui; Han, Min; Ge, Shuwang; Xu, Gang

    2016-01-01

    Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients' characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy. PMID:27442513

  13. Pregnancy Outcomes in Chinese Patients with Systemic Lupus Erythematosus (SLE): A Retrospective Study of 109 Pregnancies

    PubMed Central

    Ku, Ming; Guo, Shuiming; Shang, Weifeng; Li, Qing; Zeng, Rui; Han, Min; Ge, Shuwang; Xu, Gang

    2016-01-01

    Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that primarily affects women during their reproductive years. The interaction between SLE and pregnancy remains debated. The objective of this study was to analyze the fetal and maternal outcomes of Chinese women with SLE. A total of 109 pregnancies in 83 SLE patients from June 2004 to June 2014 at a tertiary university hospital were reviewed retrospectively. Patients’ characteristics, clinical and laboratory data during pregnancy were obtained from electronic medical records. After exclusion of elective abortions, the live birth rate was 61.5%. Significantly, APS (antiphospholipid syndrome), disease activity, hypertension, hypocomplementemia, thrombocytopenia, and anemia during pregnancy were more commonly observed in fetal loss pregnancies than in live birth pregnancies. Compared to the 64 women with a history of SLE, 19 women with new-onset lupus during pregnancy had worse pregnancy outcome. Furthermore, the 64 patients with a history of SLE were divided into lupus nephritis group and SLE group (non-renal involvement). We found that the lupus nephritis group had worse maternal outcome than the SLE group. We conclude that new-onset lupus during pregnancy predicts both adverse maternal and fetal outcomes, while a history of lupus nephritis predicts adverse maternal outcomes. It is essential to provide SLE women with progestational counseling and regular multispecialty care during pregnancy. PMID:27442513

  14. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  15. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  16. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  17. Intermittent hepatic porphyria in pregnancy with good perinatal outcome.

    PubMed

    Vidosavljević, Domagoj; Sijanović, Siniša; Rubin, Mirjana; Košuta Petrović, Maja; Abičić Žuljević, Kristina; Simić, Ivana

    2012-02-01

    Porphyrias are rare metabolic diseases caused by enzymatic defects of the haeme biosynthesis. Association of pregnancy and acute porphyria is rare, but mortality rate among pregnant women from acute attack has been reported up to 42%. This paper presents a patient with pregnancy complicated by intermittent hepatic porphyria with good perinatal outcome. The pattern of the attack in pregnancy varies individually and it makes porphyric pregnancies a challenge. Previously diagnosed porphyria patients should be closely monitored during pregnancy and diagnosis of acute porphyria must be also considered in all pregnant women with unexplained abdominal pain.

  18. Pregnancy Outcome after Office Microhysteroscopy in Women with Unexplained Infertility

    PubMed Central

    Seyam, Emaduldin Mostafa; Hassan, Momen Mohamed; Mohamed Sayed Gad, Mohamed Tawfeek; Mahmoud, Hazem Salah; Ibrahim, Mostafa Gamal

    2015-01-01

    make the proposed office microhysteroscopy an ideal and routine procedure in order to diagnose and to treat missed intrauterine abnormalities, especially in cases with un- explained infertility, with additional improvement of the pregnancy outcome after the procedure. PMID:26246874

  19. Risk of Adverse Pregnancy Outcomes in Women with CKD.

    PubMed

    Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Vigotti, Federica Neve; Maxia, Stefania; Lepori, Nicola; Tuveri, Milena; Massidda, Marco; Marchi, Cecilia; Mura, Silvia; Coscia, Alessandra; Biolcati, Marilisa; Gaglioti, Pietro; Nichelatti, Michele; Pibiri, Luciana; Chessa, Giuseppe; Pani, Antonello; Todros, Tullia

    2015-08-01

    CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (>1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P<0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

  20. Gestational weight gain and medical outcomes of pregnancy.

    PubMed

    Ferraro, Zachary M; Contador, Fernanda; Tawfiq, Afaf; Adamo, Kristi B; Gaudet, Laura

    2015-09-01

    This narrative review discusses gestational weight gain (GWG) and medical outcomes of pregnancy, including metabolic, cardiovascular, respiratory, musculoskeletal and psychiatric systems. Taken as a whole, the available evidence shows that excessive GWG increases the risk of all medical complications of pregnancy, and negatively impacts the long-term health and weight of both mothers and their offspring. Briefly, interventions to encourage appropriate GWG are discussed and readers are directed to resources to facilitate discussion of pregnancy weight. PMID:27512468

  1. Obesity, pregnancy complications, and birth outcomes.

    PubMed

    Marshall, Nicole E; Spong, Catherine Y

    2012-12-01

    Obesity is an increasingly common complication of pregnancy with over half of all women in the United States starting pregnancy overweight or obese. Obese women face unique physiological changes during pregnancy, and these women and their neonates are at increased risk for perinatal morbidity and mortality. In this review, we discuss physiological alterations in obese pregnant women and examine obesity-related antepartum, intrapartum, and postpartum complications along with management options.

  2. Pregnancy outcomes in a patient with Sjögren's disease with renal involvement

    PubMed Central

    Joshi, Abhishek; O'Donoghue, Keelin; Mahmood, Uzma; Banerjee, Debasish

    2013-01-01

    Background: Maternal and fetal outcome in pregnancy with renal failure is unpredictable, where each condition can adversely affect the other. We present a case of steroid sensitive Sjögren's nephritis worsened by pregnancy, demonstrated over the course of multiple pregnancies and investigated the aetiology. Case: A 28-year-old nullipara with a diagnosis of primary Sjögren's syndrome presented with a deterioration of renal function. A diagnosis of secondary tubulo-interstitial nephritis was made on renal biopsy. Her first pregnancy ended in the second trimester with a decision to deliver a female infant at 27 weeks due to worsening maternal renal function. Renal function improved immediately. A second pregnancy ended in a first trimester miscarriage. The third and fourth pregnancies delivered male infants at 35 and 34 weeks, with worsening renal function in each pregnancy, reaching end stage. Repeat biopsy showed extensive glomerulosclerosis and male cells were identified. Conclusions: This case of Sjögren's syndrome with renal disease demonstrated the increased risk of fetal and maternal adverse pregnancy outcomes. Renal function worsened in each pregnancy and progressed to end-stage renal disease. Fetal microchimerism offers an interesting mechanism for our patient's renal failure and its apparent relationship to her pregnancies.

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

    PubMed

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

    2016-01-01

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

  4. Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome.

    PubMed

    Ali, Z; Hansen, A V; Ulrik, C S

    2016-05-01

    Asthma is common among pregnant women, and the incidence of asthma exacerbations during pregnancy is high. This literature review provides an overview of the impact of exacerbations of asthma during pregnancy on pregnancy-related complications. The majority of published retrospective studies reveal that asthma exacerbations during pregnancy increase the risk of pre-eclampsia, gestational diabetes, placental abruption and placenta praevia. Furthermore, these women also have higher risk for breech presentation, haemorrhage, pulmonary embolism, caesarean delivery, maternal admission to the intensive care unit and longer postpartum hospital stay. Asthma has been associated with increased risk of intrauterine growth retardation, small-for-gestational age, low birth weight, infant hypoglycaemia and preterm birth, but more recent prospective studies have not revealed significant associations with regard to these outcomes. In conclusion, asthma exacerbations during pregnancy are associated with complications of pregnancy, labour and delivery. Prevention of exacerbations is essential to reduce the risk of complications and poor outcome.

  5. Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

    PubMed Central

    Zhang, Shun; Cardarelli, Kathryn; Shim, Ruth; Ye, Jiali; Booker, Karla L.; Rust, George

    2014-01-01

    To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes. PMID:23065298

  6. Pregnancy and pregnancy outcome in hepatitis C type 1b.

    PubMed

    Jabeen, T; Cannon, B; Hogan, J; Crowley, M; Devereux, C; Fanning, L; Kenny-Walsh, E; Shanahan, F; Whelton, M J

    2000-09-01

    A large cohort of rhesus-negative women in Ireland were inadvertently infected with hepatitis C virus following exposure to contaminated anti-D immunoglobulin in 1977-8. This major iatrogenic episode was discovered in 1994. We studied 36 women who had been infected after their first pregnancy, and compared them to an age- and parity-matched control group of rhesus-positive women. The presence of hepatitis C antibody was confirmed in all 36 by enzyme-linked immunosorbent assay and by recombinant immunoblot assay, while 26 (72%) of the cohort were HCV-RNA-positive (type 1b) on PCR testing. In the 20 years post-infection, all members of the study group had at least one pregnancy, and mean parity was 3.5. They had a total of 100 pregnancies and 85 of these went to term. There were four premature births, one being a twin pregnancy, and 11 spontaneous miscarriages. One miscarriage occurred in the pregnancy following HCV infection. There were two neonatal deaths due to severe congenital abnormalities in the PCR-positive women. Of the children born to HCV-RNA positive mothers, only one (2.3%) tested positive for the virus. Significant portal fibrosis on liver biopsy was confined to HCV-RNA-positive mothers apart from one single exception in the antibody-positive HCV-RNA-negative group. Comparison with the control group showed no increase in spontaneous miscarriage rate, and no significant difference in obstetric complications; birth weights were similar for the two groups.

  7. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study

    PubMed Central

    2009-01-01

    OBJECTIVE—To examine associations of neonatal adiposity with maternal glucose levels and cord serum C-peptide in a multicenter multinational study, the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study, thereby assessing the Pederson hypothesis linking maternal glycemia and fetal hyperinsulinemia to neonatal adiposity. RESEARCH DESIGN AND METHODS—Eligible pregnant women underwent a standard 75-g oral glucose tolerance test between 24 and 32 weeks gestation (as close to 28 weeks as possible). Neonatal anthropometrics and cord serum C-peptide were measured. Associations of maternal glucose and cord serum C-peptide with neonatal adiposity (sum of skin folds >90th percentile or percent body fat >90th percentile) were assessed using multiple logistic regression analyses, with adjustment for potential confounders, including maternal age, parity, BMI, mean arterial pressure, height, gestational age at delivery, and the baby's sex. RESULTS—Among 23,316 HAPO Study participants with glucose levels blinded to caregivers, cord serum C-peptide results were available for 19,885 babies and skin fold measurements for 19,389. For measures of neonatal adiposity, there were strong statistically significant gradients across increasing levels of maternal glucose and cord serum C-peptide, which persisted after adjustment for potential confounders. In fully adjusted continuous variable models, odds ratios ranged from 1.35 to 1.44 for the two measures of adiposity for fasting, 1-h, and 2-h plasma glucose higher by 1 SD. CONCLUSIONS—These findings confirm the link between maternal glucose and neonatal adiposity and suggest that the relationship is mediated by fetal insulin production and that the Pedersen hypothesis describes a basic biological relationship influencing fetal growth. PMID:19011170

  8. Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study

    PubMed Central

    2014-01-01

    Background The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain. PMID:24418321

  9. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome

    PubMed Central

    Nelson, Scott M.; Matthews, Phillippa; Poston, Lucilla

    2010-01-01

    BACKGROUND Obesity among pregnant women is highly prevalent worldwide and is associated in a linear manner with markedly increased risk of adverse outcome for mother and infant. Obesity in the mother may also independently confer risk of obesity to her child. The role of maternal metabolism in determining these outcomes and the potential for lifestyle modification are largely unknown. METHODS Relevant studies were identified by searching PubMed, the metaRegister of clinical trials and Google Scholar without limitations. Sensitive search strategies were combined with relevant medical subject headings and text words. RESULTS Maternal obesity and gestational weight gain have a significant impact on maternal metabolism and offspring development. Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of type 2 diabetes and, potentially, gestational diabetes. CONCLUSIONS Maternal obesity requires the development of effective interventions to improve pregnancy outcome. Strategies that incorporate a detailed understanding of the maternal metabolic environment and its consequences for the health of the mother and the growth of the child are likely to identify the best approach. PMID:19966268

  10. Methamphetamine abuse during pregnancy: outcome and fetal effects.

    PubMed

    Little, B B; Snell, L M; Gilstrap, L C

    1988-10-01

    Methamphetamines are a popular class of recreational drugs sometimes abused by women of childbearing age. The effects of methamphetamine abuse on pregnancy outcome and embryofetal development are not known. In this study, we compared pregnancy and fetal outcome in 52 women who abused methamphetamines with a randomly selected control group of 52 non-drug-abusing women. Body weight, length, and head circumference were significantly decreased in neonates born to mothers who abused methamphetamines during pregnancy. However, the frequency of congenital anomalies was not significantly increased in this group.

  11. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Borgstein, Alexander Berend-Jan; Sondaal, Stephanie FV; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

    2016-01-01

    Background Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to

  12. Pregnancy planning, smoking behaviour during pregnancy, and neonatal outcome: UK millennium cohort study

    PubMed Central

    2013-01-01

    Background Pre-pregnancy health and care are important for the health of the future generations. Smoking during pregnancy has been well-researched and there is clear evidence of harm. But there has been little research on the health impact of planning for pregnancy. This study aims to investigate the independent effects of pregnancy planning and smoking during pregnancy on neonatal outcome. Methods This analysis made use of data from the UK Millennium Cohort Study. The study sample consisted of 18,178 singleton babies born in UK between 2000 and 2001. The neonatal outcomes of interest were low birthweight (<2.5 Kg) and pre-term birth (<37 completed weeks gestation). Logistic regression was used to estimate the association between pregnancy planning and/or smoking and neonatal outcome. Adjusted odds ratios were used to calculate population attributable risk fractions (PAFs). Results 43% of mothers did not plan their pregnancy and 34% were smoking just before and/or during pregnancy. Planners were half as likely to be smokers just before pregnancy, and more likely to give up or reduce the amount smoked if smokers. Unplanned pregnancies had 24% increased odds of low birth weight and prematurity compared to planned pregnancies (AORLBW1.24, 95% CI 1.04-1.48; AORPREM1.24, 95% CI 1.05-1.45), independent of smoking status. The odds of low birth weight for babies of mothers who were smoking just before pregnancy was 91% higher than that of mothers who were not (AORLBW1.91, 95% CI 1.56-2.34). Women who quit or reduced the amount smoked during pregnancy lowered the risk of a low birth weight baby by one third (AORLBW0.66, 95% CI 0.51-0.85) compared with women whose smoking level did not change. Smaller effects were found for prematurity. If all women planned their pregnancy and did not smoke before or during pregnancy, 30% of low birthweight and 14% of prematurity could, in theory, be avoided. Conclusions Planning a pregnancy and avoiding smoking during pregnancy has clear

  13. Rubella and pregnancy: diagnosis, management and outcomes.

    PubMed

    Bouthry, Elise; Picone, Olivier; Hamdi, Ghada; Grangeot-Keros, Liliane; Ayoubi, Jean-Marc; Vauloup-Fellous, Christelle

    2014-12-01

    Rubella is a mild viral disease that typically occurs in childhood. Rubella infection during pregnancy causes congenital rubella syndrome, including the classic triad of cataracts, cardiac abnormalities and sensorineural deafness. Highly effective vaccines have been developed since 1969, and vaccination campaigns have been established in many countries. Although there has been progress, the prevention and diagnosis of rubella remain problematic. This article reviews the implications and management of rubella during pregnancy. PMID:25066688

  14. Rubella and pregnancy: diagnosis, management and outcomes.

    PubMed

    Bouthry, Elise; Picone, Olivier; Hamdi, Ghada; Grangeot-Keros, Liliane; Ayoubi, Jean-Marc; Vauloup-Fellous, Christelle

    2014-12-01

    Rubella is a mild viral disease that typically occurs in childhood. Rubella infection during pregnancy causes congenital rubella syndrome, including the classic triad of cataracts, cardiac abnormalities and sensorineural deafness. Highly effective vaccines have been developed since 1969, and vaccination campaigns have been established in many countries. Although there has been progress, the prevention and diagnosis of rubella remain problematic. This article reviews the implications and management of rubella during pregnancy.

  15. Perinatal outcomes associated with the use of glargine during pregnancy

    PubMed Central

    Di Cianni, G; Torlone, E; Lencioni, C; Bonomo, M; Di Benedetto, A; Napoli, A; Vitacolonna, E; Mannino, D; Lapolla, A

    2008-01-01

    Aims Insulin glargine (IG), with its non-peaking action profile, might be useful in diabetic pregnancy. However, data on its safety are limited and its use during pregnancy is not recommended. This study focused on the effects of IG on perinatal outcome, particularly to estimate the rate of congenital anomalies and birthweight. Methods This retrospective study included women with pre-gestational diabetes who used IG before (at least 1 month) and during pregnancy. For all women we recorded data regarding maternal glycaemic control and pregnancy outcome. We also compared women treated with IG throughout pregnancy and women who stopped taking IG at an earlier stage. Results From 27 centres, 107 Type 1 diabetic pregnancies were identified. IG was started 10.3 ± 6.9 months before conception and in 57.4% of cases was stopped during the first trimester; 42.6% of women continued using it until the end of pregnancy. There were six abortions (four spontaneous and two induced) and five newborns (4.9%) with congenital anomalies. Glycaemic control, birthweight and the prevalence of macrosomia and neonatal morbidity were similar in women who used IG for the full term compared with those who stopped IG earlier during pregnancy. Conclusions This study, although limited, suggests that IG is safe and effective; the rate of congenital malformations was within the range expected for diabetic pregnancies treated with more traditional forms of insulin. IG used throughout pregnancy did not seem to influence birthweight or increase adverse outcomes. Diabet. Med. 25, 993–996 (2008) PMID:18959615

  16. The Assessment of Diet Quality and Its Effects on Health Outcomes Pre-pregnancy and during Pregnancy.

    PubMed

    Martin, Julie C; Zhou, Shao J; Flynn, Angela C; Malek, Lenka; Greco, Rebecca; Moran, Lisa

    2016-03-01

    Overweight and obesity pre pregnancy or during pregnancy is associated with an increased risk for maternal obstetric and fetal complications. Diet is one modifiable risk factor that women may be motivated to improve. General healthy eating guidelines, micronutrient sufficiency and macronutrient quantity and quality are important nutrition considerations pre and during pregnancy. With regards to specific nutrients, health authorities have recommendations for folate and/or iodine supplementation; but not consistently for iron and omega-3 despite evidence for their association with health outcomes. There are modest additional requirements for energy and protein, but not fat or carbohydrate, in mid-late pregnancy. Diet indices and dietary pattern analysis are additional tools or methodologies used to assess diet quality. These tools have been used to determine dietary intakes and patterns and their association with pregnancy complications and birth outcomes pre or during pregnancy. Women who may unnecessarily resist foods due to fear of food contamination from listeriosis and methylmercury may limit their diet quality and a balanced approached is required. Dietary intake may also vary according to certain population characteristics. Additional support for women who are younger, less educated, overweight and obese, from socially disadvantaged areas, smokers and those who unnecessarily avoid healthy foods, is required to achieve a higher quality diet and optimal lifestyle peri conception. PMID:26886241

  17. Childhood victimization: relationship to adolescent pregnancy outcome.

    PubMed

    Stevens-Simon, C; McAnarney, E R

    1994-07-01

    Childhood sexual abuse is a common antecedents of adolescent pregnancy. We studied the pregnancies of 127 poor, black, 12- to 18-year-olds; 42 (33%) of whom reported that they had been physically or sexually abused prior to conception. We hypothesized that during pregnancy: (a) Previously abused adolescents report more stress and depression and less adequate social support than do nonabused adolescents; and (b) Previously abused adolescents obtain less prenatal care, gain less weight, engage in more substance abuse, and give birth to smaller babies than do nonabused adolescents. Consistent with the first study hypothesis, we found that abused adolescents scored significantly higher on stress and depression scales and rated their families as less supportive than did nonabused adolescents. Although there were no group differences in the rate of weight gain or the quantity of prenatal care obtained during pregnancy, abused adolescents were more likely to report substance use during pregnancy and gave birth to significantly smaller, (2,904 +/- 676 vs. 3,198 +/- 443 grams; p = .01), less mature (38.0 +/- 3.4 vs. 39.1 +/- 1.7 weeks; p = .05) infants. Our finding demonstrate the importance of asking pregnant adolescents about abuse. PMID:7922731

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

    PubMed

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

    2012-06-01

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

  19. Improving the accuracy of maternal mortality and pregnancy related death.

    PubMed

    Schaible, Burk

    2014-01-01

    Comparing abortion-related death and pregnancy-related death remains difficult due to the limitations within the Abortion Mortality Surveillance System and the International Statistical Classification of Diseases and Related Health Problems (ICD). These methods lack a systematic and comprehensive method of collecting complete records regarding abortion outcomes in each state and fail to properly identify longitudinal cause of death related to induced abortion. This article seeks to analyze the current method of comparing abortion-related death with pregnancy-related death and provide solutions to improve data collection regarding these subjects.

  20. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

    PubMed Central

    Wyszynski, Diego F.; Carman, Wendy J.; Cantor, Alan B.; Graham, John M.; Kunz, Liza H.; Slavotinek, Anne M.; Kirby, Russell S.; Seeger, John

    2016-01-01

    Objective. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP) or chronic ITP (cITP) diagnosed before or during pregnancy. Methods. A linkage of mothers and babies within a large US health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live births were preterm. Conclusions. The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy. PMID:27092275

  1. Neurocysticercosis in pregnancy: maternal and fetal outcomes.

    PubMed

    D'Cruz, Rebecca F; Ng, Sher M; Dassan, Pooja

    2016-07-01

    Neurocysticercosis (NCC) is a parasitic infection with the larvae of Taenia solium from contaminated pork. It is a leading cause of seizures in the developing world. Symptoms may be secondary to live or degenerating cysts, or previous infection causing calcification or gliosis. Diagnosis is based on clinical presentation, radiological confirmation of intracranial lesions and immunological testing. Management involves symptom control with antiepileptics and antiparasitic agents. Few cases have been described of maternal NCC during pregnancy. We describe a 25-year-old female presenting to a London hospital with secondary generalized seizures. MRI of the brain confirmed a calcified lesion in the right parietal lobe, and she gave a corroborative history of NCC during her childhood in India. She was stabilized initially on antiepileptics, but during her pregnancy presented with breakthrough seizures and radiological evidence of NCC reactivation. She was managed symptomatically with antiepileptics and completed the pregnancy to term with no fetal complications. PMID:27471595

  2. Neurocysticercosis in pregnancy: maternal and fetal outcomes

    PubMed Central

    D'Cruz, Rebecca F.; Ng, Sher M.; Dassan, Pooja

    2016-01-01

    Neurocysticercosis (NCC) is a parasitic infection with the larvae of Taenia solium from contaminated pork. It is a leading cause of seizures in the developing world. Symptoms may be secondary to live or degenerating cysts, or previous infection causing calcification or gliosis. Diagnosis is based on clinical presentation, radiological confirmation of intracranial lesions and immunological testing. Management involves symptom control with antiepileptics and antiparasitic agents. Few cases have been described of maternal NCC during pregnancy. We describe a 25-year-old female presenting to a London hospital with secondary generalized seizures. MRI of the brain confirmed a calcified lesion in the right parietal lobe, and she gave a corroborative history of NCC during her childhood in India. She was stabilized initially on antiepileptics, but during her pregnancy presented with breakthrough seizures and radiological evidence of NCC reactivation. She was managed symptomatically with antiepileptics and completed the pregnancy to term with no fetal complications. PMID:27471595

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

    PubMed

    van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B; Horcajadas, J A; Farquharson, R G; Exalto, N

    2009-01-01

    BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases covering the period 1980-2008. RESULTS Clinically relevant associations of adverse outcome in the subsequent pregnancy with an odds ratio (OR) > 2.0 after complications in a previous pregnancy are the risk of perinatal death after a single previous miscarriage, the risk of very preterm delivery (VPTD) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing pregnancy with an OR > 2.0 after complications in the index pregnancy are the risk of LBW and very low birthweight (VLBW) after a threatened miscarriage, the risk of pregnancy-induced hypertension, pre-eclampsia, placental abruption, preterm delivery (PTD), small for gestational age and low 5-min Apgar score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small uncontrolled studies. Larger population-based controlled studies are needed to confirm these findings. Nevertheless, identification of these risks will improve obstetric care. PMID:19270317

  4. Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

    PubMed Central

    Pourali, Leila; Ayati, Sedigheh; Jelodar, Shahrzad; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan

    2016-01-01

    Introduction: Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minute Apgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1st and 5th min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus). Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART. PMID:27326416

  5. Sickle Cell Disease in Pregnancy: Trend and Pregnancy Outcomes at a Tertiary Hospital in Tanzania

    PubMed Central

    Muganyizi, Projestine S.; Kidanto, Hussein

    2013-01-01

    SCD in pregnancy is associated with increased adverse fetal and maternal outcomes. In Tanzania where the frequency of sickle cell trait is 13% there has been scanty data on SCD in pregnancy. With progressive improvement in childhood survival the burden of SCD in pregnancy will increase. We analyzed all deliveries at Muhimbili National Hospital (MNH) from 1999 to 2011. Fetal and maternal outcomes of SCD deliveries were compared with non-SCD. Data were analyzed using IBM SPSS statistics version 19. Chi square and Fisher Exact tests were used to compare proportions and the independent t-test for continuous data. To predict risks of adverse effects, odds ratios were determined using multivariate logistic regression. A p-value<0.05 was considered significant. In total, 157,473 deliveries occurred at MNH during the study period, of which 149 were SCD (incidence of 95 SCD per 100,000 deliveries). The incidence of SCD had increased from 76 per 100,000 deliveries in the 1999–2002 period to over 100 per 100, 000 deliveries in recent years. The mean maternal age at delivery was lower in SCD (24.0±5.5 years) than in non-SCD deliveries (26.2±6.0 years), p<0.001. Compared with non-SCD (2.9±0.7 Kg), SCD deliveries had less mean birth-weight (2.6±0.6 Kg), p<0.001. SCD were more likely than non-SCD to deliver low APGAR score at 5 minutes (34.5% Vs 15.0%, OR = 3.0, 95%CI: 2.1–4.2), stillbirths (25.7% Vs 7.5%, OR = 4.0, 95%CI: 2.8–5.8). There was excessive risk of maternal deaths in SCD compared to non-SCD (11.4% Vs 0.4%, OR = 29, 95%CI: 17.3–48.1). The leading cause of deaths in SCD was infections in wholly 82% in contrast to only 32% in non-SCD. In conclusion SCD in pregnancy is an emerging problem at MNH with increased adverse fetal outcomes and excessive maternal mortality mainly due to infections. PMID:23418582

  6. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia

    PubMed Central

    Adachi, Kristina; Nielsen-Saines, Karin

    2016-01-01

    Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia. PMID:27144177

  7. Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia.

    PubMed

    Adachi, Kristina; Nielsen-Saines, Karin; Klausner, Jeffrey D

    2016-01-01

    Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia. PMID:27144177

  8. Perinatal outcomes following maternal asthma and cigarette smoking during pregnancy.

    PubMed

    Hodyl, Nicolette A; Stark, Michael J; Scheil, Wendy; Grzeskowiak, Luke E; Clifton, Vicki L

    2014-03-01

    Does cigarette smoking in pregnancy explain the increased risk of adverse perinatal outcomes that occur with maternal asthma or does it compound the effect? Using population based birth records, a retrospective analysis was conducted of all singleton pregnancies in South Australia over 10 years (1999-2008; n=172 305), examining maternal asthma, cigarette smoking and quantity of smoking to estimate odds ratios. Compared with nonasthmatic females who did not smoke during pregnancy, both asthmatic females who smoked and those who did not smoke during pregnancy had a significantly increased risk of gestational diabetes, antepartum haemorrhage, polyhydramnios, premature rupture of membranes, emergency Caesarean section, and the child being small for gestational age and having congenital abnormalities. These associations suggest that asthma, independently of maternal smoking, increases the risk of these adverse perinatal outcomes. Maternal smoking was itself associated with an increased risk of a number of poor neonatal outcomes, with a dose-response relationship observed. Notably, maternal asthma combined with cigarette smoking significantly increased the risk of preterm birth and urinary tract infections to a greater degree than with either exposure alone. Maternal asthma and cigarette smoking during pregnancy are both independently associated with adverse perinatal outcomes and, combined, compound the risk of preterm birth and urinary tract infections.

  9. Improving Outcomes for Teenage Pregnancy and Early Parenthood for Young People in Out-of-Home Care: A Review of the Literature

    ERIC Educational Resources Information Center

    Mendes, Philip

    2009-01-01

    Young people leaving out-of-home care are overrepresented among teenage parents. This paper examines the research literature and identifies key factors that contribute to early pregnancy and parenthood for care leavers, the challenges of early parenting and the positive effects of early parenting. The implications for out-of-home care policy and…

  10. Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

    PubMed Central

    Grzeskowiak, Luke E.; Smith, Brian; Roy, Anil; Dekker, Gustaaf A.

    2016-01-01

    There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201) These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone. PMID:27730170

  11. Bacterial Vaginosis and Pregnancy Outcome in Lagos, Nigeria.

    PubMed

    Afolabi, Bosede B; Moses, Olusanjo E; Oduyebo, Oyinlola O

    2016-01-01

    Background.  Bacterial vaginosis (BV) is a complex clinical syndrome characterized by alterations in the normal vaginal flora and a malodorous discharge when symptomatic. In pregnancy, BV has been associated with adverse outcomes such as miscarriage, premature rupture of membranes, preterm birth, and low birth weight. This study was conducted to determine the prevalence and associations of BV and pregnancy outcomes among pregnant women in Lagos University Teaching Hospital (LUTH). Methods.  We conducted a prospective observational study with high vaginal swabs obtained from consecutive newly registered antenatal women between 14 and 36 weeks gestation. The women were monitored until delivery, and their pregnancy outcome and demographic data were obtained using an interviewer-administered questionnaire. Results.  Bacterial vaginosis was diagnosed by Nugent score in 64 of 246 women, giving a prevalence rate of 26%. Bacterial vaginosis was significantly associated with preterm delivery (risk ratio [RR], 2.68; 95% confidence interval [CI], 1.44-4.98), low birth weight (RR, 3.20; 95% CI, 1.29-7.94), and premature rupture of membranes (RR, 6.75; 95% CI, 3.11-14.67). The association between BV and miscarriage (<28 weeks gestation) and neonatal admission for various morbidities was not statistically significant. Conclusions.  The prevalence rate of BV among pregnant women in LUTH is high and is significantly associated with adverse pregnancy outcome. Routine screening and treatment of women preconceptually may enable interventions to prevent these adverse outcomes. PMID:26989754

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

    PubMed Central

    SANT’ANA, Adriana Campos Passanezi; de CAMPOS, Marinele R.; PASSANEZI, Selma Campos; de REZENDE, Maria Lúcia Rubo; GREGHI, Sebastião Luiz Aguiar; PASSANEZI, Euloir

    2011-01-01

    Objectives The aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes. Material and Methods Pregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG – "no intervention" (n=17) or IG- "intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (<37 weeks), low birth weight (<2.5 kg), late abortion (14-24 weeks) or abortion (<14 weeks). The results obtained were statistically evaluated according to OR, unpaired t test and paired t test at 5% significance level. Results No significant differences were observed between groups at baseline examination. Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (p<0.0001), except for PI. Significant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001). The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02]. Conclusions Periodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes. PMID:21552714

  13. The Quebec Pregnancy Cohort – Prevalence of Medication Use during Gestation and Pregnancy Outcomes

    PubMed Central

    Bérard, Anick; Sheehy, Odile

    2014-01-01

    Purpose We evaluated the potential and the validity of the Quebec Pregnancy Cohort (QPC) as a research tool in perinatal pharmacoepidemiology. Methods The QPC was built by linking four administrative databases: RAMQ (medical and pharmaceutical data), Med-Echo (hospitalizations), ISQ (births/deaths), and MELS (Ministry of Education data). A self-administered questionnaire was sent to a random sample of women to collect lifestyle information. The QPC includes data on all pregnancies of women covered by the Quebec provincial prescription drug insurance between 1998 and 2008. Date of entry in the QPC is the first day of pregnancy, and women are followed during and after pregnancy; children are followed after birth up until 2009. The prevalence of prescribed medications before, during and after pregnancy was compared between time-window. Pregnancy outcomes were also estimated among pregnancies ending with a live born infant. Results The QPC included 289,688 pregnancies of 186,165 women. Among them, 167,398 ended with a delivery representing 19.4% of all deliveries occurring in the Province of Quebec between 1998–2009. The total frequency of abortions was 35.9% in the QPC comparable to the 36.4% observed in the Province of Quebec. The prevalence of prescribed medication use was 74.6%, 59.0%, and 79.6% before, during and after pregnancy, respectively. Although there was a statistically significant decrease in the proportion of use once the pregnancy was diagnosed (p<.01), post-pregnancy prescribed medication use returned above the pre-pregnancy level. The prevalence of pregnancy outcomes found in the QPC were similar to those observed in the Province of Quebec. Conclusion The QPC is an excellent tool for the study of the risk and benefit of drug use during the perinatal period. This cohort has the advantage of including a validated date of beginning of pregnancy giving the possibility of assigning the exact gestational age at the time of maternal exposure. PMID:24705674

  14. Hypertensive disorders of pregnancy, respiratory outcomes and atopy in childhood.

    PubMed

    Shaheen, Seif O; Macdonald-Wallis, Corrie; Lawlor, Debbie A; Henderson, A John

    2016-01-01

    Few epidemiological studies have investigated the role of hypertensive disorders of pregnancy in the aetiology of childhood respiratory and atopic outcomes.In the Avon Longitudinal Study of Parents and Children we examined associations of maternal gestational hypertension, hypertension before pregnancy and pre-eclampsia with wheezing at 18 months, wheezing and asthma at 7 years and lung function at 8-9 years, after controlling for potential confounders (n=5322-8734, depending on outcome).Gestational hypertension was not associated with any of the outcomes. There was weak evidence for a positive association between pre-eclampsia and early wheezing (adjusted OR 1.31, 95% CI 0.94-1.82, compared to normotensive pregnancies) and for negative associations between pre-eclampsia and forced expiratory volume in 1 s (adjusted mean difference in sd score -0.14, 95% CI -0.33-0.06) and maximal mid-expiratory flow (-0.15, 95% CI -0.34-0.04). Hypertension before pregnancy was positively associated with wheezing (OR 1.63, 95% CI 1.16-2.31) and asthma (OR 1.34, 95% CI 1.00-1.79).Gestational hypertension is unlikely to be a risk factor for childhood respiratory disorders; hypertension before pregnancy may be a risk factor for childhood wheezing and asthma, but this finding needs replication. Larger studies are needed to confirm whether pre-eclampsia is associated with impaired childhood lung function.

  15. Iodine supplementation in pregnancy and its effects on perinatal outcome.

    PubMed

    Joshi, A; Pokhrel, T; Bastola, S P; Banjara, M R; Joshi, A B

    2011-06-01

    Iodine is an important micronutrient for mental growth and development. Limited information is available on the role of iodine supplementation in pregnancy and its effect on perinatal outcome. We designed intervention study to assess the effect of iodine supplementation during second half pregnancy and its effect on perinatal outcomes (maternal and neonatal health). Among 60 intervened with oral iodine tablet in pregnancy and 60 control pregnant women in Sindhupalchowk District Hospital Chautara, we assessed maternal and neonatal health after the delivery. The significant differences were found among duration of pregnancy, weight of pregnant mother before and after intervention of at least three months duration (56.1 kg vs. 59.6 kg, p < 0.001), weight of neonate (3.3 kg in intervention vs. 3.0 kg in control, p < 0.001), and thyroxin hormone (1.1 ng in intervention vs. 1.2 ng in control, p < 0.001) of women between intervened and control subjects. Therefore, regular supplementation of iodine in oral form for more than three months during pregnancy preferably during early stage will bring significant positive changes in perinatal outcomes. PMID:22364098

  16. Case series: Pregnancy Outcome in Patients with Uterine Fibroids.

    PubMed

    Radhika, B H; Naik, Kusuma; Shreelatha, S; Vana, Harshini

    2015-10-01

    Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy. PMID:26557577

  17. Case series: Pregnancy Outcome in Patients with Uterine Fibroids

    PubMed Central

    Naik, Kusuma; Shreelatha, S.; Vana, Harshini

    2015-01-01

    Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy. PMID:26557577

  18. The Relationship between Prenatal Parental Stress and Pregnancy Outcome.

    ERIC Educational Resources Information Center

    Neihardt, Joanne E.

    To explore the relationship between prenatal parental stress and pregnancy outcome, this study investigated the hypothesis that parents of infants with defects would report greater amounts of stress in the year prior to their infant's birth than would parents of normally developing infants. Data on levels of parental stress were obtained from 37…

  19. Obstetrical catastrophe averted: successful outcome of an abdominal pregnancy.

    PubMed

    Joshi, Bharti; Aggarwal, Neelam; Singh, Anju

    2014-10-01

    Abdominal pregnancy is defined as an implantation in peritoneal cavity, exclusive of tubal, ovarian, or intraligmentary pregnancy.These pregnancies are rarely encountered and can go undiagnosed until advanced period of gestation [1]. Frequency of abdominal pregnancy has been directly related to the frequency of ectopic gestation as constituting 2% of ectopics and nearly 0.01% of all pregnancies [2-4]. These pregnancies are seen more commonly in developing countries and poses special challenges to the clinician. Advanced abdominal pregnancy is life-threatening condition and carries high risk of hemorrhage, disseminated intravascular coagulation, bowel injury, and fistulae [5]. The perinatal outcome is mainly influenced by the availability of blood supply and site of implantation [6]. Most of the fetus die in utero because of compromised environment, and those who survive face problems due to congenital malformations [3,7]. Patients of abdominal pregnancy can have variable clinical presentation, and physical examination may be inconclusive for making diagnosis [7,8]. Clinical features like irregular bleeding per vaginum, abdominal pain, dyspepsia, altered bowel habits, malpresentation, and extremely anteriorly placed cervix should raise the suspicion [2,3,8,9]. Diagnostic challenge with oxytocin stimulation, abdominal x-ray, hysterosalpingography, and ultrasonography has been used as tools to assist in diagnosis [10,11]. Magnetic resonance imaging is found to complement sonography in making accurate diagnosis and can be useful to demonstrate the relationship between fetus, the cervix, and the myometrium [12]. We hereby report a successful operative delivery of a live baby after a term extrauterine abdominal pregnancy in a multigravida in whom the diagnosis was made after laparotomy.

  20. Obstetric outcomes in reduced and non-reduced twin pregnancies

    PubMed Central

    AlShelaly, UmmKulthoum E.; Al-Mousa, Noor H.; Kurdi, Wesam I.

    2015-01-01

    Objectives: To compare pregnancy outcomes between high-order multiple pregnancies resulting from assisted reproductive technology (ART) reduced to twins and non-reduced pregnancies, and to evaluate indications for using ART. Methods: This is a descriptive retrospective review of women with high-order multiple pregnancies reduced to twin carried out at the Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia between December 2010 and December 2013. The control group consisted of subjects with twin pregnancies who received their fertility treatment at the same hospital during the same period. Results: One hundred and twelve women were included in this study. Of women reaching fetal viability, significantly more women delivered before the thirtieth week in the study group (50% versus 12%, p<0.004). Miscarriage/delivery prior to fetal viability, chorioamnionitis, and preterm premature rupture of membranes were statistically higher in the study group. A total of 83% of the miscarriages in the study group were in women carrying 4 or more fetuses initially, and 50% of women in the study group were multiparous with no clear indication for fertility treatment. Conclusion: Although fetal reduction is a safe procedure, it is associated with complications. Primary prevention of high-order multiple pregnancy is recommended. PMID:26318473

  1. 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

  2. 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

  3. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes.

    PubMed

    Stang, Jamie; Huffman, Laurel G

    2016-04-01

    It is the position of the Academy of Nutrition and Dietetics that all women of reproductive age receive education about maternal and fetal risks associated with prepregnancy obesity, excessive gestational weight gain, and significant postpartum weight retention, including potential benefits of lifestyle changes. Behavioral counseling to improve dietary intake and physical activity should be provided to overweight and obese women, beginning in the preconception period and continuing throughout pregnancy, for at least 12 to 18 months postpartum. Weight loss before pregnancy may improve fertility and reduce the risk of poor maternal-fetal outcomes, such as preterm birth, gestational diabetes, gestational hypertension, pre-eclampsia, assisted delivery, and select congenital anomalies. Lifestyle interventions that moderate gestational weight gain may reduce the risk of poor pregnancy outcomes, such as gestational diabetes, gestational hypertension, large for gestational age, and macrosomia, as well as lower the risk for significant postpartum retention. Postpartum interventions that promote healthy diet and physical activity behaviors may reduce postpartum weight retention and decrease obesity-related risks in subsequent pregnancies. Analysis of the evidence suggests that there is good evidence to support the role of diet, physical activity, and behavior changes in promoting optimal weight gain during pregnancy; however, there is currently a relative lack of evidence in other areas related to reproductive outcomes.

  4. Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes.

    PubMed

    Stang, Jamie; Huffman, Laurel G

    2016-04-01

    It is the position of the Academy of Nutrition and Dietetics that all women of reproductive age receive education about maternal and fetal risks associated with prepregnancy obesity, excessive gestational weight gain, and significant postpartum weight retention, including potential benefits of lifestyle changes. Behavioral counseling to improve dietary intake and physical activity should be provided to overweight and obese women, beginning in the preconception period and continuing throughout pregnancy, for at least 12 to 18 months postpartum. Weight loss before pregnancy may improve fertility and reduce the risk of poor maternal-fetal outcomes, such as preterm birth, gestational diabetes, gestational hypertension, pre-eclampsia, assisted delivery, and select congenital anomalies. Lifestyle interventions that moderate gestational weight gain may reduce the risk of poor pregnancy outcomes, such as gestational diabetes, gestational hypertension, large for gestational age, and macrosomia, as well as lower the risk for significant postpartum retention. Postpartum interventions that promote healthy diet and physical activity behaviors may reduce postpartum weight retention and decrease obesity-related risks in subsequent pregnancies. Analysis of the evidence suggests that there is good evidence to support the role of diet, physical activity, and behavior changes in promoting optimal weight gain during pregnancy; however, there is currently a relative lack of evidence in other areas related to reproductive outcomes. PMID:27017177

  5. Paternal influences on pregnancy complications and birth outcomes

    SciTech Connect

    Cleghorn de Rohrmoser, D.C.

    1992-01-01

    The purpose of this study was to investigate the relationship of selected characteristics of the paternal work environment and occupational history to the incidence of complications in pregnancy, complications in labor and anomalies in birth outcomes. The literature suggested that male exposure to teratogenic hazards in the form of radiation and chemical compounds, primarily in the form of solvents, has been implicated in reproductive disorders and malformed offspring in animals. Similarly, some recent research suggests that the exposure of male workers to such hazards on their job may have consequences for their spouses and children. Based on these experimental research studies and analyses of persons working in high risk occupations, a broader study of the potential contribution of paternal work environment variables to the success of pregnancy and birth outcomes seemed warranted. Based upon the literature review, a model was proposed for predicting complications in pregnancy, complications in labor and birth outcome (normal birth, low birth weight, congenital malformations and fetal death). From the 1980 National Natality Survey and the 1980 National Fetal Mortality Survey, four sub-samples of married couples, with both husband and wife employed, were selected on the basis of one of the four birth outcomes. The model called for controlling a range of maternal intrinsic and extrinsic health and behavioral variables known to be related to birth outcomes. Multiple logistic regression procedures were used to analyze the effects of father's exposure to radiation and solvents on the job, to complications in pregnancy and labor, and to birth outcome, while controlling for maternal variables. The results indicated that none of the paternal variables were predictors of complications in labor. Further, there was no clear pattern of results, though father's degree of exposure to solvents, and exposures to radiation did reach significance in some analyses.

  6. The influence of pregnancy termination on the outcome of subsequent pregnancies: a retrospective cohort study

    PubMed Central

    Scholten, Brenda L; Page-Christiaens, Godelieve C M L; Franx, Arie; Hukkelhoven, Chantal W P M; Koster, Maria P H

    2013-01-01

    Objective To compare the incidences of preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems (ie, placenta praevia, placental abruption and retained placenta) and postpartum haemorrhage between women with and without a history of pregnancy termination. Design  A retrospective cohort study using aggregated data from a national perinatal registry. Setting All midwifery practices and hospitals in the Netherlands. Participants All pregnant women with a singleton pregnancy without congenital malformations and a gestational age of ≥20 weeks who delivered between January 2000 and December 2007. Main outcome measures Preterm delivery, cervical incompetence treated by cerclage, placenta praevia, placental abruption, retained placenta and postpartum haemorrhage. Results A previous pregnancy termination was reported in 16 000 (1.2%) deliveries. The vast majority of these (90–95%) were performed by surgical methods. The incidence of all outcome measures was significantly higher in women with a history of pregnancy termination. Adjusted ORs (95% CI) for cervical incompetence treated by cerclage, preterm delivery, placental implantation or retention problems and postpartum haemorrhage were 4.6 (2.9 to 7.2), 1.11 (1.02 to 1.20), 1.42 (1.29 to 1.55) and 1.16 (1.08 to 1.25), respectively. Associated numbers needed to harm were 1000, 167, 111 and 111, respectively. For any listed adverse outcome, the number needed to harm was 63. Conclusions In this large nationwide cohort study, we found a positive association between surgical termination of pregnancy and subsequent preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems and postpartum haemorrhage in a subsequent pregnancy. Absolute risks for these outcomes, however, remain small. Medicinal termination might be considered first whenever there is a choice between both methods. PMID:23793655

  7. Atrazine and Pregnancy Outcomes: A Systematic Review of Epidemiologic Evidence

    PubMed Central

    Goodman, Michael; Mandel, Jack S; DeSesso, John M; Scialli, Anthony R

    2014-01-01

    Atrazine (ATR) is a commonly used agricultural herbicide that has been the subject of epidemiologic studies assessing its relation to reproductive health problems. This review evaluates both the consistency and the quality of epidemiologic evidence testing the hypothesis that ATR exposure, at usually encountered levels, is a risk factor for birth defects, small for gestational age birth weight, prematurity, miscarriages, and problems of fetal growth and development. We followed the current methodological guidelines for systematic reviews by using two independent researchers to identify, retrieve, and evaluate the relevant epidemiologic literature on the relation of ATR to various adverse outcomes of birth and pregnancy. Each eligible paper was summarized with respect to its methods and results with particular attention to study design and exposure assessment, which have been cited as the main areas of weakness in ATR research. As a quantitative meta-analysis was not feasible, the study results were categorized qualitatively as positive, null, or mixed. The literature on ATR and pregnancy-related health outcomes is growing rapidly, but the quality of the data is poor with most papers using aggregate rather than individual-level information. Without good quality data, the results are difficult to assess; however, it is worth noting that none of the outcome categories demonstrated consistent positive associations across studies. Considering the poor quality of the data and the lack of robust findings across studies, conclusions about a causal link between ATR and adverse pregnancy outcomes are not warranted. PMID:24797711

  8. Bacterial Vaginosis and Pregnancy Outcome in Lagos, Nigeria

    PubMed Central

    Afolabi, Bosede B.; Moses, Olusanjo E.; Oduyebo, Oyinlola O.

    2016-01-01

    Background. Bacterial vaginosis (BV) is a complex clinical syndrome characterized by alterations in the normal vaginal flora and a malodorous discharge when symptomatic. In pregnancy, BV has been associated with adverse outcomes such as miscarriage, premature rupture of membranes, preterm birth, and low birth weight. This study was conducted to determine the prevalence and associations of BV and pregnancy outcomes among pregnant women in Lagos University Teaching Hospital (LUTH). Methods. We conducted a prospective observational study with high vaginal swabs obtained from consecutive newly registered antenatal women between 14 and 36 weeks gestation. The women were monitored until delivery, and their pregnancy outcome and demographic data were obtained using an interviewer-administered questionnaire. Results. Bacterial vaginosis was diagnosed by Nugent score in 64 of 246 women, giving a prevalence rate of 26%. Bacterial vaginosis was significantly associated with preterm delivery (risk ratio [RR], 2.68; 95% confidence interval [CI], 1.44–4.98), low birth weight (RR, 3.20; 95% CI, 1.29–7.94), and premature rupture of membranes (RR, 6.75; 95% CI, 3.11–14.67). The association between BV and miscarriage (<28 weeks gestation) and neonatal admission for various morbidities was not statistically significant. Conclusions. The prevalence rate of BV among pregnant women in LUTH is high and is significantly associated with adverse pregnancy outcome. Routine screening and treatment of women preconceptually may enable interventions to prevent these adverse outcomes. PMID:26989754

  9. Snoring during Pregnancy and Delivery Outcomes: A Cohort Study

    PubMed Central

    O'Brien, Louise M.; Bullough, Alexandra S.; Owusu, Jocelynn T.; Tremblay, Kimberley A.; Brincat, Cynthia A.; Chames, Mark C.; Kalbfleisch, John D.; Chervin, Ronald D.

    2013-01-01

    Study Objective: This cohort study examined the impact of maternal snoring on key delivery outcomes such as mode of delivery, infant birth centile, and small-for-gestational age. Design: Cohort study. Setting: A large tertiary medical center. Patients or Participants: Pregnant women in their third trimester were recruited between March 2007 and December 2010. Measurements and Results: Women were screened for habitual snoring, as a known marker for sleep disordered breathing. Outcome data were obtained from medical records following delivery and birth centiles were calculated. Of 1,673 women, a total of 35% reported habitual snoring (26% with pregnancy-onset snoring and 9% with chronic snoring). After adjusting for confounders, chronic snoring was associated with small-forgestational age (OR 1.65, 95%CI 1.02-2.66, P = 0.041) and elective cesarean delivery (OR 2.25, 95%CI 1.22-4.18, P = 0.008). Pregnancy-onset snoring was associated with emergency cesarean delivery (OR 1.68, 95%CI 1.22-2.30, P = 0.001). Conclusion: Maternal snoring during pregnancy is a risk factor for adverse delivery outcomes including cesarean delivery and small-for-gestational age. Screening pregnant women for symptoms of SDB may provide an early opportunity to identify women at risk of poor delivery outcomes. Clinical Trials Registration: Identifier: NCT01030003. Citation: O'Brien LM; Bullough AS; Owusu JT; Tremblay KA; Brincat CA; Chames MC; Kalbfleisch JD; Chervin RD. Snoring during pregnancy and delivery outcomes: a cohort study. SLEEP 2013;36(11):1625-1632. PMID:24179294

  10. Acute promyelocytic leukemia during pregnancy: a systematic analysis of outcome.

    PubMed

    Verma, Vivek; Giri, Smith; Manandhar, Samyak; Pathak, Ranjan; Bhatt, Vijaya Raj

    2016-01-01

    The outcomes of acute promyelocytic leukemia (APL) in pregnancy are largely unknown. The MEDLINE database was systematically searched to obtain 43 articles with 71 patients with new-onset APL during pregnancy. Induction therapy included various regimens of all-trans retinoic acid (ATRA), cytarabine, and anthracycline and resulted in a complete remission rate of 93%. Obstetric and fetal complications included pre-term deliveries (46%), spontaneous/therapeutic abortion/intrauterine death (33.3%) and other neonatal complications (25.9%). Mothers diagnosed in the first trimester were more likely to experience obstetric (p < 0.01) and fetal (p < 0.01) complications. To our knowledge, this is the largest systematic review of APL in pregnancy. The vast majority of APL patients in pregnancy may achieve remission with initial induction therapy. APL or its therapy in pregnancy, however, is associated with a high risk of fetal and obstetrical complications. The results of our study may help in patient counseling and informed decision-making. PMID:26110880

  11. Delivery outcome after the use of meclozine in early pregnancy.

    PubMed

    Källén, Bengt; Mottet, Isabelle

    2003-01-01

    In some countries, including Sweden, no risk is considered to exist with the use of meclozine for nausea and vomiting in pregnancy (NVP), but in other countries warnings against use during pregnancy are given. Rat tests indicate a teratogenic risk and published epidemiological studies are of restricted size. Delivery outcome was studied in 16,536 women who reported the use of meclozine in early pregnancy and was compared with all 540,660 women who gave birth. Information on drug usage was obtained prospectively in early pregnancy. Risk factors for using meclozine were young maternal age, to have had a previous child, not to smoke, to have a low body mass index. The use of some other drugs (antihypertensives, thyroxine, anticonvulsants) decreased the use of meclozine. Maternal diagnoses of preeclampsia or diabetes were less frequent when the woman had used meclozine. The twinning rate was increased and the sex distribution of the infants low (female excess). Preterm birth, low birth weight, short body length, and small head circumference occurred at a reduced rate after meclozine use, notably for boys. Also the rate of congenital malformations was reduced. If anything, delivery outcome is better than expected when the mother used meclozine. These beneficial effects are probably secondary to NVP. Meclozine can apparently be used without risk at this condition. PMID:12952140

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

    PubMed Central

    Kurtz, Will S; Glueck, Charles J; Hutchins, Robert K; Sisk, Robert A; Wang, Ping

    2016-01-01

    Background Ocular vascular occlusion (OVO), first diagnosed during or immediately after giving birth, often reflects superposition of the physiologic thrombophilia of pregnancy on previously undiagnosed underlying familial or acquired thrombophilia associated with spontaneous abortion, eclampsia, or maternal thrombosis. Specific aim We describe OVO, first diagnosed during pregnancy or immediately postpartum, in three young females (ages 32, 35, 40) associated with previously undiagnosed familial thrombophilia. Results Branch retinal artery occlusion (BRAO) occurred at 9 and 13 weeks gestation in two females, aged 32 and 35. Central retinal vein occlusion occurred immediately postpartum in a 40-year-old. One of the two females with BRAO subsequently developed eclampsia, and one had a history of unexplained first trimester spontaneous abortion. All three females were found to have previously unexplained familial thrombophilia. The two females with BRAO had low first trimester free protein S 42 (41%), lower normal limit (50%), and one of these two had high factor VIII (165%, upper normal limit 150%). The woman with central retinal vein occlusion had high factor XI (169%, upper normal limit 150%). Enoxaparin (40–60 mg/day) was started and continued throughout pregnancy in both females with BRAO to prevent maternal–placental thrombosis, and of these two females, one had an uncomplicated pregnancy course and term delivery, and the second was at gestational week 22 without complications at the time of this manuscript. There were no further OVO events in the two females treated with enoxaparin or in the untreated patient with postpartum eclampsia. Conclusion OVO during pregnancy may be a marker for familial or acquired thrombophilia, which confers increased thrombotic risk to the mother and pregnancy, associated with spontaneous abortion or eclampsia. OVO during pregnancy, particularly when coupled with antecedent adverse pregnancy outcomes, should prompt urgent

  13. Effects of maternity care coordination on pregnancy outcomes: propensity-weighted analyses.

    PubMed

    Hillemeier, Marianne M; Domino, Marisa E; Wells, Rebecca; Goyal, Ravi K; Kum, Hye-Chung; Cilenti, Dorothy; Timothy Whitmire, J; Basu, Anirban

    2015-01-01

    Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination (MCC) on pregnancy outcomes in North Carolina. Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received MCC services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to conventional ordinary least squares analyses. The unadjusted preterm birth rate was lower among women who received MCC services (7.0 % compared to 8.3 % among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 % point reduction in preterm birth risk; p < 0.05). MCC services were also associated with lower pregnancy weight gain (p = 0.10). No effects of MCC were seen for birthweight. These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome. PMID:24770956

  14. Triethnic differences in pregnancy outcomes: findings from the GLOWBS study.

    PubMed Central

    Levin, J. S.

    1991-01-01

    Findings are presented from the Galveston Low Birthweight Survey (GLOWBS), conducted at The University of Texas Medical Branch from 1986 through 1987. One full year of delivery logbook data were abstracted on all live, single births (N = 3904) to Anglo (n = 2114), black (n = 902), and Hispanic (n = 888) mothers. Analyses include triethnic comparisons of pregnancy outcomes and maternal characteristics through analysis of variance and both crude and adjusted logistic regression for deleterious pregnancy outcomes in blacks relative to non-blacks. The most striking finding is a consistent black disadvantage that withstands controlling for parity, age, and marital status. Blacks have a significantly lower mean birthweight, shorter mean gestation, lower 1-minute and 5-minute Apgar scores, and a higher incidence of both low birthweight (RR = 1.89) and prematurity (RR = 1.57) than either Anglos or Hispanics, between whom no differences are found. PMID:1956081

  15. Pre-conception counselling for key cardiovascular conditions in Africa: optimising pregnancy outcomes.

    PubMed

    Zühlke, Liesl; Acquah, Letitia

    2016-01-01

    The World Health Organisation (WHO) supports pre-conception care (PCC) towards improving health and pregnancy outcomes. PPC entails a continuum of promotive, preventative and curative health and social interventions. PPC identifies current and potential medical problems of women of childbearing age towards strategising optimal pregnancy outcomes, whereas antenatal care constitutes the care provided during pregnancy. Optimised PPC and antenatal care would improve civil society and maternal, child and public health. Multiple factors bar most African women from receiving antenatal care. Additionally, PPC is rarely available as a standard of care in many African settings, despite the high maternal mortality rate throughout Africa. African women and healthcare facilitators must cooperate to strategise cost-effective and cost-efficient PPC. This should streamline their limited resources within their socio-cultural preferences, towards short- and long-term improvement of pregnancy outcomes. This review discusses the relevance of and need for PPC in resource-challenged African settings, and emphasises preventative and curative health interventions for congenital and acquired heart disease. We also consider two additional conditions, HIV/AIDS and hypertension, as these are two of the most important co-morbidities encountered in Africa, with significant burden of disease. Finally we advocate strongly for PPC to be considered as a key intervention for reducing maternal mortality rates on the African continent. PMID:27213854

  16. Improving the management of an advanced extrauterine pregnancy using pelvic arteriography in a hybrid operating suite.

    PubMed

    Smrtka, Michael P; Gunatilake, Ravindu; Miller, Michael J; Heine, R Phillips; Brown, Haywood L

    2012-11-01

    Advanced extrauterine pregnancy is an extremely rare, life-threatening pregnancy complication. Management of these pregnancies presents significant challenges, especially when they have progressed to an advanced stage of fetal viability. With high rates of maternal and fetal mortality associated with this complication, delivery or pregnancy interruption should be expedited following diagnosis. Localization of the placenta and its blood supply is critical to preoperative planning. Hybrid operating suites that can accommodate a multidisciplinary team of subspecialists may improve the chance of a successful outcome with this rare complication.

  17. Effects of posttraumatic stress disorder on pregnancy outcomes

    PubMed Central

    Rogal, Shari S.; Poschman, Karalee; Belanger, Kathleen; Howell, Heather B.; Smith, Megan V.; Medina, Jessica; Yonkers, Kimberly A.

    2007-01-01

    Background The purpose of this study was to determine the association between posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, and the risk of delivering a low birthweight (<2500 grams) or preterm (<37 weeks gestational age) infant. Methods Pregnant women were recruited from obstetrics clinics and screened for major and minor depressive disorder, panic disorder, PTSD, and substance use. Current episodes of PTSD were diagnosed according to the MINI International Neuropsychiatric Interview, and pregnancy outcomes were abstracted from hospital records. Results Among the 1100 women included in analysis, 31 (3%) were in episode for PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorder, and prior preterm delivery were significantly associated with a diagnosis of PTSD. Preterm delivery was non-significantly higher in pregnant women with (16.1%) compared to those without (7.0%) PTSD (OR= 2.82, 95% C.I. 0.95, 8.38). Low birthweight (LBW) was present in 6.5% of women and was not significantly associated with a diagnosis of PTSD in pregnancy after adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder (OR= 1.82, 95% C.I.1.01, 3.29). Limitations There was a low prevalence of PTSD in this cohort, resulting in limited power. Conclusions These data suggest a possible association between PTSD and preterm delivery. Coupled with the association found between LBW and a depressive disorder, these results support the utility of screening for mental health disorders in pregnancy. PMID:17291588

  18. Prospective Study of Pregnancy and Newborn Outcomes in Mothers with West Nile Illness during Pregnancy

    PubMed Central

    Pridjian, Gabriella; Sirois, Patricia A.; McRae, Scott; Hinckley, Alison F.; Rasmussen, Sonja A.; Kissinger, Patricia; Buekens, Pierre; Hayes, Edward B.; O’Leary, Dan; Kuhn, Stephanie; Swan, Kenneth F.; Xiong, Xu; Wesson, Dawn M.

    2016-01-01

    Background A previous case report of West Nile virus (WNV) illness during pregnancy suggested that WNV could be a cause of congenital defects. We performed a prospective, longitudinal cohort study of pregnant women with WNV illness to increase our knowledge of the effects of WNV illness during pregnancy. Methods Participants were enrolled in 2005 to 2008 from pregnant women with serologically confirmed WNV illness reported to the Centers for Disease Control and Prevention. Comparison was made to WNV-uninfected women, matched on maternal age and enrollment month. Pregnancy and newborn data were collected; cord blood WNV serology was obtained. Pediatric exams and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) were performed. Results Twenty-eight WNV-infected mothers and 25 WNV-uninfected mothers participated. Maternal demographics were similar except for a higher rate of planned pregnancies, education, and household income in the WNV-uninfected mothers. There were no differences in pregnancy and delivery characteristics except that infected mothers had a higher incidence of febrile illnesses and used more medications. Birth weight, length, head circumference, and rate of congenital malformations were similar in babies born to WNV-infected and -uninfected mothers. Follow-up physical exams were generally normal. The Bayley-III assessments, available for 17 children born to mothers with WNV illness, showed performance at or above age level across domains. Conclusion The risk for adverse pregnancy and newborn outcomes in women experiencing WNV illness in pregnancy appears to be low, but future studies with larger numbers are needed to rule out a small risk. PMID:27223334

  19. Pregnancy outcomes following the administration of high doses of dexamethasone in early pregnancy

    PubMed Central

    Kayvan Jafari, Sabah; Nezafat Firizi, Maryam; Abbaspour, Ali Reza; Ghafoori Gharib, Fahime; Ghobadi, Yusef; Gholizadeh, Samira

    2016-01-01

    Objective In the present study, we aimed to evaluate the effects of high doses of dexamethasone (DEX) in early pregnancy on pregnancy outcomes. Methods Pregnant BALB/c mice were treated with high-dose DEX in the experimental group or saline in the control group on gestational days (GDs) 0.5 to 4.5. Pregnant mice were sacrificed on GDs 7.5, 13.5, or 18.5 and their peripheral blood, placentas, fetuses, and uterine tissue were collected. Decidual and placenta cell supernatants were examined to evaluate the effect of DEX on the proliferation of mononuclear cells, the quantity of uterine macrophages and uterine natural killer (uNK) cells, and levels of progesterone and 17β-estradiol, as determined by an 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide assay, immunohistochemistry, and enzyme-linked immunosorbent assay, respectively. We also were measured fetal and placental growth parameters on GD 18.5. Results We found that high doses of DEX were associated with an increased abortion rate, enhancement of the immunosuppressive effect of the decidua, alterations in placental growth parameters, decreased progesterone and 17β-estradiol levels, and a reduced frequency of macrophages and uNK cells. Conclusion Our data suggest that the high-dose administration of DEX during early pregnancy negatively affected pregnancy outcomes. PMID:27104153

  20. Body composition changes in pregnancy: measurement, predictors and outcomes

    PubMed Central

    Widen, EM; Gallagher, D

    2014-01-01

    Prevalence of overweight and obesity has risen in the United States over the past few decades. Concurrent with this rise in obesity has been an increase in pregravid body mass index and gestational weight gain affecting maternal body composition changes in pregnancy. During pregnancy, many of the assumptions inherent in body composition estimation are violated, particularly the hydration of fat-free mass, and available methods are unable to disentangle maternal composition from fetus and supporting tissues; therefore, estimates of maternal body composition during pregnancy are prone to error. Here we review commonly used and available methods for assessing body composition changes in pregnancy, including: (1) anthropometry, (2) total body water, (3) densitometry, (4) imaging, (5) dual-energy X-ray absorptiometry, (6) bioelectrical impedance and (7) ultrasound. Several of these methods can measure regional changes in adipose tissue; however, most of these methods provide only whole-body estimates of fat and fat-free mass. Consideration is given to factors that may influence changes in maternal body composition, as well as long-term maternal and offspring outcomes. Finally, we provide recommendations for future research in this area. PMID:24667754

  1. 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

  2. Indigenous Women of Latin America: Unintended Pregnancy, Unsafe Abortion, and Reproductive Health Outcomes

    PubMed Central

    Wurtz, Heather

    2013-01-01

    Indigenous women in Latin America have poorer reproductive health outcomes than the general population and face considerable barriers in accessing adequate health services. Indigenous women have high rates of adolescent fertility and unintended pregnancy and may face increased risks for morbidity and mortality related to unsafe abortion. However, research among this population, particularly focusing on social and cultural implications of unwanted pregnancy and unsafe abortion, is significantly limited. This article reviews the literature on unsafe abortion in Latin America and describes successful interventions to ameliorate reproductive health outcomes within Indigenous communities. It also explores important implications for future research. Shedding light on the circumstances, perspectives, and lived realities of Indigenous women of childbearing age, could encourage further qualitative investigation and mitigate negative outcomes through improved understanding of the topic, targeted culturally appropriate interventions, and recommendations for future policy and programming reformations. PMID:23772229

  3. Experimental primary cytomegalovirus infection in pregnancy: timing and fetal outcome.

    PubMed

    Kumar, M L; Prokay, S L

    1983-01-01

    In contrast to intrauterine rubella infection, the relationship between timing of maternal cytomegalovirus (CMV) infection and fetal outcome has not been clearly defined. In order to investigate this relationship, a guinea pig model was utilized to assess the fetal consequences of maternal CMV infection during the first, second, or third trimester of pregnancy. Congenital infection occurred in 24 of 35 newborn guinea pigs (69%) delivered to mothers infected during the third trimester, with localization of virus to salivary gland in 17 of the 24 infected newborn guinea pigs. In contrast, only one of 28 (5%) progeny sacrificed following first-trimester maternal infection was congenitally infected (p less than 0.01). Second-trimester maternal infection was associated with an intermediate risk of intrauterine infection with transmission of virus to 17 of 54 progeny (33%) (p less than 0.01). Eight of the 10 fetuses delivered after second-trimester infection had virus in multiple organs including the brain. These data suggest that timing of maternal CMV infection is an important variable affecting fetal outcome, with increased risk of intrauterine infection when maternal infection occurs late in pregnancy. However, if fetal infection occurs earlier in pregnancy, it appears to present a greater threat to the fetus, with the potential for dissemination of virus in multiple fetal tissues, including the brain. PMID:6295164

  4. Heart Valve Prostheses in Pregnancy: Outcomes for Women and Their Infants

    PubMed Central

    Lawley, Claire M.; Algert, Charles S.; Ford, Jane B.; Nippita, Tanya A.; Figtree, Gemma A.; Roberts, Christine L.

    2014-01-01

    Background As the prognosis of women with prosthetic heart valves improves, and increasing number are contemplating and undertaking pregnancy. Accurate knowledge of perinatal outcomes is essential, assisting counseling and guiding care. The aims of this study were to assess outcomes in a contemporary population of women with heart valve prostheses undertaking pregnancy and to compare outcomes for women with mechanical and bioprosthetic prostheses. Methods and Results Longitudinally linked population health data sets containing birth and hospital admissions data were obtained for all women giving birth in New South Wales, Australia, 2000–2011. This included information identifying presence of maternal prosthetic heart valve. Cardiovascular and birth outcomes were evaluated. Among 1 144 156 pregnancies, 136 involved women with a heart valve prosthesis (1 per 10 000). No maternal mortality was seen among these women, although the relative risk for an adverse event was higher than the general population, including severe maternal morbidity (139 versus 14 per 1000 births, rate ratio [RR]=9.96, 95% CI 6.32 to 15.7), major maternal cardiovascular event (44 versus 1 per 1000, RR 34.6, 95% CI 14.6 to 81.6), preterm birth (183 versus 66 per 1000, RR=2.77, 95% CI 1.88 to 4.07), and small‐for‐gestational‐age infants (193 versus 95 per 1000, RR=2.03, 95% CI 1.40 to 2.96). There was a trend toward increased maternal and perinatal morbidity in women with a mechanical valve compared with those with a bioprosthetic valve. Conclusions Pregnancies in women with a prosthetic heart valve demonstrate an increased risk of an adverse outcome, for both mothers and infants, compared with pregnancies in the absence of heart valve prostheses. In this contemporary population, the risk was lower than previously reported. PMID:24970269

  5. Teenage pregnancy: a comparative study of the outcome and complications.

    PubMed

    Thekkekkara, Tina; Veenu, J

    2009-01-01

    This study compares the outcome and complications of pregnancy among teenagers with those above 19 years of age. This retrospective study conducted in a maternity hospital in rural Karnataka, under the guidance of the department of community medicine, St Johns National Academy of Health Sciences, Bangalore, included 221 women who delivered between February 2003 and April 2003. The data was tabulated in excel spreadsheet and analysed using epi 6 programme. Anaemia among teenage multigravidae was found to be a significant health problem. There were no statistically significant differences between the gestational age at delivery and the mode of delivery in the different age groups. Teenage pregnancy was not found to be associated with an increased risk for antenatal complications or postnatal complications. There was no increased incidence of low birth weight or congenital anomalies among the babies of teenage mothers. Mortality was not found to be increased both among the teenage mothers as well as their babies. PMID:19588686

  6. 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

  7. 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

  8. Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes.

    PubMed

    Cutts, Diana B; Coleman, Sharon; Black, Maureen M; Chilton, Mariana M; Cook, John T; de Cuba, Stephanie Ettinger; Heeren, Timothy C; Meyers, Alan; Sandel, Megan; Casey, Patrick H; Frank, Deborah A

    2015-06-01

    Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW; <2,500 g) and preterm delivery (<37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, comparing prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p < 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight (p = 0.08). Postnatal homelessness was not associated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a marker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide housing and health care to homeless women during pregnancy may result in improved birth outcomes.

  9. Medication Safety During Pregnancy: Improving Evidence-Based Practice.

    PubMed

    Sinclair, Susan M; Miller, Richard K; Chambers, Christina; Cooper, Elizabeth M

    2016-01-01

    Nearly 90% of women in the United States have taken medications during pregnancy. Medication exposures during pregnancy can result in adverse pregnancy and neonatal outcomes including birth defects, fetal loss, intrauterine growth restriction, prematurity, and longer-term neurodevelopmental outcomes. Advising pregnant women about the safety of medication use during pregnancy is complicated by a lack of data necessary to engage the woman in an informed discussion. Routinely, health care providers turn to the package insert, yet this information can be incomplete and can be based entirely on animal studies. Often, adequate safety data are not available. In a busy clinical setting, health care providers need to be able to quickly locate the most up-to-date information in order to counsel pregnant women concerned about medication exposure. Deciding where to locate the best available information is difficult, particularly when the needed information does not exist. Pregnancy registries are initiated to obtain more data about the safety of specific medication exposures during pregnancy; however, these studies are slow to produce meaningful information, and when they do, the information may not be readily available in a published form. Health care providers have valuable data in their everyday practice that can expand the knowledge base about medication safety during pregnancy. This review aims to discuss the limitations of the package insert regarding medication safety during pregnancy, highlight additional resources available to health care providers to inform practice, and communicate the importance of pregnancy registries for expanding knowledge about medication safety during pregnancy. PMID:26771055

  10. The effect of exposure to hypergravity on pregnant rat dams, pregnancy outcome and early neonatal development

    NASA Astrophysics Data System (ADS)

    Ladd, B.; Nguon, K.; Sajdel-Sulkowska, E. M.

    2006-01-01

    We previously reported that hypergravity exposure affects food intake and mass gain during pregnancy. In the present study, we explored the hypothesis that changes in maternal body mass in hypergravity-exposed pregnant rat dams affect pregnancy outcome and early offspring development. Furthermore, we hypothesized that the changes observed at 1.5G will be magnified at higher gravity and by exposure during critical developmental periods. To test this hypothesis, we compared maternal body mass gain, food consumption, birth outcome and early offspring development between Sprague Dawley rat dams exposed to graded (1.5 1.75G) chronic hypergravity (HG) or rotation (rotational control, RC) on a 24-ft centrifuge for 22.5 h starting on gestational day (G) 10 with dams housed under identical conditions but not exposed to hypergravity (SC). We also compared maternal body mass, food consumption, birth outcome and early offspring development between rat dams exposed to 1.65G during different stages of pregnancy and nursing. Exposure to hypergravity resulted in transient loss in body mass and prolonged decrease in food consumption in HG dams, but the changes observed at 1.5G were not magnified at 1.65G or 1.75G. On the other hand RC dams gained more mass and consumed more food than SC dams. Exposure to hypergravity also affected pregnancy outcome as evidenced by decreased litter size, lowered neonatal mass at birth, and higher neonatal mortality; pregnancy outcome was not affected in RC dams. Neonatal changes evidenced by impaired righting response observed at 1.5G was magnified at higher gravity and was dependent on the period of hypergravity exposure. On the other hand, righting response was improved in RC neonates. Hypergravity exposure during early postpartum affected the food consumption of nursing mothers and affected early survival of their offspring. The changes observed in dams and neonates appear to be due to hypergravity exposure since animals exposed to the rotation

  11. Effect of Intensive Oral Hygiene Regimen During Pregnancy on Periodontal Health, Cytokine Levels, and Pregnancy Outcomes: A Pilot Study

    PubMed Central

    Kaur, Maninder; Geisinger, Maria L.; Geurs, Nicolaas C.; Griffin, Russell; Vassilopoulos, Philip J.; Vermeulen, Lisa; Haigh, Sandra; Reddy, Michael S.

    2015-01-01

    Background Data are limited on the potential effect of intensive oral hygiene regimens and periodontal therapy during pregnancy on periodontal health, gingival crevicular fluid (GCF) and serum cytokines, and pregnancy outcomes. Methods A clinical trial was conducted on 120 community-dwelling, 16- to 35-year-old pregnant women at 16 to 24 weeks of gestation. Each participant presented with clinical evidence of generalized, moderate-to-severe gingivitis. Oral hygiene products were provided, together with instructions for an intensive daily regimen of hygiene practices. Non-surgical therapy was provided at baseline. Oral examinations were completed at baseline and again at 4 and 8 weeks. In addition, samples of blood and GCF were collected at baseline and week 8. Mean changes in clinical variables and GCF and serum cytokine levels (interleukin [IL]-1β, IL-6, tumor necrosis factor [TNF]-α) between baseline and week 8 were calculated using paired t test. Pregnancy outcomes were recorded at parturition. Results Results indicated a statistically significant reduction in all clinical variables (P <0.0001) and decreased levels of TNF-α (P = 0.0076) and IL-1β (P = 0.0098) in GCF during the study period. The rate of preterm births (<37 weeks of gestation) was 6.7% (P = 0.113) and low birth weight (<2,500 g) was 10.2% (P = 1.00). Conclusions Among the population studied, intensive instructions and non-surgical periodontal therapy provided during 8 weeks at early pregnancy resulted in decreased gingival inflammation and a generalized improvement in periodontal health. Large-scale, randomized, controlled studies are needed to substantiate these findings. PMID:25079400

  12. Factors influencing outcome of pregnancy in heavy-drinking women.

    PubMed

    Qazi, Q H; Chua, A; Milman, D; Solish, G

    1982-01-01

    18 pregnant women identified as heavy drinkers by the criteria of Cahalan et al., gave birth to 6 normal infants, 5 infants with fetal alcohol syndrome (FAS) and 7 with partial FAS. Average daily alcohol consumption of mothers of normal infants was less than that of mothers of FAS and partial FAS infants. Lower socioeconomic class, higher parity and increased use of tobacco and other drugs were non-alcohol-related maternal factors which appeared to influence the outcome of pregnancy in heavy-drinking women.

  13. The Relationship between Maternal Employment Status and Pregnancy Outcomes

    PubMed Central

    Khojasteh, Farnoush; Arbabisarjou, Azizollah; Boryri, Tahereh; Safarzadeh, Amneh; Pourkahkhaei, Mohammad

    2016-01-01

    Background and Objectives: Women comprise a large percentage of the workforce in industrial countries. In Europe and many other places in the world, women of reproductive age comprise a significant proportion of the workforce at the workplaces, and the rules and regulations require employers to evaluate and minimize health risks to pregnant women. In U.K, 70%, and in the United States 59% of women are employed. In Iran, 13% of women are employed, which comes down to less than 5% at Sistan& Baluchestan Province. Various studies have reported contradictory results about the effects of maternal employment tasks such as standing, repetitive bending, climbing stairs, and lifting heavy objects during pregnancy on fetal growth, preterm birth and other obstetric complications. Given the growing number of working women, and potential complications for mothers, the present study has conducted to investigate the relationship between maternal employment status and pregnancy outcomes in Zahedan city, Iran. Materials and Methods: This cross-sectional study was based on survey conducted on 227 women (121 housewives, and 106 employed women) attending health centers in 2014. Using purposive convenient sampling method, eligible pregnant mothers (with no chronic diseases, singleton pregnancy, gravida 1-3, and no addiction) were selected as study subjects. Data were collected and recorded through a researcher-made questionnaire and also from mothers’ medical records, including personal details, prenatal and labor complications, and infant’s details. Collected data were fed into the SPSS version 21(IBM Corp, USA). Results: Frequency of placental abruption was greater among housewives (P=0.02), and a significant relationship was found between employment status and lifting heavy objects, which was more frequent among housewives (P=0.01). Lifting heavy objects during pregnancy was only significantly related to reduced amniotic fluid (P=0.001) and low birth weight (P=0.01). Frequency

  14. G-CSF Intrauterine for Thin Endometrium, and Pregnancy Outcome

    PubMed Central

    Tehraninejad, Ensieh; Davari Tanha, Fateme; Asadi, Ebrahim; Kamali, Koorosh; Aziminikoo, Elham; Rezayof, Elahe

    2015-01-01

    Objective: To evaluate effects of G-CSF on a cancelled ART cycle due to thin endometrium. Materials and methods: In a nonrandomized clinical trial from January 2011 to January 2013 in two tertiary university based hospitals fifteen patients undergoing embryo transfer and with the history of cycle cancellation due to thin endometrium were studied. Intrauterine infusion of G-CSF was done on the day of oocyte pick-up or 5 days before embryo transfer. The primary outcome to be measured was an endometrium thickened to at least 6 mm and the secondary outcome was clinical pregnancy rate and consequently take-home baby. All previous cycles were considered as control for each patient. Results: The G-CSF was infused at the day of oocyte retrieval or 5 days before embryo transfer. The endometrial thickness reached from 3.593±0.251 mm to 7.120 ± 0.84 mm. The mean age, gravidity, parity, and FSH were 35.13± 9.531 years, 3, 1 and 32.78 ± 31.10 mIU/ml, respectively. The clinical pregnancy rate was 20%, and there was one missed abortion, a mother death at 34 weeks, and a preterm labor at 30 weeks due to PROM. Conclusion: G-CSF may increase endometrial thickness in the small group of patients who had no choice except cycle cancellation or surrogacy. PMID:26622308

  15. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

    PubMed Central

    Buhary, Badurudeen Mahmood; Almohareb, Ohoud; Aljohani, Naji; Alzahrani, Saad H.; Elkaissi, Samer; Sherbeeni, Suphia; Almaghamsi, Abdulrahman; Almalki, Mussa

    2016-01-01

    Context: Diabetes in pregnancy (DIP) is either pregestational or gestational. Aims: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. Settings and Design: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. Subjects and Methods: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. Statistical Analysis Used: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. Results: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. Conclusions: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception. PMID:27366714

  16. Effects of emergency cervical cerclage on pregnancy outcome: a retrospective study of 158 cases.

    PubMed

    Zhu, Li-Qiong; Chen, Hui; Chen, Li-Bin; Liu, Ying-Lin; Tian, Jian-Ping; Wang, Yun-Hui; Zhang, Rui; Zhang, Jian-Ping

    2015-01-01

    The aim of this study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes. The study included 158 women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Pregnancy outcomes and pregnancy outcome related to clinical features were analyzed retrospectively. Analysis revealed that the placement of emergency cerclage led to the delivery of live infants with a success rate of 82.28%. The mean interval between cerclage and delivery was 52.16.±26.62 days, with a mean gestation at delivery of 30.3±4.7 weeks and a mean birth weight of 1934.69±570.37 g. No severe maternal complications such as maternal death, hematosepsis, and hysterorrhexis occurred after the operation. Two women (1.25%) had laceration of the cervix, 1 woman (0.61%) suffered pulmonary edema, and 2 women (1.25%) developed deep vein thrombosis (DVT). There were significant correlations between the pregnancy outcome and risk factors, including any presenting symptoms, cervical dilatation, postoperative white blood cell count, and C-reactive protein (CRP) value. No significant difference was found in women with good vs. poor outcome in terms of maternal age and obstetric histories. Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester.

  17. Effects of Emergency Cervical Cerclage on Pregnancy Outcome: A Retrospective Study of 158 Cases

    PubMed Central

    Zhu, Li-Qiong; Chen, Hui; Chen, Li-Bin; Liu, Ying-Lin; Tan, Jian-Ping; Wang, Yun-Hui; Zhang, Rui; Zhang, Jian-Ping

    2015-01-01

    The aim of this study was to evaluate the effectiveness and safety of emergency cervical cerclage in women with advanced cervical dilatation and bulging of fetal membranes. The study included 158 women who underwent emergency cervical cerclage because of cervix dilatation and protruding membranes in mid-trimester at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Pregnancy outcomes and pregnancy outcome related to clinical features were analyzed retrospectively. Analysis revealed that the placement of emergency cerclage led to the delivery of live infants with a success rate of 82.28%. The mean interval between cerclage and delivery was 52.16.±26.62 days, with a mean gestation at delivery of 30.3±4.7 weeks and a mean birth weight of 1934.69±570.37 g. No severe maternal complications such as maternal death, hematosepsis, and hysterorrhexis occurred after the operation. Two women (1.25%) had laceration of the cervix, 1 woman (0.61%) suffered pulmonary edema, and 2 women (1.25%) developed deep vein thrombosis (DVT). There were significant correlations between the pregnancy outcome and risk factors, including any presenting symptoms, cervical dilatation, postoperative white blood cell count, and C-reactive protein (CRP) value. No significant difference was found in women with good vs. poor outcome in terms of maternal age and obstetric histories. Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester. PMID:25975832

  18. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome.

    PubMed

    Procter, Sandra B; Campbell, Christina G

    2014-07-01

    It is the position of the Academy of Nutrition and Dietetics that women of childbearing age should adopt a lifestyle optimizing health and reducing risk of birth defects, suboptimal fetal development, and chronic health problems in both mother and child. Components leading to a healthy pregnancy outcome include healthy prepregnancy weight, appropriate weight gain and physical activity during pregnancy, consumption of a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of alcohol and other harmful substances, and safe food handling. Pregnancy is a critical period during which maternal nutrition and lifestyle choices are major influences on mother and child health. Inadequate levels of key nutrients during crucial periods of fetal development may lead to reprogramming within fetal tissues, predisposing the infant to chronic conditions in later life. Improving the well-being of mothers, infants, and children is key to the health of the next generation. This position paper and the accompanying practice paper (www.eatright.org/members/practicepapers) on the same topic provide registered dietitian nutritionists and dietetic technicians, registered; other professional associations; government agencies; industry; and the public with the Academy's stance on factors determined to influence healthy pregnancy, as well as an overview of best practices in nutrition and healthy lifestyles during pregnancy.

  19. Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study.

    PubMed

    Bouvier, Sylvie; Cochery-Nouvellon, Eva; Lavigne-Lissalde, Géraldine; Mercier, Erick; Marchetti, Tess; Balducchi, Jean-Pierre; Marès, Pierre; Gris, Jean-Christophe

    2014-01-16

    The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome (APS) treated with prophylactic low-molecular-weight heparin (LMWH) plus low-dose aspirin (LDA) has not been documented. We observed women without a history of thrombosis who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal loss at or beyond the 10th week. We compared the frequencies of complications during new pregnancies between treated women with APS (n = 513; LMWH + LDA) and women negative for antiphospholipid antibodies as controls (n = 791; no treatment). Among APS women, prior fetal loss was a risk factor for fetal loss, preeclampsia (PE), premature birth, and the occurrence of any placenta-mediated complication. Being positive for anticardiolipin immunoglobulin M antibodies was a risk factor for any placenta-mediated complication. Among women with a history of recurrent abortion, APS women were at a higher risk than other women of PE, placenta-mediated complications, and neonatal mortality. Among women with prior fetal loss, LMWH + LDA-treated APS women had lower pregnancy loss rates but higher PE rates than other women. Improved therapies, in particular better prophylaxis of late pregnancy complications, are urgently needed for obstetric APS and should be evaluated according to the type of pregnancy loss.

  20. Diabetes in pregnancy outcomes: a systematic review and proposed codification of definitions.

    PubMed

    Feig, Denice S; Corcoy, Rosa; Jensen, Dorte Moller; Kautzky-Willer, Alexandra; Nolan, Christopher J; Oats, Jeremy J N; Sacks, David A; Caimari, Francisca; McIntyre, H David

    2015-10-01

    Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, definitions of outcomes vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed on published and ongoing randomized controlled trials in the area of diabetes in pregnancy between 01 Jan 2000 and 01 Jun 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published randomized controlled trials on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed and 53 were included. Among the ongoing randomized controlled trials published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and foetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided (i) will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will (ii) facilitate future systematic reviews and formal meta analyses and (iii) ultimately improve outcomes for mothers and babies.

  1. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar

    PubMed Central

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    Background What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. Material/Methods The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients’ desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. Results The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. Conclusions Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  2. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar.

    PubMed

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    BACKGROUND What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. MATERIAL AND METHODS The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients' desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. RESULTS The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. CONCLUSIONS Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  3. Waiting time to pregnancy and pregnancy outcome among Danish workers in the textile, clothing, and footwear industries.

    PubMed

    Schaumburg, I; Boldsen, J L

    1992-06-01

    The relationship between time from planned to achieved pregnancy and pregnancy outcome has been studied in a group of 18,658 workers in the textile, clothing and footwear industries. Information on pregnancy outcome and delay in conception in the period 1979-84 was collected by self administered questionnaires in 1985. The response rate was 70.3%. During the study period there had been 5,171 live births and 708 spontaneous abortions. Information on delay in conception was collected in broad categories. The data were analysed by means of a newly developed statistical parametric model in order to collect all possible information from the highly grouped data. Median waiting time before a pregnancy which ended in spontaneous abortion was 1.68 times longer than median waiting time before a pregnancy leading to a live birth. There seems to be a correlation between the length of the waiting time and abortion.

  4. 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

  5. Pregnancy losses in cattle: potential for improvement.

    PubMed

    Diskin, M G; Waters, S M; Parr, M H; Kenny, D A

    2016-01-01

    For heifers, beef and moderate-yielding dairy cows, it appears that the fertilisation rate generally lies between 90% and 100%. For high-producing dairy cows, there is a less substantive body of literature, but it would appear that the fertilisation rate is somewhat lower and possibly more variable. In cattle, the major component of embryo loss occurs in the first 16 days following breeding (Day 0), with emerging evidence of greater losses before Day 8 in high-producing dairy cows. In cattle, late embryo mortality causes serious economic losses because it is often recognised too late to rebreed females. Systemic concentrations of progesterone during both the cycle preceding and following insemination affect embryo survival, with evidence of either excessive or insufficient concentrations being negatively associated with survival rate. The application of direct progesterone supplementation or treatments to increase endogenous output of progesterone to increase embryo survival cannot be recommended at this time. Energy balance and dry matter intake during the first 4 weeks after calving are critically important in determining pregnancies per AI when cows are inseminated at 70-100 days after calving. Level of concentrate supplementation of cows at pasture during the breeding period has minimal effects on conception rates, although sudden reductions in dietary intake should be avoided. For all systems of milk production, more balanced breeding strategies with greater emphasis on fertility and feed intake and/or energy must be developed. There is genetic variability within the Holstein breed for fertility traits, which can be exploited. Genomic technology will not only provide scientists with an improved understanding of the underlying biological processes involved in fertilisation and the establishment of pregnancy, but also, in the future, could identify genes responsible for improved embryo survival. Such information could be incorporated into breeding objectives in

  6. Does regional anaesthesia improve outcome?

    PubMed

    Hopkins, P M

    2015-12-01

    This review examines the recent evidence of an impact of regional anaesthesia on important clinical outcomes. Evidence was obtained from a variety of studies, with increasing numbers of analyses of large databases being prominent. The benefits and limitations of these approaches are considered in order to provide a context for interpretation of the data they generate. There should be little argument that correctly performed and appropriately used regional anaesthetic techniques can provide the most effective postoperative analgesia for the duration of the block, but the majority of studies suggest that this does not translate into improved longer-term surgical outcomes. The evidence for reduced incidence of major complications when regional anaesthesia is compared with, or added to, general anaesthesia is mixed. There appears to be a small effect in reducing blood loss during major joint arthroplasty. Some, but not all, studies demonstrate a reduced incidence of respiratory and infective complications with regional anaesthesia, but the effect on cardiovascular complications is variable. There are even some data consistent with a hypothesis that general anaesthesia may be protective against postoperative cognitive dysfunction. In conclusion, there is probably no generally applicable benefit in long-term outcomes with regional anaesthesia. More likely is an interaction between patient factors, the surgical procedure, and the relative capability of the anaesthetist to manage different types of anaesthesia.

  7. Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

    PubMed Central

    Ray, Ellen; Sharps, Phyllis; Bullock, Linda

    2015-01-01

    Abstract The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered “risky,” including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient–provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health. PMID:25265285

  8. Pregnancy outcomes in myeloproliferative neoplasms: UK prospective cohort study.

    PubMed

    Alimam, Samah; Bewley, Susan; Chappell, Lucy C; Knight, Marian; Seed, Paul; Gray, Gabriella; Harrison, Claire; Robinson, Susan

    2016-10-01

    The reported higher risk of maternal and fetal complications in women with myeloproliferative neoplasms (MPN) poses challenge during pregnancy. A national prospective study of maternal and fetal outcomes of pregnant women with a diagnosis of MPN was undertaken via the United Kingdom Obstetric Surveillance System between January 2010 and December 2012. Fifty-eight women with a diagnosis of MPN were identified; 47 (81%) essential thrombocythaemia, five (9%) polycythaemia vera, five (9%) myelofibrosis and one (2%) MPN-unclassified. There were 58 live births. The incidence of miscarriage was 1·7/100 (95% confidence interval [CI]: 0·04-9·24) and the perinatal mortality rate was 17/1000 (95% CI: 0·44-92·36) live and stillbirths. Incidence of maternal complications was 9% (5/57) pre-eclampsia, 9% (5/57) post-partum haemorrhage and 3·5% (2/57) post-partum haematoma. There were no maternal deaths or thrombotic events. Delivery was induced in 45% (24/53) of women and the Caesarean section rate was 45% (24/53). The majority (85%, 45/53) delivered at term (>37 weeks gestation). Twenty-two percent (12/54) of neonates were below the 10% centile for growth and 13% (7/54) required admission to a neonatal care-unit; there were no neonatal deaths. The findings of this large, UK prospective study suggests women with MPN appear to have successful pregnancies with better outcomes than would be anticipated from the literature.

  9. Intimate partner violence during pregnancy: maternal and neonatal outcomes.

    PubMed

    Alhusen, Jeanne L; Ray, Ellen; Sharps, Phyllis; Bullock, Linda

    2015-01-01

    The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health. PMID:25265285

  10. Pregnancy outcomes in myeloproliferative neoplasms: UK prospective cohort study.

    PubMed

    Alimam, Samah; Bewley, Susan; Chappell, Lucy C; Knight, Marian; Seed, Paul; Gray, Gabriella; Harrison, Claire; Robinson, Susan

    2016-10-01

    The reported higher risk of maternal and fetal complications in women with myeloproliferative neoplasms (MPN) poses challenge during pregnancy. A national prospective study of maternal and fetal outcomes of pregnant women with a diagnosis of MPN was undertaken via the United Kingdom Obstetric Surveillance System between January 2010 and December 2012. Fifty-eight women with a diagnosis of MPN were identified; 47 (81%) essential thrombocythaemia, five (9%) polycythaemia vera, five (9%) myelofibrosis and one (2%) MPN-unclassified. There were 58 live births. The incidence of miscarriage was 1·7/100 (95% confidence interval [CI]: 0·04-9·24) and the perinatal mortality rate was 17/1000 (95% CI: 0·44-92·36) live and stillbirths. Incidence of maternal complications was 9% (5/57) pre-eclampsia, 9% (5/57) post-partum haemorrhage and 3·5% (2/57) post-partum haematoma. There were no maternal deaths or thrombotic events. Delivery was induced in 45% (24/53) of women and the Caesarean section rate was 45% (24/53). The majority (85%, 45/53) delivered at term (>37 weeks gestation). Twenty-two percent (12/54) of neonates were below the 10% centile for growth and 13% (7/54) required admission to a neonatal care-unit; there were no neonatal deaths. The findings of this large, UK prospective study suggests women with MPN appear to have successful pregnancies with better outcomes than would be anticipated from the literature. PMID:27612319

  11. Maternal over weight and obesity: its effect on pregnancy outcome.

    PubMed

    Mazumder, U; Sarker, S; Riaz, B K; Chowdhury, T A

    2011-04-01

    Obesity in pregnancy remains a significant health problem that result in physiological, emotional, social and economic consequences on woman, their families and society. Obesity is considered one of the nutritional problems complicating pregnancy in our country. This study was conducted in antenatal clinic at out patient department of Obstetrics & Gynecology, BIRDEM Hospital, one of the countries largest tertiary level hospitals, during January 2007 to December 2008. During the study period of two years, a total no. of 100 cases were enrolled in two groups. Out of this 50 were control and 50 were over weight and obese. In this study, Mean of height, weight and BMI of the over weight and obese group were 5.21±0.21, 79.35±13.66, 32.36±4.76 respectively. The Mean of birth weight, APGAR score after 1 min and after 5 min of the over weight and obese group were 3.07±0.75, 7.10±1.11, 9.92±0.98 respectively and in normal weight group were 2.74±0.55, 7.40±1.56, 9.92±1.83 respectively. There was significant difference in birth weight, APGAR score after 1 min between the groups (p<0.05) but there was no significant difference in APGAR score after 5 min between groups (p>0.05). Regarding the fetal outcome in this study, 20% of the over weight and obese group delivered macrosomic baby in comparison to only 4% in the normal weight group. On the other hand 46% of the case group had to refer their babies to the neonatal unit in comparison to only 12% in the control group. Gestational Diabetes Mellitus (GDM) (46%) and Preeclampsia (44%) developed more in obese group. Eighty eight (88%) of obese and overweight mother experienced in caesarean delivery. Asphyxia, Respiratory Distress Syndrome (RDS), congenital anomaly and prenatal death were more in the over weight and obese group than normal weight group. Thus, overweight and obesity has got significant deleterious effect on maternal and perinatal outcomes of pregnancy. PMID:21522090

  12. Perinatal outcome of ICSI pregnancies compared with a matched group of natural conception pregnancies in Flanders (Belgium): a cohort study.

    PubMed

    Ombelet, Willem; Peeraer, Karen; De Sutter, Petra; Gerris, Jan; Bosmans, Eugene; Martens, Guy; Ruyssinck, Gunther; Defoort, Paul; Molenberghs, Geert; Gyselaers, Wilfried

    2005-08-01

    A retrospective cohort study was conducted with an intracytoplasmic sperm injection (ICSI) group and a naturally conceived comparison group. A total of 1655 singleton and 1102 twin ICSI births were studied with regard to perinatal outcome. Control subjects (naturally conceived pregnancies) were selected from a regional registry and were matched for maternal age, parity, place of delivery, year of birth and fetal sex. The main outcome measures were duration of pregnancy, birth weight, Apgar score <5 after 5 min, neonatal complications, perinatal death and congenital malformations. Twin births, when compared with singletons, carry a much higher risk of poor perinatal outcome. For both ICSI singletons and ICSI twins, no significant difference was found between ICSI and naturally conceived pregnancies for all investigated parameters. After excluding like-sex twin pairs, ICSI twin pregnancies were at increased risk for perinatal mortality (OR = 2.74, CI = 1.26-5.98), prematurity (OR = 1.38, CI = 1.10-1.75) and low birth weight (OR = 1.34, CI = 1.06-1.69) compared with spontaneously conceived different-sex twin pairs. In conclusion, the perinatal outcome of ICSI singleton and twin pregnancies was very similar to that of spontaneously conceived pregnancies in this large cohort study. After excluding like-sex twin pairs, ICSI twins were at increased risk for prematurity, low birth weight and higher perinatal mortality compared with the natural conception comparison group.

  13. Marijuana use and pregnancy: prevalence, associated characteristics, and birth outcomes.

    PubMed

    Mark, Katrina; Desai, Andrea; Terplan, Mishka

    2016-02-01

    This study examines the prevalence, behaviors, and birth outcomes associated with marijuana use in pregnancy. This was a retrospective cohort from a university-based prenatal care clinic from July 1, 2009 to June 30, 2010. The primary exposure was marijuana use, defined by self-report or urine toxicology. Demographic and outcome data were determined by chart review and analyzed by chi-square test, Fisher's exact test, ANOVA, and logistic regression. Three hundred and ninety-six patients initiated prenatal care during this time frame; 116 (29.3 %) of whom screened positive for marijuana at initial visit. Patients who used marijuana were less likely to have graduated high school (p = 0.016) or be employed (p = 0.015); they were more likely to use tobacco (p < 0.001) or alcohol (p = 0.032) and report a history of abuse (p = 0.010) or depressed mood (p = 0.023). When analyzed via logistic regression, only tobacco use remained associated with marijuana use (adjusted odds ratio (OR) = 3.3; 95 % confidence interval (CI): 1.9-5.9). Birth outcomes were available for 170 (43.0 %) patients. Only 3 (1.9 %) tested positive for marijuana at the time of delivery. Marijuana use was not related to incidence of low birth weight (13.8 % vs 14.0 %, p = 1.00), preterm delivery (17.7 % vs 12.0 %, p = 0.325), or NICU admissions (25.5 % vs 15.8 %, p = 0.139). Prenatal care utilization was equal between marijuana users and non-users. Although marijuana is common among obstetric patients at prenatal care initiation, most cease use by delivery. Marijuana is strongly correlated with cigarette use. We found no differences in birth outcomes or utilization of prenatal care by marijuana exposure.

  14. Social support in improving perinatal outcome: the Resource Mothers Program.

    PubMed

    Heins, H C; Nance, N W; Ferguson, J E

    1987-08-01

    This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy. Each Resource Mother is assigned to a pregnant teenage primigravida and serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatal care in the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002). PMID:3601290

  15. Social support in improving perinatal outcome: the Resource Mothers Program.

    PubMed

    Heins, H C; Nance, N W; Ferguson, J E

    1987-08-01

    This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy. Each Resource Mother is assigned to a pregnant teenage primigravida and serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatal care in the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002).

  16. Etiologic characteristics and index pregnancy outcomes of recurrent pregnancy losses in Korean women

    PubMed Central

    Lee, Gi Su; Rhee, Jeong Ho; Kim, Jong In

    2016-01-01

    Objective The goal of this study was to evaluate the etiologies and clinical outcomes of Korean recurrent pregnancy loss (RPL) patients. And also, we investigated the differences between primary and secondary RPL patients, between two and three or more pregnancy losses. Methods One hundred seventy eight women diagnosed as RPL were enrolled. We performed chromosomal analysis, thyroid stimulating hormone, prolactin, blood glucose, plasminogen activator inhibitor-1, natural killer cell proportion, anticardiolipin antibodies, antiphospholipid antibodies, lupus anticoagulant, anti-β2glycoprotein-1 antibodies, antinuclear antibody, protein C, protein S, antithrombin III, homocysteine, MTFHR gene, factor V Leiden mutation, and hysterosalphingography/hysteroscopic evaluation. Results The mean age was 34.03±4.30 years, and mean number of miscarriages was 2.69±1.11 (range, 2 to 11). Anatomical cause (13.5%), chromosomal abnormalities (5.6%), and endocrine disorders (34.3%) were observed in RPL women. Elevated natural killer cell and antiphospholipid antibodies were observed in 43.3% and 7.3% each. Among of 178 women, 77 women were pregnant. After management of those women, live birth rate was 84.4% and mean gestational weeks was 37.63±5.12. Women with three or more RPL compared with women with two RPL had more common anatomical cause such as intrauterine adhesions and lower rates of spontaneous pregnancy. Compare with secondary RPL women, immunological abnormalities were more common in primary RPL. However, miscarriage rates were not different. Conclusion Immunological factor including autoimmune and alloimmune disorders was most common etiology of RPL. Inherited thrombophilia showed different patterns with other ethnic countries. Miscarriage rates were not different between primary and secondary RPL, or between two and three or more miscarriages group. PMID:27668201

  17. Etiologic characteristics and index pregnancy outcomes of recurrent pregnancy losses in Korean women

    PubMed Central

    Lee, Gi Su; Rhee, Jeong Ho; Kim, Jong In

    2016-01-01

    Objective The goal of this study was to evaluate the etiologies and clinical outcomes of Korean recurrent pregnancy loss (RPL) patients. And also, we investigated the differences between primary and secondary RPL patients, between two and three or more pregnancy losses. Methods One hundred seventy eight women diagnosed as RPL were enrolled. We performed chromosomal analysis, thyroid stimulating hormone, prolactin, blood glucose, plasminogen activator inhibitor-1, natural killer cell proportion, anticardiolipin antibodies, antiphospholipid antibodies, lupus anticoagulant, anti-β2glycoprotein-1 antibodies, antinuclear antibody, protein C, protein S, antithrombin III, homocysteine, MTFHR gene, factor V Leiden mutation, and hysterosalphingography/hysteroscopic evaluation. Results The mean age was 34.03±4.30 years, and mean number of miscarriages was 2.69±1.11 (range, 2 to 11). Anatomical cause (13.5%), chromosomal abnormalities (5.6%), and endocrine disorders (34.3%) were observed in RPL women. Elevated natural killer cell and antiphospholipid antibodies were observed in 43.3% and 7.3% each. Among of 178 women, 77 women were pregnant. After management of those women, live birth rate was 84.4% and mean gestational weeks was 37.63±5.12. Women with three or more RPL compared with women with two RPL had more common anatomical cause such as intrauterine adhesions and lower rates of spontaneous pregnancy. Compare with secondary RPL women, immunological abnormalities were more common in primary RPL. However, miscarriage rates were not different. Conclusion Immunological factor including autoimmune and alloimmune disorders was most common etiology of RPL. Inherited thrombophilia showed different patterns with other ethnic countries. Miscarriage rates were not different between primary and secondary RPL, or between two and three or more miscarriages group.

  18. Clinical outcomes after assisted reproductive technology in twin pregnancies: chorionicity-based comparison

    PubMed Central

    Sun, Luming; Zou, Gang; Wei, Xing; Chen, Yan; Zhang, Jun; Okun, Nanette; Duan, Tao

    2016-01-01

    The chorionicity–based evaluation of the perinatal risk in twin pregnancies after assisted reproductive technology (ART) is lacking. A retrospective review was performed of all twin pregnancies monitored prenatally and delivered at our hospital between 2010 and 2014. Chorionicity was diagnosed by ultrasound examination at first trimester and confirmed by postnatal pathology. Pregnancy and perinatal outcomes were prospectively recorded. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated in a logistic regression model. A total of 1153 twin pregnancies were analyzed. The occurrence of preterm premature rupture of membranes (PPROM) was 3 times as frequent in monochorionic diamniotic (MCDA) twin pregnancies after ART as in those spontaneous counterparts (aOR 3.0; 95%CI 1.1–3.2). The prevalence of intrahepatic cholestasis of pregnancies (ICP) was significantly higher in dichorionic diamniotic (DCDA) twin pregnancies following ART compared to spontaneous DCDA pregnancies (aOR 3.3; 95%CI 1.3–5.6). Perinatal outcomes did not differ between two conception methods, either in MCDA or DCDA twin pregnancies. Based on differentiation of chorionicity, ART is associated with the increased risk of PPROM in MCDA twin pregnancies and with a higher rate of ICP in DCDA twin gestations. ART does not increase adversity of perinatal outcomes in twin pregnancies. PMID:27243373

  19. Effect of assisted hatching on pregnancy outcomes: a systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Li, Da; Yang, Da-Lei; An, Jing; Jiao, Jiao; Zhou, Yi-Ming; Wu, Qi-Jun; Wang, Xiu-Xia

    2016-01-01

    Emerging evidence suggests that assisted hatching (AH) techniques may improve clinical pregnancy rates, particularly in poor prognosis patients; however, there still remains considerable uncertainty. We conducted a meta-analysis to verify the effect of AH on pregnancy outcomes. We searched for related studies published in PubMed, Web of Science, and Cochrane library databases from start dates to October 10, 2015. Totally, 36 randomized controlled trials with 6459 participants were included. Summary odds ratios (ORs) with 95% confidence intervals (CIs) for whether by AH or not were estimated. We found a significant increase in clinical pregnancy (OR = 1.16, 95% CI = 1.00-1.36, I(2) = 48.3%) and multiple pregnancy rates (OR = 1.50, 95% CI = 1.11-2.01, I(2) = 44.0%) with AH when compared to the control. Numerous subgroup analyses stratified by hatching method, conception mode, extent of AH, embryos transfer status, and previous failure history were also carried out. Interestingly, significant results of clinical pregnancy as well as multiple pregnancy rates were observed among women who received intracytoplasmic sperm injection, and who received AH which the zona were completely removed. In summary, this meta-analysis supports that AH was associated with an increased chance of achieving clinical pregnancy and multiple pregnancy. Whether AH significantly changes live birth and miscarriage rates needs further investigations. PMID:27503701

  20. Effect of assisted hatching on pregnancy outcomes: a systematic review and meta-analysis of randomized controlled trials

    PubMed Central

    Li, Da; Yang, Da-Lei; An, Jing; Jiao, Jiao; Zhou, Yi-Ming; Wu, Qi-Jun; Wang, Xiu-Xia

    2016-01-01

    Emerging evidence suggests that assisted hatching (AH) techniques may improve clinical pregnancy rates, particularly in poor prognosis patients; however, there still remains considerable uncertainty. We conducted a meta-analysis to verify the effect of AH on pregnancy outcomes. We searched for related studies published in PubMed, Web of Science, and Cochrane library databases from start dates to October 10, 2015. Totally, 36 randomized controlled trials with 6459 participants were included. Summary odds ratios (ORs) with 95% confidence intervals (CIs) for whether by AH or not were estimated. We found a significant increase in clinical pregnancy (OR = 1.16, 95% CI = 1.00–1.36, I2 = 48.3%) and multiple pregnancy rates (OR = 1.50, 95% CI = 1.11–2.01, I2 = 44.0%) with AH when compared to the control. Numerous subgroup analyses stratified by hatching method, conception mode, extent of AH, embryos transfer status, and previous failure history were also carried out. Interestingly, significant results of clinical pregnancy as well as multiple pregnancy rates were observed among women who received intracytoplasmic sperm injection, and who received AH which the zona were completely removed. In summary, this meta-analysis supports that AH was associated with an increased chance of achieving clinical pregnancy and multiple pregnancy. Whether AH significantly changes live birth and miscarriage rates needs further investigations. PMID:27503701

  1. Maternal and Live-birth Outcomes of Pregnancies following Assisted Reproductive Technology: A Retrospective Cohort Study

    PubMed Central

    Zhu, Linling; Zhang, Yu; Liu, Yifeng; Zhang, Runjv; Wu, Yiqing; Huang, Yun; Liu, Feng; Li, Meigen; Sun, Saijun; Xing, Lanfeng; Zhu, Yimin; Chen, Yiyi; Xu, Li; Zhou, Liangbi; Huang, Hefeng; Zhang, Dan

    2016-01-01

    This study was carried out to explore associations between assisted reproductive technology (ART) and maternal and neonatal outcomes compared with similar outcomes following spontaneously conceived births. We conducted a retrospective cohort study of pregnancies conceived by ART (N = 2641) during 2006–2014 compared to naturally conceived pregnancies (N = 5282) after matching for maternal age and birth year. Pregnancy complications, perinatal complications and neonatal outcomes of enrolled subjects were investigated and analysed by multivariate logistic regression. We found that pregnancies conceived by in vitro fertilization (IVF) were associated with a significantly increased incidence of gestational diabetes mellitus, gestational hypertension, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of membranes, placental adherence, postpartum haemorrhage, polyhydramnios, preterm labour, low birth weight, and small-for-date infant compared with spontaneously conceived births. Pregnancies conceived by intracytoplasmic sperm injection (ICSI) showed similar elevated complications, except some of the difference narrowed or disappeared. Singleton pregnancies or nulliparous pregnancies following ART still exhibited increased maternal and neonatal complications. Therefore, we conclude that pregnancies conceived following ART are at increased risks of antenatal complications, perinatal complications and poor neonatal outcomes, which may result from not only a higher incidence of multiple pregnancy, but also the manipulation involved in ART processes. PMID:27762324

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

    PubMed

    Cho, Eun-Hee; Hur, Junguk; Lee, Kyung-Ju

    2015-01-01

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

  3. Preterm birth in twin pregnancies: Clinical outcomes and predictive parameters

    PubMed Central

    Dolgun, Zehra Nihal; Inan, Cihan; Altintas, Ahmet Salih; Okten, Sabri Berkem; Sayin, Niyazi Cenk

    2016-01-01

    Objective: To document the neonatal outcomes of preterm birth in twin pregnancies and to investigate whether perinatal and obstetric parameters are associated with clinical outcomes. Methods: This retrospective trial was conducted on data gathered from 176 preterm twins delivered in the obstetrics and gynecology department of our tertiary care center. Data extracted from medical files of 88 pregnant women who gave preterm birth (at 260/7 to 366/7 gestational weeks) to twins were analyzed. Maternal/fetal descriptive and obstetric parameters, sonographic data, route of delivery, indication for cesarean section, birth weight, Apgar scores, head circumference, umbilical cord length and placental weight were noted. Results: The average age of the pregnant women was 28.8±6.4 years and ultrasonographic gestational age was 31.9±2.6 weeks. Apgar scores at 1st minute were affected significantly by fetal body weight (p=0.001), gestational age (p=0.001), height (p=0.004) and head circumference (p=0.011). None of these variables exhibited a noteworthy effect on Apgar scores at 5th minute. Conclusion: Efforts must be made to achieve advancement of gestational age until delivery in the follow-up preterm of twins. A well-established algorithm with special emphasis to risk factors is necessary to standardize and popularize the appropriate management strategy.

  4. Preterm birth in twin pregnancies: Clinical outcomes and predictive parameters

    PubMed Central

    Dolgun, Zehra Nihal; Inan, Cihan; Altintas, Ahmet Salih; Okten, Sabri Berkem; Sayin, Niyazi Cenk

    2016-01-01

    Objective: To document the neonatal outcomes of preterm birth in twin pregnancies and to investigate whether perinatal and obstetric parameters are associated with clinical outcomes. Methods: This retrospective trial was conducted on data gathered from 176 preterm twins delivered in the obstetrics and gynecology department of our tertiary care center. Data extracted from medical files of 88 pregnant women who gave preterm birth (at 260/7 to 366/7 gestational weeks) to twins were analyzed. Maternal/fetal descriptive and obstetric parameters, sonographic data, route of delivery, indication for cesarean section, birth weight, Apgar scores, head circumference, umbilical cord length and placental weight were noted. Results: The average age of the pregnant women was 28.8±6.4 years and ultrasonographic gestational age was 31.9±2.6 weeks. Apgar scores at 1st minute were affected significantly by fetal body weight (p=0.001), gestational age (p=0.001), height (p=0.004) and head circumference (p=0.011). None of these variables exhibited a noteworthy effect on Apgar scores at 5th minute. Conclusion: Efforts must be made to achieve advancement of gestational age until delivery in the follow-up preterm of twins. A well-established algorithm with special emphasis to risk factors is necessary to standardize and popularize the appropriate management strategy. PMID:27648040

  5. Pre-pregnancy Dating Violence and Birth Outcomes among Adolescent Mothers in a National Sample

    PubMed Central

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

    2015-01-01

    adolescent relationships prior to pregnancy may improve Black adolescent mothers’ birth outcomes. Intervening on long-term violence may be particularly important. PMID:24366966

  6. 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

  7. 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

  8. 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

  9. 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.

  10. Analysis of pregnancy and infant health outcomes among women in the National Smallpox Vaccine in Pregnancy Registry who received Anthrax Vaccine Adsorbed.

    PubMed

    Conlin, Ava Marie S; Bukowinski, Anna T; Gumbs, Gia R

    2015-08-26

    The National Smallpox Vaccine in Pregnancy Registry (NSVIPR) actively follows women inadvertently vaccinated with smallpox vaccine during or shortly before pregnancy to evaluate their reproductive health outcomes. Approximately 65% of NSVIPR participants also inadvertently received Anthrax Vaccine Adsorbed (AVA) while pregnant, providing a ready opportunity to evaluate pregnancy and infant health outcomes among these women. AVA-exposed pregnancies were ascertained using NSVIPR and electronic healthcare data. Rates of pregnancy loss and infant health outcomes, including major birth defects, were compared between AVA-exposed and AVA-unexposed pregnancies. Analyses included AVA-exposed and AVA-unexposed pregnant women who also received smallpox vaccine 28 days prior to or during pregnancy. Rates of adverse outcomes among the AVA-exposed group were similar to or lower than expected when compared with published reference rates and the AVA-unexposed population. The findings provide reassurance of the safety of AVA when inadvertently received by a relatively young and healthy population during pregnancy.

  11. The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes

    PubMed Central

    2015-01-01

    Background The Global Network for Women's and Children's Health Research (Global Network) supports and conducts clinical trials in resource-limited countries by pairing foreign and U.S. investigators, with the goal of evaluating low-cost, sustainable interventions to improve the health of women and children. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to efforts to discover strategies for improving pregnancy outcomes in resource-limited settings. Because most of the sites in the Global Network have weak registration within their health care systems, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry of pregnancies at the Global Network sites to provide precise data on health outcomes and measures of care. Methods Pregnant women are enrolled in the MNHR if they reside in or receive healthcare in designated groups of communities within sites in the Global Network. For each woman, demographic, health characteristics and major outcomes of pregnancy are recorded. Data are recorded at enrollment, the time of delivery and at 42 days postpartum. Results From 2010 through 2013 Global Network sites were located in Argentina, Guatemala, Belgaum and Nagpur, India, Pakistan, Kenya, and Zambia. During this period, 283,496 pregnant women were enrolled in the MNHR; this number represented 98.8% of all eligible women. Delivery data were collected for 98.8% of women and 42-day follow-up data for 98.4% of those enrolled. In this supplement, there are a series of manuscripts that use data gathered through the MNHR to report outcomes of these pregnancies. Conclusions Developing public policy and improving public health in countries with poor perinatal outcomes is, in part, dependent upon understanding the outcome of every pregnancy. Because the worst pregnancy outcomes typically occur in countries with limited health registration

  12. Pregnancy outcomes of liver transplant recipients: a systematic review and meta-analysis.

    PubMed

    Deshpande, Neha A; James, Nathan T; Kucirka, Lauren M; Boyarsky, Brian J; Garonzik-Wang, Jacqueline M; Cameron, Andrew M; Singer, Andrew L; Dagher, Nabil N; Segev, Dorry L

    2012-06-01

    Approximately 14,000 women of reproductive age are currently living in the United States after liver transplantation (LT), and another 500 undergo LT each year. Although LT improves reproductive function in women with advanced liver disease, the associated pregnancy outcomes and maternal-fetal risks have not been quantified in a broad manner. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles that were published between 2000 and 2011 and reported pregnancy-related outcomes for LT recipients. Eight of 578 unique studies met the inclusion criteria, and these studies represented 450 pregnancies in 306 LT recipients. The post-LT live birth rate [76.9%, 95% confidence interval (CI) = 72.7%-80.7%] was higher than the live birth rate for the US general population (66.7%) but was similar to the post-kidney transplantation (KT) live birth rate (73.5%). The post-LT miscarriage rate (15.6%, 95% CI = 12.3%-19.2%) was lower than the miscarriage rate for the general population (17.1%) but was similar to the post-KT miscarriage rate (14.0%). The rates of pre-eclampsia (21.9%, 95% CI = 17.7%-26.4%), cesarean section delivery (44.6%, 95% CI = 39.2%-50.1%), and preterm delivery (39.4%, 95% CI = 33.1%-46.0%) were higher than the rates for the US general population (3.8%, 31.9%, and 12.5%, respectively) but lower than the post-KT rates (27.0%, 56.9%, and 45.6%, respectively). Both the mean gestational age and the mean birth weight were significantly greater (P < 0.001) for LT recipients versus KT recipients (36.5 versus 35.6 weeks and 2866 versus 2420 g). Although pregnancy after LT is feasible, the complication rates are relatively high and should be considered during patient counseling and clinical decision making. More case and center reports are necessary so that information on post-LT pregnancy outcomes and complications can be gathered to improve the clinical management of pregnant LT recipients. Continued reporting to active

  13. Pregnancy outcome after cerclage for cervical incompetence at the University of Port Harcourt Teaching Hospital, Port Harcourt.

    PubMed

    Ikimalo, John I; Izuchukwu, Kenneth E; Inimgba, Nestor

    2012-09-01

    Cervical incompetence is often associated with mid trimester pregnancy losses and preterm labour. cervical cerclage to prevent miscarriage and preterm labour is practiced world wide. The objective of this study was to document the feto-maternal outcome following cervical cerclage for cervical incompetence. The study reviewed all case files of pregnant women who had cervical cerclage for cervical incompetence between January 1, 2004 to December 31, 2008, at the University of Port Harcourt Teaching Hospital. The study found an incidence of 0.17% of cervical incompetence among the antenatal population. Following cervical cerclage, miscarriage rate was 9.4%. Preterm delivery occurred in 21.8% while term pregnancy occurred in 68.8% of the women. There is improvement in pregnancy outcome after cervical cerclage for cervical incompetence hence we recommend the insertion for true cases of cervical incompetence.

  14. 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

  15. Maternal smokeless tobacco use and adverse pregnancy outcome.

    PubMed

    Hossain, M M; Rahman, M E; Khan, T H

    2014-01-01

    This study was conducted to determine the association between prolonged smokeless tobacco (ST) use for more than 5 years by mothers and pregnancy outcome. It was a retrospective cohort study done on department of paediatrics and department of gynecology & obstetrics, Dhaka Medical College Hospital, Dhaka from January 2009 to December 2010. A total of 340 mother-neonate pairs were included in the study. A total of 170 mothers using smokeless tobacco for more than 5 years and their recently delivered newborn infants (mother-neonate pair) were enrolled as cases and 170 mother-neonate pairs without history of taking ST as controls. Frequency of spontaneous abortion, stillbirth, preterm delivery and LBW baby in case & control groups was assessed. Smokeless tobacco used by mothers for >5 years had significant association with spontaneous abortion (p<0.01), stillbirth (p<0.01), preterm delivery (p<0.001) & LBW baby (p<0.001) and carries a risk of having spontaneous abortion, stillbirth, preterm delivery & LBW 2.2 times, 2.1 times, 2.9 times & 3.3 times respectively more than non users of smokeless tobacco. It can be concluded that prolonged use of smokeless tobacco for more than 5 years is significantly associated with spontaneous abortion, stillbirth, preterm delivery and LBW baby.

  16. 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

  17. 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.

  18. Woman abuse and pregnancy outcome among women in Khoram Abad, Islamic Republic of Iran.

    PubMed

    Khodakarami, N; Naji, H; Dashti, M G; Yazdjerdi, M

    2009-01-01

    We carried out a descriptive analysis on the pregnancy outcome in 313 pregnant women abused, 160 non-abused). Abuse was statistically significantly correlated with mean weight gain during pregnancy, mean frequency of the prenatal care, prolonged labour (dystocia), premature rupture of membrane, low mean birth weight and mean gestational age at birth. Given the high likelihood that a woman will access health care services during her pregnancy, physicians providing prenatal care are in a strategic position to screen for partner abuse.

  19. Pregnancy outcome in patients exposed to direct oral anticoagulants - and the challenge of event reporting.

    PubMed

    Beyer-Westendorf, Jan; Michalski, Franziska; Tittl, Luise; Middeldorp, Saskia; Cohen, Hannah; Abdul Kadir, Rezan; Arachchillage, Deepa Jayakody; Arya, Roopen; Ay, Cihan; Marten, Sandra

    2016-09-27

    Today, direct oral anticoagulants (DOAC) are widely used alternatives to Vitamin-K antagonists (VKA). Women of reproductive age may become pregnant during anticoagulation and, while VKA carry an embryotoxic potential, the risk of DOAC embryopathy is unknown. As a result, some patients elect to terminate pregnancy for fear of DOAC embryotoxicity. To assess the risk of DOAC embryopathy, we reviewed cases of DOAC exposure in pregnancy collected from physicians, literature and pharmacovigilance systems of drug authorities and manufacturers. A total of 357 reports including duplicates were available from which 233 unique cases could be identified. Information on pregnancy outcome was available in only 137/233 cases (58.8 %): 67 live births (48.9 %); 31 miscarriages (22.6 %); 39 elective pregnancy terminations (28.5 %). In 93 cases (39.9 %) no outcome data were available (including 3 cases of ongoing pregnancy). Of the 137 pregnancies with reported outcomes, seven showed abnormalities (5.1 %) of which three (2.2 %) could potentially be interpreted as embryopathy: live birth with facial dysmorphism; miscarriage in week 10 with limb abnormality; elective pregnancy termination due to a foetal cardiac defect in a woman who had to terminate a previous pregnancy due to Fallot tetralogy. Within its limitations (small numbers, incomplete outcome data) our results do not indicate that DOAC exposure in pregnancy carries a high risk of embryopathy or that DOAC exposure per se should be used to direct patient counselling towards pregnancy termination. Pregnancy outcome data are inconsistently captured in pharmacovigilance databases indicating the strong need for a more robust system of reporting. PMID:27384740

  20. Pregnancy outcome in patients exposed to direct oral anticoagulants - and the challenge of event reporting.

    PubMed

    Beyer-Westendorf, Jan; Michalski, Franziska; Tittl, Luise; Middeldorp, Saskia; Cohen, Hannah; Abdul Kadir, Rezan; Arachchillage, Deepa Jayakody; Arya, Roopen; Ay, Cihan; Marten, Sandra

    2016-09-27

    Today, direct oral anticoagulants (DOAC) are widely used alternatives to Vitamin-K antagonists (VKA). Women of reproductive age may become pregnant during anticoagulation and, while VKA carry an embryotoxic potential, the risk of DOAC embryopathy is unknown. As a result, some patients elect to terminate pregnancy for fear of DOAC embryotoxicity. To assess the risk of DOAC embryopathy, we reviewed cases of DOAC exposure in pregnancy collected from physicians, literature and pharmacovigilance systems of drug authorities and manufacturers. A total of 357 reports including duplicates were available from which 233 unique cases could be identified. Information on pregnancy outcome was available in only 137/233 cases (58.8 %): 67 live births (48.9 %); 31 miscarriages (22.6 %); 39 elective pregnancy terminations (28.5 %). In 93 cases (39.9 %) no outcome data were available (including 3 cases of ongoing pregnancy). Of the 137 pregnancies with reported outcomes, seven showed abnormalities (5.1 %) of which three (2.2 %) could potentially be interpreted as embryopathy: live birth with facial dysmorphism; miscarriage in week 10 with limb abnormality; elective pregnancy termination due to a foetal cardiac defect in a woman who had to terminate a previous pregnancy due to Fallot tetralogy. Within its limitations (small numbers, incomplete outcome data) our results do not indicate that DOAC exposure in pregnancy carries a high risk of embryopathy or that DOAC exposure per se should be used to direct patient counselling towards pregnancy termination. Pregnancy outcome data are inconsistently captured in pharmacovigilance databases indicating the strong need for a more robust system of reporting.

  1. Contraceptive Use and Pregnancy Outcomes among Opioid Drug-Using Women: A Retrospective Cohort Study

    PubMed Central

    Cornford, Charles S.; Close, Helen J.; Bray, Roz; Beere, Deborah; Mason, James M.

    2015-01-01

    Objective The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors. Method This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored. Results Drug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception. Conclusions This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing

  2. Surrounding Greenness and Pregnancy Outcomes in Four Spanish Birth Cohorts

    PubMed Central

    Sunyer, Jordi; Basagaña, Xavier; Ballester, Ferran; Lertxundi, Aitana; Fernández-Somoano, Ana; Estarlich, Marisa; García-Esteban, Raquel; Mendez, Michelle A.; Nieuwenhuijsen, Mark J.

    2012-01-01

    Background: Green spaces have been associated with improved physical and mental health; however, the available evidence on the impact of green spaces on pregnancy is scarce. Objectives: We investigated the association between surrounding greenness and birth weight, head circumference, and gestational age at delivery. Methods: This study was based on 2,393 singleton live births from four Spanish birth cohorts (Asturias, Gipuzkoa, Sabadell, and Valencia) located in two regions of the Iberian Peninsula with distinct climates and vegetation patterns (2003–2008). We defined surrounding greenness as average of satellite-based Normalized Difference Vegetation Index (NDVI) (Landsat 4–5 TM data at 30 m × 30 m resolution) during 2007 in buffers of 100 m, 250 m, and 500 m around each maternal place of residence. Separate linear mixed models with adjustment for potential confounders and a random cohort effect were used to estimate the change in birth weight, head circumference, and gestational age for 1-interquartile range increase in surrounding greenness. Results: Higher surrounding greenness was associated with increases in birth weight and head circumference [adjusted regression coefficients (95% confidence interval) of 44.2 g (20.2 g, 68.2 g) and 1.7 mm (0.5 mm, 2.9 mm) for an interquartile range increase in average NDVI within a 500-m buffer] but not gestational age. These findings were robust against the choice of the buffer size and the season of data acquisition for surrounding greenness, and when the analysis was limited to term births. Stratified analyses indicated stronger associations among children of mothers with lower education, suggesting greater benefits from surrounding greenness. Conclusions: Our findings suggest a beneficial impact of surrounding greenness on measures of fetal growth but not pregnancy length. PMID:22899599

  3. Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis

    PubMed Central

    Shah, Prakesh S.; Ohlsson, Arne

    2009-01-01

    Background Reduced intake of micronutrients during pregnancy exposes women to nutritional deficiencies and may affect fetal growth. We conducted a systematic review to examine the efficacy of prenatal supplementation with multimicronutrients on pregnancy outcomes. Methods We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for relevant articles published in English up to December 2008. We also searched the bibliographies of selected articles as well as clinical trial registries. The primary outcome was low birth weight; secondary outcomes were preterm birth, small-for-gestational-age infants, birth weight and gestational age. Results We observed a significant reduction in the risk of low birth weight among infants born to women who received multimicronutrients during pregnancy compared with placebo (relative risk [RR] 0.81, 95% confidence interval [CI] 0.73–0.91) or iron–folic acid supplementation (RR 0.83, 95% CI 0.74–0.93). Birth weight was significantly higher among infants whose mothers were in the multimicronutrient group than among those whose mothers received iron–folic acid supplementation (weighted mean difference 54 g, 95% CI 36 g–72 g). There was no significant differences in the risk of preterm birth or small-for-gestational-age infants between the 3 study groups. Interpretation Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron–folic acid supplementation. There was no significant effect of multimicronutrient supplementation on the risk of preterm birth or small-for-gestational-age infants. PMID:19506270

  4. Teenage Pregnancy Prevention and Adolescents' Sexual Outcomes: An Experiential Approach

    ERIC Educational Resources Information Center

    Somers, Cheryl L.

    2006-01-01

    This study evaluates the effectiveness of an experiential approach to teen pregnancy (TP) prevention called "Baby Think It Over," a computerized infant simulator, on adolescents' attitudes and behaviors regarding teen pregnancy and sexuality. Recently, a more realistic model called "Real Care Baby" was developed. The small amount of research on…

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

    PubMed Central

    Ge, Xing; Tao, Fangbiao

    2016-01-01

    Objective To examine the prevalence of snoring during pregnancy and its effects on key pregnancy outcomes. Methods Pregnant women were consecutively recruited in their first trimester. Habitual snoring was screened by using a questionnaire in the 1st and 3rd trimester, respectively. According to the time of snoring, participants were divided into pregnancy onset snorers, chronic snorers and non-snorers. Logistic regressions were performed to examine the associations between snoring and pregnancy outcomes. Results Of 3 079 pregnant women, 16.6% were habitual snorers, with 11.7% were pregnancy onset snorers and 4.9% were chronic snorers. After adjusting for potential confounders, chronic snorers were independently associated with gestational diabetes mellitus (GDM) (RR 1.66, 95%CI 1.09–2.53). Both pregnancy onset and chronic snorers were independently associated with placental adhesion (RR 1.96, 95%CI 1.17–3.27, and RR 2.33, 95%CI 1.22–4.46, respectively). Pregnancy onset snorers were at higher risk of caesarean delivery (RR 1.37, 95%CI 1.09–1.73) and having macrosomia (RR 1.54, 95%CI 1.05–2.27) and large for gestational age (LGA) (RR 1.71, 95%CI 1.31–2.24) infants. In addition, being overweight or obese before pregnancy plays an important role in mediating snoring and adverse pregnancy outcomes. Conclusions Maternal snoring may increase the risk of adverse pregnancy outcomes, and being overweight or obese before pregnancy with snoring is remarkable for researchers. Further studies are still needed to confirm our results. PMID:26871434

  6. A rare case of dermatomyositis revealed during pregnancy with good outcome.

    PubMed

    Awatef, Kelati; Salim, Gallouj; Zahra, Mernissi Fatima

    2016-01-01

    There are only few case reports in the literature documenting outcome of pregnancy in patients with DM in contrast with those of other connective tissue diseases especially when dermatomyositis is revealed during pregnancy, most of the publications reported a poor prognosis for both the mother and the fetus, yet, in our case we confirmed the results of the rare recent cases that have tended to show a good outcome, after the treatment with glucocorticoid and immunosuppressant therapy. PMID:27279944

  7. Variation in outcomes in trials reporting effects of diet and lifestyle based intervention on pregnancy outcomes: a systematic review.

    PubMed

    Rogozinska, E; Fen, Y; Molyneaux, E; Khan, K S; Thangaratinam, S

    2014-07-01

    Obesity is a growing threat to women of childbearing age. Increased maternal weight or excessive weight gain in pregnancy is associated with adverse pregnancy outcomes. Interventions based on diet and physical activity minimise gestational weight gain with varied effect on a number of clinical outcomes. There is no consensus amongst the trialists on the core outcomes that need to be reported to inform the clinical care of pregnant women. The aim of this systematic review is to evaluate variation in the type and quality of outcomes reported in systematic reviews and randomised controlled trials on diet and lifestyle interventions on maternal and fetal outcomes. We will assess the correlation between the type of outcome, the quality of the studies and journal impact factor. We searched the major databases from the inception to October 2013 without language restrictions. We used current recommendations for quality of outcome reporting using a 6-point scale. The quality assessment of systematic reviews and RCTs was performed using the AMSTAR and Jadad scoring systems. Additionally we obtained journals' impact factor in the year of publication. We calculated Spearman rank coefficient to assess the correlation between the type of outcome, and study quality. An overview of outcome reporting will show the current attitude of the researchers towards outcomes of importance when conducting trials on diet and lifestyle management in pregnancy. If our abstract is accepted, we will provide the details of the results.

  8. What is the best treatment of heterotopic cervical pregnancies for a successful pregnancy outcome?

    PubMed Central

    Kim, Ji Won; Park, Han Moie; Lee, Woo Sik

    2012-01-01

    Heterotopic pregnancy is rare event and the risk is increased with assisted reproductive technology procedures. Heterotopic cervical pregnancy is even more unusual. We report a rare case of heterotopic cervical pregnancy that was managed successfully. A 36-year-old women who conceived by IVF-ICSI was diagnosed with heterotopic cervical pregnancy. She visited the emergency room with vaginal bleeding at 5 weeks of gestation and underwent careful intracervical gestational sac reduction with forceps under abdominal guidance the next day. The postoperative course was uneventful and with regular check-ups, the intrauterine pregnancy (IUP) progressed unremarkably through 41 weeks with delivery of a healthy newborn. We reviewed a total of 37 cases of heterotopic pregnancy that have been reported in the English language literature. There have been many attempts to eliminate the cervical embryo while preserving the IUP, and complete cervical evacuation is important in order to avoid infection, bleeding, and premature birth. PMID:23346531

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

    Cancer.gov

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

  10. Pregnancy outcomes after exposure to tocilizumab: A retrospective analysis of 61 patients in Japan

    PubMed Central

    Nakajima, Ken; Watanabe, Omi; Mochizuki, Mayumi; Nakasone, Ayako; Ishizuka, Nobuhiko; Murashima, Atsuko

    2016-01-01

    Abstract Objectives: To assess the effects of tocilizumab on pregnancy outcomes in Japanese patients with rheumatic disease. Methods: Data from Chugai’s tocilizumab safety database (April 2005 to October 2014) were retrospectively analyzed to identify pregnancy outcomes in patients exposed to tocilizumab. Results: Data were available for 61 pregnancies exposed to tocilizumab, and outcomes were reported for 50 of those pregnancies. In 36 births, no congenital anomalies were identified; however, six neonatal abnormalities were reported: five cases of low birth weight (<2500 g) and one case of neonatal asphyxia. Of 36 births, tocilizumab was resumed during lactation in two patients, with no subsequent adverse events reported in newborns. The spontaneous abortion rate was 18.0% (9 of 50 pregnancies), which is comparable to the rate in the general population. The five terminated pregnancies included one case of caudal regression syndrome. Conclusions: The present retrospective study of 61 pregnancies exposed to tocilizumab at conception indicated no increased rates of spontaneous abortion or congenital abnormalities in patients with rheumatic disease. However, further study is necessary to confirm the benefit-risk profile of tocilizumab treatment during pregnancy. PMID:26873562

  11. 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

  12. Statistical analysis of epidemiologic data of pregnancy outcomes

    SciTech Connect

    Butler, W.J.; Kalasinski, L.A. )

    1989-02-01

    In this paper, a generalized logistic regression model for correlated observations is used to analyze epidemiologic data on the frequency of spontaneous abortion among a group of women office workers. The results are compared to those obtained from the use of the standard logistic regression model that assumes statistical independence among all the pregnancies contributed by one woman. In this example, the correlation among pregnancies from the same woman is fairly small and did not have a substantial impact on the magnitude of estimates of parameters of the model. This is due at least partly to the small average number of pregnancies contributed by each woman.

  13. Traffic pollution at the home address and pregnancy outcomes in Stockholm, Sweden

    PubMed Central

    Olsson, David; Mogren, Ingrid; Eneroth, Kristina; Forsberg, Bertil

    2015-01-01

    Background For the past two decades, several studies have reported associations between elevated levels of ambient air pollution and adverse pregnancy outcomes, although with varying conclusions. Objectives To examine possible associations between the traffic pollution situation at the home address, for women who did not change address during pregnancy, and three types of pregnancy outcomes: spontaneous preterm delivery, children born small for gestational age (SGA) and pregnancy-induced hypertensive disorders. Methods We used data for the Greater Stockholm Area from the Swedish Medical Birth Register to construct a cohort based on all pregnancies conceived between July 1997 and March 2006, n=100 190. The pregnancy average nitrogen oxide, NOx, levels and annual mean daily vehicles at the home address were used as exposure variables. Mixed-model logistic regression was performed to assess any associations between exposure and outcome. Results There was an association between elevated traffic pollution exposure during pregnancy and pregnancy-induced hypertensive disorders. A 10 µg/m3 increase in the pregnancy average NOx level at the home address resulted in an OR of 1.17 (95% CI 1.10 to 1.26). The 2nd to 4th quartiles of NOx were all associated with an increased risk of SGA, but there was no difference in the risk estimate among the higher quartiles. There was a tendency of a higher risk of spontaneous preterm delivery in relation to higher levels of NOx. There was no evidence of an association between vehicle flow, the cruder indicator of traffic pollution, and the studied outcomes in this study. Conclusions In this large cohort, there was a fairly strong association between vehicle exhaust levels at the home address and pregnancy-induced hypertensive disorders, after adjustment for important risk factors. PMID:26275899

  14. 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

  15. Pregnancy incidence and outcome before and after cervical intraepithelial neoplasia: a retrospective cohort study.

    PubMed

    Kalliala, Ilkka; Anttila, Ahti; Nieminen, Pekka; Halttunen, Mervi; Dyba, Tadeusz

    2014-12-01

    We performed a retrospective cohort study of 3530 women treated for cervical intraepithelial neoplasia (CIN) in Helsinki University Central Hospital, Finland, to investigate whether CIN treatment itself affects pregnancy incidence and outcome. We estimated the incidence of live births, miscarriages, extrauterine pregnancies, molar pregnancies, and termination of pregnancies (TOPs) before and after CIN treatment using nationwide registers. Women were followed up until death, emigration, sterilization, or the end of 2004. The comparison of incidence of pregnancy outcomes before and after the treatment was estimated by calculating hazard ratios (HRs) with conditional Poisson regression. After 76,162 woman-years of follow-up, the incidence of any pregnancy remained constant over CIN-treatment, HR 1.02 and 95% confidence interval (CI) 0.97-1.08, but the incidence of the first pregnancy was significantly elevated after treatment, HR 1.13, and 95% CI 1.03-1.23. The incidence of live births was significantly elevated after treatment, HR 1.08 and 95% CI 1.01-1.15. Incidence of miscarriages, TOPs, extrauterine pregnancies, and molar pregnancies was not elevated. TOPs was significantly increased in the first pregnancy, HR 1.40, 95% CI 1.15-1.72 and after treatment by the loop electrosurgical excision procedure (LEEP), HR 1.36, 95% CI 1.15-1.60. CIN treatment did not reduce pregnancy incidence and women had more live births after than before CIN treatment. TOPs was more common in the first pregnancy or after treatment by LEEP. We encourage research on the psychosocial consequences of CIN treatment also in other countries and settings.

  16. Pregnancy outcomes with thyroxine replacement for subclinical hypothyroidism: Role of thyroid autoimmunity

    PubMed Central

    Jayaraman, Muthukrishnan; Verma, Abhyuday; Harikumar, K. V. S.; Ugale, Meena; Modi, Kirtikumar

    2013-01-01

    Objective: To study pregnancy outcomes in relation to thyroid peroxidase antibody (TPOAb) status with optimum thyroxine replacement for subclinical hypothyroidism. Materials and Methods: Ninety-eight women with subclinical hypothyroidism were followed up until the end of their pregnancy. TPO antibody status was performed for 59 women (positive 20, negative 39). Levothyroxine was supplemented to maintain TSH between 0.3-3 mIU/l in all patients, irrespective of TPOAb status. Pregnancy outcomes were noted as pregnancy-induced hypertension (PIH), antepartum or postpartum hemorrhage, preterm delivery, and spontaneous abortion. Outcomes were compared between 3 groups as per TPO antibody status (positive, negative, and undetermined), which were matched for age and gestational period. Results: Thyroid autoimmunity was noted in 34% of women screened for TPO antibody. A total of 11 adverse pregnancy outcomes were recorded (4 spontaneous abortions, 4 preterm deliveries, 3 PIH) with no significant difference between the groups. Conclusion: Adverse pregnancy outcomes were not different in the 3 groups with adequate thyroxine replacement for pregnant women with subclinical hypothyroidism targeting TSH in euthyroid range, irrespective of thyroid autoimmunity status. PMID:23776906

  17. Abnormal maternal serum alpha fetoprotein and pregnancy outcome.

    PubMed

    Zarzour, S J; Gabert, H A; Diket, A L; St Amant, M; Miller, J M

    1998-01-01

    The objective was to assess the occurrence of miscarriages, low birth weight, and karyotype abnormalities found with low and elevated maternal serum alpha-fetoprotein (MSAFP) among women who had genetic amniocentesis performed. A retrospective study of 2,159 women who had MSAFP analysis prior to amniocentesis was conducted. Pregnancy outcomes were obtained from record review and physicians follow-up. Limits of MSAFP used in analysis were <0.5 adjusted multiples of the median (MOM) (lower levels) and >2.0 MOM (upper levels). Autosomal trisomy was found in 1.6% with low, 0.9% normal, and 0.6% with elevated MSAFP values. Sex chromosome abnormalities were present only in patients with normal MSAFP, [45X (n = 6), 47XXY (n = 2), 69XXX]. Of five open neural tube defects, four had elevated MSAFP and one had a normal value. Omphalocele was identified in four patients, two with normal and two with elevated MSAFP. Gastroschisis was found in one low and one elevated MSAFP. Amniotic fluid alpha-fetoprotein (AFAFP) values did not correlate with MSAFP values. Patients with low MSAFP levels had a greater prevalence of abnormal karyotype (19 of 249, prevalence = 0.076) than patients with an elevated MSAFP level (2 or 166, prevalence = 0.012 OR (odds ratio) = 0.20 (P value = 0.024) when unadjusted for maternal age, and OR = 0.09 (P value = 0.001) when adjusted for maternal age. Spontaneous abortion occurred more often in patients with elevated (4 of 166, or 4%) than normal or low (20 of 1948, or 1%) values of MSAFP (odds ratio 4.32, P = 0.020 when adjusted for maternal age). Birth weight below 2,500 g was present less frequently with low or normal MSAFP (136 of 1,760, or 7.7%) than in elevated MSAFP (21 of 144 or 14.6%) (odds ratio 2.04, P = 0.005, unadjusted; and odds ratio = 2.32, P = 0.003, adjusted for maternal age). Female fetuses were present more often with low MSAFP (136 of 249, or 55%) than elevated levels 43% (71 of 164, or 43%; P = 0.024). We conclude that patients

  18. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton.

    PubMed

    Moon, Rebecca J; Harvey, Nicholas C; Cooper, Cyrus

    2015-08-01

    Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes. PMID:25862787

  19. ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the fetal skeleton.

    PubMed

    Moon, Rebecca J; Harvey, Nicholas C; Cooper, Cyrus

    2015-08-01

    Vitamin D status has been increasingly associated with wide-ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including pre-eclampsia, gestational diabetes and the mode and timing of delivery. The findings are inconsistent, and currently there is a lack of data from high-quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation. Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for offspring birthweight, calcium concentrations and bone mass as well as for reduced maternal pre-eclampsia. However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish the potential efficacy and safety of vitamin D supplementation to improve particular outcomes.

  20. Aluminium sulphate in water in north Cornwall and outcome of pregnancy.

    PubMed Central

    Golding, J; Rowland, A; Greenwood, R; Lunt, P

    1991-01-01

    OBJECTIVE--To determine whether the excess aluminum sulphate accidentally added to the local water supply in north Cornwall in July 1988 had an adverse effect on the outcome of pregnancies. DESIGN--Outcomes of all singleton pregnancies in the affected area at the time of the incident (n = 92) were compared with those in two control groups: pregnancies in this area completed before the incident (n = 68) and pregnancies in a neighbouring area (n = 193). SUBJECTS--Mothers in the three groups, among whom there were 13 miscarriages, five terminations of pregnancy, and 336 live births. MAIN OUTCOME MEASURES--Fetal and perinatal loss, birth weight, gestation, obstetric complications, neonatal condition, and congenital defects. RESULTS--Among 88 pregnancies in women exposed to excess aluminum sulphate there was no excess of perinatal deaths (n = 0), low birthweight (n = 3), preterm delivery (n = 4), or severe congenital malformations (n = 0). There was, however, an increased rate of talipes in exposed fetuses (four cases, one control; p = 0.01). CONCLUSIONS--Because of small numbers it is not possible to say that high doses of aluminum sulphate are safe in pregnancy, but there is no evidence from this study of major problems apparent at birth. PMID:2043811

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

    PubMed Central

    Monari, Francesca; Pedrielli, Giulia; Vergani, Patrizia; Pozzi, Elisa; Mecacci, Federico; Serena, Caterina; Neri, Isabella; Facchinetti, Fabio

    2016-01-01

    Objective To evaluate outcome in the pregnancy following a stillbirth (SB) by a placental vascular disorders. Study Design A prospective, observational, multicenter study was conducted in woman with a history of stillbirth (> 22 weeks) between 2005 and June 2013, in 3 Italian University Hospitals. Causes of SB were previously identified after extensive investigations. Pregnant women were enrolled within the first trimester. The main outcome was “adverse neonatal outcome”, including perinatal death, fetal growth restriction, early preterm birth <33+6 weeks, hypoxic-ischemic encephalopathy, intracranial hemorrhage or respiratory distress. Results Out of 364 index pregnancies, 320 women (87.9%) had a subsequent pregnancy during the study period. Forty-seven had an early pregnancy loss. Out of 273 babies, 67 (24.5%) had an adverse perinatal outcome, including 1 SB and 1 early neonatal death (3.7/1000). Women who had a SB related to placental vascular disorders (39.6%), were at higher risk of an adverse neonatal outcome compared with women whose SB was unexplained or resulted from other causes (Adj. OR = 2.1, 95%CI: 1.2–3.8). Moreover, also obesity independently predicts an adverse perinatal outcome (Adj OR = 2.1, 95%CI: 1.1–4.3). Conclusion When previous SB is related to placental vascular disorders there is a high risk for adverse neonatal outcomes in the subsequent pregnancy. Maternal obesity is an additional risk factor. PMID:27228078

  2. Maternal smoking during pregnancy and birth outcomes in a sample of Romanian women.

    PubMed

    Meghea, Cristian I; Rus, Ioana A; Cherecheş, Răzvan M; Costin, Nicolae; Caracostea, Gabriela; Brinzaniuc, Alexandra

    2014-09-01

    Smoking during pregnancy is causally associated with reduced birth weight and is strongly related to preterm birth. Smoking cessation in early pregnancy seems to reduce these risks, although the research evidence is limited. In a sample of Romanian women, differences in birth outcomes were assessed between non-smokers and women who continued to smoke during pregnancy and non-smokers and women who stopped smok- ing when they found out about the pregnancy. Pregnant women were recruited in two urban clinics (N= 474). A baseline questionnaire collected information on their smoking status, depressive symptoms, stress, demographics, and other characteristics at recruitment. The women reported the newborn weight and birth term by phone in the first weeks following birth. Descriptive statistics and multivariate regressions were used to ana- lyze the relationship between smoking status during pregnancy and birth outcomes. Over 61% (N = 290) women were non-smokers, 15% (N= 72) smoked during pregnancy, and 24% (N= 112) quit smoking when they found out about the pregnancy. Compared to non-smokers, continuous smokers delivered babies 165 grams lighter (95% CI -313, -17). Women who stopped smoking when they ascertained the pregnancy had higher odds of delivering a newborn who was small for gestational age compared to non-smokers (OR= 2.16, 95% CI 1.05, 4.43). Elevated maternal stress was associated with reduced birth weight (-113 grams, 95% CI -213, -11), and higher odds of a preterm birth (OR=2.8, 95% CI 1.17, 6.76). In a predominantly urban sample of Romanian women, continuous maternal smoking during pregnancy was a risk factor for restricted foetal growth. Smoking cessation when the pregnancy was ascertained did not seem to reduce this risk. Smoking prevention efforts should therefore begin before pregnancy and should integrate psychological components, addressing maternal stress in particular.

  3. Effectiveness of Continuum of Care—Linking Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Mortality: A Systematic Review and Meta-Analysis

    PubMed Central

    Kikuchi, Kimiyo; Okawa, Sumiyo; Zamawe, Collins O. F.; Shibanuma, Akira; Nanishi, Keiko; Iwamoto, Azusa; Saw, Yu Mon; Jimba, Masamine

    2016-01-01

    In an era of Sustainable Development Goals, maternal, newborn, and child health still require improvement. Continuum of care is considered key to improving the health status of these populations. The continuum of care is a series of care strategies starting from pre-pregnancy to motherhood-childhood. The effectiveness of such linkage between the pregnancy, birth, and postnatal periods has been demonstrated. However, almost no study has assessed the impact of linkage that starts from pre-pregnancy to pregnancy care on maternal and child health. The present study attempts to fill this gap by assessing the effectiveness of the care linkage between pre-pregnancy and pregnancy care for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. We performed a systematic review and meta-analysis of randomized and quasi-randomized controlled trials in low- and middle-income countries. The outcome variables were neonatal, perinatal, and maternal mortality. We searched databases such as PubMed/Medline, POPLINE, EBSCO/CINAHL, and ISI Web of Science for the period 2000–2014, using broad search terms (e.g., pre-pregnancy OR adolescent OR mother), combined with search terms specific for interventions, (e.g., family planning OR contraception OR spacing). From the 1,325 retrieved articles, five studies were finally analyzed. The meta-analysis showed that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.71–0.89, I2 = 62%) and perinatal mortality (RR: 0.84; 95% CI: 0.75–0.94, I2 = 73%), but did not show an effect on maternal mortality. Neonatal and perinatal mortality could be reduced by linking pre-pregnancy and pregnancy care. This linkage of pre-pregnancy and pregnancy cares is an essential component of continuum of care to improve newborn health. Review Registration PROSPERO International prospective register of systematic reviews (CRD

  4. Impact of nutrition education and medical supervision on pregnancy outcome.

    PubMed

    Sachdeva, R; Mann, S K

    1993-11-01

    Sixty Punjabi women from low and lower middle income groups were selected from eight villages of Ludhiana district. The supplements of iron, folic acid and calcium in the form of Folifer and Calcium Sandoz tablets were regularly supplied to experimental (E) group from second trimester onwards. A pamphlet about the diet during pregnancy was distributed to the E group along with four individual and three group contacts during the second half of pregnancy. The control (C) group was provided iron and folate supplements as per Government practice. Body height, weight, mid-upper arm circumference (MUA) and skinfold thickness of the subjects were recorded. Weight gained during pregnancy and post partum weight were also recorded and body mass index was calculated. In addition, crown heel length (CHL), birth weight (BW), skinfold thickness, MUA, head circumference (HC), Chest circumference (CC) and ponderal index (PI) of the neonates were recorded within eight hours of their birth. The gain in weight during pregnancy was 6.30 and 5.7 kg in E and C groups respectively. The study revealed that BW, CHL, skinfold thickness and PI of the newborns were significantly (p < 0.01) higher in E group. The mean BW of newborns in E and C groups was 2700 g and 2300 g, respectively. Weight gained during pregnancy had significant (p < 0.05) correlation to MUA, BW and skinfold thickness of the newborn.

  5. An integrated randomized intervention to reduce behavioral and psychosocial risks: pregnancy and neonatal outcomes.

    PubMed

    Subramanian, Siva; Katz, Kathy S; Rodan, Margaret; Gantz, Marie G; El-Khorazaty, Nabil M; Johnson, Allan; Joseph, Jill

    2012-04-01

    While biomedical risks contribute to poor pregnancy and neonatal outcomes in African American (AA) populations, behavioral and psychosocial risks (BPSR) may also play a part. Among low income AA women with psychosocial risks, this report addresses the impacts on pregnancy and neonatal outcomes of an integrated education and counseling intervention to reduce BPSR, as well as the contributions of other psychosocial and biomedical risks. Subjects were low income AA women ≥18 years living in the Washington, DC, metropolitan area and seeking prenatal care. Subjects (n = 1,044) were screened for active smoking, environmental tobacco smoke exposure (ETSE), depression, or intimate partner violence (IPV) and then randomized to intervention (IG) or usual care (UCG) groups. Data were collected prenatally, at delivery, and postpartum by maternal report and medical record abstraction. Multiple imputation methodology was used to estimate missing variables. Rates of pregnancy outcomes (miscarriage, live birth, perinatal death), preterm labor, Caesarean section, sexually transmitted infection (STI) during pregnancy, preterm birth (<37 weeks), low birth weight (<2,500 g), very low birth weight (<1,500 g), small for gestational age, neonatal intensive care unit (NICU) admission, and >2 days of hospitalization were compared between IG and UCG. Logistic regression models were created to predict outcomes based on biomedical risk factors and the four psychosocial risks (smoking, ETSE, depression, and IPV) targeted by the intervention. Rates of adverse pregnancy and neonatal outcomes were high and did not differ significantly between IG and UCG. In adjusted analysis, STI during the current pregnancy was associated with IPV (OR = 1.41, 95% CI 1.04-1.91). Outcomes such as preterm labor, caesarian section in pregnancy and preterm birth, low birth weight, small for gestational age, NICU admissions and >2 day hospitalization of the infants were associated with biomedical risk

  6. Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency.

    PubMed

    Rogenhofer, Nina; Bohlmann, Michael K; Beuter-Winkler, Petra; Würfel, Wolfgang; Rank, Andreas; Thaler, Christian J; Toth, Bettina

    2014-03-01

    Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.

  7. Factors influencing the risk of abnormal pregnancy outcome in epileptic women: a multi-centre prospective study.

    PubMed

    Steegers-Theunissen, R P; Renier, W O; Borm, G F; Thomas, C M; Merkus, H M; Op de Coul, D A; De Jong, P A; van Geijn, H P; Wouters, M; Eskes, T K

    1994-07-01

    We studied pregnancy outcome in preconceptionally recruited epileptic and control women in a multi-centre prospective non-intervention study at two university hospitals and three general hospitals. We evaluated 225 singleton pregnancies: 119 pregnancies of epileptic women who received either antiepileptic drugs (AEDs) (n = 99) or not (n = 20), and 106 pregnancies of controls. The main outcome measures were abnormal pregnancy outcome: major and minor congenital malformations, ectopic pregnancies, abortions; neonatal headcircumference; birth weight and birth length. Epileptic women had a two-fold risk of having an abnormal pregnancy outcome or an infant with minor malformations compared to healthy controls (odds ratio, with 95% confidence interval, respectively 2.1 (1.1, 4.0) and 2.0 (1.0, 4.0)). A significant correlation between the prevalence of abnormal pregnancy outcome and duration of epilepsy and AED treatment was found (risk increased by 9% (6%, 16%) per annum). No significant effect in terms of the type, the number or the serum level of the AEDs could be established. The head circumference of infants of epileptic mothers was significantly smaller (0.7 (1.2, 0.28 cm) compared to controls. An effect on the outcome of pregnancy of maternal folate supplementation or of folate blood concentrations during the periconceptional period and first trimester of pregnancy could not be determined. The severity of maternal epilepsy and/or AED treatment influences pregnancy outcome. PMID:7805647

  8. Program Characteristics that Predict Improved Learner Outcomes

    PubMed Central

    Patterson, Margaret Becker; Mellard, Daryl

    2011-01-01

    This study identifies adult education program characteristics that predict improved learner outcomes through statistical analyses of data across four years in a single state. Data indicate that, collectively, several predictors contribute to our understanding of learner outcomes, including (a) learner entry level, (b) size of community, (c) staff qualifications, and (d) learner exposure to high quality services. A surprising finding was the lack of robust outcome predictors that maintain consistency from one year to another. PMID:22348153

  9. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    PubMed

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions.

  10. The Effect of School-Based Health Clinics on Teenage Pregnancy and Parenting Outcomes: An Integrated Literature Review

    ERIC Educational Resources Information Center

    Strunk, Julie A.

    2008-01-01

    Teenage pregnancy outcomes have become an increasing concern in the United States. Education and support of pregnant teens are critical factors that may determine good or poor pregnancy outcomes. Poor outcomes may include low birth weight, developmental delays, and poor academic performance. Although the number of teenagers experiencing pregnancy…

  11. Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital

    PubMed Central

    Sari, Mustafa Erkan; Kurt, Aslihan; Sakar, Vefa Selimova; Atalay, Cemal Resat

    2015-01-01

    Introduction Epilepsy has a prevalence of 1.65% in adults, and every 1 in 200 pregnancies encounters its complications. We aimed to present the existing condition of and our experience with epileptic pregnant women for whom the prepregnancy counseling is inadequate in Turkey. Methods We evaluated 149 epileptic pregnant women between March 2009 and January 2015. Demographic features of the patients, along with type and duration of epileptic seizure, time of diagnosis, date of last seizure prior to pregnancy, number and duration of seizures during pregnancy, type of AEDs, result and week of termination of pregnancy, and birth weight were registered, and also, we evaluated perinatal complications and fetal malformations. Results Mean age of the patients was 27.12 ± 5.4 years, and mean duration from the diagnosis of epilepsy to pregnancy was 9.68 ± 5.91 years. Twenty-seven (18.12%) and 101 (67.78%) patients had polytherapy and monotherapy, respectively. We observed epileptic seizures in 103 (69.12%) patients during pregnancy, and seizures mostly occurred in the first and third trimesters. Forty-one (39.80%) patients had seizures in all three trimesters. Forty-two (28.18%) patients among all patients who had seizures during pregnancy had 5 or more seizures. Major malformations, namely, cleft lip and palate, ventriculoseptal defect, and spina bifida were observed in the patients. Mean birth week was 38.43 ± 1.68 weeks, and mean birth weight was 2965.31 ± 453.94 grams. Twenty-two patients had normal spontaneous vaginal delivery whereas 118 patients had cesarean section. Conclusions Pregnant women with epilepsy have their own risks. These women should be followed by experienced obstetricians and neurologists during their pregnancies. Appropriate management and follow-up lead to good results almost the same as general population. PMID:26527567

  12. Pregnancy Outcomes in Liver and Cardiothoracic Transplant Recipients: A UK National Cohort Study

    PubMed Central

    Mohamed-Ahmed, Olaa; Nelson-Piercy, Cathy; Bramham, Kate; Gao, Haiyan; Kurinczuk, Jennifer J.; Brocklehurst, Peter; Knight, Marian

    2014-01-01

    Introduction There are an increasing number of reports of pregnancy in transplant recipients but many questions remain regarding the effect of the transplant on pregnancy outcome, the pregnancy on the graft and the medication on the fetus. The majority of studies reporting outcomes in transplant recipients have focused on women with kidney transplants, and have included retrospective, voluntary registries or single centre studies. Methods The UK Obstetric Surveillance System (UKOSS) was used to prospectively identify all pregnant women with a liver or cardiothoracic transplant in the United Kingdom, between January 2007 and January 2012. Data were collected on demographics, transplant characteristics, immunosuppression regimens, antenatal care, maternal, graft and neonatal outcomes. In an exploratory analysis, we tested for associations between “poor fetal outcome” and medications used before or during pregnancy. Results and conclusions We report 62 pregnancies in 56 liver transplant recipients and 14 pregnancies in 14 cardiothoracic transplant recipients (including 10 heart, three lung and one heart-lung recipient). Liver transplant recipients, in comparison to cardiothoracic, had similar livebirth rates (92% vs. 87%) but better fetal outcomes (median gestational age 38 weeks vs. 35 weeks; median birthweight 2698 g vs. 2365 g), fewer caesarean deliveries (47% vs. 62%), fewer maternal intensive care (ICU) admissions (19% vs. 29%) and fewer neonatal ICU admissions (25% vs. 54%). Nine women (12%) were taking mycophenolate mofetil at conception, which was associated with adverse fetal outcomes. Pregnancy in transplant recipients may have successful outcomes, but complication rates are high, emphasising the role of pre-conception counselling and further research into the long-term effect on maternal and graft survival rates. PMID:24586554

  13. Improving access to emergency contraception under the Scottish Sexual Health Strategy: can rates of unintended pregnancy be reduced?

    PubMed

    McGowan, James G

    2013-09-01

    Unintended pregnancy is a global sexual health problem. Outcomes of unintended pregnancy include unwanted childbirth and abortion, which may be associated with negative physical and psychosocial health implications for women. In Scotland, the Scottish Sexual Health Strategy has the stated goal of improving the sexual health of the people of Scotland. One aim of the Strategy is to reduce rates of unintended pregnancy and one policy designed to achieve this is 'widening access to emergency contraception'. This paper examines the success of this policy with reference to the implicit link it makes between expanding access to emergency contraception and increasing its effective use, aiming thereby to reduce rates of unintended pregnancy. Since there is evidence that previous policies and strategies expanding access to emergency contraception have failed to reduce such rates, alternative approaches to achieve a reduction in unintended pregnancies are discussed.

  14. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  15. Lifestyle, distress and pregnancy outcomes in the Childhood Cancer Survivor Study cohort

    PubMed Central

    GAWADE, Prasad L.; OEFFINGER, Kevin C.; SKLAR, Charles A.; GREEN, Daniel M.; KRULL, Kevin R.; CHEMAITILLY, Wassim; STOVALL, Marilyn; LEISENRING, Wendy; ARMSTRONG, Gregory T.; ROBISON, Leslie L.; NESS, Kirsten K.

    2014-01-01

    OBJECTIVE To evaluate associations between prepregnancy lifestyle factors, psychological distress and adverse pregnancy outcomes among female survivors of childhood cancer. STUDY DESIGN We examined pregnancies of 1,192 female participants from the Childhood Cancer Survivor Study. Generalized linear models, adjusted for age at diagnosis, age at pregnancy, parity, and education were used to calculate the odds ratio (OR) and confidence interval (CI) for associations between prepregnancy inactivity, overweight or obese status, smoking status, risky drinking, psychological distress and pregnancy outcomes. Interactions between lifestyle factors, psychological distress, type of cancer and cancer treatment were assessed in multivariable models. RESULTS The median age of study participants at the beginning of pregnancy was 28 years (range: 14–45). Among 1,858 reported pregnancies, there were 1,300 singleton live births (310 were preterm), 21 stillbirths, 397 miscarriages, and 140 medical abortions. Prepregnancy physical inactivity, risky drinking, distress and depression were not associated with any pregnancy outcomes. Compared to those who had never smoked, survivors with > 5 pack-years smoking history had a higher risk for miscarriage among those treated with > 2.5 Gy uterine radiation (OR: 53.9; 95% CI: 2.2, 1,326.1) than among those treated with ≤ 2.5 Gy uterine radiation (OR: 1.9; 95% CI: 1.2, 3.0). There was a significant interaction between smoking and uterine radiation (Pinteraction = 0.01). CONCLUSION While most lifestyle factors and psychological distress were not predictive of adverse pregnancy outcomes, the risk for miscarriage was significantly increased among survivors exposed to > 2.5 Gy uterine radiation who had a history of smoking. PMID:25068563

  16. ATLANTIC DIP: Pregnancy Outcome for Women With Pregestational Diabetes Along the Irish Atlantic Seaboard

    PubMed Central

    Dunne, Fidelma P.; Avalos, Gloria; Durkan, Meave; Mitchell, Yvonne; Gallacher, Therese; Keenan, Marita; Hogan, Marie; Carmody, Louise A.; Gaffney, Geraldine

    2009-01-01

    OBJECTIVE Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006–2007. RESEARCH DESIGN AND METHODS The Atlantic Diabetes in Pregnancy group, representing five antenatal centers in a wide geographical location, was established in 2005. All women with diabetes for >6 months before the index pregnancy were included. Results were collected electronically via the DIAMOND Diabetes Information System. Pregnancy outcome was compared with background rates. RESULTS There were 104 singleton pregnancies. The stillbirth rate (25/1,000) was 5 times, perinatal mortality rate (25/1,000) 3.5 times, and congenital malformation rate (24/1,000) 2 times that of the background population. A total of 28% of women received prepregnancy care, 43% received prepregnancy folic acid, and 51% achieved an A1C ≤7% at first antenatal visit. CONCLUSIONS Women are not well prepared for pregnancy, and outcomes are suboptimal. A regional prepregnancy care program and centralized glucose management are urgently needed. PMID:19564472

  17. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes.

    PubMed

    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.

  18. 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

  19. Follow-up of pregnancy in acromegalic women: different presentations and outcomes.

    PubMed

    Atmaca, A; Dagdelen, S; Erbas, T

    2006-03-01

    Pregnancy in acromegaly is a rather rare event since the fertility is reduced in acromegalic women. Besides, metabolic complications of acromegaly are harmful to both mother and fetus. Little is known about the outcome of pregnancy in acromegalic women. Here, we report seven cases of pregnancy out of 48 acromegalic women followed for 16 years. At diagnosis, five patients had macroadenoma, one patient had microadenoma and the size of the tumor was not documented in one patient. In one patient, acromegaly was initially diagnosed during pregnancy at 29 weeks. When she was 33 weeks, she developed pituitary apoplexy and had an emergency transsphenoidal resection of her macroadenoma during which she also had a cesarian section and delivered a healthy baby girl. In the remaining six patients, pregnancy occurred 6 to 64.5 months after the adenoma resection. Three patients received radiotherapy before getting pregnant. In three patients, pregnancy occurred during bromocriptine treatment and the drug was withdrawn. In one patient, pregnancy occurred during chronic octreotide treatment and therapeutic abortion was performed. In another patient, therapeutic abortion was performed because of uncontrolled disease. In the remaining four patients, there were neither worsening of symptoms nor tumor growth. All four patients gave birth to full-term healthy infants. Out of our seven patients, two developed gestational diabetes mellitus which was controlled with diet. None of the patients had coronary artery disease, hypertension or dyslipidemia. These cases show that pregnancy might be uneventful in acromegalic women when the disease is controlled with prior surgery and radiotherapy.

  20. The Maternal Microbiome and Pregnancy Outcomes that Impact Infant Health: A Review

    PubMed Central

    Mulle, Jennifer G.; Ferranti, Erin P.; Edwards, Sara; Dunn, Alexis B.; Corwin, Elizabeth J.

    2015-01-01

    The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This manuscript provides a summary review of research investigating: (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and excessive gestational weight gain; (2) factors with an established link to adverse pregnancy outcomes that are known to influence the composition of the maternal microbiome; and (3) strategies for promoting a healthy maternal microbiome, recognizing that much more research is needed in this area. PMID:26317856

  1. Impact of maternal substance use during pregnancy on childhood outcome

    PubMed Central

    Shankaran, Seetha; Lester, Barry M.; Das, Abhik; Bauer, Charles R.; Bada, Henrietta S.; Lagasse, Linda; Higgins, Rosemary

    2013-01-01

    Summary The impact of maternal substance abuse is reflected in the 2002–2003 National Survey on Drug Use and Health. Among pregnant women in the 15–44 age group, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively. Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in central nervous system and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy. PMID:17317350

  2. Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies.

    PubMed

    Bobotsis, R; Gulliver, W P; Monaghan, K; Lynde, C; Fleming, P

    2016-09-01

    Psoriasis is a chronic inflammatory disorder with significant physical and psychological sequelae. The majority of individuals experience disease onset in early adult life - for women this often occurs during their reproductive years. While some autoimmune diseases have been shown to affect pregnancy outcomes adversely, such a relationship has not been well studied in psoriasis. We searched PubMed, Embase and the Cochrane database for published articles examining psoriasis and adverse pregnancy outcomes, and included observational studies and clinical trials evaluating direct measures of maternal and fetal morbidity and mortality. Four of the nine included articles reported a statistically significant increase in the risk of at least one outcome, including spontaneous abortion, caesarean delivery, low birth weight, macrosomia, large-for-gestational age, and a composite outcome consisting of both prematurity and low birth weight. However, these associations were not always consistent across studies. Overall, there was no clear evidence of increased adverse outcomes in pregnant women with psoriasis. PMID:26991866

  3. Community and Federal Collaboration to Assess Pregnancy Outcomes in Alaska Native Women, 1997–2005

    PubMed Central

    England, Lucinda J.; Shapiro-Mendoza, Carrie K.; Wilson, Hoyt G.; Klejka, Joseph; Tucker, Myra; Lewis, Claire; Kendrick, Juliette S.

    2015-01-01

    The objectives are to report the estimated prevalence of pregnancy complications and adverse pregnancy outcomes in a defined population of Alaska Native women and also examine factors contributing to an intensive and successful collaboration between a tribal health center and the Centers for Disease Control and Prevention. Investigators abstracted medical record data from a random sample of singleton deliveries to residents of the study region occurring between 1997 and 2005. We used descriptive statistics to estimate the prevalence and 95 % confidence intervals of selected pregnancy complications and adverse pregnancy outcomes. Records were examined for 505 pregnancies ending in a singleton delivery to 469 women. Pregnancy complication rates were 5.9 % (95 % CI 4.0, 8.4) for gestational diabetes mellitus, 6.1 % (95 % CI 4.2, 8.6 %) for maternal chronic hypertension and 11.5 % (95 % CI 8.8, 14.6) for pregnancy associated hypertension, and 22.9 % (95 % CI 19.2–26.5 %) for anemia. The cesarean section rate was 5.5 % (95 % CI 3.5, 7.5) and 3.8 % (95 % CI 2.3, 5.8) of newborns weighed >4,500 g. Few previous studies reported pregnancy outcomes among Alaska Native women in a specific geographic region of Alaska and regarding the health needs in this population. We highlight components of our collaboration that contributed to the success of the study. Studies focusing on special populations such as Alaska Native women are feasible and can provide important information on health indicators at the local level. PMID:23775248

  4. Community and federal collaboration to assess pregnancy outcomes in Alaska Native women, 1997-2005.

    PubMed

    Kim, Shin Y; England, Lucinda J; Shapiro-Mendoza, Carrie K; Wilson, Hoyt G; Klejka, Joseph; Tucker, Myra; Lewis, Claire; Kendrick, Juliette S

    2014-04-01

    The objectives are to report the estimated prevalence of pregnancy complications and adverse pregnancy outcomes in a defined population of Alaska Native women and also examine factors contributing to an intensive and successful collaboration between a tribal health center and the Centers for Disease Control and Prevention. Investigators abstracted medical record data from a random sample of singleton deliveries to residents of the study region occurring between 1997 and 2005. We used descriptive statistics to estimate the prevalence and 95% confidence intervals of selected pregnancy complications and adverse pregnancy outcomes. Records were examined for 505 pregnancies ending in a singleton delivery to 469 women. Pregnancy complication rates were 5.9% (95% CI 4.0, 8.4) for gestational diabetes mellitus, 6.1% (95% CI 4.2, 8.6%) for maternal chronic hypertension and 11.5% (95% CI 8.8, 14.6) for pregnancy associated hypertension, and 22.9% (95% CI 19.2-26.5 %) for anemia. The cesarean section rate was 5.5% (95% CI 3.5, 7.5) and 3.8% (95% CI 2.3, 5.8) of newborns weighed >4,500 g. Few previous studies reported pregnancy outcomes among Alaska Native women in a specific geographic region of Alaska and regarding the health needs in this population. We highlight components of our collaboration that contributed to the success of the study. Studies focusing on special populations such as Alaska Native women are feasible and can provide important information on health indicators at the local level. PMID:23775248

  5. Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period.

    PubMed

    Hildebrand, Ainslie M; Liu, Kuan; Shariff, Salimah Z; Ray, Joel G; Sontrop, Jessica M; Clark, William F; Hladunewich, Michelle A; Garg, Amit X

    2015-12-01

    Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (<2500 g), small for gestational age, or preterm birth (<37 weeks' gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (<2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes.

  6. Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy

    PubMed Central

    Hodes, Anke R; Tichnell, Crystal; te Riele, Anneline S J M; Murray, Brittney; Groeneweg, Judith A; Sawant, Abhishek C; Russell, Stuart D; van Spaendonck-Zwarts, Karin Y; van den Berg, Maarten P; Wilde, Arthur A; Tandri, Harikrishna; Judge, Daniel P; Hauer, Richard N W; Calkins, Hugh; van Tintelen, J Peter; James, Cynthia A

    2016-01-01

    Objectives To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Methods From a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1–4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised. Obstetric outcomes were ascertained. Incidence of VA and HF were compared with rates in the non-pregnant state. Long-term disease course was compared with 117 childbearing-aged female patients with ARVD/C who had not experienced pregnancy with ARVD/C. Results Treatment during pregnancy (n=39) included β blockers (n=16), antiarrhythmics (n=6), diuretics (n=3) and implantable cardioverter defibrillators (ICDs) (n=28). In five pregnancies (13%), a single VA occurred, including two ICD-terminated events. Arrhythmias occurred disproportionately in probands without VA history (p=0.045). HF, managed on an outpatient basis, developed in two pregnancies (5%) in women with pre-existing overt biventricular or isolated right ventricular disease. All infants were live-born without major obstetric complications. Caesarean sections (n=11, 28%) had obstetric indications, except one (HF). β Blocker therapy was associated with lower birth weight (3.1±0.48 kg vs 3.7±0.57 kg; p=0.002). During follow-up children remained healthy (median 3.4 years), and mothers were without cardiac mortality or transplant. Neither VA nor HF incidence was significantly increased during pregnancy. ARVD/C course (mean 6.5±5.6 years) did not differ based on pregnancy history. Conclusions While most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF. PMID:26719359

  7. Effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome

    PubMed Central

    Zeng, Xian-Ling; Zhang, Ya-Fei; Tian, Quan; Xue, Yan; An, Rui-Fang

    2016-01-01

    Abstract Aim: The aim of the study is to evaluate the effects of metformin on pregnancy outcomes in women with polycystic ovary syndrome (PCOS). Methods: We searched electronic databases and bibliographies of relevant papers to identify studies comparing the pregnancy outcomes in the metformin group with those in the placebo or blank control group. Then, we did this meta-analysis based on the PRISMA guidelines. The primary outcomes included early pregnancy loss (EPL), preterm delivery, term delivery, and gestational diabetes mellitus (GDM). Secondary outcomes included pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), fetal malformation, vaginal delivery (VD), cesarean section (CS), and metformin's side effects, such as nausea or gastrointestinal discomfort. Certainly, data about neonatal death and macrosomia were analyzed if data available. Results: Finally, 13 studies including 5 randomized controlled trials (RCT) and 8 cohort studies involving 1606 pregnant women with PCOS were analyzed. The pooled OR of EPL was 0.19 with obvious statistical significance, manifesting that metformin help to lower the rate of EPL (95% CI 0.12–0.28, P < 0.00001). Simultaneously, metformin showed the advantage of reducing the prevalence of preterm delivery (OR 0.37, 95% CI 0.20–0.68, P = 0.002). In addition, metformin could promote term delivery greatly and the pooled OR was 5.23 with sharp statistical difference (95% CI 3.12–8.75, P < 0.00001). Conclusion: Metformin treatment in women with PCOS throughout pregnancy could increase the possibility of term delivery, VD and reduce the risk of EPL, preterm labor, pregnancy complications such as GDM and PIH, with no serious side effects. Moreover, metformin was not teratogenic based on the limited data. So we may recommend metformin treatment for women with PCOS during the whole pregnancy period for it is quite beneficial and safe for both mothers and babies. PMID:27603343

  8. Effect of progesterone treatment due to threatened abortion in early pregnancy for obstetric and perinatal outcomes.

    PubMed

    Duan, Lijun; Yan, Denglu; Zeng, Weiyue; Yang, Xiao; Wei, Qiang

    2010-01-01

    Progesterone supplementation has been used in a large number of women with threatened abortion for decades, despite various degrees of success, and contradictory and ever-changing views about its efficacy. The majority of previous literature has mainly focused on evaluation the effect of progesterone on pregnancy outcome of threatened abortion. No controlled epidemiological studies of obstetric and perinatal outcomes, including preterm birth, pregnancy complications and low birth weight newborns, in pregnant women with progesterone treatment have been published. The data of 523 pregnant women with progesterone treatment in the second and third months of pregnancy due to threatened abortion was compared with the data of other 21,054 pregnant women in the Department of Obstetrics, West China Second University Hospital for a period of 6years from January 2002 to October 2008. There was no difference in mean gestational age at delivery and birth weight, in addition the rate of preterm birth, pregnancy complications and low birth weight newborns. Intramuscular progesterone treatment due to threatened abortion during early pregnancy did not associate with a higher risk for pregnancy complications, preterm birth and low birth weight newborns. PMID:20079582

  9. Role of Abnormal Sperm Morphology in Predicting Pregnancy Outcomes.

    PubMed

    Shabtaie, Samuel A; Gerkowicz, Sabrina A; Kohn, Taylor P; Ramasamy, Ranjith

    2016-09-01

    The evaluation of strict morphology for predicting successful pregnancy has been controversial, nevertheless remains an essential component of semen analysis. Patients with teratozoospermia (abnormal strict morphology) have traditionally been counseled to undergo assisted reproduction. However, recent studies suggest that patients with abnormal sperm morphology alone should not be precluded from attempting natural conception before undergoing assisted reproduction. The goal of this review is to provide an update on the evaluation of sperm morphology for prognosis in assisted reproductive techniques such as intrauterine insemination and in vitro fertilization with or without intracytoplasmic sperm injection. Additionally, we propose a logical approach to the evaluation of a patient with teratozoospermia seeking fertility treatment. PMID:27469478

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

    PubMed

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

    2009-01-01

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

  11. Adverse Outcomes of IVF/ICSI Pregnancies Vary Depending on Aetiology of Infertility

    PubMed Central

    Kuivasaari-Pirinen, Paula; Raatikainen, Kaisa; Hippeläinen, Maritta; Heinonen, Seppo

    2012-01-01

    In vitro fertilization (IVF) is a risk factor for pregnancy, but there have been few studies on the effect of infertility's aetiology. Thus, we have assessed the role of aetiology on IVF pregnancy outcomes in a retrospective cohort study comparing the outcomes of IVF singleton pregnancies with those of spontaneous pregnancies in the general Finnish population. The study group consisted of 255 women with births resulting from singleton IVF pregnancies. Six subgroups were formed according to the following causes of infertility: anovulation (27%), endometriosis (19%), male factor (17%), tubal factor (15%), polycystic ovary syndrome (11%), and unexplained infertility (12%). The reference group consisted of 26,870 naturally conceived women. Adjusted odds ratios (AORs), for confounding factors such as age and parity, were estimated using logistic regression analysis. Women with endometriosis and anovulation had increased risks of preterm birth (AOR 3.25, 95% CI 1.5–7.1 and AOR 2.1, and 95% CI 1.0–4.2, resp.), while women in couples with male factor infertility had a twofold risk of admission to neonatal intensive care (AOR 2.5, 95% CI 1.2–5.3). The findings show that the aetiology of infertility influenced the obstetrics outcome, and that pooling results may obscure some increased risks among subgroups. PMID:22570795

  12. Women's physical activity and pregnancy outcome: a longitudinal analysis from the Philippines.

    PubMed

    Barnes, D L; Adair, L S; Popkin, B M

    1991-03-01

    We assessed the effects of physical activity on pregnancy outcome in 2741 Filipino women identified during pregnancy as part of a two-year longitudinal study. Specific elements of physical activity hypothesized to be relevant to pregnancy outcome were posture, energy expenditure, and physical stress. Variables were developed for nine household and 48 formal and informal economic activities. Analyses were stratified by whether the woman performed formal waged work outside of the home, income-related activity at home, or was economically inactive. Results show that traditional definitions of physical activity and work based on participation in the formal labour force ignore a sizeable amount of home economic production, as well as the physical demands of housework. We saw no difference in risk of low birthweight or preterm delivery in economically active compared to economically inactive women. However, we found that increased amounts of standing activity affected pregnancy outcome in certain groups of women. Accurate assessment of the effects of physical activity during pregnancy must examine specific components of the activity, rather than relying on formal employment as a proxy for exposure.

  13. Demographic correlates of paternity confidence and pregnancy outcomes among Albuquerque men.

    PubMed

    Anderson, Kermyt G; Kaplan, Hillard; Lancaster, Jane B

    2006-12-01

    We examine the demographic correlates of paternity confidence, or men's assessment of the likelihood that they are the genetic father of a particular child. Evolutionary theory predicts that men will provide less parental investment for putative genetic offspring who are unlikely to be their actual offspring, but confidence of paternity has not been as extensively examined as its importance would merit. Using self-reported data on paternity confidence in 3,360 pregnancies reported by men living in Albuquerque, New Mexico, we find that low paternity confidence is more common among unmarried couples and for unplanned pregnancies. We also find that men are more likely not to state paternity confidence (i.e., they refuse to answer the question) if a pregnancy is unplanned. We additionally examine the pregnancy outcomes associated with confidence of paternity. We find that low paternity confidence pregnancies are significantly more likely to be aborted, and pregnancies for which paternity confidence is unstated are more likely to be aborted or to miscarry. Both abortion and miscarriage are associated with unmarried couples, with unplanned pregnancies, and with couples who have fewer children together.

  14. Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development.

    PubMed

    Christian, Lisa M

    2012-01-01

    It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.

  15. Psychoneuroimmunology in Pregnancy: Immune Pathways Linking Stress with Maternal Health, Adverse Birth Outcomes, and Fetal Development

    PubMed Central

    Christian, Lisa M.

    2011-01-01

    It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development. PMID:21787802

  16. Caffeine intake and pregnancy outcomes: a meta-analytic review.

    PubMed

    Santos, I S; Victora, C G; Huttly, S; Morris, S

    1998-01-01

    Epidemiological publications on the relationship of caffeine to birth weight and duration of human pregnancy, from 1966 to 1995, were searched through Medline. Each study was treated as the stratification variable, and its weight average was proportional to the inverse of its variance. Twenty-six studies were located. Among the twenty-two studies on birth weight, eleven were on mean birth weight, nine on low birth weight (LBW), and four on intrauterine growth retardation (IUGR). Combined analysis of mean birth weight study results showed a significant decrease in birth weight of nearly 43g among newborns of the heaviest caffeine-consuming mothers. LBW, IUGR, and preterm delivery displayed significant homogeneity in the test results, indicating that a pooled estimate should not be taken as na adequate measure. The high heterogeneity of the available literature on the effects of caffeine on LBW, IUGR, and preterm delivery prevents estimation of reliable pooled estimates through meta-analysis. Further assessment of caffeine intake during pregnancy is needed in future research.

  17. Comparative analysis of perinatal outcome of spontaneous pregnancy reduction and multifetal pregnancy reduction in triplet pregnancies conceived after assisted reproductive technique

    PubMed Central

    Bhandari, Shilpa; Ganguly, Ishita; Agrawal, Pallavi; Bhandari, Shweta; Singh, Aparna; Gupta, Nitika

    2016-01-01

    INTRODUCTION: With the advent of assisted reproductive treatment options, the incidence of multiple pregnancies has increased. Although the need for elective single embryo transfer is emphasized time and again, its uniform applicability in practice is yet a distant goal. In view of the fact that triplet and higher order pregnancies are associated with significant fetomaternal complications, the fetal reduction is a commonly used option in such cases. This retrospective study aims to compare the perinatal outcome in patients with triplet gestation who have undergone spontaneous fetal reduction (SFR) as against those in whom multifetal pregnancy reduction (MFPR) was done. MATERIALS AND METHODS: In the present study, eighty patients with triplet gestation at 6 weeks were considered. The patients underwent SFR or MFPR at or before 12–13 weeks and were divided into two groups (34 and 46), respectively. RESULTS: Our study found no statistical difference in perinatal outcome between the SFR and MFPR groups in terms of average gestational age at delivery, abortion rate, preterm delivery rate, and birth weight. The study shows that the risk of aborting all fetuses after SFR is three times (odds ratio [OR] = 3.600, 95% confidence interval [CI] = 0.2794–46.388) that of MFPR in subsequent 2 weeks. There were more chances of loss of extra fetus in SFR (23.5%) group than MFPR group (8.7%) (OR = 3.889, 95% CI = 1.030–14.680). As neither group offers any significant benefit from preterm delivery, multiple pregnancies continue to be responsible for preterm delivery despite fetal reduction. CONCLUSION: There appears to be some advantages of MFPR in perinatal outcome when compared to SFR, especially if the latter happens at advanced gestation. Therefore, although it is advisable to wait for SFR to occur, in patients with triplet gestation at 11–12 weeks, MFPR is a viable option to be considered. PMID:27803585

  18. Pregnancy outcomes in women potentially exposed to solvent-contaminated drinking water in San Jose, California

    SciTech Connect

    Wrensch, M.; Swan, S.; Lipscomb, J.; Epstein, D.; Fenster, L.; Claxton, K.; Murphy, P.J.; Shusterman, D.; Neutra, R. )

    1990-02-01

    During 1980-1981, solvents leaked from an underground storage tank of a semiconductor firm in southern Santa Clara County, California, contaminating local drinking water. The contaminated well was closed in December 1981. An epidemiologic study conducted in 1983 confirmed statistically significant excesses of adverse pregnancy outcomes in an exposed community compared with an unexposed community, but could not establish a causal connection between the leak and the adverse outcomes. This study expanded the first study; adverse pregnancy outcomes occurring in 1980-1985 were studied in two communities exposed to the contaminated drinking water and in two demographically comparable but unexposed communities. The period 1980-1981 was the time period in which the well was considered to have been contaminated and 1982-1985 was considered the postcontamination time period. Both exposed and unexposed communities were considered unexposed during the latter period (1982-1985). Out of 10,055 households surveyed, interviews were conducted with 1,105 women who reported one or more eligible pregnancies. Miscarriages and birth defects were validated by medical record review or physician reports. Although the authors again observed statistically significant excesses of spontaneous abortions and birth defects in the originally studied exposed area in 1980-1981, they observed deficits of these outcomes in the second exposed study area. Adjustment for potential confounders did not alter these findings. Analyses of pregnancy outcomes during 1981 in relation to exposure estimates based on hydrogeologic modeling of water and contaminant distribution within the exposed areas also indicated that the leak was not likely to have caused the observed excesses of adverse pregnancy outcomes in the originally studied area.

  19. Correlation of maternal-fetal attachment and health practices during pregnancy with neonatal outcomes

    PubMed Central

    Maddahi, Maryam Sadat; Dolatian, Mahrokh; khoramabadi, Monirsadat; Talebi, Atefeh

    2016-01-01

    Introduction Low birth weight due to preterm delivery or intrauterine growth restriction (IUGR) is the strongest factor contributing to prenatal, neonatal, and postnatal mortality. Maternal–fetal attachment plays a significant role in maternal and fetal health. Health practices performed by the mother during pregnancy constitute one of the factors that may affect neonatal outcomes. The present study was conducted to identify the relationship between maternal–fetal attachment and health practices during pregnancy with neonatal outcomes. Methods This cross-sectional study was conducted on 315 pregnant women with a gestational age of 33–41 weeks who presented to hospitals in Sirjan (Iran) between December 2014 and February 2015. The data collection tools used included the Health Practices in Pregnancy Questionnaire and the Maternal Fetal Attachment Scale. Data were analyzed using IBM-SPSS version 20, focusing on the Pearson product–moment correlation and the logistic regression model. Statistical significance was set to p<0.05. Results The mean score of maternal–fetal attachment was 60.34, and the mean score of health practices was 123.57. The mean birth weight of the neonates was 3052.38 g. Health practices (p<0.05, r=0.11) and maternal-fetal attachment (p<0.01, r=0.23) were positively and significantly correlated with neonatal outcomes. A significant positive relationship was also observed between maternal–fetal attachment and neonatal outcomes. No significant relationships were observed between health practices during pregnancy and neonatal outcomes. Conclusion Maternal-fetal attachment and health practices during pregnancy are positively and significantly correlated with neonatal outcomes. PMID:27648191

  20. Laparoscopic Management of Interstitial Pregnancy and Fertility Outcomes after Ipsilateral Salpingectomy – Three Case Reports

    PubMed Central

    Manea, Cristina; Pavlidou, Evangelia; Urias, Aline Andrey; Bouquet de la Jolinière, Jean; Dubuisson, Jean Bernard; Feki, Anis

    2014-01-01

    Background: Interstitial pregnancy after ipsilateral salpingectomy is a rare event with potentially serious consequences. Optimal management strategy remains uncertain and debated. In addition, fertility sparing is determinant of the treatment choice. Cases: Here, we report three cases of interstitial pregnancy occurring after homolateral salpingectomy. We expose the therapeutic option held in all three situations, which associated laparoscopic procedure followed by intramuscular methotrexate injection with successful outcome for all patients. We also report the fertility outcome for the first patient, discussing the timing and mode of delivery. Cesarean section at term was performed for this patient. Conclusion: In these three situations, we obtained a successful result using a minimally invasive surgical approach combined with systemic methotrexate injection. Cesarean section at term for subsequent intrauterine pregnancy seems to be the safest delivery strategy, although no clear data exist in literature. PMID:25593958

  1. [Antithrombotic therapy and pregnancy].

    PubMed

    Chauleur, Céline; Raia, Tiphaine; Gris, Jean-Christophe

    2013-09-01

    The incidence of venous thromboembolism (VTE) during pregnancy is about one event per 1000 pregnancies and placenta-mediated pregnancy complications (PC) occurred in 15%. Knowing the biological combined with clinical risk factors would help to prevent problems during the pregnancy. Several antithrombotic therapies exist, including very recent ones but LMWH and aspirin are still molecules of choice. The women should be assessed for VTE and PC risk in order to improve the outcome.

  2. The effects of prenatal cannabis exposure on fetal development and pregnancy outcomes: a protocol

    PubMed Central

    Gunn, Jayleen K L; Rosales, Cecilia B; Center, Katherine E; Nuñez, Annabelle V; Gibson, Steven J; Ehiri, John E

    2015-01-01

    Introduction The effects of exposure to marijuana in utero on fetal development are not clear. Given that the recent legislation on cannabis in the US is likely to result in increased use, there is a need to assess the effects of prenatal cannabis exposure on fetal development and pregnancy outcomes. The objective of this review is to assess the effects of prenatal exposure to cannabis on pregnancy outcomes (including maternal and child outcomes). Methods and analyses Major databases will be searched from inception to the latest issue, with the aim of identifying studies that reported the effects of prenatal exposure to cannabis on fetal development and pregnancy outcomes. Two investigators will independently review all titles and abstracts to identify potential articles. Discrepancies will be resolved by repeated review, discussion and consensus. Study quality assessment will be undertaken, using standard protocols. To qualify for inclusion, studies must report at least one maternal or neonatal outcome post partum. Cross-sectional, case–control, cohort and randomised controlled trials published in English will be included. In order to rule out the effects of other drugs that may affect fetal development and pregnancy outcomes, studies will only be included if they report outcomes of prenatal exposure to cannabis while excluding other illicit substances. Data from eligible studies will be extracted, and data analysis will include a systematic review and critical appraisal of evidence, and meta-analysis if data permit. Meta-analysis will be conducted if three or more studies report comparable statistics on the same outcome. Ethics and dissemination The review which will result from this protocol has not already been conducted. Preparation of the review will follow the procedures stated in this protocol, and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethical approval of data will not be required since

  3. Maternal and foetal outcome of 206 high risk pregnancy cases in border guard hospital, dhaka.

    PubMed

    Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S

    2015-04-01

    This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post

  4. Pregnancy outcomes in youth with type 2 diabetes: The TODAY Study experience

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. The TODAY study was a randomized controlled trial comparing three treatment options for youth with type 2 diabetes. Informed consent included the req...

  5. Pregnancy outcomes in two growth restricted fetuses with in utero cerebral lactate.

    PubMed

    Andescavage, N; Limperopoulos, C; Evangelou, I; Murnick, J; du Plessis, A

    2015-01-01

    Elevated cerebral lactate is increasingly detected by magnetic resonance spectroscopy in the human fetus diagnosed with various pathologic conditions. However, the significance of detectable cerebral lactate remains uncertain. We present two cases of fetal cerebral lactate with adverse pregnancy outcomes. PMID:26518409

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

    EPA Science Inventory

    Pregnancy and Perinatal Outcomes in Relation to Drinking Water Arsenic Exposure in BaMen, Inner Mongolia, China
    Danelle T. Lobdell, Zhixiong Ning, Richard K. Kwok, Judy Mumford, Zhi Yi Liu, Pauline Mendola

    Introduction: Close to 40 million people worldwide are exposed t...

  7. 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…

  8. Folic acid supplementation and IVF pregnancy outcome in women with unexplained infertility.

    PubMed

    Murto, T; Skoog Svanberg, A; Yngve, A; Nilsson, T K; Altmäe, S; Wånggren, K; Salumets, A; Stavreus-Evers, A

    2014-06-01

    Folic acid supplements are commonly used by infertile women which leads to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to IVF pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P < 0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P < 0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility. Folate is one of the B vitamins which has been suggested to be related to infertility. Folic acid is an artificial form of folate which is commonly used in dietary supplements. Folic acid supplementation has been shown to increase folate concentrations and decrease concentrations of the amino acid homocysteine in the blood. Folic acid supplementation is commonly used by infertile women, but the effect on pregnancy outcome in women with a diagnosis of unexplained infertility has not been thoroughly investigated. In the present study, folic acid supplement use and folate status (concentrations of folate and homocysteine) in women with unexplained infertility were evaluated in relation to pregnancy outcome. In addition, the use of folic acid supplements and folate

  9. The influence of maternal age on the outcomes of pregnancies complicated by bleeding at less than 12 weeks.

    PubMed

    Mbugua Gitau, Godfrey; Liversedge, Helen; Goffey, Dawn; Hawton, Annemarie; Liversedge, Neil; Taylor, Myles

    2009-01-01

    The effect of maternal age on the outcome of threatened miscarriage after ultrasound has confirmed fetal heart (FH) pulsation was assessed. At a university teaching hospital, 138 women presenting with bleeding before 12 weeks' gestation were followed up until delivery or pregnancy loss. Those with multiple or ectopic pregnancy, social termination of pregnancy, assisted conception and temporary residence were excluded. Outcome measures were pregnancy loss, fetal abnormalities, preterm delivery, low birthweight and cesarean delivery. Age over 35 years was significantly associated with reduced live-birth and increased miscarriage rates. Women over 35 years of age had higher cesarean section and pregnancy loss rates than the younger women. The combination of bleeding in early pregnancy and advanced age increases risk of pregnancy loss even after ultrasound has confirmed FH pulsation. PMID:19140048

  10. 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

  11. Paclitaxel improves outcome from traumatic brain injury

    PubMed Central

    Cross, Donna J.; Garwin, Gregory G.; Cline, Marcella M.; Richards, Todd L.; Yarnykh, Vasily; Mourad, Pierre D.; Ho, Rodney J.Y.; Minoshima, Satoshi

    2016-01-01

    Pharmacologic interventions for traumatic brain injury (TBI) hold promise to improve outcome. The purpose of this study was to determine if the microtubule stabilizing therapeutic paclitaxel used for more than 20 years in chemotherapy would improve outcome after TBI. We assessed neurological outcome in mice that received direct application of paclitaxel to brain injury from controlled cortical impact (CCI). Magnetic resonance imaging was used to assess injury-related morphological changes. Catwalk Gait analysis showed significant improvement in the paclitaxel group on a variety of parameters compared to the saline group. MRI analysis revealed that paclitaxel treatment resulted in significantly reduced edema volume at site-of-injury (11.92 ± 3.0 and 8.86 ± 2.2 mm3 for saline vs. paclitaxel respectively, as determined by T2-weighted analysis; p ≤ 0.05), and significantly increased myelin tissue preservation (9.45 ± 0.4 vs. 8.95 ± 0.3, p ≤ 0.05). Our findings indicate that paclitaxel treatment resulted in improvement of neurological outcome and MR imaging biomarkers of injury. These results could have a significant impact on therapeutic developments to treat traumatic brain injury. PMID:26086366

  12. Will Interventions Targeting Conscientiousness Improve Aging Outcomes?

    ERIC Educational Resources Information Center

    English, Tammy; Carstensen, Laura L.

    2014-01-01

    The articles appearing in this special section discuss the role that conscientiousness may play in healthy aging. Growing evidence suggests that conscientious individuals live longer and healthier lives. However, the question remains whether this personality trait can be leveraged to improve long-term health outcomes. We argue that even though it…

  13. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders.

    PubMed

    Black, Kirsten I; Day, Carolyn A

    2016-01-01

    Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area. PMID:27199563

  14. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders

    PubMed Central

    Black, Kirsten I.; Day, Carolyn A.

    2016-01-01

    Much has been written about the consequences of substance use in pregnancy, but there has been far less focus on the prevention of unintended pregnancies in women with substance use disorders (SUDs). We examine the literature on pregnancy incidence for women with SUDs, the clinical and economic benefits of increasing access to long-acting reversible contraceptive (LARC) methods in this population, and the current hurdles to increased access and uptake. High rates of unintended pregnancies and poor physical and psychosocial outcomes among women with SUDs underscore the need for increased access to, and uptake of, LARC methods among these women. A small number of studies that focused on improving access to contraception, especially LARC, via integrated contraception services predominantly provided in drug treatment programs were identified. However, a number of barriers remain, highlighting that much more research is needed in this area. PMID:27199563

  15. Relationship between donor sperm parameters and pregnancy outcome after intrauterine insemination: analysis of 2821 cycles in 1355 couples.

    PubMed

    Guan, H-T; Zheng, Y; Wang, J-J; Meng, T-Q; Xia, W; Hu, S-H; Xiong, C-L; Rao, M

    2016-02-01

    The aim of this study was to investigate whether sperm parameters can affect the pregnancy outcome of artificial intrauterine insemination with cryopreserved donor spermatozoon (AID). A total of 1355 couples received 2821 AID treatment cycles in the Reproductive Medicine Center of the Tongji Medical College between January 2010 and December 2013, and the data were collected and retrospectively analysed. The relationship between pre-freezing, post-thawing as well as optimised sperm parameters and AID pregnancy outcome was investigated. Clinical pregnancy rate and cumulated pregnancy rate were also calculated. A total of 728 cycles from 2821 treatment cycles achieved pregnancies, and cumulated pregnancy rate was 25.81%. Pre-freezing progressive sperm motility in pregnant cycles was higher than that in nonpregnant cycles (P = 0.001); logistic regression analysis also indicated that pre-freezing progressive sperm motility was the only parameter affecting pregnancy outcome (P = 0.0001). Our study also showed that the cumulated pregnancy rate increased progressively and reached a plateau after the fifth cycle. In conclusion, pre-freezing progressive sperm motility should be a valuable predictor for AID pregnancy outcome. Female fertility factors should be considered, or IVF/ICSI should be recommended when couples received more than 5 AID cycles without pregnancy.

  16. Maternal Work Status and Pregnancy Outcomes: A Pilot.

    ERIC Educational Resources Information Center

    Pitzer, Martha S.

    Investigated were effects of maternal work status and parity on specific outcomes in maternal psychology and physiology and infant physiology. In addition, the study design and the usefulness of instruments were evaluated, and the feasibility of subject recruitment and retention was assessed. Subjects were 20 women between 18 and 35 years of age…

  17. Drinking water contaminants and adverse pregnancy outcomes: a review.

    PubMed Central

    Bove, Frank; Shim, Youn; Zeitz, Perri

    2002-01-01

    Concern for exposures to drinking water contaminants and their effects on adverse birth outcomes has prompted several studies evaluating chlorination disinfection by-products and chlorinated solvents. Some of these contaminants are found to be teratogenic in animal studies. This review evaluates 14 studies on chlorination disinfection by-products such as trihalomethanes (THMs) and five studies on chlorinated solvents such as trichloroethylene (TCE). The adverse birth outcomes discussed in this review include small for gestational age (SGA), low birth weight, preterm birth, birth defects, spontaneous abortions, and fetal deaths. Because of heterogeneities across the studies in the characterization of birth outcomes, the assessment and categorization of exposures, and the levels and mixtures of contaminants, a qualitative review was conducted. Generally, the chief bias in these studies was exposure misclassification that most likely underestimated the risk, as well as distorted exposure-response relationships. The general lack of confounding bias by risk factors resulted from these factors not being associated with drinking water exposures. The studies of THMs and adverse birth outcomes provide moderate evidence for associations with SGA, neural tube defects (NTDs), and spontaneous abortions. Because fewer studies have been conducted for the chlorinated solvents than for THMs, the evidence for associations is less clear. Nevertheless, the findings of excess NTDs, oral clefts, cardiac defects, and choanal atresia in studies that evaluated TCE-contaminated drinking water deserve follow-up. PMID:11834464

  18. Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia.

    PubMed

    Logue, Omar C; George, Eric M; Bidwell, Gene L

    2016-08-01

    Preeclampsia (PE) is a form of gestational hypertension that complicates ∼5% of pregnancies worldwide. Over 70% of the fatal cases of PE are attributed to cerebral oedema, intracranial haemorrhage and eclampsia. The aetiology of PE originates from abnormal remodelling of the maternal spiral arteries, creating an ischaemic placenta that releases factors that drive the pathophysiology. An initial neurological outcome of PE is the absence of the autonomically regulated cardiovascular adaptations to pregnancy. PE patients exhibit sympathetic overactivation, in comparison with both normotensive pregnant and hypertensive non-pregnant females. Moreover, PE diminishes baroreceptor reflex sensitivity (BRS) beyond that observed in healthy pregnancy. The absence of the cardiovascular adaptations to pregnancy, combined with sympathovagal imbalance and a blunted BRS leads to life-threatening neurological outcomes. Behaviourally, the increased incidences of maternal depression, anxiety and post-traumatic stress disorder (PTSD) in PE are correlated to low fetal birth weight, intrauterine growth restriction (IUGR) and premature birth. This review addresses these neurological consequences of PE that present in the gravid female both during and after the index pregnancy. PMID:27389588

  19. 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

  20. The Relationship of the Factor V Leiden Mutation and Pregnancy Outcomes for Mother and Fetus

    PubMed Central

    Dizon-Townson, Donna; Miller, Connie; Sibai, Baha; Spong, Catherine Y.; Thom, Elizabeth; Wendel, George; Wenstrom, Katharine; Samuels, Philip; Cotroneo, Margaret A.; Moawad, Atef; Sorokin, Yoram; Meis, Paul; Miodovnik, Menachem; O’Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.; Gabbe, Steven G.

    2013-01-01

    Objective We sought to estimate the frequency of pregnancy-related thromboembolic events among carriers of the factor V Leiden (FVL) mutation without a personal history of thromboembolism, and to evaluate the impact of maternal and fetal FVL mutation carriage or other thrombophilias on the risk of adverse outcomes. Methods Women with a singleton pregnancy and no history of thromboembolism were recruited at 13 clinical centers before 14 weeks of gestation from April 2000 to August 2001. Each was tested for the FVL mutation, as was the resultant conceptus after delivery or after miscarriage, when available. The incidence of thromboembolism (primary outcome), and of other adverse outcomes, was compared between FVL mutation carriers and noncarriers. We also compared adverse outcomes in a secondary nested carrier-control analysis of FVL mutation and other coagulation abnormalities. In this secondary analysis, we defined carriers as women having one or more of the following traits: carrier for FVL mutation, protein C deficiency, protein S deficiency, antithrombin III deficiency, activated protein C resistance, or lupus anticoagulant-positive, heterozygous for prothrombin G20210A or homozygous for the 5,10 methylenetetrahydrofolate reductase mutations. Carriers of the FVL mutation alone (with or without activated protein C resistance) were compared with those having one or more other coagulation abnormalities and with controls with no coagulation abnormality. Results One hundred thirty-four FVL mutation carriers were identified among 4,885 gravidas (2.7%), with both FVL mutation status and pregnancy outcomes available. No thromboembolic events occurred among the FVL mutation carriers (0%, 95% confidence interval 0–2.7%). Three pulmonary emboli and one deep venous thrombosis occurred (0.08%, 95% confidence interval 0.02–0.21%), all occurring in FVL mutation noncarriers. In the nested carrier-control analysis (n = 339), no differences in adverse pregnancy outcomes were

  1. Outcomes of Pregnancy Following Surgery for Stress Urinary Incontinence: A Systematic Review

    PubMed Central

    Pollard, Matthew E.; Morrisroe, Shelby; Anger, Jennifer T.

    2016-01-01

    Purpose Although few data have been published on the safety of childbearing after surgery for stress urinary incontinence, a large proportion of physicians recommend that women wait to complete childbearing before pursuing surgical treatment for stress urinary incontinence. We systematically reviewed the available literature to examine the safety of pregnancy after stress urinary incontinence surgery, and to measure the effect of such pregnancy on continence outcomes. Materials and Methods The review was conducted according to the recommendations of the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) group. We performed a systematic review to identify articles published before January 2011 on pregnancy after incontinence surgery. Databases searched include PubMed®, EMBASE® and the Cochrane Review. Our literature search identified 592 titles, of which 20 articles were ultimately included in the review. Results Data were tabulated from case reports, case series and physician surveys. The final analysis in each category included 32, 19 and 67 patients, respectively. Urinary retention developed during pregnancy in 2 women, 1 of whom was treated with a sling takedown and the other with intermittent catheterization. Of these 2 women 1 also had an episode of pyelonephritis during pregnancy, possibly related to the intermittent catheterization. The incidence of postpartum stress urinary incontinence ranged from 5% to 18% after cesarean delivery and from 20% to 30% after vaginal delivery. Conclusions Although the data on outcomes in the literature are limited and further studies need to be performed on the subject, the current data suggests that any increase in risks for pregnancy after surgery for stress incontinence may be small. A low risk of urinary retention during pregnancy may exist. Although some data suggest that cesarean deliveries may result in a lower rate of recurrent stress urinary incontinence than vaginal deliveries, a formal analysis could

  2. Adverse Fetal Outcomes Associated with Immunosuppressive Medications for Chronic Immune Mediated Diseases in Pregnancy

    PubMed Central

    Cooper, William O.; Cheetham, T. Craig; Li, De-Kun; Stein, C. Michael; Callahan, S. Todd; Morgan, Thomas M.; Shintani, Ayumi K.; Chen, Ning; Griffin, Marie R.; Ray, Wayne A.

    2014-01-01

    Objective We assessed the risk of adverse fetal outcomes following exposure to individual immunosuppressive drugs in pregnant women with chronic immune mediated diseases. Methods We used health plan data from Tennessee Medicaid and Kaiser Permanente Northern California and Southern California linked with vital records and medical records. Women with inflammatory arthropathies, systemic lupus erythematosus, and inflammatory bowel disease who filled prescriptions for immunosuppressive treatments during pregnancy were included. Major congenital malformations, fetal deaths, and life-threatening neonatal complications were identified from electronic data and validated with medical record review. Results The cohort included 608 infants, including 437 with exposure during pregnancy (402 first trimester, 35 second and third trimester only) and 171 whose mothers filled prescriptions for immunosuppressives before, but not during, pregnancy. There were 25 pregnancies (4.1% of the cohort) with confirmed major congenital malformations, 10 fetal deaths (1.6%), 23 life-threatening neonatal complications among preterm infants (20.4%), and 10 (2.1%) life-threatening complications among term infants. Compared to the reference group (medication treatment before, but not during, pregnancy), the risk ratios for adverse fetal outcomes associated with immunosuppressive use during pregnancy by exposure category included: methotrexate [risk ratio 1.39 (95% confidence interval 0.43,4.53)], tumor necrosis factor inhibitors [0.98 (0.38,2.55)], hydroxychloroquine [1.33 (0.69,2.55)], and other immunosuppressives [0.98, (0.48,1.98)]. Conclusions We found no evidence of a large increase in risk of adverse fetal outcomes from first trimester exposure to immunosuppressive medications, though confidence intervals for risk ratios were wide. Further studies will be needed as use of these medications increases over time. PMID:24504818

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

    PubMed

    Murphy, Deirdre J; Dunney, Clare; Mullally, Aoife; Adnan, Nita; Deane, Richard

    2013-08-27

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

  4. Observational Cohort Study of Pregnancy Outcome after First-Trimester Exposure to Fluoroquinolones

    PubMed Central

    Wacker, Evelin; Meister, Reinhard; Panse, Mary; Weber-Schoendorfer, Corinna; Oppermann, Marc; Schaefer, Christof

    2014-01-01

    Fluoroquinolones are avoided during pregnancy due to developmental toxicity in animals. The aim of this study was to assess the fetal risk after intrauterine fluoroquinolone exposure. We performed an observational study of a prospectively ascertained cohort of pregnant women exposed to a fluoroquinolone during the first trimester. Pregnancy outcomes were compared to those of a cohort exposed to neither fluoroquinolones nor teratogenic or fetotoxic drugs. The outcomes evaluated were major birth defects (structural abnormalities of medical, surgical, or cosmetic relevance), spontaneous abortion, and elective termination of pregnancy. Pregnancy outcomes of 949 women with fluoroquinolone treatment were compared with those of 3,796 nonexposed controls. Neither the rate of major birth defects (2.4%; adjusted odds ratio [ORadj], 0.91; 95% confidence interval [CI], 0.6 to 1.5) nor the risk of spontaneous abortion (adjusted hazard ratio [HRadj], 1.01; 95% CI, 0.8 to 1.3) was increased. However, there was a nonsignificant increase in major birth defects after exposure to moxifloxacin (6/93, 6.5%; crude odds ratio [ORcrude], 2.40; 95% CI, 0.8 to 5.6). Neither a critical exposure time window within the first trimester nor a specific pattern of birth defects was demonstrated for any of the fluoroquinolones. The rate of electively terminated pregnancies was increased among the fluoroquinolone-exposed women (HRadj, 1.32; 95% CI, 1.03 to 1.7). The gestational ages at delivery and birth weights did not differ between groups. Our study did not detect an increased risk of spontaneous abortion or major birth defects. These reassuring findings support the recommendation to allow fluoroquinolone use in early pregnancy in selected cases. After the use of moxifloxacin, a detailed fetal ultrasound examination should be considered. PMID:24841264

  5. Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study.

    PubMed

    Grazuleviciene, Regina; Danileviciute, Asta; Dedele, Audrius; Vencloviene, Jone; Andrusaityte, Sandra; Uždanaviciute, Inga; Nieuwenhuijsen, Mark J

    2015-05-01

    There is increasing evidence that green space can improve the health and well-being of urban residents. However, there has been no consistent evidence of the effect of city parks on reproductive health. We investigated whether surrounding greenness levels and/or distance to city parks affect birth outcomes. This study was based on 3292 singleton live-births from the Kaunas birth cohort, Lithuania (2007-2009), who were enrolled in the FP7 PHENOTYPE project study. Residential surrounding greenness level was ascertained as average of satellite-based normalized difference vegetation index (NDVI) within buffers of 100 m, 300 m, and 500 m of each maternal home and distance to a city park was defined as distance to boundaries of the nearest city park. For each indicator of green space exposure, linear or logistic regression models were constructed to estimate change in birth outcomes adjusted for relevant covariates. An increase in distance to a city parks was associated with an increase in risk of preterm birth and decrease of gestational age. We found a statistically significant association between low surrounding greenness and term low birth weight. After assessing effect modification based on the low surrounding greenness (NDVI-5001000 m), we found increased risks for low birth weight (OR 2.23, 1.20-4.15), term low birth weight (OR 2.97, 1.04-8.45) and preterm birth (OR 1.77, 1.10-2.81) for subjects with low surrounding greenness and farther distance from a park. Both higher surrounding greenness level and proximity to park have beneficial effects on pregnancy outcomes. A beneficial park effect on foetal growth is most apparent in the environment with low surrounding greenness level. Further investigation is needed to confirm this association. PMID:25757723

  6. Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study

    PubMed Central

    Grazuleviciene, Regina; Danileviciute, Asta; Dedele, Audrius; Vencloviene, Jone; Andrusaityte, Sandra; Uždanaviciute, Inga; Nieuwenhuijsen, Mark J.

    2015-01-01

    There is increasing evidence that green space can improve the health and well-being of urban residents. However, there has been no consistent evidence of the effect of city parks on reproductive health. We investigated whether surrounding greenness levels and/or distance to city parks affect birth outcomes. This study was based on 3292 singleton live-births from the Kaunas birth cohort, Lithuania (2007–2009), who were enrolled in the FP7 PHENOTYPE project study. Residential surrounding greenness level was ascertained as average of satellite-based normalized difference vegetation index (NDVI) within buffers of 100 m, 300 m, and 500 m of each maternal home and distance to a city park was defined as distance to boundaries of the nearest city park. For each indicator of green space exposure, linear or logistic regression models were constructed to estimate change in birth outcomes adjusted for relevant covariates. An increase in distance to a city parks was associated with an increase in risk of preterm birth and decrease of gestational age. We found a statistically significant association between low surrounding greenness and term low birth weight. After assessing effect modification based on the low surrounding greenness (NDVI-500 < median) and the distance to city parks (>1000 m), we found increased risks for low birth weight (OR 2.23, 1.20–4.15), term low birth weight (OR 2.97, 1.04–8.45) and preterm birth (OR 1.77, 1.10–2.81) for subjects with low surrounding greenness and farther distance from a park. Both higher surrounding greenness level and proximity to park have beneficial effects on pregnancy outcomes. A beneficial park effect on foetal growth is most apparent in the environment with low surrounding greenness level. Further investigation is needed to confirm this association. PMID:25757723

  7. Surrounding greenness, proximity to city parks and pregnancy outcomes in Kaunas cohort study.

    PubMed

    Grazuleviciene, Regina; Danileviciute, Asta; Dedele, Audrius; Vencloviene, Jone; Andrusaityte, Sandra; Uždanaviciute, Inga; Nieuwenhuijsen, Mark J

    2015-05-01

    There is increasing evidence that green space can improve the health and well-being of urban residents. However, there has been no consistent evidence of the effect of city parks on reproductive health. We investigated whether surrounding greenness levels and/or distance to city parks affect birth outcomes. This study was based on 3292 singleton live-births from the Kaunas birth cohort, Lithuania (2007-2009), who were enrolled in the FP7 PHENOTYPE project study. Residential surrounding greenness level was ascertained as average of satellite-based normalized difference vegetation index (NDVI) within buffers of 100 m, 300 m, and 500 m of each maternal home and distance to a city park was defined as distance to boundaries of the nearest city park. For each indicator of green space exposure, linear or logistic regression models were constructed to estimate change in birth outcomes adjusted for relevant covariates. An increase in distance to a city parks was associated with an increase in risk of preterm birth and decrease of gestational age. We found a statistically significant association between low surrounding greenness and term low birth weight. After assessing effect modification based on the low surrounding greenness (NDVI-5001000 m), we found increased risks for low birth weight (OR 2.23, 1.20-4.15), term low birth weight (OR 2.97, 1.04-8.45) and preterm birth (OR 1.77, 1.10-2.81) for subjects with low surrounding greenness and farther distance from a park. Both higher surrounding greenness level and proximity to park have beneficial effects on pregnancy outcomes. A beneficial park effect on foetal growth is most apparent in the environment with low surrounding greenness level. Further investigation is needed to confirm this association.

  8. Impact of Different Treatment Approaches on Pregnancy Outcomes in 99 Women Treated for Hodgkin Lymphoma

    SciTech Connect

    De Sanctis, Vitaliana; Filippone, Francesco Romeo; Alfo, Marco; Muni, Roberta; Cavalieri, Elena; Pulsoni, Alessandro; Annechini, Giorgia; Valeriani, Maurizio; Osti, Mattia Falchetto; Minniti, Giuseppe; Enrici, Riccardo Maurizi

    2012-11-01

    Purpose: The aim of this study was to evaluate the pregnancy outcomes in women with Hodgkin lymphoma (HL) diagnosis, treated between 1972 and 1999 at Department of Radiotherapy and Hematology of University 'Sapienza' of Roma. Methods and Materials: We retrospectively studied 99 female patients that conceived after treatment for HL. Fifty-nine (59%) were treated with chemotherapy and radiotherapy, 32 (32%) with radiotherapy alone as supradiaphragmatic or as infradiaphragmatic and 8 (8%) patients with chemotherapy alone. Results: Ninety-nine patients reported 145 pregnancies. We observed 132 deliveries (2 of them twin births) after a median of 55 months (range, 14-278 months) from the end of therapy. Twelve women (12%) experienced 13 miscarriages after a median of 50 months (range, 13-120) from the end of therapy. We recorded 9/132 (7%) premature births and 3/134 babies (2%) were underweight at the time of birth. We recorded 2 cases of congenital malformations. No statistical differences were recorded when adverse pregnancy outcomes were analyzed with respect to chemotherapy alone, radiotherapy alone, or combined therapy. Conclusions: No significant associations between pregnancy outcomes and therapeutic approaches were found. In particular, the infradiaphragmatic radiotherapy showed no statistical association with miscarriages, premature birth, and low birth weight at term when compared with other therapeutic approaches.

  9. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

    PubMed

    Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.

  10. Polarisation of equine pregnancy outcome associated with a maternal MHC class I allele: Preliminary evidence.

    PubMed

    Kydd, J H; Case, R; Winton, C; MacRae, S; Sharp, E; Ricketts, S L; Rash, N; Newton, J R

    2016-05-30

    Identification of risk factors which are associated with severe clinical signs can assist in the management of disease outbreaks and indicate future research areas. Pregnancy loss during late gestation in the mare compromises welfare, reduces fecundity and has financial implications for horse owners. This retrospective study focussed on the identification of risk factors associated with pregnancy loss among 46 Thoroughbred mares on a single British stud farm, with some but not all losses involving equid herpesvirus-1 (EHV-1) infection. In a sub-group of 30 mares, association between pregnancy loss and the presence of five common Thoroughbred horse haplotypes of the equine Major Histocompatibility Complex (MHC) was assessed. This involved development of sequence specific, reverse transcriptase polymerase chain reactions and in several mares, measurement of cytotoxic T lymphocyte activity. Of the 46 mares, 10 suffered late gestation pregnancy loss or neonatal foal death, five of which were EHV-1 positive. Maternal factors including age, parity, number of EHV-1 specific vaccinations and the number of days between final vaccination and foaling or abortion were not significantly associated with pregnancy loss. In contrast, a statistically significant association between the presence of the MHC class I B2 allele and pregnancy loss was identified, regardless of the fetus/foal's EHV-1 status (p=0.002). In conclusion, this study demonstrated a significantly positive association between pregnancy loss in Thoroughbred mares and a specific MHC class I allele in the mother. This association requires independent validation and further investigation of the mechanism by which the mare's genetic background contributes to pregnancy outcome. PMID:27139027

  11. Prolonged time to pregnancy is associated with a greater risk of adverse outcomes.

    PubMed

    Raatikainen, Kaisa; Harju, Maija; Hippeläinen, Maritta; Heinonen, Seppo

    2010-08-01

    Births with known time to pregnancy (TTP) during the period 1989-2007 (n=17,114) were analyzed to investigate associations between TTP and pregnancy outcome among couples that conceived spontaneously. The adjusted odds ratio (95% confidence interval) for poor neonatal health, including low Apgar score, low umbilical vein pH, and need for neonatal intensive care, was 1.51 (1.09-2.09) in women who had a TTP of 25-36 months and 1.60 (1.18-2.19) in women who had a TTP of >or=37 months compared with women with a TTP of 0-6 months.

  12. Associations among Trueperella pyogenes, endometritis diagnosis, and pregnancy outcomes in dairy cows.

    PubMed

    Bicalho, M L S; Lima, F S; Machado, V S; Meira, E B; Ganda, E K; Foditsch, C; Bicalho, R C; Gilbert, R O

    2016-01-15

    The objective of this study was to evaluate three commonly used methods for endometritis diagnosis by comparing each one's association with the presence of intrauterine Trueperella pyogenes (TP) and reproductive performance. Lactating Holstein cows (n = 452) were evaluated a single time at 35 ± 3 days postpartum to diagnose endometritis on the basis of three criteria: presence of purulent vaginal discharge (PVD) detected by a Metricheck device, presence of purulent uterine lavage fluid (PUL), presence of cytologic endometritis (CE) based on relative abundance of polymorphonuclear leukocytes in uterine lavage fluid. A threshold of polymorphonuclear leukocytes greater than 5% was used to diagnose the occurrence of CE. Also, a swab of the uterine lavage was cultured to evaluate the presence of TP and determine its association with endometritis diagnosis criteria and pregnancy outcomes. The results showed that cows positive for TP had increased prevalence of PVD and PUL and tended to have greater prevalence of CE. Median time to pregnancy was 56 days longer, and hazard of pregnancy was 34% lower for TP-positive cows than for TP-negative cows. Presence of PUL led to a 35% lower hazard of pregnancy and 34-day-longer median time to pregnancy than cows without PUL. Likewise, cows diagnosed with PVD had a 47% lower hazard of pregnancy and 57-day-longer median time to pregnancy than cows without PVD. Cows diagnosed with CE had a 27% lower hazard of pregnancy and 42-day-longer median time to pregnancy than cows without CE. When the three different diagnostic methods were used as independent variables in a Cox's proportional hazard model that evaluated hazard of pregnancy, the variable PVD was the only statistically significant variable. Combined PUL and CE or combined PUL and PVD had no additional effects on hazard of pregnancy when compared with only PUL, only PVD, or only CE as the criterion to determine endometritis. However, combined PVD and CE had an additive

  13. How to improve IVF-ICSI outcome by sperm selection.

    PubMed

    Berkovitz, A; Eltes, F; Lederman, H; Peer, S; Ellenbogen, A; Feldberg, B; Bartoov, B

    2006-05-01

    In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF-ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF-IMSI trial, with matched couples, who underwent a standard IVF-ICSI procedure, confirmed that pregnancy rate following IVF-IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF-ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P pregnancy and delivery rates and significantly higher abortion rates than microinjection with 'best' spermatozoa (25.7 versus 58.2%, P

  14. Pregnancy: Managing obesity during pregnancy-what are the options?

    PubMed

    Dodd, Jodie M

    2015-12-01

    In a new trial, provision of antenatal dietary and lifestyle advice to pregnant women who are obese is associated with modest improvements in maternal diet. This intervention is, however, inadequate to affect pregnancy and birth outcomes, and challenges the notion that limiting gestational weight gain can improve pregnancy outcomes.

  15. Calcium-Vitamin D Co-supplementation Affects Metabolic Profiles, but not Pregnancy Outcomes, in Healthy Pregnant Women

    PubMed Central

    Asemi, Zatollah; Samimi, Mansooreh; Siavashani, Mehrnush Amiri; Mazloomi, Maryam; Tabassi, Zohreh; Karamali, Maryam; Jamilian, Mehri; Esmaillzadeh, Ahmad

    2016-01-01

    Background: Pregnancy is associated with unfavorable metabolic profile, which might in turn result in adverse pregnancy outcomes. The current study was designed to evaluate the effects of calcium plus Vitamin D administration on metabolic status and pregnancy outcomes in healthy pregnant women. Methods: This randomized double-blind placebo-controlled clinical trial was performed among 42 pregnant women aged 18–40 years who were at week 25 of gestation. Subjects were randomly allocated to consume either 500 mg calcium-200 IU cholecalciferol supplements (n = 21) or placebo (n = 21) for 9 weeks. Blood samples were obtained at the onset of the study and after 9-week trial to determine related markers. Post-delivery, the newborn's weight, length, and head circumference were measured during the first 24 h after birth. Results: Consumption of calcium-Vitamin D co-supplements resulted in a significant reduction of serum high-sensitivity C-reactive protein levels compared with placebo (−1856.8 ± 2657.7 vs. 707.1 ± 3139.4 μg/mL, P = 0.006). We also found a significant elevation of plasma total antioxidant capacity (89.3 ± 118.0 vs. −9.4 ± 164.9 mmol/L, P = 0.03), serum 25-hydroxyvitamin D (2.5 ± 3.5 vs. −1.7 ± 1.7 ng/mL, P < 0.0001), and calcium levels (0.6 ± 0.6 vs. −0.1 ± 0.4 mg/dL, P < 0.0001). The supplementation led to a significant decrease in diastolic blood pressure (−1.9 ± 8.3 vs. 3.1 ± 5.2 mmHg, P = 0.02) compared with placebo. No significant effect of calcium-Vitamin D co-supplements was seen on other metabolic profiles. We saw no significant change of the co-supplementation on pregnancy outcomes as well. Conclusions: Although calcium-Vitamin D co-supplementation for 9 weeks in pregnant women resulted in improved metabolic profiles, it did not affect pregnancy outcomes. PMID:27076887

  16. Unplanned pregnancy and the impact on sibling health outcomes.

    PubMed

    Lordan, Grace; Frijters, Paul

    2013-08-01

    This work considers whether planning matters with respect to the effect of a new sibling on another siblings' health. Objective health outcomes are observed before and after a new addition to the family. To date, the literature on family size has focused on a quality-quantity trade-off; the more children in a family, the less resources devoted to each child. We present a theoretical framework which highlights that the quantity-quality trade-off may only be relevant in the case of an unplanned sibling. We also suggest that a planned sibling may result in health gains for the other children. We use two waves of data for more than 1800 children from Peru from the Young Lives Project to test our hypothesis. The data relate to the children at 1 and 5 years. For health outcomes, height for age and weight for age Z are considered. The results highlight significant negative independent effects on height for age when an unplanned sibling is added to the household. In addition, we find positive sibling effects on height for age when a planned sibling arrives. We find only small planning effects for weight for age. We view our hypothesis as a pathway that can further explain the quantity-quality trade-off. PMID:22941673

  17. Baby on board: do responses to stress in the maternal brain mediate adverse pregnancy outcome?

    PubMed

    Douglas, Alison J

    2010-07-01

    Stress and adverse environmental surroundings result in suboptimal conditions in a pregnant mother such that she may experience poor pregnancy outcome including complete pregnancy failure and preterm labor. Furthermore her developing baby is at risk of adverse programming, which confers susceptibility to long term ill health. While some mechanisms at the feto-maternal interface underlying these conditions are understood, the underlying cause for their adverse adaptation is often not clear. Progesterone plays a key role at many levels, including control of neuroendocrine responses to stress, procuring the required immune balance and controlling placental and decidual function, and lack of progesterone can explain many of the unwanted consequences of stress. How stress that is perceived by the mother inhibits progesterone secretion and action is beginning to be investigated. This overview of maternal neuroendocrine responses to stress throughout pregnancy analyses how they interact to compromise progesterone secretion and precipitate undesirable effects in mother and offspring.

  18. Mode of delivery and other pregnancy outcomes of patients with documented scoliosis.

    PubMed

    Lebel, David E; Sergienko, Ruslan; Wiznitzer, Arnon; Velan, Gad J; Sheiner, Eyal

    2012-06-01

    The aim of this study was to explore whether scoliosis is a risk factor for adverse obstetric outcomes and specifically for cesarean delivery (CD) and labor dystocia. Association between scoliosis and pregnancy outcome was studied before. Confounding conclusions prevent proper counseling of patients. Appropriate statistical analysis of a suitable cohort is helpful in resolving this issue. A retrospective population-based study comparing all singleton pregnancies of women with and without documented scoliosis was conducted. Deliveries occurred between the years 1988 and 2009. Multiple logistic regression models were used to control for confounders. Out of 229,116 patients which were included in our cohort, 0.043% (n = 98) had a documented scoliosis. These patients had higher rates of fertility treatments (7.1% vs. 1.6%; p < 0.001). Scoliosis was found to be significantly associated with labor induction (36.7% vs. 26.3 %; p = 0.02) and cesarean deliveries (21.4% vs. 13.1%; p = 0.014). Using multiple logistic regression models, with CD as the outcome variable, controlling for confounders such as nulliparity, labor induction and maternal age, scoliosis was not found to be an independent risk factor for CD (OR = 1.56, 95% CI 1.9-2.7; p = 0.121). Scoliosis is not a risk factor for adverse pregnancy outcome, and specifically for labor dystocia. PMID:22070615

  19. Fetal ventriculomegaly: Pregnancy outcomes and follow-ups in ten years.

    PubMed

    Chu, Nan; Zhang, Yueping; Yan, Yingliu; Ren, Yunyun; Wang, Ling; Zhang, Bin

    2016-05-23

    The aim of this study is to evaluate the pregnancy outcomes and prognoses for fetuses with ventriculomegaly. Two hundred and forty-one cases of fetuses with ventriculomegaly were included in this study. The subjects were divided into three groups according to their lateral ventricular width: "Mild Ventriculomegaly" (10 ‒ < 12 mm), "Moderate Ventriculomegaly" (12 ‒ < 15 mm) and "Severe Ventriculomegaly" (≥ 15 mm). Pediatric examination records and telephone interviews were conducted to track the outcomes of children until the age of 9 years. Eight-two cases were Isolated Ventriculomegaly (34.0%), while Non-Isolated Ventriculomegaly was found in 159 cases (66.0%). The pregnancy was terminated in 91 cases, and a higher abortion ratio was found in the NIVM (Non-Isolated Ventriculomegaly) group compared with the IVM (Isolated Ventriculomegaly) group. The fetuses were delivered in 150 cases, and four infants suffered deaths with NIVM. Of the surviving fetuses, 7 with IVM and 9 with NIVM showed significant abnormalities. The Mild and Moderate VM groups had more favorable prognoses compared with the Severe VM group. Regarding the outcomes and progression of lateral ventricular width, 1 out of 42 cases in the regressed group and 19 out of 108 cases in the stable group showed significant abnormalities. This study suggests that the degree and the progression of ventricular dilatation are main factors that affect pregnancy outcomes and prognoses.

  20. Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

    PubMed Central

    Drehmer, Michele; Duncan, Bruce Bartholow; Kac, Gilberto; Schmidt, Maria Inês

    2013-01-01

    Objective To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes. Methods Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy. Results In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester. Conclusion Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy. PMID:23382944

  1. Pregnancy Outcome of Multiparous Women Aged over 40 Years.

    PubMed

    Ates, Seda; Batmaz, Gonca; Sevket, Osman; Molla, Taner; Dane, Cem; Dane, Banu

    2013-01-01

    Objective. The aim of this study was to evaluate the effect of maternal age on prenatal and obstetric outcome in multiparaous women. Materials and Methods. A retrospective case control study was conducted, including women aged 40 years and over (study group, n = 97) who delivered at 20 week's gestation or beyond and women aged 20-29 years (control group, n = 97). Results. The mean age of women in the study group was 41.2 ± 1.7 years versus 25.4 ± 2.3 years in the control group. Advanced maternal age was associated with a significantly higher rate of hypertension, diabetes mellitus, fetal complication, and 5-minute Apgar scores <7 (P < 0.05). Caeserean section rate, incidence of placental abruption, preterm delivery, and neonatal intensive care unit admission were more common in the older group, but the differences were not statistically significant. Conclusions. Advanced maternal age is related to maternal and neonatal complications.

  2. Fertility and Pregnancy Outcome After Abdominal Irradiation That Included or Excluded the Pelvis in Childhood Tumor Survivors

    SciTech Connect

    Sudour, Helene; Chastagner, Pascal; Claude, Line; Desandes, Emmanuel; Klein, Marc; Carrie, Christian; Bernier, Valerie

    2010-03-01

    Purpose: To evaluate fertility after abdominal and/or pelvic irradiation in long-term female survivors. Methods and Materials: Puberty and pregnancy outcome were analyzed in female survivors of childhood cancer (aged <18 years) treated with abdominal and/or pelvic radiotherapy (RT) at one of two French centers (Nancy and Lyon) between 1975 and 2004. Data were obtained from medical records and questionnaires sent to the women. Results: A total of 84 patients who had received abdominal and/or pelvic RT during childhood and were alive and aged more than 18 years at the time of the study made up the study population. Of the 57 female survivors treated with abdominal RT that excluded the pelvis, 52 (91%) progressed normally through puberty and 23 (40%) had at least one recorded pregnancy. Of the 27 patients treated with pelvic RT, only 10 (37%) progressed normally through puberty and 5 (19%) had at least one recorded pregnancy. Twenty-two women (seventeen of whom were treated with pelvic RT) had certain subfertility. A total of 50 births occurred in 28 women, with one baby dying at birth; one miscarriage also occurred. There was a high prevalence of prematurity and low birth weight but not of congenital malformations. Conclusions: Fertility can be preserved in patients who undergo abdominal RT that excludes the pelvis, taking into account the other treatments (e.g., chemotherapy with alkylating agents) are taken into account. When RT includes the pelvis, fertility is frequently impaired and women can have difficulty conceiving. Nevertheless, pregnancies can occur in some of these women. The most important factor that endangers a successful pregnancy after RT is the total dose received by the ovaries and uterus. This radiation dose has to be systematically recorded to improve our ability to follow up patients.

  3. HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis.

    PubMed

    Tan, J; Liu, X; Mao, X; Yu, J; Chen, M; Li, Y; Sun, X

    2016-10-01

    Hepatitis B virus infection characterized by HBsAg positivity during pregnancy is a well-recognized issue in developing countries, but the association between HBsAg positivity and adverse maternal outcomes remains uncertain. To examine the association between HBsAg positivity during pregnancy and adverse maternal outcomes, a retrospective cohort study was conducted in Sichuan province, China. Deliveries were recorded from six hospitals between 1 January 2009 and 31 December 2010. Pre-eclampsia, gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), intrahepatic cholestasis, Caesarean section and placenta previa were prespecified adverse maternal outcomes. We used two multivariate logistic regression models to assess the association between HBsAg positivity and adverse maternal outcomes. In total, 948 (4.2%) pregnant women were HBsAg positive from 22 374 deliveries. Pregnant women with positive HBsAg had higher risk of GDM (aOR1.41, 95%CI 1.15-1.74), PPH (1.44, 1.13-1.83), intrahepatic cholestasis (1.74, 1.40-2.16) and Caesarean section (1.24, 1.06-1.45). No statistical associations were found between HBsAg positivity and pre-eclampsia (1.36, 0.94-1.97), and placenta previa (1.21, 0.87-1.67). HBsAg positivity during pregnancy was associated with higher risk of multiple adverse maternal outcomes. Although the causality has yet to be established, efforts may be warranted in routine care, particularly in those with high risk for adverse maternal outcomes, given the volume population infected with HBsAg. Future studies are needed to establish causality and examine the impact of HBeAg on the adverse outcomes. PMID:27167604

  4. Trading water to improve environmental flow outcomes

    NASA Astrophysics Data System (ADS)

    Connor, Jeffery D.; Franklin, Brad; Loch, Adam; Kirby, Mac; Wheeler, Sarah Ann

    2013-07-01

    As consumptive extractions and water scarcity pressures brought about by climate change increase in many world river basins, so do the risks to water-dependent ecological assets. In response, public or not for profit environmental water holders (EWHs) have been established in many areas and bestowed with endowments of water and mandates to manage water for ecological outcomes. Water scarcity has also increasingly spawned water trade arrangements in many river basins, and in many instances, EWHs are now operating in water markets. A number of EWHs, especially in Australia, begin with an endowment of permanent water entitlements purchased from irrigators. Such water entitlements typically have relatively constant interannual supply profiles that often do not match ecological water demand involving flood pulses and periods of drying. This article develops a hydrologic-economic simulation model of the Murrumbidgee catchment within the Murray-Darling Basin to assess the scope of possibilities to improve environmental outcomes through EWH trading on an annual water lease market. We find that there are some modest opportunities for EWHs to improve environmental outcomes through water trade. The best opportunities occur in periods of drought and for ecological outcomes that benefit from moderately large floods. We also assess the extent to which EWH trading in annual water leases may create pecuniary externalities via bidding up or down the water lease prices faced by irrigators. Environmental water trading is found to have relatively small impacts on water market price outcomes. Overall our results suggest that the benefits of developing EWH trading may well justify the costs.

  5. Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses.

    PubMed

    Ornoy, Asher; Tenenbaum, Alexander

    2006-05-01

    Women may be infected during pregnancy with infectious agents that are often passed unnoticed; however, the causative agent may still traverse the placenta and infect the developing embryo and fetus. Several of these agents (i.e. rubella, cytomegalovirus or Toxoplasma Gondii) may cause severe fetal damage, but most other infections in pregnancy seem to be much less dangerous to the fetus. In this review we discuss the effects of several viral infections during pregnancy where the effects on the developing embryo and fetus are infrequent, but they may sometimes cause severe neonatal disease. The following viruses are discussed: coxsackie and echoviruses, measles and mumps, polioviruses, Japanese and Venezuelan equine encephalitis viruses, West Nile virus and hepatitis viruses A, B, C, D and E. Coxsackie B virus may cause an increase in early spontaneous abortions and rarely, fetal myocarditis; echoviruses do not seem to damage the fetus; measles and mumps may cause increased early and late fetal death and neonatal measles or mumps. The viruses affecting the nervous system may increase early and late spontaneous abortions and, rarely, cause severe damage to the fetal brain. Hepatitis B virus has a high rate of vertical transmission causing fetal and neonatal hepatitis. Hepatitis A, C and E are rarely transmitted trans-placentally; if transmitted, they may cause hepatitis. There is no evidence that immunization in pregnancy against these diseases (with attenuated viruses) may adversely affect pregnancy outcome. PMID:16480851

  6. Corpus luteal contribution to maternal pregnancy physiology and outcomes in assisted reproductive technologies.

    PubMed

    Conrad, Kirk P; Baker, Valerie L

    2013-01-15

    Investigations in the rat model of pregnancy indicate an important role for the corpus luteal (CL) hormone relaxin in the maternal circulatory and osmoregulatory changes in pregnancy, which are epitomized by profound vasodilation and modest hypoosmolality, respectively. In a pilot study of infertile women who became pregnant through donor eggs, in vitro fertilization, and embryo transfer, the gestational rise in glomerular filtration and fall in plasma osmolality were markedly subdued. Because these women were infertile, they lacked a CL and circulating relaxin (and possibly other vasoactive CL hormones). Based on these findings in pregnant rats and women, we hypothesize that infertile women conceiving through donor eggs will have overall subdued circulatory changes (e.g., attenuated reduction in systemic vascular resistance and subdued increase in cardiac output) particularly during early pregnancy when CL hormones predominate before the full development and maturation of the placenta. In contrast, infertile women conceiving by autologous eggs retrieved after ovarian stimulation and fresh embryo transfer may have a relatively hyperdynamic circulation due to the presence of many CL (up to 20 or more) and higher circulating levels of vasodilatory ovarian hormones such as relaxin. Emerging evidence suggests that women undergoing Assisted Reproductive Technologies (ART) have increased risk for adverse pregnancy outcomes such as preeclampsia and small for gestational-age babies. This increased risk may be partly caused by the maternal milieu, which is not physiological in ART pregnancies due to the abnormal status of the CL.

  7. Withdrawal of valproic acid treatment during pregnancy and seizure outcome: Observations from EURAP.

    PubMed

    Tomson, Torbjörn; Battino, Dina; Bonizzoni, Erminio; Craig, John; Lindhout, Dick; Perucca, Emilio; Sabers, Anne; Thomas, Sanjeev V; Vajda, Frank

    2016-08-01

    Based on data from the EURAP observational International registry of antiepileptic drugs (AEDs) and pregnancy, we assessed changes in seizure control and subsequent AED changes in women who underwent attempts to withdraw valproic acid (VPA) during the first trimester of pregnancy. Applying Bayesian statistics, we compared seizure control in pregnancies where VPA was withdrawn (withdrawal group, n = 93), switched to another AED (switch group, n = 38), or maintained (maintained-therapy group, n = 1,588) during the first trimester. The probability of primarily or secondarily generalized tonic-clonic seizures (GTCS) was lower in the maintained-therapy group compared with the other two groups, both in the first trimester and for the entire duration of pregnancy. GTCS were twice as common during pregnancy in the withdrawal (33%) and switch groups (29%) compared with the maintained-treatment group (16%). Limitations in the data and study design do not allow to establish a cause-effect relationship between treatment changes and seizure outcome, but these observations provide a signal that withdrawal of, or switch from, VPA during the first trimester could lead to loss of seizure control, and highlight the need for a specifically designed prospective observational study. PMID:27319360

  8. Is there any effect of oocyte count retrieved in the OPU procedure on pregnancy outcomes?

    PubMed

    Gün, I; Özdamar, Ö; Şahin, S; Akpak, Y K; Sofuoğlu, K

    2016-01-01

    We aimed to investigate whether the number of oocytes retrieved during ovum pick-up has any effect on pregnancy outcomes when using the gonadotropin-releasing hormone or GnRH long agonist or antagonist protocols. A retrospective study was conducted between 2012 and 2014. The patients were grouped according to the number of oocytes retrieved at ovum pick-up; < 10 oocytes (Group 1), 10-14 oocytes (Group 2) and ≥ 15 oocytes (Group 3). Biochemical pregnancy rates were compared among the three groups. Statistical analysis was performed using one-way ANOVA test for continuous variables and chi-square test for categorical variables. In total, 825 treatment cycles were included in the study. Groups 1, 2 and 3 consisted of 514, 206 and 105 patients, respectively. There was no difference among the three groups regarding biochemical pregnancy rates (22.8%, 28.6% and 28.6%; p = 0.166, respectively). The results of our study suggest that the number of eggs retrieved has no effect on pregnancy outcome in assisted reproductive technology treatment.

  9. Uterine Fibroid Embolisation – Potential Impact on Fertility and Pregnancy Outcome

    PubMed Central

    David, M.; Kröncke, T.

    2013-01-01

    The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes. PMID:26633901

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

    PubMed Central

    Meeker, John D.; Benedict, Merle D.

    2013-01-01

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

  11. Maternal occupation and industry and the pregnancy outcome of U.S. married women, 1980.

    PubMed

    Shilling, S; Lalich, N R

    1984-01-01

    Data from the 1980 National Natality and National Fetal Mortality Surveys were used to characterize the occupations of women during the year before delivery; to search for disproportionate numbers of adverse pregnancy outcomes in specific occupational groups; and to compare demographic, reproductive, and lifestyle characteristics of employed mothers to those of mothers not employed in the year before delivery. National estimates were derived from the sample through a complex poststratified ratio adjustment procedure. For all pregnancy outcome groups, the greatest proportion of mothers were employed in three industry categories: professional and related services, wholesale and retail trade, and manufacturing; and in four occupation categories: clerical and kindred workers; professional, technical, and kindred workers; service workers; and operatives. Compared with employed mothers of live-born infants, a greater proportion of employed mothers of low birth weight infants worked full-time but stopped working before the third trimester. Compared with unemployed mothers, a larger proportion of employed mothers were between 20-29 years old, college educated, had a total family income of $21,000 or more per year, received early prenatal care, had no previous pregnancy, and drank alcohol during pregnancy. Estimates from this study may be used to (a) provide a better perspective of the magnitude of reproductive health problems, (b) target certain industrial populations for further research, and (c) assist in identifying causes of reproductive failure.

  12. HYPERGLYCOSYLATED HUMAN CHORIONIC GONADOTROPIN AS AN EARLY PREDICTOR OF PREGNANCY OUTCOMES AFTER IN VITRO FERTILIZATION

    PubMed Central

    Chuan, Sandy; Homer, Michael; Pandian, Raj; Conway, Deirdre; Garzo, Gabriel; Yeo, Lisa; Su, H. Irene

    2014-01-01

    Objective To determine if hyperglycosylated hCG (hhCG), produced by invasive trophoblasts, measured as early as 9 days after egg retrieval can predict ongoing pregnancies (OP) after in vitro fertilization and fresh embryo transfer (IVF-ET). Design Cohort Setting Academic ART center Patients Consecutive patients undergoing IVF-ET Interventions Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Outcome Ongoing pregnancy (OP) beyond 9 weeks of gestation Results OP (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. D9 hhCG levels >110 pg/mL was 96% specific for OP, yielding a positive predictive value of 95%. Compared to D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67). Diagnostic test characteristics were similar between D16 hhCG and hCG levels. Conclusions In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable. HhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. At this early assessment, hhCG is superior to traditional hCG and highly predictive of ongoing pregnancies. PMID:24355054

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

    PubMed

    Papapanou, Panos N

    2015-12-01

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

  14. Evaluation of a pregnancy outcome risk reduction program in a local health department.

    PubMed

    Tavris, D; Healy-Haney, N; Anderson, I M

    2000-04-01

    This study assesses the effectiveness of the Waukesha County Public Health Department's Prenatal Care Coordination Program (PNCC) in reducing self-reported risk factors for adverse pregnancy outcomes in pregnant clients, through assessment, preventive counseling and follow-up. There were 166 clients seen in the program. They were seen at up to three follow-up visits, with 83 seen at the 12-week follow-up visit, 106 seen at the 24-week follow-up visit, 74 seen at the 38-week follow-up visit, and 151 seen for at least one follow-up visit. Statistically significant improvement was seen between the first and last follow-up visit for each of the five categories of risk factors that were assessed. Mean alcohol intake decreased from 9.6 drinks per month at baseline to none by the 38-week follow-up visit. Mean cigarette smoking decreased from 12.8 cigarettes per day to 2.4. Street drug use decreased almost completely. There were statistically significant increases in milk, meat, fruit, bread, and vegetable consumption, and folic acid and multi-vitamin supplementation.

  15. The Sociocultural Context of Mexican-Origin Pregnant Adolescents' Attitudes Toward Teen Pregnancy and Links to Future Outcomes.

    PubMed

    Killoren, Sarah E; Zeiders, Katharine H; Updegraff, Kimberly A; Umaña-Taylor, Adriana J

    2016-05-01

    Given the negative developmental risks associated with adolescent motherhood, it is important to examine the sociocultural context of adolescent mothers' lives to identify those most at risk for poor outcomes. Our goals were to identify profiles of Mexican-origin pregnant adolescents' cultural orientations and their attitudes toward teen pregnancy, and to investigate how these profiles were linked to adolescents' pregnancy intentions, family resources, and short-term family, educational, and parenting outcomes. With a sample of 205 Mexican-origin adolescent mothers, we identified three profiles based on cultural orientations and attitudes toward teen pregnancy: Bicultural-Moderate Attitudes, Acculturated-Moderate Attitudes, and Enculturated-Low Attitudes. The results indicated that enculturated pregnant adolescents had the least favorable attitudes toward teen pregnancy, and the lowest levels of family income, pregnancy intentions, pregnancy support, and educational expectations compared to acculturated and bicultural pregnant adolescents; acculturated adolescents (with the highest family income and high levels of pregnancy support) had the highest levels of parenting efficacy 10 months postpartum. Our findings suggest that enculturated adolescent mothers (with less positive attitudes toward teen pregnancy) may benefit from educational support programs and enculturated and bicultural adolescent mothers (with moderately positive attitudes toward teen pregnancy) may benefit from programs to increase parenting efficacy. Such targeted interventions may, in turn, reduce the likelihood of adolescent mothers experiencing negative educational and parenting outcomes.

  16. Noncompaction cardiomyopathy and pregnancy: An alarming coexistence ending in a favourable outcome

    PubMed Central

    Plastiras, Sotiris C; Pamboucas, Constantinos; Toumanidis, Savvas

    2012-01-01

    Noncompaction of the left ventricular myocardium has gained increasing recognition over the past 25 years. This rare disease is caused by the arrest of myocardial morphogenesis. The classical triad of complications are heart failure, arrhythmias, including sudden cardiac death, and systemic embolic events. There is a paucity of data regarding women with left ventricular noncompaction cardiomyopathy and pregnancy outcome. The first report of an uneventful vaginal delivery without deterioration of left ventircular noncompaction cardiomyopathy is presented. PMID:23620702

  17. Reproductive health and pregnancy outcomes among French gulf war veterans

    PubMed Central

    Verret, Catherine; Jutand, Mathe-Aline; De Vigan, Catherine; Bégassat, Marion; Bensefa-Colas, Lynda; Brochard, Patrick; Salamon, Roger

    2008-01-01

    Background Since 1993, many studies on the health of Persian Gulf War veterans (PGWVs) have been undertaken. Some authors have concluded that an association exists between Gulf War service and reported infertility or miscarriage, but that effects on PGWV's children were limited. The present study's objective was to describe the reproductive outcome and health of offspring of French Gulf War veterans. Methods The French Study on the Persian Gulf War (PGW) and its Health Consequences is an exhaustive cross-sectional study on all French PGWVs conducted from 2002 to 2004. Data were collected by postal self-administered questionnaire. A case-control study nested in this cohort was conducted to evaluate the link between PGW-related exposures and fathering a child with a birth defect. Results In the present study, 9% of the 5,666 Gulf veterans who participated reported fertility disorders, and 12% of male veterans reported at least one miscarriage among their partners after the PGW. Overall, 4.2% of fathers reported at least one child with a birth defect conceived after the mission. No PGW-related exposure was associated with any birth defect in children fathered after the PGW mission. Concerning the reported health of children born after the PGW, 1.0% of children presented a pre-term delivery and 2.7% a birth defect. The main birth defects reported were musculoskeletal malformations (0.5%) and urinary system malformations (0.3%). Birth defect incidence in PGWV children conceived after the mission was similar to birth defect incidence described by the Paris Registry of Congenital Malformations, except for Down syndrome (PGWV children incidence was lower than Registry incidence). Conclusion This study did not highlight a high frequency of fertility disorders or miscarriage among French PGW veterans. We found no evidence for a link between paternal exposure during the Gulf War and increased risk of birth defects among French PGWV children. PMID:18442369

  18. Antiphospholipid antibodies and pregnancy outcomes in women heterozygous for Factor V Leiden

    PubMed Central

    Manuck, Tracy; Branch, D. Ware; Lai, Yinglei; Sibai, Baha; Spong, Catherine Y.; Wendel, George; Wenstrom, Katharine; Samuels, Philip; Caritis, Steve N.; Sorokin, Yoram; Miodovnik, Menachem; O’Sullivan, Mary J.; Conway, Deborah; Wapner, Ronald J.

    2010-01-01

    Antiphospholipid antibodies are associated with a spectrum of pregnancy complications, including preeclampsia and small for gestational age (SGA) fetuses. We sought to assess anticardiolipin and anti-β2-glycoprotein I (anti-β2-GPI) IgG and IgM antibody prevalence and the relationship of these antibodies to pregnancy complications in women with the Factor V Leiden (FVL) mutation. The study comprised a secondary analysis of a multicenter, prospective observational study of FVL prevalence among 5,188 asymptomatic pregnant women. A subset of 362 women (117 FVL heterozygotes, 245 matched controls) had serum collected at the time of the original study and underwent serum analysis for anticardiolipin and anti-β2-GPI IgG and IgM as a part of this analysis. The primary outcome was preeclampsia and/or SGA (<10%). The overall prevalence of anticardiolipin and anti-β2-GPI IgG and IgM antibodies was low and did not vary with FVL status. Forty-seven women (13.0%) developed preeclampsia and/or SGA. There were no differences in primary outcome rates between women with and without aPL antibodies, regardless of FVL mutation status. Among FVL carriers, the presence of antiphospholipid antibodies does not appear to contribute to adverse pregnancy outcome. PMID:20439118

  19. Correlation of pregnancy outcome with quadruple screening test at second trimester

    PubMed Central

    Yazdani, Shahla; Rouholahnejad, Rahele; Asnafi, Nesa; Sharbatdaran, Majid; Zakershob, Marziihe; Bouzari, Zinatossadat

    2015-01-01

    Background: Abnormal levels of the markers AFP, hCG, and uE3 could be useful in predicting adverse pregnancy outcomes. This study was designed to determine the correlation between second trimester maternal serum markers and adverse pregnancy outcome (APO). Methods: In this historical cohort study, we randomly followed 231 obstetric patients with quadruple screening test in 14-18 weeks of gestation from March 2012 to March 2013 in a medical laboratory in Babol, Iran. We measured maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The risk of adverse pregnancy outcomes (APOs) were then compared between patients with negative and positive test results. We used Chi-square and Fisher-exact tests for qualitative variables and t-test for quantitative variables. Demographic differences between the two groups were minimized by applying logistic regression. Results: The risk of having an APO such as pre-eclampsia (p=0.008), fetal growth restriction (p=0.028) and premature rupture of membrane (p=0.040) increased significantly in patients with abnormal markers. Conclusion: Abnormal results of quadruple screening test could be associated with APO in women with normal appearing fetus. PMID:26913244

  20. Vaginal Mucosal Homeostatic Response May Determine Pregnancy Outcome in Women With Bacterial Vaginosis: A Pilot Study.

    PubMed

    Faure, Emmanuel; Faure, Karine; Figeac, Martin; Kipnis, Eric; Grandjean, Teddy; Dubucquoi, Sylvain; Villenet, Céline; Grandbastien, Bruno; Brabant, Gilles; Subtil, Damien; Dessein, Rodrigue

    2016-02-01

    Bacterial vaginosis (BV) is considered as a trigger for an inflammatory response that could promote adverse pregnancy outcome (APO). We hypothesized that BV-related inflammation could be counterbalanced by anti-inflammatory and mucosal homeostatic responses that could participate in pregnancy outcomes.A total of 402 vaginal self-samples from pregnant women in their first trimester were screened by Nugent score. In this population, we enrolled 23 pregnant women with BV but without APO, 5 pregnant women with BV and developing APO, 21 pregnant women with intermediate flora, and 28 random control samples from pregnant women without BV or APO.BV without APO in pregnant women was associated with 28-fold interleukin-8, 5-fold interleukin-10, and 40-fold interleukin-22 increases in expression compared to controls. BV associated with APO in pregnant women shared 4-fold increase in tumor necrosis factor, 100-fold decrease in interleukin-10, and no variation in interleukin-22 expressions compared to controls. Next-generation sequencing of vaginal microbiota revealed a shift from obligate anaerobic bacteria dominance in BV without APO pregnant women to Lactobacillus dominance microbiota in BV with APO.Our results show that the anti-inflammatory and mucosal homeostatic responses to BV may determine outcome of pregnancy in the setting of BV possibly through effects on the vaginal microbiota. PMID:26844497

  1. Vaginal Mucosal Homeostatic Response May Determine Pregnancy Outcome in Women With Bacterial Vaginosis

    PubMed Central

    Faure, Emmanuel; Faure, Karine; Figeac, Martin; Kipnis, Eric; Grandjean, Teddy; Dubucquoi, Sylvain; Villenet, Céline; Grandbastien, Bruno; Brabant, Gilles; Subtil, Damien; Dessein, Rodrigue

    2016-01-01

    Abstract Bacterial vaginosis (BV) is considered as a trigger for an inflammatory response that could promote adverse pregnancy outcome (APO). We hypothesized that BV-related inflammation could be counterbalanced by anti-inflammatory and mucosal homeostatic responses that could participate in pregnancy outcomes. A total of 402 vaginal self-samples from pregnant women in their first trimester were screened by Nugent score. In this population, we enrolled 23 pregnant women with BV but without APO, 5 pregnant women with BV and developing APO, 21 pregnant women with intermediate flora, and 28 random control samples from pregnant women without BV or APO. BV without APO in pregnant women was associated with 28-fold interleukin-8, 5-fold interleukin-10, and 40-fold interleukin-22 increases in expression compared to controls. BV associated with APO in pregnant women shared 4-fold increase in tumor necrosis factor, 100-fold decrease in interleukin-10, and no variation in interleukin-22 expressions compared to controls. Next-generation sequencing of vaginal microbiota revealed a shift from obligate anaerobic bacteria dominance in BV without APO pregnant women to Lactobacillus dominance microbiota in BV with APO. Our results show that the anti-inflammatory and mucosal homeostatic responses to BV may determine outcome of pregnancy in the setting of BV possibly through effects on the vaginal microbiota. PMID:26844497

  2. Association of Smoking Habits of Mother during Pregnancy with Pregnancy Outcome

    PubMed Central

    AZIMI, Cyrus; LOTFI, Mahshid

    2013-01-01

    Background: The objectives of this work were to study the association of maternal smoking habits with stillbirths, abortions, neonatal deaths, birth weights, placental weights and the outcomes on the 28th day of life. Methods: A questionnaire was developed and completed with the hospitals’ recorded data collected over a period of 5 years from 47,000 babies born in several hospitals in Ontario, Canada. The mothers were classified into four categories: non-smokers, light smokers (less than 10 cigarettes per day), moderate smokers (between 10 and 19 cigarettes per day) and heavy smokers (20 or more cigarettes per day). The population surveyed was of mixed ethnicity from both rural and urban areas. Statistical analysis was performed using the SPSS statistical package. Results: Even the light smoking habit has an effect on the birth weight and the placental weight but for other characteristics, stillbirth, abortion, and the outcomes on the 28th day of life, no significant difference observed between light smokers and non-smokers. Conclusion: While quit smoking must be the ultimate goal for any smoker, the present study concludes that moderate and heavy smokers, if they will not be able to quit, they should reduce their number of cigarettes per day to at least the level of light smokers to achieve the same results for non-smokers. All characteristics show significant difference between non-smokers and moderate and heavy smokers. PMID:24427753

  3. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies.

    PubMed

    Dalfrà, Maria Grazia; Busetto, Luca; Chilelli, Nino Cristiano; Lapolla, Annunziata

    2012-09-01

    It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.

  4. Pregnancy outcome of assisted reproductive technology cycle in patients with hypogonadotropic hypogonadism

    PubMed Central

    Pandurangi, Monna; Tamizharasi, M.; Reddy, N. Sanjeeva

    2015-01-01

    CONTEXT: Ovulation induction in patients with hypogonadotropic hypogonadism (HH) is a challenge to the treating physician. The threshold for ovarian response in HH may differ substantially from that of normal patients. To reach that threshold levels of follicle stimulating hormone, in a step-up protocol longer duration of stimulation is required in some cases so as to prevent multiple pregnancy and to eliminate the risk of ovarian hyperstimulation syndrome. AIM: To evaluate the duration of stimulation, quality of oocytes, and embryo, and the pregnancy outcome in the assisted reproductive technology (ART) cycles in patients with HH. MATERIALS AND METHODS: Over the period of 4 years, we had 14 patients with HH in whom 21 cycles of ovulation induction were done. Of these 7 patients underwent oocyte retrieval and intracytoplasmic sperm injection (ICSI). We present a retrospective study of these 7 patients who underwent ART to evaluate the duration of stimulation, quality of oocytes and embryo, and the pregnancy outcome. RESULTS: In the study group on ovulation induction with gonadotropins, only one patient had the duration of stimulation of the standard 12 days, the remaining 6 patients took ≥12 days to respond to stimulation (maxium being 54 days). Mean ET in these patients was 8.9 mm. Six patients had >70% good quality MII oocytes. One patient responded poorly and had only 2 good quality MII oocytes (50%). After ICSI procedure, resultant embryos were of grade 1 and 2 in all the patients irrespective of the duration of stimulation. Fertilization rate in these patients was 85% (except in one 50% fertilization rate), and the cumulative pregnancy rate was 68.6%. CONCLUSION: In the patients with HH the quality of oocytes and embryos, and the pregnancy rate is not affected even if the duration of stimulation is prolonged. PMID:26538857

  5. Pregnancy Outcomes of In Vitro Fertilization with or without Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study in Chinese Patients

    PubMed Central

    Jiang, Xuan; Deng, Cheng-Yan; Sun, Zheng-Yi; Chen, Wei-Lin; Wang, Han-Bi; Zhou, Yuan-Zheng; Jin, Li

    2015-01-01

    Background: The effect of ovarian hyperstimulation syndrome (OHSS) on pregnancy outcomes of in vitro fertilization (IVF) patients is still ambiguous. This study aimed to analyze pregnancy outcomes of IVF with or without OHSS in Chinese patients. Methods: A retrospective cohort study was undertaken to compare pregnancy outcomes between 190 women with OHSS and 197 women without OHSS. We examined the rates of clinical pregnancy, multiple pregnancies, miscarriage, live birth, preterm delivery, preterm birth before 34 weeks’ gestation, cesarean delivery, low birth weight (LBW), and small-for-gestational age (SGA) between the two groups. Odds ratios (ORs) and 95% confidence intervals (CIs) of measure of clinical pregnancy were also analyzed. Results: The clinical pregnancy rate of OHSS patients was significantly higher than that of non-OHSS patients (91.8% vs. 43.5%, P < 0.001). After controlling for drug protocol and causes of infertility, the adjusted ORs of moderate OHSS and severe/critical OHSS for clinical pregnancy were 4.65 (95% CI, 1.86–11.61) and 5.83 (95% CI, 3.45–9.86), respectively. There were no significant differences in rates of multiple pregnancy (4.0% vs. 3.7%) and miscarriage (16.1% vs. 17.5%) between the two groups. With regard to ongoing clinical pregnancy, we also found no significant differences in the rates of live birth (82.1% vs. 78.8%), preterm delivery (20.9% vs. 17.5%), preterm birth before 34 weeks’ gestation (8.6% vs. 7.9%), cesarean delivery (84.9% vs. 66.3%), LBW (30.2% vs. 23.5%), and SGA (21.9% vs. 17.6%) between the two groups. Conclusion: OHSS, which occurs in the luteal phase or early pregnancy in IVF patients and represents abnormal transient hemodynamics, does not exert any obviously adverse effect on the subsequent pregnancy. PMID:26612291

  6. Perforated peptic ulcer: how to improve outcome?

    PubMed

    Møller, Morten Hylander; Adamsen, Sven; Wøjdemann, Morten; Møller, Ann Merete

    2009-01-01

    Despite the introduction of histamine H2-receptor antagonists, proton-pump inhibitors and the discovery of Helicobacter pylori, both the incidence of emergency surgery for perforated peptic ulcer and the mortality rate for patients undergoing surgery for peptic ulcer perforation have increased. This increase has occurred despite improvements in perioperative treatment and monitoring. To improve the outcome of these patients, it is necessary to investigate the reasons behind this high mortality rate. In this review we evaluate the existing evidence in order to identify significant risk factors with an emphasis on risks that are preventable. A systematic review including randomized studies was carried out. There are a limited number of studies of patients with peptic ulcer perforation. Most of these studies are of low evident status. Only a few randomized, controlled trials have been published. The mortality rate and the extent of postoperative complications are fairly high but the reasons for this have not been thoroughly explained, even though a number of risk factors have been identified. Some of these risk factors can be explained by the septic state of the patient on admission. In order to improve the outcome of patients with peptic ulcer perforation, sepsis needs to be factored into the existing knowledge and treatment.

  7. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome.

    PubMed

    Kaiser, Lucia Lynn; Allen, Lindsay

    2002-10-01

    It is the position of the American Dietetic Association that women of childbearing potential should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; consumption of a variety of foods in accordance with the Food Guide Pyramid; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food-handling. Prenatal weight gain within the Institute of Medicine (IOM) recommended ranges is associated with better pregnancy outcomes. The total energy needs during pregnancy range between 2,500 to 2,700 kcal a day for most women, but prepregnancy body mass index, rate of weight gain, maternal age, and physiological appetite must be considered in tailoring this recommendation to the individual. The consumption of more food to meet energy needs and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This statement also includes recommendations pertaining to use of alcohol, tobacco, caffeine, street drugs, and other substances during pregnancy; food safety; and management of common complaints during pregnancy and specific health problems. In particular for medical nutrition therapy, pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria (PKU), certain chronic health problems, or a history of substance abuse should be referred to a qualified dietetics professional. PMID:12396171

  8. Vaccination with a Live Attenuated Cytomegalovirus Devoid of a Protein Kinase R Inhibitory Gene Results in Reduced Maternal Viremia and Improved Pregnancy Outcome in a Guinea Pig Congenital Infection Model

    PubMed Central

    Bierle, Craig J.; Swanson, Elizabeth C.; McVoy, Michael A.; Wang, Jian Ben; Al-Mahdi, Zainab; Geballe, Adam P.

    2015-01-01

    ABSTRACT Development of a vaccine to prevent congenital cytomegalovirus infection is a major public health priority. Live vaccines attenuated through mutations targeting viral mechanisms responsible for evasion of host defense may be both safe and efficacious. Safety and vaccine efficacy were evaluated using a guinea pig cytomegalovirus (GPCMV) model. Recombinant GPCMV with a targeted deletion of gp145 (designated Δ145), a viral protein kinase R (PKR) inhibitor, was generated. Attenuation was evaluated following inoculation of 107 PFU of Δ145 or parental virus into guinea pigs immunosuppressed with cyclophosphamide. Efficacy was evaluated by immunizing GPCMV-naive guinea pigs twice with either 105 or 106 PFU of Δ145, establishing pregnancy, and challenging the guinea pigs with salivary gland-adapted GPCMV. The immune response, maternal viral load, pup mortality, and congenital infection rates in the vaccine and control groups were compared. Δ145 was substantially attenuated for replication in immunocompromised guinea pigs. Vaccination with Δ145 induced enzyme-linked immunosorbent assay (ELISA) and neutralizing antibody levels comparable to those achieved in natural infection. In the higher- and lower-dose vaccine groups, pup mortality was reduced to 1/24 (4%) and 4/29 (14%) pups, respectively, whereas it was 26/31 (81%) in unvaccinated control pups (P < 0.0001 for both groups versus the control group). Congenital infection occurred in 20/31 (65%) control pups but only 8/24 (33%) pups in the group vaccinated with 106 PFU (P < 0.05). Significant reductions in the magnitude of maternal DNAemia and pup viral load were noted in the vaccine groups compared to those in the controls. Deletion of a GPCMV genome-encoded PKR inhibitor results in a highly attenuated virus that is immunogenic and protective as a vaccine against transplacental infection. IMPORTANCE Previous attempts to develop successful immunization against cytomegalovirus have largely centered on subunit

  9. Antiretroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

    PubMed Central

    Alemu, Fekadu Mazengia; Yalew, Alemayehu Worku; Fantahun, Mesganaw; Ashu, Eta Ebasi

    2015-01-01

    Background: Despite significant efforts to understand adverse pregnancy outcome in women receiving Antiretroviral Therapy (ART), ART-related adverse birth outcomes are still poorly understood. We systematically review ART-related adverse birth outcomes among HIV-infected pregnant women; we also review the covariates associated with adverse birth outcomes in the aforementioned group. Methods: The main source for our systematic review was electronic bibliographic databases. Databases such as MEDLINE, PubMed, EMBASE and AIDSLINE were searched. Furthermore, search engines such as Google and Google Scholar were specifically searched for gray literature. Methodological quality of available literature was assessed using the Newcastle - Ottawa Quality Assessment Scale & M. Hewitt guideline. We examined a total of 1,124 papers and reviewed the studies using the PICOT criteria which stands for Patient (population), Intervention (or “Exposure”), Comparison, Outcome and Type of study. Finally, 32 methodologically fit studies were retained and included in our review. Results: Frequently observed adverse birth outcomes included low birth weight (LBW), Preterm Birth (PB), Small for Gestational Age (SGA), while still birth and congenital anomalies were infrequent. Type of regimen such as Protease Inhibitor (PI) based regimens and timing of initiation of ART are some of the factors associated with adverse pregnancy outcomes. Covariates principally included malnutrition and other co-morbidities such as malaria and HIV. Conclusions and Public Health Implications: There is growing evidence in published literature suggesting that ART might be causing adverse birth outcomes among pregnant women in developing countries. There is a need to consider regimen types for HIV-infected pregnant women. There is need to design large cohort studies.

  10. Laboratory work and pregnancy outcomes: a study within the National Birth Cohort in Denmark

    PubMed Central

    Zhu, J L; Knudsen, L E; Andersen, A‐M N; Hjollund, N H; Olsen, J

    2006-01-01

    Aims To examine pregnancy outcomes in women doing laboratory work. Methods Using data from the Danish National Birth Cohort (1997–2003), the authors conducted a prospective cohort study of 1025 female laboratory technicians and 8037 female teachers (as reference). The laboratory technicians were asked about laboratory work tasks during pregnancy in an interview (at around 16 weeks of gestation). Pregnancy outcomes were obtained by linking the cohort to the national registers. Hazard ratios (HRs) of late fetal loss and diagnosing of congenital malformations were calculated by using Cox regression, and odds ratios (ORs) of preterm birth and small for gestational age were calculated by using logistic regression. Results Overall, there were no significant differences in pregnancy outcomes between laboratory technicians and teachers. However, we found that laboratory technicians working with radioimmunoassay or radiolabelling had an increased risk of preterm birth (OR = 2.2, 95% CI 0.8 to 6.2 for radioimmunoassay, and OR = 1.9, 95% CI 0.8 to 4.6 for radiolabelling) and “major” malformations (HR = 2.1, 95% CI 1.0 to 4.7 for radioimmunoassay, and HR = 1.8, 95% CI 0.9 to 3.7 for radiolabelling). The ORs of preterm birth doubled for women working with these tasks every day or several times a week. When an exposure matrix was applied, an increased risk of “major” malformations for exposure to organic solvents was seen. Conclusions The results did not indicate any high risk of reproductive failures in laboratory technicians in general. Exposure to radioisotopes may carry a high risk of preterm birth and congenital malformations. This finding deserves further investigation. PMID:16361406

  11. Fetal outcomes following emergency department point-of-care ultrasound for vaginal bleeding in early pregnancy

    PubMed Central

    Varner, Catherine; Balaban, Dahlia; Borgundvaag, Bjug; McLeod, Shelley; Carver, Sally

    2016-01-01

    Objective To determine 20- and 40-week fetal outcomes following documentation of fetal cardiac activity (FCA) and intrauterine pregnancy (IUP) in women at less than 20 weeks’ gestation presenting to the emergency department (ED) with vaginal bleeding. Design Prospective observational cohort study. Setting Single-centre tertiary care ED. Participants Pregnant women at less than 20 weeks’ gestation presenting to the ED with vaginal bleeding. Intervention All study participants underwent ED point-of-care ultrasound (POCUS) to document IUP and FCA. Main outcome measures Prevalence of spontaneous abortion or pregnancy loss by 40 weeks’ gestational age following ED POCUS documentation of FCA or IUP in women at less than 20 weeks’ gestation. Results A total of 85 of 111 eligible patients were enrolled; FCA and IUP were detected in 43 (50.6%) and 54 (63.5%) participants, respectively. Participants with documented FCA on ED POCUS were less likely to experience pregnancy loss than participants without documented FCA were (5.0% vs 92.7%; Δ = 87.7%; 95% CI 71.0% to 93.7%), and participants with documented IUP were less likely to experience pregnancy loss than participants without documented IUP were (22.0% vs 93.5%; Δ = 71.5%; 95% CI 52.1% to 81.9%). Compared with radiologist-interpreted ultrasound, ED POCUS had sensitivity of 88.9% (95% CI 75.9% to 96.2%) and specificity of 100.0% (95% CI 89.6% to 100.0%) for documenting FCA, and sensitivity of 96.0% (95% CI 86.3% to 99.4%) and specificity of 93.1% (95% CI 77.2% to 99.0%) for documenting IUP. Conclusion In this cohort of women presenting to the ED with bleeding in the first 20 weeks of pregnancy, detection of IUP and especially FCA using POCUS performed by providers certified by the Canadian Emergency Ultrasound Society was associated with ongoing viable pregnancy at 20 and 40 weeks’ gestational age. These data might be useful for ED physicians counseling women with symptomatic early pregnancies about the chance

  12. DETERMINATION OF MATERNAL SERUM ZINC, IRON, CALCIUM AND MAGNESIUM DURING PREGNANCY IN PREGNANT WOMEN AND UMBILICAL CORD BLOOD AND THEIR ASSOCIATION WITH OUTCOME OF PREGNANCY

    PubMed Central

    Khoushabi, Fahimeh; Shadan, Mohammad Reza; Miri, Ali; Sharifi-Rad, Javad

    2016-01-01

    Background: Trace elements and specially minerals are critical for the development of fetus. Many minerals are transferred to the fetus for fetal stores in the latter part of the pregnancy. It has been shown that various trace elements such as Zinc, Iron, Calcium and Magnesium are metabolically interrelated and there is alteration in their concentration during pregnancy. Beyond pregnancy is associated with increased demand of all the nutrients and deficiency of any of these could affect pregnancy, delivery and outcome of pregnancy. Aim: To study the levels of trace elements namely zinc, iron, magnesium and calcium in maternal and umbilical cord blood and their association with pregnancy outcome. Methods: Sixty pregnant women in Zabol, Iran were selected from those who had registered their names for the prenatal care and who had followed up till the 3rd trimester of pregnancy ending in child birth. Biochemical parameters analyzed with help of the biochemical laboratory. Data were analyzed by SPSS software. Results: The mean biochemical profile such, serum calcium, magnesium, zinc and iron in the pregnant women were as follow: in the 1st trimester 8.3, 1.9, 74.9 and 74.4 µg/dl respectively; in the 2nd trimester 8.5, 1.9, 73.1 and 79.3 µg/dl, respectively; in the 3rd trimester 8.6, 1.9, 68.4, and 82.2 µg/dl, respectively. In the umbilical cord blood, the mean serum calcium, magnesium, zinc and iron were 8.5, 1.9, 84.1, and 89.8 µg/dl, respectively. The mean serum calcium and magnesium during the three trimesters of pregnancy were not significantly different from that in the umbilical cord blood, while the mean serum zinc and iron in the umbilical cord blood were significantly different (p<0.05) in the three trimester of pregnancy. The mean birth weight of neonates was 3.1 kg and 12% of neonates showed low birth weight. Our findings showed that, except magnesium, the profile of other biochemical variables, namely, calcium, zinc and iron in the umbilical cord blood

  13. Working with industry for improved patient outcomes.

    PubMed

    Shorney, Richard

    Various codes of practice, guidelines and protocols exist that support the engagement between health professionals and industry. Of importance is how these engagements can be encouraged to support improved patient outcomes. This article reviews the policies that exist from both the perspective of the health professionals and that of industry within the wound-care market space. Health professionals' engagement with wound-care companies in various guises in practice, including advancement of medical technologies; education development; provision on the safe and effective use of products; and true, practical research and evaluations of products. Joint working initiatives do exist between the NHS and industry that are transparent, mutually beneficial, support patient safety, ensure improved patient experience, and drive clinical effectiveness.

  14. Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology.

    PubMed

    Boyama, Burcu Aydin; Cepni, Ismail; Imamoglu, Metehan; Oncul, Mahmut; Tuten, Abdullah; Yuksel, Mehmet Aytac; Kervancioglu, Mehmet Ertan; Kaleli, Semih; Ocal, Pelin

    2016-01-01

    The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 μmol/l in the non-pregnant group and 3.37 ± 0.92 μmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 μmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

  15. Pregnancy outcomes, infant mortality, and arsenic in drinking water in West Bengal, India.

    PubMed

    von Ehrenstein, O S; Guha Mazumder, D N; Hira-Smith, M; Ghosh, N; Yuan, Y; Windham, G; Ghosh, A; Haque, R; Lahiri, S; Kalman, D; Das, S; Smith, A H

    2006-04-01

    Between 2001 and 2003, the authors studied pregnancy outcomes and infant mortality among 202 married women in West Bengal, India. Reproductive histories were ascertained using structured interviews. Arsenic exposure during each pregnancy, including all water sources used, was assessed; this involved measurements from 409 wells. Odds ratios for spontaneous abortion, stillbirth, neonatal mortality, and infant mortality were estimated with logistic regression based on the method of generalized estimating equations. Exposure to high concentrations of arsenic (> or =200 microg/liter) during pregnancy was associated with a sixfold increased risk of stillbirth after adjustment for potential confounders (odds ratio (OR) = 6.07, 95% confidence interval (CI): 1.54, 24.0; p = 0.01). Arsenic-related skin lesions were found in 12 women who had a substantially increased risk of stillbirth (OR = 13.1, 95% CI: 3.17, 54.0; p = 0.002). The odds ratio for neonatal death was 2.81 (95% CI: 0.73, 10.8). No association was found between arsenic exposure and spontaneous abortion (OR = 1.01, 95% CI: 0.38, 2.70) or overall infant mortality (OR = 1.33, 95% CI: 0.43, 4.04). This study adds to the limited evidence that exposure to high concentrations of arsenic during pregnancy increases the risk of stillbirth. However, there was no indication of the increased rates of spontaneous abortion and overall infant mortality that have been reported in some studies.

  16. Fetal volume measurements with three dimensional ultrasound in the first trimester of pregnancy, related to pregnancy outcome, a prospective cohort study

    PubMed Central

    2012-01-01

    Background First trimester growth restriction is associated with an increased risk of adverse birth outcomes (preterm birth, low birth weight and small for gestational age at birth). The differences between normal and abnormal growth in early pregnancy are small if the fetal size is measured by the crown-rump-length. Three-dimensional ultrasound volume measurements might give more information about fetal development than two-dimensional ultrasound measurements. Detection of the fetus with a small fetal volume might result in earlier detection of high risk pregnancies and a better selection of high risk pregnancies. Methods A prospective cohort study, performed at the Máxima Medical Centre, in Eindhoven-Veldhoven, the Netherlands. During the routine first trimester scan with nuchal translucency measurement 500 fetal volumes will be obtained. The gestational age is based on the first day of the last menstrual period in a regular menstrual cycle and by the crown-rump-length. The acquired datasets are collected and stored on a hard disk for offline processing and volume calculation. The investigator who performs the volume measurements is blinded for the results of the first trimester scan. The manual mode will be used to outline the Region Of Interest, the fetal head and rump, in all cross sections. The fetal volumes are calculated with a rotational step of 9°. First, the relation between fetal volume and gestational age, for a set of participants with normal pregnancies (training set), will be assessed. This model will then be used to determine expected values of fetal volume for a normal pregnancy, which will be referred to as expected normal values. Secondly, for a new set of participants with normal pregnancies and a set of participants with complicated pregnancies (together defined as validation set), the observed fetal volumes (FVobserved) are compared with their expected normal values (FVexpected) and expressed as a percentage of the expected normal value

  17. Changes in the determinants of fertility in Korea: analyses of pregnancy intervals and outcomes.

    PubMed

    Cho, N H; Ahn, N

    1993-07-01

    Korea completed the whole process of what is called the demographic transition to a low fertility and mortality level with the successful implementation of the national family planning program in 1962, and this has been accompanied by rapid socioeconomic development. Most of the fertility decline was due to a rising age at marriage and to lower marital fertility. The national family planning program, combined with the widespread practice of induced abortion, has placed an important role in reducing marital fertility, particularly among older women. This paper aims, therefore, to examine the determinants of fertility and their changes over time in an effort to suggest future population policy directions for Korea. The analysis is divided into 2 parts-estimation of pregnancy intervals by applying the proportional hazards model, and estimation of the determinants of fertility by adopting the logistic regression model to find out whether a pregnancy terminates in a live birth or in an abortion. In both analyses, the sex was included as the main explanatory variable. A woman's education has been shown to have a significant effect on delaying the timing or on the wife's age at first pregnancy, but its effect on the pace of subsequent pregnancies is much smaller and often positive. On the other hand, the woman's education has a consistently positive effect on the probability of a pregnancy ending in an abortion although the effect shows a steady decline over time. Form first parity, the sex composition of previous children stands out consistently as the most important factor in deciding both the pace of pregnancy and its outcome. The pregnancy risks of the women with sons are reduced by almost 50% at the second and third parities. The probability of a pregnancy ending in an abortion also increases substantially when parents already have a son. The decline of the desired family size but the sustained strong son preference has made the sex of children a more important

  18. 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

  19. Factors Associated with Placenta Praevia in Primigravidas and Its Pregnancy Outcome

    PubMed Central

    Nur Azurah, Abdul Ghani; Wan Zainol, Zakaria; Lim, Pei Shan; Shafiee, Mohd Nasir; Kampan, Nirmala; Mohsin, Wan Syahirah; Mokhtar, Norfilza Mohd; Muhammad Yassin, Muhammad Abdul Jamil

    2014-01-01

    Aim. To examine the factors associated with placenta praevia in primigravidas and also compare the pregnancy outcomes between primigravidas and nonprimigravidas. Method. A retrospective cohort study was conducted in women who underwent caesarean section for major placenta praevia in a tertiary university hospital from January 2007 till December 2013. Medical records were reviewed. Result. Among 243 with major placenta praevia, 56 (23.0%) were primigravidas and 187 (77.0%) were nonprimigravidas. Factors associated with placenta praevia in the primigravidas were history of assisted conception (P = 0.02) and history of endometriosis (P = 0.01). For maternal outcomes, the nonprimigravidas required earlier delivery than primigravidas (35.76 ± 2.54 weeks versus 36.52 ± 1.95 weeks, P = 0.03) and had greater blood loss (P = 0.04). A vast majority of the primigravidas had either posterior type II or type III placenta praevia. As for neonatal outcomes, the Apgar score at 1 minute was significantly lower for the nonprimigravidas (7.89 ± 1.72 versus 8.39 ± 1.288.39 ± 1.28, P = 0.02). Conclusion. This study highlighted that endometriosis and assisted conception were highly associated with placenta praevia in primigravida. Understanding the pregnancy outcomes of women with placenta praevia can assist clinicians in identifying patients who are at higher risk of mortality and morbidity. Identifying potential risk factors in primigravida may assist in counseling and management of such patients. PMID:25478587

  20. Pregnancy and childhood health and developmental outcomes with the use of posthumous human sperm.

    PubMed

    Robson, Stephen J; Campbell, Simone; McDonald, Janelle; Tremellen, Kelton; Carlin, Emily; Maybury, Genevieve

    2015-10-01

    Although there is now considerable experience in obtaining sperm from a cadaver, there is little or no published data regarding pregnancy, birth and long-term childhood health and development outcomes when posthumous sperm is used in in vitro fertilisation (IVF). We report the results from treatment of four women undergoing IVF treatment using posthumously acquired human sperm from their deceased partners. In all cases, testicular tissue was obtained in a mortuary setting, and the duration from death to posthumous sperm retrieval ranged from 12 to 48 h. The age of women treated ranged from 31 to 41 years. Fertilization rates ranged from 40 to 100%. Singleton pregnancies were obtained for each of the four women. One pregnancy was complicated by preterm birth at 31 weeks; the other three delivered at term. One baby was growth restricted but morphologically normal; the other children had term birthweights in the normal range. All four children were have shown normal health and developmental outcomes, with the follow-up ranging from 1 to 7 years.

  1. [Impact of chemical and physical environmental factors on the course and outcome of pregnancy].

    PubMed

    Slama, R; Cordier, S

    2013-09-01

    We review the epidemiological literature on the possible impact of chemical and physical factors on pregnancy outcome. Effects of in-utero exposures on child health are not considered here. The highest levels of evidence concern the effects of passive smoking (on fetal growth), of lead (pregnancy-induced hypertension, fetal growth), of some Polychlorinated Biphenyls (PCB; on fetal growth) and, to a lesser extent, of atmospheric pollutants (on fetal growth and preterm delivery). For the other compounds, in particular non-persistent chemicals, the literature, which is generally based on poor exposure assessment, is less informative. In conclusion, the last decades have witnessed the development of mother-child cohorts in which exposure biomarkers have been assayed, allowing a large number of publications. For some persistent compounds, for which efficient exposure assessment approaches have been used, the literature indicates a likely impact on pregnancy outcomes. With the exception of air pollutants, the literature on non-persistent compounds is little conclusive; the assay of exposure biomarkers in repeated biological samples collected at relevant time points could help further increase knowledge regarding any health impact.

  2. Pregnancy and childhood health and developmental outcomes with the use of posthumous human sperm.

    PubMed

    Robson, Stephen J; Campbell, Simone; McDonald, Janelle; Tremellen, Kelton; Carlin, Emily; Maybury, Genevieve

    2015-10-01

    Although there is now considerable experience in obtaining sperm from a cadaver, there is little or no published data regarding pregnancy, birth and long-term childhood health and development outcomes when posthumous sperm is used in in vitro fertilisation (IVF). We report the results from treatment of four women undergoing IVF treatment using posthumously acquired human sperm from their deceased partners. In all cases, testicular tissue was obtained in a mortuary setting, and the duration from death to posthumous sperm retrieval ranged from 12 to 48 h. The age of women treated ranged from 31 to 41 years. Fertilization rates ranged from 40 to 100%. Singleton pregnancies were obtained for each of the four women. One pregnancy was complicated by preterm birth at 31 weeks; the other three delivered at term. One baby was growth restricted but morphologically normal; the other children had term birthweights in the normal range. All four children were have shown normal health and developmental outcomes, with the follow-up ranging from 1 to 7 years. PMID:26384405

  3. Associations of Pregnancy Outcomes and PM2.5 in a National Canadian Study

    PubMed Central

    Stieb, David M.; Chen, Li; Beckerman, Bernardo S.; Jerrett, Michael; Crouse, Daniel L.; Omariba, D. Walter Rasugu; Peters, Paul A.; van Donkelaar, Aaron; Martin, Randall V.; Burnett, Richard T.; Gilbert, Nicolas L.; Tjepkema, Michael; Liu, Shiliang; Dugandzic, Rose M.

    2015-01-01

    Background Numerous studies have examined associations between air pollution and pregnancy outcomes, but most have been restricted to urban populations living near monitors. Objectives We examined the association between pregnancy outcomes and fine particulate matter in a large national study including urban and rural areas. Methods Analyses were based on approximately 3 million singleton live births in Canada between 1999 and 2008. Exposures to PM2.5 (particles of median aerodynamic diameter ≤ 2.5 μm) were assigned by mapping the mother’s postal code to a monthly surface based on a national land use regression model that incorporated observations from fixed-site monitoring stations and satellite-derived estimates of PM2.5. Generalized estimating equations were used to examine the association between PM2.5 and preterm birth (gestational age < 37 weeks), term low birth weight (< 2,500 g), small for gestational age (SGA; < 10th percentile of birth weight for gestational age), and term birth weight, adjusting for individual covariates and neighborhood socioeconomic status (SES). Results In fully adjusted models, a 10-μg/m3 increase in PM2.5 over the entire pregnancy was associated with SGA (odds ratio = 1.04; 95% CI 1.01, 1.07) and reduced term birth weight (–20.5 g; 95% CI –24.7, –16.4). Associations varied across subgroups based on maternal place of birth and period (1999–2003 vs. 2004–2008). Conclusions This study, based on approximately 3 million births across Canada and employing PM2.5 estimates from a national spatiotemporal model, provides further evidence linking PM2.5 and pregnancy outcomes. Citation Stieb DM, Chen L, Beckerman BS, Jerrett M, Crouse DL, Omariba DW, Peters PA, van Donkelaar A, Martin RV, Burnett RT, Gilbert NL, Tjepkema M, Liu S, Dugandzic RM. 2016. Associations of pregnancy outcomes and PM2.5 in a National Canadian Study. Environ Health Perspect 124:243–249; http://dx.doi.org/10.1289/ehp.1408995 PMID:26090691

  4. Pregnancy Outcome in Relation to Treatment of Murine Typhus and Scrub Typhus Infection: A Fever Cohort and a Case Series Analysis

    PubMed Central

    McGready, Rose; Prakash, John Antony Jude; Benjamin, Santosh Joseph; Watthanaworawit, Wanitda; Anantatat, Tippawan; Tanganuchitcharnchai, Ampai; Ling, Clare L.; Tan, Saw Oo; Ashley, Elizabeth A.; Pimanpanarak, Mupawjay; Blacksell, Stuart D.; Day, Nicholas P.; Singhasivanon, Pratap; White, Nicholas J.; Nosten, François; Paris, Daniel H.

    2014-01-01

    Background There is a paucity of published reports on pregnancy outcome following scrub and murine typhus despite these infections being leading causes of undifferentiated fever in Asia. This study aimed to relate pregnancy outcome with treatment of typhus. Methodology/Principal Findings Data were analyzed from: i) pregnant women with a diagnosis of scrub and/or murine typhus from a fever cohort studies; ii) case series of published studies in PubMed using the search terms “scrub typhus” (ST), “murine typhus” (MT), “Orientia tsutsugamushi”, “Rickettsia tsutsugamushi”, “Rickettsia typhi”, “rickettsiae”, “typhus”, or “rickettsiosis”; and “pregnancy”, until February 2014 and iii) an unpublished case series. Fever clearance time (FCT) and pregnancy outcome (miscarriage and delivery) were compared to treatment. Poor neonatal outcome was a composite measure for pregnancies sustained to 28 weeks or more of gestation ending in stillbirth, preterm birth, or delivery of a growth restricted or low birth weight newborn. Results There were 26 women in the fever cohort. MT and ST were clinically indistinguishable apart from two ST patients with eschars. FCTs (median [range] hours) were 25 [16–42] for azithromycin (n = 5), 34 [20–53] for antimalarials (n = 5) and 92 [6–260] for other antibiotics/supportive therapy (n = 16). There were 36.4% (8/22) with a poor neonatal outcome. In 18 years, 97 pregnancies were collated, 82 with known outcomes, including two maternal deaths. Proportions of miscarriage 17.3% (14/81) and poor neonatal outcomes 41.8% (28/67) were high, increasing with longer FCTs (p = 0.050, linear trend). Use of azithromycin was not significantly associated with improved neonatal outcomes (p = 0.610) Conclusion The published ST and MT world literature amounts to less than 100 pregnancies due to under recognition and under diagnosis. Evidence supporting the most commonly used treatment, azithromycin, is

  5. Highlights of Trends in Pregnancies and Pregnancy Rates by Outcome: Estimates for the United States, 1976-96.

    ERIC Educational Resources Information Center

    Ventura, Stephanie J.; Mosher, William D.; Curtin, Sally C.; Abma, Joyce C.; Henshaw, Stanley

    1999-01-01

    This report presents key findings from a comprehensive report on pregnancies and pregnancy rates for U.S. women. The study incorporates birth, abortion, and fetal loss data to compile national estimates of pregnancy rates according to a variety of characteristics, including age, race, Hispanic origin, and marital status. Data from the National…

  6. Zinc supplementation during pregnancy: effects on selected blood constituents and on progress and outcome of pregnancy in low-income women of Mexican descent.

    PubMed

    Hunt, I F; Murphy, N J; Cleaver, A E; Faraji, B; Swendseid, M E; Coulson, A H; Clark, V A; Browdy, B L; Cabalum, T; Smith, J C

    1984-09-01

    The effects of zinc supplementation on levels of various blood constituents and the outcome of pregnancy in 213 Hispanic women attending a prenatal clinic in Los Angeles was assessed in this double-blind study. The women were randomized into either a control (C) or a zinc-supplemented (Z) group and received similar vitamin and mineral supplements except that 20 mg zinc was added to the Z group's capsules. At the final interview, women (C + Z) with low serum Zn levels (less than or equal to 53 micrograms/dl) had higher (p less than 0.01) mean ribonuclease activity and lower (p less than 0.01) mean delta-aminolevulinic acid dehydratase activity than women with acceptable serum zinc levels. The incidence of pregnancy-induced hypertension was higher (p less than 0.003) in the C than in the Z group, but pregnancy-induced hypertension was not associated with low serum zinc levels at either the initial or final interview. The expected increase in serum copper levels was greater (less than 0.001) in women with pregnancy-induced hypertension (C + Z) than in normotensives. Except for pregnancy-induced hypertension, there was a higher incidence of abnormal outcomes of pregnancy in the noncompliers than in the compliers (C + Z). PMID:6475822

  7. The Problem of Confounding in Studies of the Effect of Maternal Drug Use on Pregnancy Outcome

    PubMed Central

    Källén, Bengt

    2012-01-01

    In most epidemilogical studies, the problem of confounding adds to the uncertainty in conclusions drawn. This is also true for studies on the effect of maternal drug use on birth defect risks. This paper describes various types of such confounders and discusses methods to identify and adjust for them. Such confounders can be found in maternal characteristics like age, parity, smoking, use of alcohol, and body mass index, subfertility, and previous pregnancies including previous birth of a malformed child, socioeconomy, race/ethnicity, or country of birth. Confounding by concomitant maternal drug use may occur. A geographical or seasonal confounding can exist. In rare instances, infant sex and multiple birth can appear as confounders. The most difficult problem to solve is often confounding by indication. The problem of confounding is less important for congenital malformations than for many other pregnancy outcomes. PMID:22190949

  8. Complications and pregnancy outcome following uterine compression suture for postpartum haemorrhage: a single centre experience.

    PubMed

    Liu, S; Mathur, M; Tagore, S

    2014-07-01

    In the treatment of postpartum haemorrhage from uterine atony, uterine compression sutures, such as the B-Lynch suture and its modifications have a role with the advantage of preservation of the uterus for fertility. There is however, a risk that apposition of the anterior and posterior walls of the uterus will impede drainage of lochia, resulting in undesirable complications. We undertook a five-year retrospective study of all women who underwent uterine compression sutures at the KK Women's and Children's Hospital, between 2008 and 2012. In total, 23 women had uterine compression sutures during the study period, of which, nineteen women managed to conserve their uterus. Our complication rate was 25%, which included persistent vaginal discharge, pyometra and endometritis. There were three conceptions, with two successful pregnancies. Our study shows uterine compression suture to be a safe and effective alternative to avoid hysterectomy with preservation of fertility at the time of major postpartum haemorrhage. The outcome of subsequent pregnancies is reassuring.

  9. Successful pregnancy outcome in a Korean patient with symptomatic Wilson's disease

    PubMed Central

    Lee, Hyun Joo; Seong, Won Joon; Hong, Seong Yeon

    2015-01-01

    Wilson's disease is an inherited disease of copper metabolism leading to the toxic accumulation of copper, primarily in the liver and brain. Although the literature shows successful outcomes after proper treatment, pregnant patients with Wilson's disease still need close monitoring and management. Here, we report the case of a successful pregnancy in a Korean woman with Wilson's disease. A 33-year-old primigravid patient with Wilson's disease visited our antenatal clinic. Of her own volition, she had stopped her medication 2 years earlier. Oral zinc oxide therapy was started, and she was closely monitored throughout her pregnancy. She delivered a healthy female infant weighing 3.13 kg through a cesarean section. After delivery, the clinical course of both the mother and the baby were uneventful. We review crucial points in the treatment and the management dilemmas raised by the patient. PMID:26430668

  10. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort.

    PubMed

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang; Bonde, Jens Peter; Nøhr, Ellen-Aagaard; Llopis-González, Agustín; Olsen, Jørn

    2009-01-01

    In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working during pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards. PMID:19886351

  11. Successful pregnancy outcome in a Korean patient with symptomatic Wilson's disease.

    PubMed

    Lee, Hyun Joo; Seong, Won Joon; Hong, Seong Yeon; Bae, Jin Young

    2015-09-01

    Wilson's disease is an inherited disease of copper metabolism leading to the toxic accumulation of copper, primarily in the liver and brain. Although the literature shows successful outcomes after proper treatment, pregnant patients with Wilson's disease still need close monitoring and management. Here, we report the case of a successful pregnancy in a Korean woman with Wilson's disease. A 33-year-old primigravid patient with Wilson's disease visited our antenatal clinic. Of her own volition, she had stopped her medication 2 years earlier. Oral zinc oxide therapy was started, and she was closely monitored throughout her pregnancy. She delivered a healthy female infant weighing 3.13 kg through a cesarean section. After delivery, the clinical course of both the mother and the baby were uneventful. We review crucial points in the treatment and the management dilemmas raised by the patient.

  12. Successful pregnancy outcome in a Korean patient with symptomatic Wilson's disease.

    PubMed

    Lee, Hyun Joo; Seong, Won Joon; Hong, Seong Yeon; Bae, Jin Young

    2015-09-01

    Wilson's disease is an inherited disease of copper metabolism leading to the toxic accumulation of copper, primarily in the liver and brain. Although the literature shows successful outcomes after proper treatment, pregnant patients with Wilson's disease still need close monitoring and management. Here, we report the case of a successful pregnancy in a Korean woman with Wilson's disease. A 33-year-old primigravid patient with Wilson's disease visited our antenatal clinic. Of her own volition, she had stopped her medication 2 years earlier. Oral zinc oxide therapy was started, and she was closely monitored throughout her pregnancy. She delivered a healthy female infant weighing 3.13 kg through a cesarean section. After delivery, the clinical course of both the mother and the baby were uneventful. We review crucial points in the treatment and the management dilemmas raised by the patient. PMID:26430668

  13. Pregnancy outcome in women with müllerian duct anomalies.

    PubMed

    Stein, A L; March, C M

    1990-04-01

    The outcomes of 186 pregnancies in 150 women with müllerian duct anomalies who delivered over an eight-year period were analyzed. The average birth weight was 2,919 g. Eighty-three percent of the deliveries were by cesarean section; malpresentation was the indication for 80% of those deliveries. The incidences of breech presentation and transverse lie were 61% and 11%, respectively. Delivery of preterm infants occurred in 25% of the pregnancies, and 12% were small for their gestational age. There were two sets of twins. A history of a previous preterm infant, recurrent abortion or a second-trimester loss was given by 13%, 9% and 59% of the patients, respectively. Of patients examined for renal anomalies, 11% had a defect, usually unilateral renal agenesis.

  14. Hydrogeologic assessment of exposure to solvent-contaminated drinking water: Pregnancy outcomes in relation to exposure

    SciTech Connect

    Wrensch, M.; Swan, S.; Murphy, P.J.; Lipscomb, J.; Claxton, K.; Epstein, D.; Neutra, R. )

    1990-07-01

    We recently concluded that exposure to solvent-contaminated drinking water was an unlikely explanation for observed excesses of adverse pregnancy outcomes during 1980-1981 in the Los Paseos neighborhood of Santa Clara County, California, because these excesses were not observed in an adjacent exposed area. The validity of this conclusion depends on the assumption that the two areas had comparable exposure. Using quantitative methods to model movement of the solvent leak plume and water flow within the distribution system, we estimated that women with adverse outcomes were no more likely to have received contaminated water than women with normal live births. These results strengthen the conclusion that exposures to water from the contaminated well were not responsible for the excess of adverse outcomes observed in the Los Paseos area.

  15. Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors

    PubMed Central

    Sieving, Renee E.; McRee, Annie-Laurie; McMorris, Barbara J.; Beckman, Kara J.; Pettingell, Sandra L.; Bearinger, Linda H.; Garwick, Ann W.; Oliphant, Jennifer A.; Plowman, Shari; Resnick, Michael D.; Secor-Turner, Molly

    2015-01-01

    Importance Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. Objective To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. Design Randomized controlled trial. Setting Community and school-based primary care clinics. Participants Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. Intervention Offered during an 18-month period, Prime Time includes case management and youth leadership programs. Main Outcome Measures Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. Results At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. Conclusions and Relevance This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth. PMID:23440337

  16. Complications and fetal outcome in diabetic pregnancy. Intensified conventional versus insulin pump therapy.

    PubMed

    Burkart, W; Hanker, J P; Schneider, H P

    1988-01-01

    From 1978 to 1986 a total of 189 pregnant diabetic women gave birth at our hospital. In this randomized prospective study the influence of maternal diabetes treatment in normoglycemic patients, continuous subcutaneous insulin infusion (n = 48) versus intensified conventional treatment (n = 41), is evaluated. These two groups of patients are further compared to patients (n = 28) who underwent conventional diabetes treatment during pregnancy. It can be shown from our data that the rate of complications such as preeclampsia, intrauterine growth retardation, premature labor and premature delivery can be reduced by intensified conventional and insulin pump treatment as compared to conventionally treated patients with late onset of pregnancy care. As expected, in the groups of CSII and ICT patients no difference in the rate of pregnancy complications nor in fetal outcome could be demonstrated. Among CSII pregnancies 12/48 were complicated, in the ICT population the respective figure was 13/41 (CT: 20/28). The mean gestational age at the time of delivery ranged between 38 and 40 weeks, depending on the severity of maternal diabetes. CT patients were delivered earlier in all White classes. Fetal morbidity was nearly equal in CSII and ICT children, in CT patients it was greatly enhanced. Also the mortality (perinatal and neonatal) was considerably larger in CT patients (6/28), again, in the CSII and ICT population the mortality was nearly identical (2/48 and 3/41). We conclude, from our prospective information, that insulin pump therapy during pregnancy is indicated if intensified conventional treatment does not lead to normoglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Endometrial thickness as a predictor of pregnancy outcomes in 10787 fresh IVF-ICSI cycles.

    PubMed

    Yuan, Xi; Saravelos, Sotirios H; Wang, Qiong; Xu, Yanwen; Li, Tin-Chiu; Zhou, Canquan

    2016-08-01

    This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1: < 8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3: > 11 and ≤15 mm; Group 4: > 15 mm) demonstrated significant differences (P < 0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P < 0.001), live birth (OR = 1.078; P < 0.001), spontaneous abortion (OR = 0.948; P < 0.001), and ectopic pregnancy (OR = 0.851; P < 0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion.

  18. Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring.

    PubMed

    Alwan, Nisreen A; Hamamy, Hanan

    2015-06-01

    Iron is an essential micronutrient and is important not only in carrying oxygen but also to the catalytic activity of a variety of enzymes. In the fetus, it is vital to the synthesis of hemoglobin and in brain development. Iron deficiency (ID) anemia in pregnancy is a common problem, even in high-income country settings. Around 50% of pregnant women worldwide are anemic, with at least half of this burden due to ID. Iron supplements are widely recommended and used during pregnancy globally. However, the evidence on the extent of benefit they contribute to the offspring's health is not well established, and their routine use has its side effects and drawbacks. Dietary iron intake is difficult to assess accurately and it is unlikely to be sufficient to meet the demands of pregnancy if women start with inadequate body iron stores at conception. Evidence from experimental animal models suggests that maternal ID during pregnancy is associated with fetal growth restriction, as well as offspring obesity and high blood pressure later in life. The possible biological mechanisms for this observed association may be due to ID-induced changes in placental structure and function, enzyme expression, nutrient absorption, and fetal organ development. However, such evidence is limited in human studies. Prenatal ID in experimental animal models also adversely affected the developing brain structures, neurotransmitter systems, and myelination resulting in acute brain dysfunction during the period of deficiency and persistence of various postnatal neurobehavioral abnormalities as well as persistent dysregulation of some genes into adult life after iron repletion pointing to the possibility of gene expression changes. The evidence from human population studies is limited and heterogeneous and more research is needed in the future, investigating the effects of ID in pregnancy on future offspring health outcomes. PMID:27617121

  19. Two Pregnancies with a Different Outcome in a Patient with Alport Syndrome

    PubMed Central

    Kitanovska, Biljana Gerasimovska; Gerasimovska, Vesna; Livrinova, Vesna

    2016-01-01

    BACKGROUND: Alport syndrome is a genetic disease that progresses to chronic kidney failure, with X-linked, autosomal dominant or autosomal recessive type of inheritance. Women are generally carriers of the mutation and have a milder form of the disease. During pregnancy, they have an increased risk of impaired kidney function and preeclampsia. CASE PRESENTATION: A 27-year old woman, gravida 1, para 0, in her 23rd gestational week came to the outpatient unit of the University Clinic of Nephrology for the first time because of slowly progressing proteinuria and Alport syndrome. She was admitted to the gynaecological ward in her 29th gw for proteinuria which increased from 3.8 g/day up to 20 g/day and the serum creatinine increased to 120- 150 micromol/l. She was delivered in the 30th gestational week due to obstetrical indications with a cesarian section and delivered a baby with a birth weight of 880 g. After delivery, proteinuria decreased to 2 g/d within 2 months and an angiotensin-converting enzyme inhibitor (ACEI) was started. Her second pregnancy, after 2 years, had an uneventful course and she delivered a healthy baby weighing 3000 g in the 39th week. Six months after the second delivery, her renal function remained normal and her proteinuria was 2 g/d. CONCLUSIONS: Pre-pregnancy counselling and frequent controls during pregnancy are necessary for women with Alport syndrome, as well as regular monitoring after delivery. Recent reports are more in favour of good pregnancy and nephrological outcomes in women with Alport syndrome when renal disease is not advanced.

  20. [Physical exertion at work and the course and outcome of pregnancy].

    PubMed

    Makowiec-Dabrowska, T; Siedlecka, J

    1996-01-01

    The authors present the latest data on the effect of physical load on pregnancy course and outcome, and they indicate that such as load may become a risk factor for preterm birth and low birth weight. The probability of pregnancy complications induced by great physical load is related to physiological changes occurring in the female body during pregnancy. Observations made in regard to physical load related with sport or recreation activities confirm such a likelihood. In the literature on the effect of occupation-related physical load on pregnancy course and outcome, the following factors are emphasised: intensity of physical activity (work), work pace, handling heavy objects, body position during work performance, time spent in standing position, and daily or weekly distribution of working time. The study results indicate evidently negative effect of occupation-related physical load only in the case low living standards experienced by pregnant women. The results of the studies carried out in Poland showed that high occupation burden is an independent risk factor or preterm birth and hypotrophia. Therefore, according to current regulations concerning job restrictions for pregnant women only light work and standing position limited to three hours during shift are permissible, whereas forced body position and forced work pace (e.g. at production belt) are forbidden. In the discussion, the authors compare the legal regulations binding in our country with the European Union's legislation on the protection of pregnant women against harmful factors occurring in the work environment. Attention is also turned to the need for bringing our legal regulations closer to solutions adopted by the European Union, especially in the case of lack of jobs in a given enterprise which could be performed by pregnant women.

  1. Lifestyle, nutrient intake, iron status, and pregnancy outcome in pregnant women of advanced maternal age.

    PubMed

    Bae, Hyun Sook

    2011-02-01

    The purpose of this study was to investigate how advanced maternal age influences lifestyle, nutrient intake, iron status, and pregnancy outcomes in pregnant women. The subjects of this study were 112 pregnant women who were receiving prenatal care at gynecologists located in Seoul. The subjects were divided into two groups according to their ages: those over age 35 were the advanced age group of pregnant women (AP) and those under age 35 were the young age group of pregnant women (YP). General factors, nutrient intakes, iron status, and pregnancy outcomes of the two groups were then compared. It was found that 72.5% of the YP group and 51.2% of the AP group had pre-pregnancy alcohol drinking experience; indicating that the YP group had more pre-pregnancy alcohol consumption than the AP group (P < 0.05). The only difference found in nutrient intake between the two groups was their niacin intakes which were 16.83 ± 8.20 mg/day and 13.76 ± 5.28 mg/day, respectively. When gestational age was shorter than 38.7 weeks, the average infant birth weight was 2.95 ± 0.08 kg, and when gestational age was longer than 40 weeks, it averaged at about 3.42 ± 0.08 kg. In other words, as gestational age increased, infant birth weight increased (P < 0.0001), and when maternal weight increased more than 15 kg, the infant birth weight increased significantly (P < 0.05). In conclusion, in order to secure healthy human resources, with respect to advanced aged women, it is necessary to intervene by promoting daily habits that consist of strategic increases in folate and calcium intake along with appropriate amounts of exercise.

  2. 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 ...

  3. Twin pregnancy diagnosis in Holstein cows: discriminatory powers and accuracy of diagnosis by transrectal palpation and outcome of twin pregnancies.

    PubMed Central

    Day, J D; Weaver, L D; Franti, C E

    1995-01-01

    The objective of this prospective cohort study was to determine the sensitivity, specificity, accuracy, and predictive value of twin pregnancy diagnosis by rectal palpation and to examine fetal survival, culling rates, and gestational lengths of cows diagnosed with twins. In this prospective study, 5309 cows on 14 farms in California were followed from pregnancy diagnosis to subsequent abortion or calving. The average sensitivity, specificity, accuracy, and predictive value of twin pregnancy diagnosis were 49.3%, 99.4%, 96.0%, and 86.1%, respectively. The abortion rate for single pregnancies of 12.0% differed significantly from those for bicornual twin pregnancies and unicornual twin pregnancies of 26.2% and 32.4%, respectively (P < 0.05). The early calf mortality between cows calving with singles (3.2%) and twins (15.7%) were significantly different (P < 0.005). The difference in fetal survival between single pregnancies and all twin pregnancies resulted in 0.42 and 0.29 viable heifers per pregnancy, respectively. The average gestation for single, bicornual, and unicornual pregnancies that did not abort before drying-off was 278, 272, and 270 days, respectively. Results of this study show that there is an increased fetal wastage associated with twin pregnancies and suggest a need for further research exploring management strategies for cows carrying twins. PMID:7728734

  4. [Intraoperative neurophysiological monitoring improves outcome in neurosurgery].

    PubMed

    Sarnthein, J; Krayenbühl, N; Actor, B; Bozinov, O; Bernays, R

    2012-01-18

    Intraoperative Neurophysiological Mo-nitoring (IONM) identifies eloquent areas or nerves fibers during neurosurgical interventions and monitors their function. For several interventions IONM has become mandatory in neurosurgery. IONM increases patient safety during surgery as the risk of neurological deficits is reduced. Safer surgery reduces the time needed for the intervention and thereby reduces risk. IONM contributes to complete resection of tumors, which in turn prolongs patients' survival. Complicated surgical interventions associated with an elevated risk of neurological deficits have only become possible due to IONM. IONM comprises a variety of procedures that are selected for a particular intervention. With appropriate selection of the procedures IONM has been shown to improve neurological and functional outcome after neurosurgical interventions. PMID:22252591

  5. Spectrum of Maternofetal Outcomes during Dengue Infection in Pregnancy: An Insight.

    PubMed

    Sharma, Swati; Jain, Sandhya; Rajaram, Shalini

    2016-01-01

    Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed. Out of sixteen women diagnosed with dengue fever, three had dengue shock syndrome (DSS) and eight had dengue haemorrhagic fever (DHF). The most common obstetric complication seen in 43% of the cases was oligohydramnios. Bleeding manifestations occurred in seven women and there were three maternal deaths. Perinatal complications included three intrauterine deaths, six nursery admissions, and one neonatal death. Thus dengue infection was associated with high maternal and perinatal mortality. In view of poor obstetric outcomes, this viral infection warrants early admission and prompt management.

  6. Circulating Influenza Virus and Adverse Pregnancy Outcomes: A Time-Series Study.

    PubMed

    Fell, Deshayne B; Buckeridge, David L; Platt, Robert W; Kaufman, Jay S; Basso, Olga; Wilson, Kumanan

    2016-08-01

    Individual-level epidemiologic studies of pregnancy outcomes after maternal influenza are limited in number and quality and have produced inconsistent results. We used a time-series design to investigate whether fluctuation in influenza virus circulation was associated with short-term variation in population-level rates of preterm birth, stillbirth, and perinatal death in Ontario between 2003 and 2012. Using Poisson regression, we assessed the association between weekly levels of circulating influenza virus and counts of outcomes offset by the number of at-risk gestations during 3 gestational exposure windows. The rate of preterm birth was not associated with circulating influenza level in the week preceding birth (adjusted rate ratio = 1.01, 95% confidence interval: 1.00, 1.02) or in any other exposure window. These findings were robust to alternate specifications of the model and adjustment for potential confounding. Stillbirth and perinatal death rates were similarly not associated with gestational exposure to influenza circulation during late pregnancy. We could not assess mortality outcomes relative to early gestational exposure because of missing dates of conception for many stillbirths. In this time-series study, population-level influenza circulation was not associated with short-term variation in rates of preterm birth, stillbirth, or perinatal death. PMID:27449415

  7. Spectrum of Maternofetal Outcomes during Dengue Infection in Pregnancy: An Insight.

    PubMed

    Sharma, Swati; Jain, Sandhya; Rajaram, Shalini

    2016-01-01

    Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed. Out of sixteen women diagnosed with dengue fever, three had dengue shock syndrome (DSS) and eight had dengue haemorrhagic fever (DHF). The most common obstetric complication seen in 43% of the cases was oligohydramnios. Bleeding manifestations occurred in seven women and there were three maternal deaths. Perinatal complications included three intrauterine deaths, six nursery admissions, and one neonatal death. Thus dengue infection was associated with high maternal and perinatal mortality. In view of poor obstetric outcomes, this viral infection warrants early admission and prompt management. PMID:27069349

  8. Fetal and neonatal outcomes in women reporting ingestion of licorice (Glycyrrhiza uralensis) during pregnancy.

    PubMed

    Choi, June-Seek; Han, Jung-Yeol; Ahn, Hyun-Kyong; Ryu, Hyun-Mee; Kim, Moon-Young; Chung, Jin-Hoon; Nava-Ocampo, Alejandro A; Koren, Gideon

    2013-01-01

    Maternal intake of licorice from dietary sources has been associated with adverse maternal and fetal outcomes. We prospectively studied the outcome of 185 singleton pregnancies who took over-the-counter or naturopathic formulations containing licorice during their pregnancy, and 370 age-matched singleton pregnant controls that were not exposed to any potential teratogen. The indication in 56.8% of the women taking licorice was for cough and cold control, with the maximum dose of 2104 mg/day and exposure occurring between the 4th day and 25th week of gestation. The rate of stillbirths was marginally higher among women who took licorice than those who did not (OR = 7.9; 95% CI 0.9-71.5; p = 0.048), and significantly higher when compared to the general population in the Republic of Korea (OR = 13.3; 95% CI 4.9-35.8; p < 0.001). Other fetal outcomes assessed in the study were similar between the two study groups, e.g., the OR of major malformations was 3.9 (95% CI 0.4-43.5; p = 0.27). In conclusion, the present study suggests that licorice is not a major teratogen. However, whether licorice may increase the risk of stillbirths requires careful consideration in further studies with a larger sample size.

  9. Investigating outcomes following the use of selective serotonin reuptake inhibitors for treating depression in pregnancy: a focus on methodological issues.

    PubMed

    Grzeskowiak, Luke E; Gilbert, Andrew L; Morrison, Janna L

    2011-11-01

    The aim of this review was to critically appraise the existing literature with a particular focus on identifying methodological issues associated with studying outcomes following the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Existing studies evaluating outcomes following prenatal SSRI exposure suffer from a number of important methodological limitations that should be taken into account when interpreting their results. The contradictory results obtained from prospective and retrospective cohort studies and case-control studies could be accounted for by dissimilarity between study populations, selection bias, detection bias, confounding, or differences in underlying maternal illness, data sources used, exposure classification, follow-up and statistical power/analysis. Only a small number of studies actually account for underlying maternal illness and how this may lead to adverse pregnancy outcomes. Even when such information is available, studies that include data on maternal illness have small sample sizes, limiting the statistical power to identify statistically and clinically relevant associations. Pregnancy outcomes may be confounded by the higher incidence of smoking, alcohol consumption and substance abuse frequently encountered amongst those suffering from depression, factors that are often insufficiently controlled for. While evidence of associations between prenatal SSRI exposure and adverse pregnancy outcomes are conflicting, there is an urgent need to evaluate how the particular SSRI used, the dose, timing and duration of use, genetics (maternal, paternal and/or fetal), concomitant medication use, maternal characteristics and underlying maternal illness all interact to alter pregnancy outcomes.

  10. Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy

    PubMed Central

    Seitz, Christoph; Hertler, Stephanie; Gawlik, Stephanie; Fluhr, Herbert; Gausepohl, Hans-Jürgen; Sohn, Christof; Pöschl, Johannes; Maul, Holger

    2015-01-01

    Objective Emergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants. Study Design Retrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38), ultrasound-indicated (UIC, n = 29) and emergency/ physical examination-indicated (PEIC, n = 33) cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max), neonatal complications (ROP, IVH)). Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group. Results Neonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max) and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2). Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM) after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM. Conclusions In our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver. PMID:26121653

  11. The Role of Cervical Cerclage in Pregnancy Outcome in Women with Uterine Anomaly

    PubMed Central

    Yassaee, Fakhrolmolouk; Mostafaee, Leila

    2011-01-01

    Background Congenital uterine malformations are the result of disturbances in mullerian duct development. In patients with recurrent miscarriage, the reported frequency of uterine anomalies varies widely, from 1.8% to 37.6%. There are reports in which cervical cerclage has been shown to prevent preterm labor in uterine anomalies. The aim of this study was to compare the role of cervical cerclage in the pregnancy outcome of women with uterine anomaly. Methods In this historical cohort study, 40 pregnant women with uterine anomaly were investigated for outcomes of pregnancy in regards to preterm and term deliveries. The participants were divided into two groups: the case group included 26 women with uterine anomaly for whom cervical cerclage was done and the control group was composed of 14 women with uterine anomaly in whom cervical cerclage was not performed. Comparison between the two groups was done and the data were analyzed by the use of chi square, Fisher's exact test and t-test with SPSS software (version 11) and p <0.05 was considered significant. Results In patients with bicornuate uterus and cervical cerclage, term delivery occurred in 76.2% and preterm delivery in 23.8%. In patients with bicornuate uterus and without cervical cerclage, term delivery occurred in 27.3% and preterm delivery in 72.7% (p <0.05). In patients with arcuate uterus and cervical cerclage, term and preterm deliveries were equal (50% vs. 50%), but in patients with arcuate uterus and without cervical cerclage, term and preterm deliveries occurred in 66.6% and 33.3% of the participants, respectively. Conclusion Cervical cerclage is an effective procedure in bicornuate uterus for the prevention of preterm deliveries but it has no effect on the outcome of pregnancy in arcuate uterus. PMID:23926514

  12. The Association of Neighborhood Social Capital and Ethnic (Minority) Density with Pregnancy Outcomes in the Netherlands

    PubMed Central

    Schölmerich, Vera L. N.; Erdem, Özcan; Borsboom, Gerard; Ghorashi, Halleh; Groenewegen, Peter; Steegers, Eric A. P.; Kawachi, Ichiro; Denktaş, Semiha

    2014-01-01

    Background Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, ‘Western’ women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital – measured as informal socializing and social connections between neighbors – as well as ethnic (minority) density. Methods Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000–2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. Results We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99). Conclusions Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but

  13. Ambient Air Pollution and Pregnancy Outcomes: A Review of the Literature

    PubMed Central

    Šrám, Radim J.; Binková, Blanka; Dejmek, Jan; Bobak, Martin

    2005-01-01

    Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes. PMID:15811825

  14. Can Probiotics Improve Your Surgical Outcomes?

    PubMed

    Ward, Tina; Nichols, Misty; Nutter, Julie

    2016-01-01

    Despite ongoing advances in medical technology, postoperative infections and infectious complications continue to be a significant cause of morbidity and mortality. Surgical trauma and prophylactic antibiotics disrupt the balance of the intestinal microbiota and barrier function of the gut, potentiating an enhanced inflammatory response and further immune system depression. With the increasing costs of health care and emergence of multidrug-resistant bacteria, alternative approaches must be explored. Many clinical studies have demonstrated that the use of probiotics, prebiotics, or a combination of both (synbiotics) as a part of innovative strategies can improve outcomes of elective abdominal and gastrointestinal surgical procedures. It has been demonstrated that probiotics play a role in gut barrier improvement and immunomodulation. However, it is evident that additional research is needed including larger, multicenter, randomized controlled trials to validate the safety and efficacy of their use in surgical patients. The purpose of this article is to discuss background of probiotic use in abdominal/gastrointestinal surgery, risk and benefits, clinical relevance for health care providers, and further implications for research. PMID:27254237

  15. Diet around conception and during pregnancy--effects on fetal and neonatal outcomes.

    PubMed

    Kind, Karen L; Moore, Vivienne M; Davies, Michael J

    2006-05-01

    Substrate supply to the fetus is a major regulator of prenatal growth. Maternal nutrition influences the availability of nutrients for transfer to the fetus. Animal experiments demonstrate that restriction of maternal protein or energy intake can retard fetal growth. Effects of maternal nutrition vary with the type and timing of the restriction and the species studied. Maternal undernutrition before conception and/or in early pregnancy can alter fetal physiology in late gestation, and influence postnatal function, often without measurable effects on birth size. In contrast, to date, observational and intervention studies in humans provide limited support for a major role of maternal nutrition in determining birth size, except where women are quite malnourished. However, recent studies report associations between newborn size and the balance of macronutrients in women's diets in Western settings. Associations between maternal dietary composition and adult blood pressure of the offspring are also reported in human populations. Most studies in women have focused on dietary content or supplementation during mid-late pregnancy. Further investigation of how maternal dietary composition, before conception and throughout pregnancy, affects fetal physiology and health of the baby will increase the understanding of how maternal diet and nutritional status influence fetal, neonatal and longer-term outcomes.

  16. Cultural factors affecting diet and pregnancy outcome of Mexican American adolescents.

    PubMed

    Gutierrez, Y M

    1999-09-01

    A study was conducted to describe the cultural beliefs, nutrition knowledge, food intake, and attitudes about weight gain of Mexican American adolescents, and their relationship to pregnancy weight gain and infant's birth weight. A convenience sample of 46 pregnant adolescents, who were self-identified Mexican American primigravidas aged 13-18 years, were recruited from 6 San Francisco Bay Area and San Jose clinic sites. Data were collected over an 18-month period from Winter 1994 to Spring 1995. Results showed that acculturation affected nutritional knowledge, attitudes about weight gain during pregnancy, and the psychosocial and educational level of pregnant Mexican American adolescents. There were no differences in the quality of diet and pregnancy outcomes, gestational weeks at delivery, or birth weight among acculturated, versus the nonacculturated adolescents. Both benefited from cultural protective factors related to their dependence on the family for emotional, economic, and social support. Nutrition recommendations should emphasize the importance of maintaining traditional food habits and nutritive value information of American foods.

  17. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes.

    PubMed

    Lapillonne, Alexandre

    2010-01-01

    Over the past decade, new evidence has shown that vitamin D deficiency may contribute to the risk of developing a wide range of common chronic diseases that are different from the classic action on calcium and bone homeostasis. Acting through the vitamin D receptor, vitamin D can produce a wide array of favorable biological effects via genomic, non-genomic or intracrine mechanisms and, therefore, contributes to the improvement of human health in humans. We hypothesize that some of these effects may be even more critical during pregnancy. The focus of this paper is to review the data on the classic and non-classic actions of vitamin D with regards to pregnancy. It appears that vitamin D insufficiency during pregnancy is potentially associated with increased risk of preeclampsia, insulin resistance and gestational diabetes mellitus. Furthermore, experimental data also anticipate that vitamin D sufficiency is critical for fetal development, and especially for fetal brain development and immunological functions. Vitamin D deficiency during pregnancy may, therefore, not only impair maternal skeletal preservation and fetal skeletal formation but also be vital to the fetal "imprinting" that may affect chronic disease susceptibility soon after birth as well as later in life. PMID:19692182

  18. Role of Tumor Necrosis Factor-α and Natural Killer Cells in Uterine Artery Function and Pregnancy Outcome in the Stroke-Prone Spontaneously Hypertensive Rat

    PubMed Central

    Nosalski, Ryszard; Morgan, Hannah; Beattie, Elisabeth; Guzik, Tomasz J.; Graham, Delyth; Delles, Christian

    2016-01-01

    Women with chronic hypertension are at increased risk of maternal and fetal morbidity and mortality. We have previously characterized the stroke-prone spontaneously hypertensive rat (SHRSP) as a model of deficient uterine artery function and adverse pregnancy outcome compared with the control Wistar–Kyoto. The activation of the immune system plays a role in hypertension and adverse pregnancy outcome. Therefore, we investigated the role of tumor necrosis factor-α in the SHRSP phenotype in an intervention study using etanercept (0.8 mg/kg SC) at gestational days 0, 6, 12, and 18 in pregnant SHRSP compared with vehicle-treated controls (n=6). Etanercept treatment significantly lowered systolic blood pressure after gestational day 12 and increased litter size in SHRSP. At gestational day 18, etanercept improved the function of uterine arteries from pregnant SHRSP normalizing the contractile response and increasing endothelium-dependent relaxation, resulting in increased pregnancy-dependent diastolic blood flow in the uterine arteries. We identified that the source of excess tumor necrosis factor-α in the SHRSP was a pregnancy-dependent increase in peripheral and placental CD3– CD161+ natural killer cells. Etanercept treatment also had effects on placental CD161+ cells by reducing the expression of CD161 receptor, which was associated with a decrease in cytotoxic granzyme B expression. Etanercept treatment improves maternal blood pressure, pregnancy outcome, and uterine artery function in SHRSP by antagonizing signaling from excess tumor necrosis factor-α production and the reduction of granzyme B expression in CD161+ natural killer cells in SHRSP. PMID:27733586

  19. Racial Differences in Birth Outcomes: The Role of General, Pregnancy, and Racism Stress

    PubMed Central

    Dominguez, Tyan Parker; Dunkel-Schetter, Christine; Glynn, Laura M.; Hobel, Calvin; Sandman, Curt A.

    2010-01-01

    Objective This study examined the role of psychosocial stress in racial differences in birth outcomes. Design Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. Main Outcome Measures The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. Results Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. Conclusions These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. PMID:18377138

  20. Associations between Maternal Antioxidant Intakes in Pregnancy and Infant Allergic Outcomes

    PubMed Central

    West, Christina E.; Dunstan, Janet; McCarthy, Suzi; Metcalfe, Jessica; D’Vaz, Nina; Meldrum, Suzanne; Oddy, Wendy H.; Tulic, Meri K.; Prescott, Susan L.

    2012-01-01

    Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease. We investigated associations between maternal intakes of β-carotene, vitamin C, vitamin E, copper and zinc, and infant allergic outcomes. Antioxidant intakes of pregnant women (n = 420) assessed prospectively by a food frequency questionnaire, were examined in relation to allergic outcomes at 1 year of age (n = 300). The main relationships with allergic outcomes were seen with dietary vitamin C and copper. Specifically, higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze. After adjustment for potential confounders the relationship with wheeze remained statistically significant. There was also an inverse linear relationship between vitamin C and food allergy. Higher dietary copper intake was associated with reduced risk of eczema, wheeze and any allergic disease. The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis, and there was also an inverse linear relationship between copper and food allergy. However, these relationships were only seen for nutrients present in food. There were no relationships between β-carotene, vitamin E or zinc and any allergic outcomes. In summary, this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze, and that copper intake is associated with reduced risk of several allergic outcomes. PMID:23201845

  1. Using AMLO to Improve the Quality of Teacher Education Outcomes

    ERIC Educational Resources Information Center

    Al-Shammari, Zaid

    2012-01-01

    This study aims to find ways to improve learning outcomes in teacher education courses by using an Analysis Model for Learning Outcomes (AMLO). It addresses the improvement of the quality of teacher education by analyzing learning outcomes and implementing curriculum modifications related to specific learning objectives and their effects on…

  2. Novel FSH receptor mutation in a case of spontaneous ovarian hyperstimulation syndrome with successful pregnancy outcome

    PubMed Central

    Chauhan, Anahita R.; Prasad, Madhva; Chamariya, Sumit; Achrekar, Swati; Mahale, Smita D.; Mittal, Kartik

    2015-01-01

    The objective is to study the FSH receptor (FSHR) for mutations in a case of spontaneous ovarian hyperstimulation syndrome (sOHSS). This is a single case study and it examined patient who presented with spontaneous critical OHSS in early pregnancy and had successful good obstetric outcome. Intervention of this study was analysis of blood for genetic analysis of FSHR postdelivery. The main outcome measure noted was FSHR mutation. The study resulted in a novel, here though unreported, heterozygous mutation in FSHR gene at nucleotide position 1346 (AC1346T to AAT) in exon 10 yielding a threonine to asparagine (Thr449Asn) substitution in the transmembrane domain helix 3 of the FSHR. To conclude FSHR gene analysis can add to our understanding of sOHSS. PMID:26752859

  3. Novel FSH receptor mutation in a case of spontaneous ovarian hyperstimulation syndrome with successful pregnancy outcome.

    PubMed

    Chauhan, Anahita R; Prasad, Madhva; Chamariya, Sumit; Achrekar, Swati; Mahale, Smita D; Mittal, Kartik

    2015-01-01

    The objective is to study the FSH receptor (FSHR) for mutations in a case of spontaneous ovarian hyperstimulation syndrome (sOHSS). This is a single case study and it examined patient who presented with spontaneous critical OHSS in early pregnancy and had successful good obstetric outcome. Intervention of this study was analysis of blood for genetic analysis of FSHR postdelivery. The main outcome measure noted was FSHR mutation. The study resulted in a novel, here though unreported, heterozygous mutation in FSHR gene at nucleotide position 1346 (AC(1346)T to AAT) in exon 10 yielding a threonine to asparagine (Thr(449)Asn) substitution in the transmembrane domain helix 3 of the FSHR. To conclude FSHR gene analysis can add to our understanding of sOHSS. PMID:26752859

  4. Safety of Tenofovir Use During Pregnancy: Early Growth Outcomes in HIV-Exposed Uninfected Infants

    PubMed Central

    SIBERRY, George K.; WILLIAMS, Paige L.; MENDEZ, Hermann; SEAGE, George R.; JACOBSON, Denise L.; HAZRA, Rohan; RICH, Kenneth C.; GRINER, Raymond; TASSIOPOULOS, Katherine; KACANEK, Deborah; MOFENSON, Lynne M.; MILLER, Tracie; DiMEGLIO, Linda A.; WATTS, D. Heather

    2012-01-01

    Objective To evaluate the association of tenofovir disoproxil fumarate (TDF) use during pregnancy with early growth parameters in HIV-exposed, uninfected (HEU) infants. Design US-based prospective cohort study of HEU children to examine potential adverse effects of prenatal TDF exposure. Methods We evaluated the association of maternal TDF use during pregnancy with small for gestational age (SGA); low birth weight (LBW, <2.5kg); weight-for-age z-scores (WAZ), length-forage z-scores (LAZ) and head circumference-for-age (HCAZ) z-scores at newborn visit; and LAZ, HCAZ, and WAZ at age one year. Logistic regression models for LBW and SGA were fit, adjusting for maternal and sociodemographic factors. Adjusted linear regression models were used to evaluate LAZ, WAZ and HCAZ by TDF exposure. Results Of 2029 enrolled children with maternal antiretroviral information, TDF was used by 449 (21%) HIV-infected mothers, increasing from 14% in 2003 to 43% in 2010. There was no difference between those exposed to combination regimens with versus without TDF for SGA, LBW, and newborn LAZ and HCAZ. However, at age one year, infants exposed to combination regimens with TDF had significantly lower adjusted mean LAZ and HCAZ than those without TDF (LAZ: −0.17 vs. −0.03, p=0.04; HCAZ: 0.17 vs. 0.42, p=0.02). Conclusions TDF use during pregnancy was not associated with increased risk for LBW or SGA. The slightly lower mean LAZ and HCAZ observed at age one year in TDF-exposed infants are of uncertain significance but underscore the need for additional studies of growth outcomes after TDF use during pregnancy. PMID:22382151

  5. Health Characteristics and Outcomes of Two Randomized Vitamin D Supplementation Trials during Pregnancy: A Combined Analysis

    PubMed Central

    Wagner, Carol L; McNeil, Rebecca B; Johnson, Donna D; Hulsey, Thomas C; Ebeling, Myla; Robinson, Christopher; Hamilton, Stuart A; Hollis, Bruce W

    2015-01-01

    Objective To assess the safety and health effects of vitamin D supplementation during pregnancy. Methods and Design Datasets from two randomized clinical trials were first analyzed separately then combined for this analysis using a common data dictionary. In the NICHD trial, women were randomized to 400, 2000, or 4000 IU vitamin D3/day, stratified by race. In the Thrasher Research Fund trial, participants were randomized to 2000 or 4000 IU vitamin D3/day. Study drugs were from the same manufacturing lot for both trials. Identical questionnaires were given for comparable sociodemographics & clinical characteristics. Outcome measures were: (1) maternal and neonatal 25(OH)D achieved, and (2) maternal comorbidities of pregnancy (COP). SAS 9.3 was used for all analyses. Results In the combined cohort, there were 110 controls, 201 in the 2000 IU group, and 193 in the 4000 IU group. No differences between groups in baseline 25(OH)D were found; however, delivery and cord blood values were greater in the 4000 IU group (p<0.0001), an effect that persisted even after controlling for race and study. A greater percent were vitamin D replete in the 4000 IU group (p<0.0001). There was a trend where the 4000 IU group had decreased rates of comorbidities of pregnancy. There was a strong association between COP and final maternal 25(OH)D; an effect that persisted even after controlling for race and study (p=0.006). Conclusions Supplementation with 4000 IU/day was associated with lower risk of hypovitaminosis D than Control and 2000 IU groups. While not statistically significant, there was a trend toward lower rates of COP as supplementation dose increased. Maternal delivery 25(OH)D was inversely associated with any comorbidity of pregnancy, with fewer events as 25(OH)D increased. Future studies are needed to confirm these findings and determine the mechanisms of action of such effects. PMID:23314242

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

    PubMed Central

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

    2010-01-01

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

  7. Pregnancy Outcome After I-131 Therapy for Patients With Thyroid Cancer

    PubMed Central

    Ko, Kuan-Yin; Yen, Ruoh-Fang; Lin, Cheng-Li; Cheng, Mei-Fang; Huang, Wen-Sheng; Kao, Chia-Hung

    2016-01-01

    Abstract The aim of this study was to evaluate the influence of I-131 therapy on pregnancy outcome in patients that received therapeutic I-131 doses for thyroid cancer in Taiwan. This nationwide population-based cohort study was based on data from 1998 to 2010 obtained from the Taiwanese National Health Insurance Research Database. We identified 11,708 women with thyroid cancer (≥15 and ≤50 years of age) by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients were divided into 2 cohorts: I-131 therapy cohort and non-I-131 therapy cohort. The mean follow-up period was 6.08 years for the I-131 cohort and 6.87 years for the non-I-131 cohort. The case cohort and the control cohort comprised 775 and 716 pregnant patients, respectively. The overall incidence of pregnancy was significantly lower in the I-131 cohort (adjusted HR = 0.77, 95% CI = 0.70–0.86) and it was also observed when the patients were stratified according to age (HR = 0.73, 95% CI = 0.64–0.83 in 25–34 years; HR = 0.63, 95% CI = 0.49–0.82 in 35–44 years). Patients in the I-131 cohort had a lower successful delivery rate, particularly among patients in 25 to 34 years (OR = 0.60, 95% CI = 0.45–0.80). No significant difference was observed for adverse pregnancy conditions between 2 cohorts. I-131 therapy is associated with decreased pregnancy and successful delivery rates. The underlying mechanism likely involves physician recommendation, patient's psychological issue, and potential impact of I-131 treatment on reproductive health. Further investigation is needed. PMID:26844507

  8. Sexual Dimorphism in Adverse Pregnancy Outcomes - A Retrospective Australian Population Study 1981-2011

    PubMed Central

    Verburg, Petra E.; Tucker, Graeme; Scheil, Wendy; Erwich, Jan Jaap H. M.; Dekker, Gus A.; Roberts, Claire Trelford

    2016-01-01

    Objectives Sexual inequality starts in utero. The contribution of biological sex to the developmental origins of health and disease is increasingly recognized. The aim of this study was to assess and interpret sexual dimorphisms for three major adverse pregnancy outcomes which affect the health of the neonate, child and potentially adult. Methods Retrospective population-based study of 574,358 South Australian singleton live births during 1981–2011. The incidence of three major adverse pregnancy outcomes [preterm birth (PTB), pregnancy induced hypertensive disorders (PIHD) and gestational diabetes mellitus (GDM)] in relation to fetal sex was compared according to traditional and fetus-at-risk (FAR) approaches. Results The traditional approach showed male predominance for PTB [20–24 weeks: Relative Risk (RR) M/F 1.351, 95%-CI 1.274–1.445], spontaneous PTB [25–29 weeks: RR M/F 1.118, 95%-CI 1.044–1.197%], GDM [RR M/F 1.042, 95%-CI 1.011–1.074], overall PIHD [RR M/F 1.053, 95%-CI 1.034–1.072] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044–1.105]. The FAR approach showed that males were at increased risk for PTB [20–24 weeks: RR M/F 1.273, 95%-CI 1.087–1.490], for spontaneous PTB [25–29 weeks: RR M/F 1.269, 95%-CI 1.143–1.410] and PIHD with term birth [RR M/F 1.074, 95%-CI 1.044–1.105%]. The traditional approach demonstrated female predominance for iatrogenic PTB [25–29 weeks: RR M/F 0.857, 95%-CI 0.780–0.941] and PIHD associated with PTB [25–29 weeks: RR M/F 0.686, 95%-CI 0.581–0.811]. The FAR approach showed that females were at increased risk for PIHD with PTB [25–29 weeks: RR M/F 0.779, 95%-CI 0.648–0.937]. Conclusions This study confirms the presence of sexual dimorphisms and presents a coherent framework based on two analytical approaches to assess and interpret the sexual dimorphisms for major adverse pregnancy outcomes. The mechanisms by which these occur remain elusive, but sex differences in placental gene

  9. Decidual Cox2 inhibition improves fetal and maternal outcomes in a preeclampsia-like mouse model

    PubMed Central

    Sones, Jenny L.; Cha, Jeeyeon; Woods, Ashley K.; Bartos, Amanda; Heyward, Christa Y.; Lob, Heinrich E.; Isroff, Catherine E.; Butler, Scott D.; Shapiro, Stephanie E.; Dey, Sudhansu K.; Davisson, Robin L.

    2016-01-01

    Preeclampsia (PE) is a disorder of pregnancy that manifests as late gestational maternal hypertension and proteinuria and can be life-threatening to both the mother and baby. It is believed that abnormal placentation is responsible for the cascade of events leading to the maternal syndrome. Embryo implantation is critical to establishing a healthy pregnancy. Defective implantation can cause adverse “ripple effects,” leading to abnormal decidualization and placentation, retarded fetal development, and poor pregnancy outcomes, such as PE and fetal growth restriction. The precise mechanism(s) of implantation defects that lead to PE remain elusive. BPH/5 mice, which spontaneously develop the cardinal features of PE, show peri-implantation defects including upregulation of Cox2 and IL-15 at the maternal-fetal interface. This was associated with decreased decidual natural killer (dNK) cells, which have important roles in establishing placental perfusion. Interestingly, a single administration of a Cox2 inhibitor (celecoxib) during decidualization restrained Cox2 and IL-15 expression, restored dNK cell numbers, improved fetal growth, and attenuated late gestational hypertension in BPH/5 female mice. This study provides evidence that decidual overexpression of Cox2 and IL-15 may trigger the adverse pregnancy outcomes reflected in the preeclamptic syndrome, underscoring the idea that Cox2 inhibitor treatment is an effective strategy for the prevention of PE-associated fetal and maternal morbidity and mortality. PMID:27159542

  10. Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study

    PubMed Central

    Liddiard, Andrea; Bhattacharya, Sohinee; Crichton, Lena

    2011-01-01

    Objectives To look retrospectively at patients undergoing elective, ultrasound indicated and rescue cervical cerclage, examine the immediate pregnancy outcomes and compare them. Design This was a retrospective observational study using the maternity and neonatal databank to identify patients having cervical cerclage between 1985 and 2009 inclusive. Data extracted included patient demographics, gestation of suture insertion, gestation at delivery, mode of delivery and initial pregnancy outcome. Further information on selected patients having cerclages over 16 weeks gestation was collected from case-notes. Setting Aberdeen Maternity Hospital, North East Scotland. Participants All patients having cervical cerclage between 1985 and 2009. Main outcome measures Gestation at delivery, live birth rate and birth weight. Results A total of 177 sutures were inserted – 116 electively and 61 as an emergency procedure. Time trends of cervical cerclage revealed a bimodal distribution and in the last four years there has been a general increase in the number of emergency sutures while the number of elective cerclages has remained relatively constant. There was little difference in the gestation at delivery between the elective and emergency cerclage groups (35 and 33 weeks, respectively), live birth rate (93% and 92%, respectively) and the difference in mean birth weight did not reach statistical significance. Case-notes were obtained for 25 patients undergoing ultrasound indicated cerclage and nine patients undergoing rescue cerclage. There was a higher suture associated complication rate in the rescue cerclage group (33% vs. 12% in the ultrasound indicated cerclage group) and the mean gestation of delivery was lower (26 weeks vs. 32 weeks). The birth weight was significantly lower and the neonatal death rate higher in the rescue cerclage group. Conclusions Elective and ultrasound indicated cervical cerclage appear to have low complication rates and high live birth rates

  11. [The influence of chemical and physical factors in the work environment on the amount of risk for abnormal pregnancy outcome].

    PubMed

    Makowiec-Dabrowska, T; Radwan-Włodarczyk, Z; Koszada-Włodarczyk, W; Siedlecka, J; Wilczyński, J

    1997-01-01

    The authors present a review of the literature on adverse effects of chemical and physical factors in the work environment on the course and outcome of pregnancy together with the results of their own study. The objective of the study was to identify the magnitude and frequency of exposures to chemical and physical factors at workposts where pregnant women were employed and to asses to what extent the existing exposure increased the risk for complications in pregnancy outcome The study involved the collection of information on factors with potential adverse effect on the course and outcome of pregnancy in employed women who were hospitalised in the Polish Mother Memorial Hospital in Lódź during the years 1992-94. The study was carried out in the group of 526 women with abnormal pregnancy outcome (N), including preterm birth (PB)--256; low birth weight < 2500 g (LBW)--232; small for gestational age (SGA)--196; asphyxia (APG)--116; and congenital malformations (M)--71. The control group (C) was composed of 683 women. As the reports on the work environment indicated working conditions in the group of women with abnormal pregnancy outcome were worse than in the control group; the presence of potentially harmful factors in the work environment were reported 57% of women in group N and 51.2% of women in group C. The increase in the risk of abnormal pregnancy outcome was relatively law (OR = 1.26). Taken into account the duration of exposure to these factors (period of employment under conditions of exposure to physical and/or chemical factors) it was revealed that pregnancy is at risk if women continue to work under such work conditions by the end of the second trimester. In this group of women odd ratio for abnormal pregnancy outcome accounted for 1.80 and it was statistically significant. The employment in the period preceding pregnancy and during the first trimester enhanced the risk insignificantly. A similar situation was observed if the risk of abnormal pregnancy

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

    PubMed

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

    2011-02-01

    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.

  13. A comparative study of pregnancy outcome in teenage girls and mature women.

    PubMed

    Thame, M; Wilks, R; Matadial, L; Forrester, T E

    1999-06-01

    The objective was to compare the pregnancy outcome of teenage girls and mature women. The design was a retrospective study of births from January to December 1990, based on the antenatal clinic and the labour ward, University Hospital of the West Indies, Jamaica. Teenage mothers, 13 to 19 years old, and a control group of mothers, 22 to 23 years old, were selected from the records of 2,394 live, singleton births between 200 and 305 days' gestation. The main outcome measures were birth weight, crown heel length, head circumference, head circumference:length ratio, ponderal index and placental weight. The results showed that in the teenage group, weight, body mass index at booking, haemoglobin concentration in each trimester, and minimum haemoglobin level during pregnancy were lower than in the control group. Systolic blood pressure in the first and the second trimesters was lower than in controls, but there was no significant difference in the third trimester nor in the delivery systolic blood pressure. Babies of teenage mothers had lower birth weights and smaller head circumferences than the babies of the control group, but there was no significant difference between the groups in crown heel length, ponderal index, head circumference:length ratio, and placental weight. These data support the hypothesis that teenaged girls are not physically mature and, as a consequence, their offspring have lower birth weights and smaller head circumferences. PMID:10492605

  14. Pregnancy outcomes with a primary complaint of perception of reduced fetal movements.

    PubMed

    Nor Azlin, M I; Maisarah, A S; Rahana, A R; Shafiee, M Nasir; Aqmar Suraya, S; Abdul Karim, A K; Jamil, M A

    2015-01-01

    Reduced fetal movement is a worrisome common complaint, not only for mothers but also for the attending medical personnel. The aim of this study was to analyse the pregnancy outcomes of women who presented primarily with reduced fetal movements (RFM). A retrospective study was performed based on patients' perception alone. Obstetric, past medical history, current presentation and outcomes of pregnancy were analysed. A total of 230 case notes were reviewed, with the majority being primigravidae. Less than half (48.7%) of the women had spontaneous labour, 45.7% had induction and 5.6% had elective caesarean section. There were no maternal complications in 97.4% (n = 224) of them. About 0.9% (n = 2) and 1.7% (n = 4) had primary postpartum haemorrhage and extended perineal tear, respectively. Although there was no major neonatal mortality and morbidity, until a randomised trial with a significant sample is conducted in the management of RFM, careful selections for elective delivery or conservative management would prevent untoward complications.

  15. Centrifugation Effects on Estrous Cycling, Mating Success and Pregnancy Outcome in Rats

    NASA Technical Reports Server (NTRS)

    Ronca, April E.; Rushing, Linda S.; Tou, Janet; Wade, Charles E.; Baer, Lisa A.

    2005-01-01

    We analyzed the effects of 2-g centrifugation on estrous cycling, mating success and pregnancy outcome in rats. Sexually mature female and male rats were assigned to either 2-g centrifuge or non-centrifuge conditions, and to non-breeding or breeding conditions. In non-breeding females, estrous cycles were analyzed by examining vaginal cytology before and for 35 days during centrifugation. Breeding females were time-mated following 7 days of adaptation to centrifugation. Following adaptation to centrifugation, estrous cycle duration over a five-cycle period was similar in centrifuged and non-centrifuged females. Identical numbers of centrifuged and non-centrifuged females conceived, however centrifuged females took four-times longer than controls to achieve conception. Births occurred at the normal gestational length. Pup birth weight and postnatal survival were p<0.05 reduced in centrifuged as compared to non-centrifuged groups. In conclusion, 2-g centrifugation had no effect on estrous cycle length or the probably of becoming pregnant but delayed conception and diminished pregnancy outcome.

  16. Comparison of maternal and fetal outcomes of IVF and spontaneously conceived twin pregnancies: three year experience of a tertiary hospital

    PubMed Central

    Göçmen, Ahmet; Güven, Şirin; Bağci, Simge; Çekmez, Yasemin; Şanlıkan, Fatih

    2015-01-01

    Objectives: The aim of this study was to compare maternal and fetal outcomes of spontaneously conceived and in-vitro fertilization (IVF) twin pregnancies that were admitted to our obstetric clinic and delivered between January 1, 2011 to November 1, 2014. Material method: A total of 84 twin pregnancies were enrolled for the study and divided into two groups: group 1 as IVF (n = 19) and group 2 as spontaneously conceived (n = 65) twin pregnancies. Data of neonatal various morbidities needs neonatal intensive care unit (NICU) such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity (ROP), and intraventricular hemorrhage (IVH) and maternal morbidities such as preeclampsia, eclampsia, postpartum bleeding, gestational diabetes mellitus(GDM) were collected by hospital records. Results: There were no statistical difference between two groups regarding hypertension related to pregnancy, intrauterine growth retardation, Apgar scores, NICU needs, birth weight and height (P > 0.05). The rate of premature rupture of membranes, maternal age, antenatal anemia and premature birth were detected higher in IVF group when compared with the other group (P < 0.05). Conclusion: Although twin pregnancies, regardless of conception method are high risk pregnancies in terms of obstetric and perinatal outcomes, premature rupture of membranes, maternal age, antenatal anemia and premature birth risks are higher in IVF twin pregnancies. PMID:26131238

  17. Severe bacterial endophthalmitis: towards improving clinical outcomes

    PubMed Central

    Novosad, Billy D; Callegan, Michelle C

    2011-01-01

    Endophthalmitis is an infection and inflammation of the interior of the eye that can result in significant vision loss. This infection occurs as a result of the seeding of organisms into the interior of the eye following surgery (postoperative), trauma (post-traumatic) or an infection in another site in the body (endogenous). The general rate of endophthalmitis has remained steady over the past several years. However, the increased use of intraocular injections to treat various degenerative and inflammatory ocular diseases, in addition to the already large and growing number of invasive ocular surgeries, may increase the opportunities in which organisms can gain access to the eye. In most cases of endophthalmitis, useful vision can be retained if proper treatment is instituted. However, in severe cases of bacterial endophthalmitis, blindness often occurs despite treatment. This article summarizes information on endophthalmitis epidemiology, treatment issues and current regimens, and recent experimental and clinical efforts to improve the outcome of severe and blinding forms of bacterial endophthalmitis. PMID:21572565

  18. Motivational tools to improve probationer treatment outcomes

    PubMed Central

    Taxman, Faye S.; Walters, Scott T.; Sloas, Lincoln B.; Lerch, Jennifer; Rodriguez, Mayra

    2015-01-01

    Background Motivational interviewing (MI) is a promising practice to increase motivation, treatment retention, and reducing recidivism among offender populations. Computer-delivered interventions have grown in popularity as a way to change behaviors associated with drug and alcohol use. Methods/Design Motivational Assistance Program to Initiate Treatment (MAPIT) is a three arm, multisite, randomized controlled trial, which examines the impact of Motivational Interviewing (MI), a Motivational Computer Program (MC), and Supervision as Usual (SAU) on addiction treatment initiation, engagement, and retention. Secondary outcomes include drug/alcohol use, probation progress, recidivism (i.e., criminal behavior) and HIV/AIDS testing and treatment among probationers. Participant characteristics are measured at baseline, 2, and 6 months after assignment. The entire study will include 600 offenders, with each site recruiting 300 offenders (Baltimore City, Maryland and Dallas, Texas). All participants will go through standard intake procedures for probation and participate in probation requirements as usual. After standard intake, participants will be recruited and screened for eligibility. Discussion The results of this clinical trial will fill a gap in knowledge about ways to motivate probationers to participate in addiction treatment and HIV care. This randomized clinical trial is innovative in the way it examines the use of in-person vs. technological approaches to improve probationer success. Trial Registration NCT01891656 PMID:26009023

  19. Do microfractures improve high tibial osteotomy outcome?

    PubMed

    Pascale, Walter; Luraghi, Simone; Perico, Laura; Pascale, Valerio

    2011-07-01

    The aim of this study was to determine if microfractures improve the outcome of high tibial osteotomy in patients with medial compartmental osteoarthritis in genu varum. Forty patients presenting with Outerbridge grade III and IV chondropathies on the femoral and/or the tibial joint surface underwent high tibial osteotomy with Puddu plates (Arthrex, Inc, Naples, Florida) for primary medial compartment osteoarthritis in genu varum at our institution. Patients were randomly assigned to either the high tibial osteotomy plus microfractures group (A; n=20) or the high tibial osteotomy alone group (B; n=20). Final assessment was conducted 5 years postoperatively, including clinical response measured by the International Knee Documentation Committee (IKDC), Lysholm score, and patient satisfaction score. All patients were blinded to the treatment received and followed the same rehabilitation protocol. A statistically significant improvement between pre- and postoperative values was observed for Lysholm and IKDC scores in both groups, without any statistically significant difference between them. Regarding the satisfaction score, there were no differences between the 2 groups in terms of preoperative self-assessment (P>.05), whereas postoperative subjective satisfaction at 5-year follow-up was significantly higher in group A than in group B (P=.0036).Our study results provide further evidence that medial tibial osteotomy is an effective surgical option for treating a varus knee associated with medial degenerative arthritis in patients wishing to continue accustomed levels of physical activity. In particular, patient satisfaction was higher among those who underwent the combined treatment involving high tibial osteotomy to correct femorotibial angle and microfractures. PMID:21717984

  20. Pregnancy

    MedlinePlus

    ... also be tired and need more rest. Your body will change as your baby grows during the nine months of your pregnancy. Don't hesitate to call your health care provider if you think you have a problem or something is bothering or worrying you.

  1. Improving Outcomes for Workers with Mental Retardation

    ERIC Educational Resources Information Center

    Fornes, Sandra; Rocco, Tonette S.; Rosenberg, Howard

    2008-01-01

    This research presents an analysis of factors predicting job retention, job satisfaction, and job performance of workers with mental retardation. The findings highlight self-determination as a critical skill in predicting the three important employee outcomes. The study examined a hypothesized job retention model and the outcome of the three…

  2. Inflammatory Mediators and Glucose in Pregnancy: Results from a Subset of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study

    PubMed Central

    Lowe, Lynn P.; Metzger, Boyd E.; Lowe, William L.; Dyer, Alan R.; McDade, Thomas W.; McIntyre, H. David

    2010-01-01

    Context: Inflammatory mediators are associated with type 2 and gestational diabetes. It is unknown whether there are associations with glucose in pregnant women with lesser degrees of hyperglycemia. Objective: The objective of the study was to examine associations of inflammatory mediators with maternal glucose levels and neonatal size in a subset of participants in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Design: Eligible pregnant women underwent a 75-g oral glucose tolerance test between 24 and 32 wk gestation, and levels of C-peptide, adiponectin, plasminogen activator inhibitor type 1 (PAI-1), C-reactive protein (CRP), and resistin were measured in fasting serum samples. Associations of inflammatory mediators with maternal glucose and with birth size were assessed using multiple linear regression analyses, adjusting for maternal body mass index (BMI), fasting C-peptide, and other potential confounders. Results: Mean levels of adiponectin declined, and PAI-1 and CRP increased across increasing levels of maternal glucose, BMI, and C-peptide. For example, for fasting plasma glucose less than 75 mg/dl and fasting plasma glucose of 90 mg/dl or greater, adiponectin was 22.5 and 17.4 μg/ml and PAI-1 was 30.9 and 34.2 ng/ml, respectively. Associations with 1- and 2-h plasma glucose remained significant for adiponectin (P < 0.001), PAI-1 (P < 0.05), and CRP (P < 0.01) after adjustment for BMI and C-peptide. Adiponectin and CRP were inversely associated with birth weight, sum of skinfolds and percent body fat, and PAI-1 with sum of skinfolds (all P < 0.05) after adjustment for confounders. Resistin was not associated with 1- or 2-h glucose or birth size. Conclusion: Levels of inflammatory mediators are associated with levels of maternal glucose in pregnant women without overt diabetes. PMID:20843942

  3. Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus

    PubMed Central

    Floss, K.; Garcia-Rocha, G.-J.; Kundu, S.; von Kaisenberg, C. S.; Hillemanns, P.; Schippert, C.

    2015-01-01

    Introduction: Besides the typical complaints and symptoms, myomas can cause sterility, infertility and complications during pregnancy. Laparoscopic interventions reach their limits with regard to organ preservation and the simultaneous desire to have children in the removal of multiple and larger intramural myoma nodes. The aim of this study is to examine fertility status and pregnancy outcome after myoma removal by minilaparotomy (skin incision maximal 8 cm) in women with pronounced uterus myomatosus. Materials and Methods: This retrospective study makes use of the data from 160 patients with an average age of 34.6 years. Factors analysed include number, size and localisation of the myomas, complaints due to the myoma, pre- and postoperative gravidity, mode of delivery, and complications of birth. Results: Indications for organ-sparing myoma enucleation were the desire to have children (72.5 %), bleeding disorders (60 %) and pressure discomfort (36.5 %). On average 4.95 (SD ± 0.41), maximally 46 myomas were removed. The largest myoma had a diameter of 6.64 cm (SD ± 2.74). 82.5 % of the patients had transmural myomas, in 17.5 % the uterine cavity was inadvertently opened. On average the operating time was 163 minutes (SD ± 45.47), the blood loss 1.59 g/dL (SD ± 0.955). 60.3 % of the patients with the desire to have children became pregnant postoperatively. 75.3 % of the pregnancies were on average carried through to the 38th week (28.4 % vaginal deliveries, 71.6 % Caesarean sections). In the postoperative period there was one case of uterine rupture in the vicinity of a previous scar. Discussion: By means of the microsurgical “mini-laparotomy” even extensive myomatous uterine changes can, in the majority of cases, be operated in an organ-sparing manner with retention of the ability to conceive and to carry a pregnancy through to maturity of the infant. The risk for a postoperative uterine rupture in a subsequent pregnancy and

  4. Functional dysphonia: strategies to improve patient outcomes

    PubMed Central

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  5. Paternal therapy with disease modifying drugs in multiple sclerosis and pregnancy outcomes: a prospective observational multicentric study

    PubMed Central

    2014-01-01

    Background Most of Multiple Sclerosis (MS) patients undergo disease modifying drug (DMD) therapy at childbearing age. The objective of this prospective, collaborative study, was to assess outcomes of pregnancies fathered by MS patients undergoing DMD. Methods Structured interviews on pregnancies fathered by MS patients gathered in the Italian Pregnancy Dataset were collected; pregnancies were divided according to father exposure or unexposure to DMD at time of procreation. Treatment were compared with multivariable logistic and linear models. Results Seventy-eight pregnancies fathered by MS patients were tracked. Forty-five patients were taking DMD at time of conception (39 beta-interferons, 6 glatiramer acetate), while 33 pregnancies were unexposed to DMD. Seventy-five pregnancies ended in live-births, 44 in the exposed and 31 in the unexposed group. No significant differences between the two groups were found in the risk of spontaneous abortion or malformations (p > 0.454), mean gestational age (p = 0.513), frequency of cesarean delivery (p = 0.644), birth weight (p = 0.821) and birth length (p = 0.649). In comparison with data of the Italian general population, the proportion of spontaneous abortion and caesarean delivery in exposed pregnancies fell within the estimates, while the proportion of pre-term delivery in the exposed group was higher than expected. Conclusions Our data indicate no association between paternal DMD exposure at time of conception and risk of spontaneous abortion, adverse fetal outcomes and congenital malformations. Further studies clarifying the role of DMD fathers intake prior and during pregnancy are desirable, to supply guidelines for clinical practice. PMID:24884599

  6. Intimate Partner Violence During Pregnancy and Adverse Neonatal Outcomes in Low-Income Women

    PubMed Central

    Bullock, Linda; Sharps, Phyllis; Schminkey, Donna; Comstock, Emily; Campbell, Jacquelyn

    2014-01-01

    Abstract Background: Intimate partner violence (IPV) affects an estimated 1.5 million U.S. women annually. IPV impacts maternal and neonatal health with higher rates of depression and low birth weight (LBW). Less studied is experiencing IPV and delivering a small for gestational age (SGA) baby. SGA neonates are at increased risk of developmental and behavioral problems. The negative sequelae persist into adulthood with increased rates of diabetes mellitus and coronary heart disease. Methods: In a sample of 239 pregnant women experiencing IPV, in urban and rural settings, we examined cross-sectional associations of severity of IPV and neonatal outcomes (i.e., birth weight and gestational age). Severity of IPV was measured by the Conflict Tactics Scale 2 and neonatal outcomes were collected at the time of delivery. Results: Outcomes were collected on 194 neonates; 14.9% (n=29) were classified as LBW, 19.1% (n=37) classified as SGA, and 9.8% (n=19) as LBW and SGA. Women reporting higher severity of IPV during pregnancy had a greater likelihood of delivering an SGA neonate (odds ratio [OR] 4.81; 95% confidence interval [95% CI] 1.86–12.47), and LBW neonate (OR 4.20; 95% CI 1.46–12.10). Conclusions: In a sample of pregnant women experiencing perinatal IPV, women experiencing greater severities of IPV were more likely to deliver a neonate with an adverse outcome. Early recognition and intervention of IPV is essential to reduce disparities in birth outcomes and long-term health outcomes for these neonates. PMID:25290007

  7. Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women2

    PubMed Central

    Mehta, Saurabh; Manji, Karim P; Young, Alicia M; Brown, Elizabeth R; Chasela, Charles; Taha, Taha E; Read, Jennifer S; Goldenberg, Robert L; Fawzi, Wafaie W

    2008-01-01

    Background Poor nutrition may be associated with mother-to-child transmission (MTCT) of HIV and other adverse pregnancy outcomes. Objective The objective was to examine the relation of nutritional indicators with adverse pregnancy outcomes among HIV-infected women in Tanzania, Zambia, and Malawi. Design Body mass index (BMI; in kg/m2) and hemoglobin concentrations at enrollment and weight change during pregnancy were prospectively related to fetal loss, neonatal death, low birth weight, preterm birth, and MTCT of HIV. Results In a multivariate analysis, having a BMI < 21.8 was significantly associated with preterm birth [odds ratio (OR): 1.82; 95% CI: 1.34, 2.46] and low birth weight (OR: 2.09; 95% CI: 1.41, 3.08). A U-shaped relation between weight change during pregnancy and preterm birth was observed. Severe anemia was significantly associated with fetal loss or stillbirth (OR: 3.67; 95% CI: 1.16, 11.66), preterm birth (OR: 2.08; 95% CI: 1.39, 3.10), low birth weight (OR: 1.76; 95% CI: 1.07, 2.90), and MTCT of HIV by the time of birth (OR: 2.26; 95% CI: 1.18, 4.34) and by 4−6 wk among those negative at birth (OR: 2.33; 95% CI: 1.15, 4.73). Conclusions Anemia, poor weight gain during pregnancy, and low BMI in HIV-infected pregnant women are associated with increased risks of adverse infant outcomes and MTCT of HIV. Interventions that reduce the risk of wasting or anemia during pregnancy should be evaluated to determine their possible effect on the incidence of adverse pregnancy outcomes and MTCT of HIV. PMID:18541551

  8. Zinc supplementation during pregnancy in low-income teenagers of Mexican descent: effects on selected blood constituents and on progress and outcome of pregnancy.

    PubMed

    Hunt, I F; Murphy, N J; Cleaver, A E; Faraji, B; Swendseid, M E; Browdy, B L; Coulson, A H; Clark, V A; Settlage, R H; Smith, J C

    1985-11-01

    As a follow-up of our study of pregnant women, we report effects of zinc supplementation during pregnancy in another population of 138 Hispanic teenagers in Los Angeles. Teenagers were randomized (double-blind) to a control or zinc-supplemented group and received similar daily vitamin and mineral supplements except for 20 mg zinc added to the zinc-supplemented group's capsules. Initially, mean dietary zinc intakes of both groups were about 50% of the Recommended Dietary Allowance and their mean serum zinc levels did not differ significantly (69.8 +/- 11.2 micrograms/dl in control and 69.0 +/- 11.4 micrograms/dl in zinc-supplemented group). Zinc supplementation did not maintain mean serum zinc levels during pregnancy but, as in our earlier study, it reduced (p = 0.018) the number of low serum zinc values (less than or equal to 53 micrograms/dl) in late pregnancy. Zinc supplementation did not affect outcome of pregnancy but serum zinc levels were lower (p = 0.038) in teenagers with pregnancy-induced hypertension than in normotensives. PMID:4061343

  9. Can prebiotics and probiotics improve therapeutic outcomes for undernourished individuals?

    PubMed Central

    Sheridan, Paul O; Bindels, Laure B; Saulnier, Delphine M; Reid, Gregor; Nova, Esther; Holmgren, Kerstin; O'Toole, Paul W; Bunn, James; Delzenne, Nathalie; Scott, Karen P

    2014-01-01

    It has become clear in recent years that the human intestinal microbiota plays an important role in maintaining health and thus is an attractive target for clinical interventions. Scientists and clinicians have become increasingly interested in assessing the ability of probiotics and prebiotics to enhance the nutritional status of malnourished children, pregnant women, the elderly, and individuals with non-communicable disease-associated malnutrition. A workshop was held by the International Scientific Association for Probiotics and Prebiotics (ISAPP), drawing on the knowledge of experts from industry, medicine, and academia, with the objective to assess the status of our understanding of the link between the microbiome and under-nutrition, specifically in relation to probiotic and prebiotic treatments for under-nourished individuals. These discussions led to four recommendations:   (1) The categories of malnourished individuals need to be differentiated To improve treatment outcomes, subjects should first be categorized based on the cause of malnutrition, additional health-concerns, differences in the gut microbiota, and sociological considerations. (2) Define a baseline “healthy” gut microbiota for each category Altered nutrient requirement (for example, in pregnancy and old age) and individual variation may change what constitutes a healthy gut microbiota for the individual. (3) Perform studies using model systems to test the effectiveness of potential probiotics and prebiotics against these specific categories These should illustrate how certain microbiota profiles can be altered, as members of different categories may respond differently to the same treatment. (4) Perform robust well-designed human studies with probiotics and/or prebiotics, with appropriate, defined primary outcomes and sample size These are critical to show efficacy and understand responder and non-responder outcomes. It is hoped that these recommendations will lead to new approaches

  10. Can prebiotics and probiotics improve therapeutic outcomes for undernourished individuals?

    PubMed

    Sheridan, Paul O; Bindels, Laure B; Saulnier, Delphine M; Reid, Gregor; Nova, Esther; Holmgren, Kerstin; O'Toole, Paul W; Bunn, James; Delzenne, Nathalie; Scott, Karen P

    2014-01-01

    It has become clear in recent years that the human intestinal microbiota plays an important role in maintaining health and thus is an attractive target for clinical interventions. Scientists and clinicians have become increasingly interested in assessing the ability of probiotics and prebiotics to enhance the nutritional status of malnourished children, pregnant women, the elderly, and individuals with non-communicable disease-associated malnutrition. A workshop was held by the International Scientific Association for Probiotics and Prebiotics (ISAPP), drawing on the knowledge of experts from industry, medicine, and academia, with the objective to assess the status of our understanding of the link between the microbiome and under-nutrition, specifically in relation to probiotic and prebiotic treatments for under-nourished individuals. These discussions led to four recommendations:   (1) The categories of malnourished individuals need to be differentiated To improve treatment outcomes, subjects should first be categorized based on the cause of malnutrition, additional health-concerns, differences in the gut microbiota, and sociological considerations. (2) Define a baseline "healthy" gut microbiota for each category Altered nutrient requirement (for example, in pregnancy and old age) and individual variation may change what constitutes a healthy gut microbiota for the individual. (3) Perform studies using model systems to test the effectiveness of potential probiotics and prebiotics against these specific categories These should illustrate how certain microbiota profiles can be altered, as members of different categories may respond differently to the same treatment. (4) Perform robust well-designed human studies with probiotics and/or prebiotics, with appropriate, defined primary outcomes and sample size These are critical to show efficacy and understand responder and non-responder outcomes. It is hoped that these recommendations will lead to new approaches that

  11. Empirical data about women's attitudes toward a biobank focused on pregnancy outcomes.

    PubMed

    Joseph, Josh W; Neidich, Alon B; Ober, Carole; Ross, Lainie Friedman

    2008-02-01

    The Chicago Lying-in Pregnancy Program (CLIPP) is a biobank designed to collect biological samples from pregnant women to study issues related to pregnancy. Despite the large number of biobanking initiatives in obstetric populations around the world, there is no published research that examines what pregnant women understand about enrollment into such programs and what their attitudes and beliefs are toward the research and its potential outcomes. Postpartum women 18 years or older who delivered at the University of Chicago Hospitals and had live infants on the General Care Nursery service were approached about participating in a survey about the CLIPP biobank and about a hypothetical pediatric biobank. Ninety-three women who had been recruited to participate in CLIPP agreed to participate in this research. Sixty-three women (68%) had previously agreed to participate in CLIPP; and 30 (32%) had refused. Both participants and non-participants understood that CLIPP had the main goal of advancing science, although almost one-half of the respondents thought that participation in CLIPP would benefit the individual participants. Eighty-five (92%) correctly believed that the research team would keep the medical information private. There was widespread optimism that the research would yield significant results. Importantly, there was no difference in these beliefs between those who enrolled and those who did not enroll in CLIPP. While education and socioeconomic status correlated with greater understanding about the methods and goals of the program, greater understanding did not correlate with willingness to participate. Our survey found widespread willingness to enroll in a pregnancy-focused biobank and optimism that the results will yield significant benefits.

  12. Pregnancy Outcomes Following In Utero Exposure to Second-Generation Antipsychotics: A Systematic Review and Meta-Analysis.

    PubMed

    Terrana, Nathan; Koren, Gideon; Pivovarov, Jacklyn; Etwel, Fatma; Nulman, Irena

    2015-10-01

    Second-generation antipsychotics (SGAs) are increasingly used for a variety of mental illnesses; however, the data regarding the safety of these medications during pregnancy are inconclusive and contradictory. We examined the risk of adverse pregnancy outcomes associated with in utero exposure to SGAs by conducting a systematic review and meta-analysis. We searched the databases EMBASE and MEDLINE from January 1990 to December 2014. Eligible studies had to report pregnant women who took SGAs during pregnancy (first trimester exposure if analyzing congenital malformations), follow a healthy comparison group in a similar manner, and report data on pregnancy outcomes. There was no restriction on language, sample size, or publication date. The primary outcome analyzed was major congenital malformations, and secondary outcomes included miscarriages, stillbirths, preterm births, small or large for gestational age neonates, and differences in gestational ages and birth weights. A total of 12 studies met our inclusion criteria, totalling 1782 cases and 1,322,749 controls. The use of SGA during the first trimester of pregnancy was associated with a significant increased risk for major congenital malformations (odds ratio, 2.03; 95% confidence interval, 1.41-2.93); however, no specific pattern of malformations was found. An increased risk was also found for preterm births (odds ratio, 1.85; 95% CI, 1.20-2.86). The use of SGA during pregnancy was not found to be associated with an increased risk for secondary outcomes analyzed. The absence of a specific pattern of malformations makes it difficult to identify an explicit risk posed by SGAs, and therefore, further studies sufficiently controlling for confounding factors are needed to validate these findings. PMID:26274044

  13. Effect of coincubation time of sperm-oocytes on fertilization, embryonic development, and subsequent pregnancy outcome.

    PubMed

    Dai, Shan-Jun; Qiao, Yu-Huan; Jin, Hai-Xia; Xin, Zhi-Min; Su, Ying-Chun; Sun, Ying-Pu; Chian, Ri-Cheng

    2012-12-01

    Several studies have reported improved IVF by shortening the time of sperm-oocyte coincubation from 16-18 hours to 1-4 hours. The objective of this study was to examine the advantages and disadvantages of a shortened sperm-oocyte coincubation time in order to assess the effects of this insemination method for clinical IVF practice. Two insemination methods, the shortened method (4 hours) and the standard method (16-18 hours) of coincubation of sperm-oocytes for two groups of patients based on the quality of sperm were compared. Group I, was composed of couples without male factor; Group II, involved couples with mild male factor. Fertilization, good quality embryos, clinical pregnancy, and implantation rates were compared by two different insemination methods. In Group I, fertilization, clinical pregnancy, and implantation rates were not different between the two insemination methods. However, the polyspermy rate was significantly higher (P < 0.05) in the shortened (7.3%) than in the standard (4.1%) insemination method. In Group II, the fertilization rate was significantly lower (P < 0.05) using the shortened insemination method (62.6%) compared to the standard insemination method (68.7%). When fertilization failed with the shortened insemination method, the clinical pregnancy and implantation rates were 34.7% and 24.1%, respectively, from the rescue intracytoplasmic sperm injection (ICSI). The live birth rate from the rescue ICSI was 32.0% with normal infants. The duration of sperm-oocyte coincubation does not affect fertilization, embryo quality, clinical pregnancy, and implantation rates. However, fertilization rates will decrease with the shortened insemination method when the sperm parameters are poor. From the results of the present study we suggest that the combination of the shortened sperm-oocyte coincubation and rescue ICSI method may be an efficient method for IVF treatment in order to prevent fertilization failure when sperm parameters were poor as mild

  14. Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin.

    PubMed

    Brenner, B; Hoffman, R; Blumenfeld, Z; Weiner, Z; Younis, J S

    2000-05-01

    Inherited and acquired thrombophilia are associated with recurrent pregnancy loss (RPL). We have evaluated the efficacy and safety of the low molecular weight heparin enoxaparin in 50 women, (mean age 26 +/- 3 years) with RPL (> or =3 losses in 1st, > or =2 losses in 2nd and > or =1 loss in 3rd trimester) who were found to harbor thrombophilia. Twenty-seven had a solitary thrombophilic defect, and twenty-three women had combined thrombophilic defects: 17--two defects and 6--three defects. Following diagnosis of thrombophilia, sixty-one subsequent pregnancies were treated with the low molecular weight heparin enoxaparin throughout gestation until 4 weeks after delivery. Dosage was 40 mg/day in women with solitary defect and 80 mg/day in combined defects. Aspirin, 75 mg daily was given in addition to enoxaparin to women with antiphospholipid syndrome. Forty-six out of 61 (75%) gestations treated by enoxaparin resulted in live birth compared to only 38/193 (20%) of the untreated pregnancies in these 50 women prior to diagnosis of thrombophilia (p <0.00001). In 23 women without a single living child following 82 untreated gestations, antithrombotic therapy resulted in 26/31 (84%) successful deliveries (p <0.0001). In 20 women with a prior living child, antithrombotic therapy improved successful delivery from 33/86 (38%) to 20/21 (95%) (p <0.0001). Enoxaparin dose of 40 mg/day resulted in live birth in 24/35 (69%) of gestations, compared to 19/23 (83%) gestations in women treated with 80 mg/day (p = 0.37). Only one thrombotic episode and one mild-bleeding episode were noticed during enoxaparin therapy. Enoxaparin is safe and effective in prevention of pregnancy loss in women with inherited and acquired thrombophilia.

  15. Effect of balanced protein energy supplementation during pregnancy on birth outcomes

    PubMed Central

    2011-01-01

    Background The nutritional status of the mother prior to and during pregnancy plays a vital role in fetal growth and development, and maternal undernourishment may lead to adverse perinatal outcomes including intrauterine growth restriction (IUGR). Several macronutrient interventions had been proposed for adequate protein and energy supplementation during pregnancy. The objective of this paper was to review the effect of balanced protein energy supplementation during pregnancy on birth outcomes. This paper is a part of a series of reviews undertaken for getting estimates of effectiveness of an intervention for input to Lives Saved Tool (LiST) model. Methods A literature search was conducted on PubMed, Cochrane Library and WHO regional data bases to identify randomized trials (RCTs) and quasi RCTs that evaluated the impact of balanced protein energy supplementation in pregnancy. Balanced protein energy supplementation was defined as nutritional supplementation during pregnancy in which proteins provided less than 25% of the total energy content. Those studies were excluded in which the main intervention was dietary advice to pregnant women for increase in protein energy intake, high protein supplementation (i.e. supplementation in which protein provides at least 25% of total energy content), isocaloric protein supplementation (where protein replaces an equal quantity of non-protein energy content), or low energy diet to pregnant women who are either overweight or who exhibit high weight gain earlier in gestation. The primary outcomes were incidence of small for gestational age (SGA) birth, mean birth weight and neonatal mortality. Quality of evidence was evaluated according to the Child Health Epidemiology Reference group (CHERG) adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Results The final number of studies included in our review was eleven comprising of both RCTs and quasi-RCTs. Our meta-analysis indicates that

  16. Hypothermia improves outcome from cardiac arrest.

    PubMed

    Bernard, S A

    2005-12-01

    Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid

  17. Altered Preconception Fatty Acid Intake Is Associated with Improved Pregnancy Rates in Overweight and Obese Women Undertaking in Vitro Fertilisation.

    PubMed

    Moran, Lisa J; Tsagareli, Victoria; Noakes, Manny; Norman, Robert

    2016-01-04

    Maternal preconception diet is proposed to affect fertility. Prior research assessing the effect of altering the fatty acid profile on female fertility is conflicting. The aim of this study was to assess the effect of preconception maternal diet, specifically fatty acid profile, on pregnancies and live births following in vitro fertilisation (IVF). Forty-six overweight and obese women undergoing IVF were randomised to a diet and physical activity intervention (intervention) or standard care (control). Outcome measures included pregnancy, live birth and pre-study dietary intake from food frequency questionnaire. Twenty pregnancies (n = 12/18 vs. n = 8/20, p = 0.12) and 12 live births (n = 7/18 vs. n = 5/20, p = 0.48) occurred following the intervention with no differences between the treatment groups. On analysis adjusted for BMI and smoking status, women who became pregnant had higher levels of polyunsaturated fatty acid (PUFA) intake (p = 0.03), specifically omega-6 PUFA and linoleic acid (LA) (p = 0.045) with a trend for an elevated intake of omega-3 PUFA (p = 0.06). There were no dietary differences for women who did or did not have a live birth. Maternal preconception PUFA, and specifically omega-6 and LA intake, are associated with improved pregnancy rates in overweight and obese women undergoing IVF. This has implications for optimising fertility through preconception nutrition.

  18. Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes

    PubMed Central

    Olmos-Ortiz, Andrea; Avila, Euclides; Durand-Carbajal, Marta; Díaz, Lorenza

    2015-01-01

    Vitamin D has garnered a great deal of attention in recent years due to a global prevalence of vitamin D deficiency associated with an increased risk of a variety of human diseases. Specifically, hypovitaminosis D in pregnant women is highly common and has important implications for the mother and lifelong health of the child, since it has been linked to maternal and child infections, small-for-gestational age, preterm delivery, preeclampsia, gestational diabetes, as well as imprinting on the infant for life chronic diseases. Therefore, factors that regulate vitamin D metabolism are of main importance, especially during pregnancy. The hormonal form and most active metabolite of vitamin D is calcitriol. This hormone mediates its biological effects through a specific nuclear receptor, which is found in many tissues including the placenta. Calcitriol synthesis and degradation depend on the expression and activity of CYP27B1 and CYP24A1 cytochromes, respectively, for which regulation is tissue specific. Among the factors that modify these cytochromes expression and/or activity are calcitriol itself, parathyroid hormone, fibroblast growth factor 23, cytokines, calcium and phosphate. This review provides a current overview on the regulation of vitamin D metabolism, focusing on vitamin D deficiency during gestation and its impact on pregnancy outcomes. PMID:25584965

  19. 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

  20. Drugs and pregnancy--outcomes of women engaged with a specialist perinatal outreach addictions service.

    PubMed

    Mayet, Soraya; Groshkova, Teodora; Morgan, Louise; MacCormack, Tracey; Strang, John

    2008-09-01

    Substance misuse during pregnancy may result in harm to both mother and child. The aims of this study were to assess changes in outcomes of women seen by a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005) and compare outcomes to the local hospital maternity population (2004-2005). A cross-sectional audit of health-care records was conducted comparing the outcomes of women in 2002-2005 with earlier data from 1989-1991 and the local maternity population (2004-2005). The service was attended by 126 women, of whom 83% of opioid-dependent women started/continued opioid maintenance treatment. Of 118 babies delivered, there were two stillbirths and one early neonatal death, 20% were premature, 28% were low birth weight, 21% required the Special Care Baby Unit and 21% of babies born to opioid-dependent mothers were treated for neonatal abstinence syndrome (NAS). Fewer babies required treatment for NAS in 2002-2005 compared to 1989-1991 (21% versus 44%). There were higher rates of miscarriage (3% versus <1%), low birth weight (28% versus 9%) and premature babies (20% versus 9%) compared to the local maternity population (2004-2005). Integrated perinatal addictions treatment may deliver benefits; however, engaging women into treatment earlier and reducing substance use before conception remains the objective.

  1. Allopurinol use in pregnancy in three women with inflammatory bowel disease: safety and outcomes: a case series

    PubMed Central

    2013-01-01

    Background Allopurinol is a frequently prescribed drug. In inflammatory bowel disease patients who shunt thiopurine metabolism towards more toxic and less desirable pathways, allopurinol is proving to be an effective add on therapy with good resultant disease control and less treatment side effects. As many such patients are young, the potential for pregnant women to be exposed to allopurinol is increasing. The safety of allopurinol in pregnancy is not known however. Case presentation We report three cases of safe use of allopurinol in pregnancy for women with inflammatory bowel disease. This included 2 patients with ulcerative colitis and 1 patient with fistulising Crohn’s disease. Allopurinol was used throughout pregnancy in all patients. All 3 pregnancies resulted in normal healthy babies born at term by Caesarean section. Conclusion It is important to evaluate and document the safety of allopurinol during pregnancy, as it is finding new roles in young patients. These three cases add significantly to the very limited data on allopurinol use in pregnancy. We encourage reporting of all cases of allopurinol use in pregnant patients and suggest an allopurinol pregnancy registry to document drug exposures and outcomes. PMID:24345189

  2. Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes.

    PubMed

    Shireman, T I; Kerling, E H; Gajewski, B J; Colombo, J; Carlson, S E

    2016-08-01

    The Kansas University DHA Outcomes Study (KUDOS) found a significant reduction in early preterm births with a supplement of 600mg DHA per day compared to placebo. The objective of this analysis was to determine if hospital costs differed between groups. We applied a post-hoc cost analysis of the delivery hospitalization and all hospitalizations in the following year to 197 mother-infant dyads who delivered at Kansas University Hospital. Hospital cost saving of DHA supplementation amounted to $1678 per infant. Even after adjusting for the estimated cost of providing 600mg/d DHA for 26 weeks ($166.48) and a slightly higher maternal care cost ($26) in the DHA group, the net saving per dyad was $1484. Extrapolating this to the nearly 4 million US deliveries per year suggests universal supplementation with 600mg/d during the last 2 trimesters of pregnancy could save the US health care system up to USD 6 billion. PMID:27499448

  3. An Update on Maternal Use of Antiepileptic Medications in Pregnancy and Neurodevelopment Outcomes.

    PubMed

    Gerard, Elizabeth E; Meador, Kimford J

    2015-06-01

    Antiepileptic drugs (AEDs) are prescribed commonly to women of childbearing age. In utero exposure to some AEDs can have significant cognitive and behavioral consequences for the unborn child. Recently, prospective studies of women taking AEDs during pregnancy have added significantly to our understanding of cognitive and behavioral teratogenic risks posed by fetal AED exposure. Valproate is clearly associated with impaired cognitive development as well as an increased risk of disorders such as autism and autism spectrum disorder. Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin monotherapy is associated with more favorable cognitive and behavioral outcomes than valproate, but more data are required to clarify if these AEDs have more subtle effects on cognition and behavior. There are insufficient data on the developmental effects of other AEDs in humans. Further, the underlying mechanisms of cognitive teratogenesis are poorly understood, including the genetic factors that affect susceptibility to AEDs. PMID:27617120

  4. Successful Pregnancy Outcome in an Operated Case of Lipomeningomyocele: A Rare Case

    PubMed Central

    Nanda, Sakshi; Aggarwal, Rohina; Tanvir

    2016-01-01

    Lipomeningomyocele is one of the types of occult spinal dysraphism associated with tethered cord syndrome, which is characterised by neurodeficit symptomatology due to stretch- induced functional disorder of the spinal cord with its caudal part attached by an in elastic tissue. There is stretching of conus medullaris and nerve roots due to disproportionate growth between vertebral column and spinal cord, resulting in various neurological deficits. Its incidence is approximately 1 in 4000 births in the USA, with a slightly higher female preponderance, although its true incidence is not known. There are very few studies on pregnancy outcome in these patients and the management dilemma in this group has prompted us to report this case. PMID:27790529

  5. An Update on Maternal Use of Antiepileptic Medications in Pregnancy and Neurodevelopment Outcomes

    PubMed Central

    Gerard, Elizabeth E.; Meador, Kimford J.

    2015-01-01

    Antiepileptic drugs (AEDs) are prescribed commonly to women of childbearing age. In utero exposure to some AEDs can have significant cognitive and behavioral consequences for the unborn child. Recently, prospective studies of women taking AEDs during pregnancy have added significantly to our understanding of cognitive and behavioral teratogenic risks posed by fetal AED exposure. Valproate is clearly associated with impaired cognitive development as well as an increased risk of disorders such as autism and autism spectrum disorder. Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin monotherapy is associated with more favorable cognitive and behavioral outcomes than valproate, but more data are required to clarify if these AEDs have more subtle effects on cognition and behavior. There are insufficient data on the developmental effects of other AEDs in humans. Further, the underlying mechanisms of cognitive teratogenesis are poorly understood, including the genetic factors that affect susceptibility to AEDs. PMID:27617120

  6. An Update on Maternal Use of Antiepileptic Medications in Pregnancy and Neurodevelopment Outcomes

    PubMed Central

    Gerard, Elizabeth E.; Meador, Kimford J.

    2015-01-01

    Antiepileptic drugs (AEDs) are prescribed commonly to women of childbearing age. In utero exposure to some AEDs can have significant cognitive and behavioral consequences for the unborn child. Recently, prospective studies of women taking AEDs during pregnancy have added significantly to our understanding of cognitive and behavioral teratogenic risks posed by fetal AED exposure. Valproate is clearly associated with impaired cognitive development as well as an increased risk of disorders such as autism and autism spectrum disorder. Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin monotherapy is associated with more favorable cognitive and behavioral outcomes than valproate, but more data are required to clarify if these AEDs have more subtle effects on cognition and behavior. There are insufficient data on the developmental effects of other AEDs in humans. Further, the underlying mechanisms of cognitive teratogenesis are poorly understood, including the genetic factors that affect susceptibility to AEDs.

  7. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis

    PubMed Central

    Frederiksen, Yoon; Farver-Vestergaard, Ingeborg; Skovgård, Ninna Grønhøj; Ingerslev, Hans Jakob; Zachariae, Robert

    2015-01-01

    Objective To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology (ART). Design Systematic review and meta-analysis. Data sources PsycINFO, PubMed, EMBASE, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014. Study selection Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach and were published in English. Data extraction Study characteristics and results were extracted and the methodological quality was assessed. Effect sizes (ES; Hedges g) were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I2, and publication bias was evaluated using Egger’s method. Possible moderators and mediators were explored with meta-analyses of variances (ANOVAs) and meta-regression. Results We identified 39 eligible studies (total N=2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (risk ratio=2.01; CI 1.48 to 2.73; p<0.001) and combined psychological outcomes (Hedges g=0.59; CI 0.38 to 0.80; p=0.001). The pooled ES for psychological outcomes were generally larger for women (g: 0.51 to 0.73) than men (0.13 to 0.34), but the difference only reached statistical significance for depressive symptoms (p=0.004). Meta-regression indicated that larger reductions in anxiety were associated with greater improvement in pregnancy rates (Slope 0.19; p=0.004). No clear-cut differences were found between effects of cognitive–behavioural therapy (CBT; g=0.84), mind–body interventions (0.61) and

  8. 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.

  9. 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

  10. Effect of Zinc Supplementation on Pregnancy and Infant Outcomes: A Systematic Review

    PubMed Central

    Chaffee, Benjamin W.; King, Janet C.

    2013-01-01

    Poor maternal zinc status has been associated with foetal loss, congenital malformations, intrauterine growth retardation, reduced birth weight, prolonged labour and preterm or post-term deliveries. A meta-analysis completed in 2007 showed that maternal zinc supplementation resulted in a small but significant reduction in preterm birth. The purposes of this analysis are to update that previous review and expand the scope of assessment to include maternal, infant and child health outcomes. Electronic searches were carried out to identify peer-reviewed, randomised controlled trials where daily zinc supplementation was given for at least one trimester of pregnancy. The co-authors applied the study selection criteria, assessed trial quality and abstracted data. A total of 20 independent intervention trials involving more than 11 000 births were identified. The 20 trials took place across five continents between 1977 and 2008. Most studies assessed the zinc effect against a background of other micronutrient supplements, but five were placebo-controlled trials of zinc alone. The provided dose of supplemental zinc ranged from 5 to 50 mg/day. Only the risk of preterm birth reached statistical significance (summary relative risk 0.86 [95% confidence interval 0.75, 0.99]). There was no evidence that supplemental zinc affected any parameter of foetal growth (risk of low birth weight, birth weight, length at birth or head circumference at birth). Six of the 20 trials were graded as high quality. The evidence that maternal zinc supplementation lowers the risk of preterm birth was graded low; evidence for a positive effect on other foetal outcomes was graded as very low. The effect of zinc supplementation on preterm birth, if causal, might reflect a reduction in maternal infection, a primary cause of prematurity. While further study would be needed to explore this possibility in detail, the overall public health benefit of zinc supplementation in pregnancy appears limited. PMID

  11. Inadequate gestational weight gain and adverse pregnancy outcomes among normal weight women in China

    PubMed Central

    Wen, Tingyuan; Lv, Yanwei

    2015-01-01

    Objective: The objective of the paper is to find the association between inadequate gestational weight gain and pregnancy outcomes in normal weight women in China. Method: A retrospective study was conducted among 13,776 normal weight pregnant women who received antenatal care and delivered singleton infants at the participating hospital during August, 2009 to July, 2013. Adverse pregnancy outcomes like low birth weight (LBW), preterm birth, birth asphyxia, neonatal intensive care unit (NICU) admission and length of hospital stay were compared and analyzed between two groups with inadequate and adequate gestational weight gain. Results: According to the IOM recommendations, inadequate gestational weight gain was found to be 14.7% in this study. Women with inadequate gestational weight gain (GWG) were found to be at a higher risk for LBW (aOR = 2.13, 95% CI: 1.75, 2.86) and preterm birth (aOR = 1.44, 95% CI: 1.21, 1.67) than those in the adequate gestational weight gain group, after adjusting for monthly family income, maternal education, occupation, and whether they received any advice regarding benefits of gestational weight gain and residential area. However, inadequate GWG was not associated with longer hospital stay (aOR = 1.13, 95% CI: 0.91-1.43) in adjusted model. In addition, the rate of birth asphyxia and NICU admission were similar in both groups (P > 0.05). Conclusions: Normal weight pregnant women with GWG below the recommended AIOM 2009 guidelines were found to be at an increased risk of low birth weight and preterm birth. PMID:25932249

  12. Frequency of rh phenotypes in relation to the outcome of pregnancy in the two groups of pregnant women.

    PubMed

    Redzić, Amira; Begić, Fatima

    2002-12-01

    Lethal and sublethal genetical factors, including Rh factor, represent endogenous risk factors of the pregnancy outcome. These factors are most frequently inherited in recessive way and they often lead to the negative outcome of pregnancies. They represent pregnancy (a prirori) risk of various degrees. Inheritance of Rh system blood groups is linked to chromosome 1 and it could be explained by two alternative theories; molecular Rh system genetics has not yet been completely explained. The first formal-genetic theory postulates three closely linked gene sites (loci C, D and E) while the second theory has a monogenic character (one locus with several allele genes). Data on 755 pregnancies, which were (for various reasons) estimated as increased risk pregnancies, were registered at Gynaecology Clinic, Clinical Centre of University of Sarajevo, during the period from 1989 to 1992. These data were collected from pregnant women who, according to the certain indications from their familiar and personal anamnesis, demanded genetic consultations. The result of investigation of the basic Rh system phenotype distribution shows no statistically significant difference between monitored pregnant women. This result is assumed as valid for both pregnant women and their partners. The same result is suggesting that the observed increased risk pregnancy samples do not significantly differ from the previously studied population samples. Therefore, it has been concluded that Rh factor is not closely related to the increased risk of individual pregnancy outcomes, that is, it does not have relevant influence on the observed reproduction parameters. This result is very interesting and deserves particular medical attention and further evaluation in the future, particularly considering known immunological phenomena resulting from relations between reproduction partners belonging to the basic Rh system phenotypes.

  13. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby's Vascular health and Iron in Pregnancy study.

    PubMed

    Alwan, Nisreen A; Cade, Janet E; McArdle, Harry J; Greenwood, Darren C; Hayes, Helen E; Simpson, Nigel A B

    2015-06-28

    Fe deficiency anaemia during early pregnancy has been linked with low birth weight and preterm birth. However, this evidence comes mostly from studies measuring Hb levels rather than specific measures of Fe deficiency. The present study aimed to examine the association between maternal Fe status during the first trimester of pregnancy, as assessed by serum ferritin, transferrin receptor and their ratio, with size at birth and preterm birth. In the Baby VIP (Baby's Vascular health and Iron in Pregnancy) study, we recruited 362 infants and their mothers after delivery in Leeds, UK. Biomarkers were measured in maternal serum samples previously obtained in the first trimester of pregnancy. The cohort included sixty-four (18 %) small for gestational age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34 and 37 weeks). First trimester maternal Fe depletion was associated with a higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1, 4·1). This relationship was attenuated when including early pregnancy Hb in the model, suggesting it as a mediator (adjusted OR 1·6, 95 % CI 0·8, 3·2). For every 10 g/l increase in maternal Hb level in the first half of pregnancy the risk of SGA was reduced by 30 % (adjusted 95 % CI 0, 40 %); levels below 110 g/l were associated with a 3-fold increase in the risk of SGA (95 % CI 1·0, 9·0). There was no evidence of association between maternal Fe depletion and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8). The present study shows that depleted Fe stores in early pregnancy are associated with higher risk of SGA. PMID:25946517

  14. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby's Vascular health and Iron in Pregnancy study.

    PubMed

    Alwan, Nisreen A; Cade, Janet E; McArdle, Harry J; Greenwood, Darren C; Hayes, Helen E; Simpson, Nigel A B

    2015-06-28

    Fe deficiency anaemia during early pregnancy has been linked with low birth weight and preterm birth. However, this evidence comes mostly from studies measuring Hb levels rather than specific measures of Fe deficiency. The present study aimed to examine the association between maternal Fe status during the first trimester of pregnancy, as assessed by serum ferritin, transferrin receptor and their ratio, with size at birth and preterm birth. In the Baby VIP (Baby's Vascular health and Iron in Pregnancy) study, we recruited 362 infants and their mothers after delivery in Leeds, UK. Biomarkers were measured in maternal serum samples previously obtained in the first trimester of pregnancy. The cohort included sixty-four (18 %) small for gestational age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34 and 37 weeks). First trimester maternal Fe depletion was associated with a higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1, 4·1). This relationship was attenuated when including early pregnancy Hb in the model, suggesting it as a mediator (adjusted OR 1·6, 95 % CI 0·8, 3·2). For every 10 g/l increase in maternal Hb level in the first half of pregnancy the risk of SGA was reduced by 30 % (adjusted 95 % CI 0, 40 %); levels below 110 g/l were associated with a 3-fold increase in the risk of SGA (95 % CI 1·0, 9·0). There was no evidence of association between maternal Fe depletion and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8). The present study shows that depleted Fe stores in early pregnancy are associated with higher risk of SGA.

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

    PubMed

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

    2013-12-20

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

  16. Associations of Meteorology with Adverse Pregnancy Outcomes: A Systematic Review of Preeclampsia, Preterm Birth and Birth Weight

    PubMed Central

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

    2013-01-01

    The relationships between meteorology and pregnancy outcomes are not well known. This article reviews available evidence on the relationships between seasonality or meteorology and three major pregnancy outcomes: the hypertensive disorders of pregnancy (including preeclampsia, eclampsia and gestational hypertension), gestational length and birth weight. In total 35, 28 and 27 studies were identified for each of these outcomes. The risks of preeclampsia appear higher for women with conception during the warmest months, and delivery in the coldest months of the year. Delivery in the coldest months is also associated with a higher eclampsia risk. Patterns of decreased gestational lengths have been observed for births in winter, as well as summer months. Most analytical studies also report decreases in gestational lengths associated with heat. Birth weights are lower for deliveries occurring in winter and in summer months. Only a limited number of studies have investigated the effects of barometric pressure on gestational length or the effects of temperature and sunshine exposure on birth weight, but these questions appear worth investigating further. Available results should encourage further etiological research aiming at enhancing our understanding of the relationships between meteorology and adverse pregnancy outcomes, ideally via harmonized multicentric studies. PMID:24362545

  17. Efforts to Improve Immunization Coverage during Pregnancy among Ob-Gyns

    PubMed Central

    Jones, Katherine M.; Carroll, Sarah; Hawks, Debra; McElwain, Cora-Ann; Schulkin, Jay

    2016-01-01

    Background. Influenza and Tdap vaccines are vital factors for improving maternal and neonatal health outcomes. Methods. A prospective, longitudinal study was conducted to determine whether the American College of Obstetricians and Gynecologists' (ACOG's) efforts to increase ob-gyn use of their immunization toolkits and vaccination administration were successful. Pre- and postintervention questionnaires were mailed to a random sample of 1,500 ACOG members between August 2012 and July 2015. Results. Significantly more postintervention survey ob-gyns reported that they received the immunization toolkits than preintervention survey ob-gyns (84.5% versus 67.0%, p < .001). The large majority of ob-gyns from both surveys (76.9% versus 78.9%) reported that they offered or planned to offer influenza vaccinations to their patients for the 2012-2013 and 2014-2015 flu seasons. Postintervention survey respondents were significantly more likely than preintervention survey participants to report that they routinely offer Tdap vaccinations to all patients during pregnancy (76.8% versus 59.3%, p < .001). Conclusion. ACOG's efforts to improve ob-gyn use of immunization toolkits and vaccine administration appear to have been successful in several ways. ACOG's toolkits are an example of an effective intervention to overcome barriers to offering vaccines and help improve influenza and Tdap immunization coverage for pregnant women. PMID:26924918

  18. Improved cycle outcomes after laparoscopic ovarian diathermy in hyper-responder patients with previous ART failure.

    PubMed

    Pabuccu, Recai; Pabuccu, Emre Goksan; Gursoy, Asli Yarci; Caglar, Gamze Sinem; Yilmaz, Muserref Banu; Ozdegirmenci, Ozlem

    2014-01-01

    Excessive response to ovarian stimulation is common among hyper-responder patients undergoing assisted reproductive technology (ART). Cycle cancellations and severe ovarian hyperstimulation syndrome (OHSS) are all detrimental consequences observed within this cohort and several approaches have been proposed to enhance outcomes. The current study is designed to evaluate whether laparoscopic ovarian diathermy (LOD) improves ART outcomes and pregnancy rates by reducing Anti-mullerian hormone (AMH) levels in a group of patients who had a history of recurrent ART failure and high response. A total of 40 hyper-responder patients with history of previous ART failure were included. Group I consisted of 22 patients that underwent LOD prior to ART. Group II consisted of 18 patients that underwent only ART. Cycle outcomes of groups were compared. Following LOD, significant reduction in AMH levels were detected in group I (4.75 ng/mL to 2.25 ng/mL). Clinical pregnancies were similar among groups (40% versus 27.8% p = 0.65). There was no cycle cancellation in Group I, whereas there were three cycle cancellations observed due to OHSS in Group II. Our results indicate that LOD might offer enhanced fertility outcomes and may reduce the likelihood of cycle cancellations in hyper-responders with previous ART failures.

  19. Rare case of combined factor V and factor X deficiency in pregnancy: presenting as secondary postpartum haemorrhage in first pregnancy and successful outcome in second pregnancy

    PubMed Central

    Panchanadikar, Tushar; Kulkarni, Yashwant

    2013-01-01

    Summary Isolated factor V and factor X deficiency is a very rare condition affecting 1 in 500,000–1,000,000 persons worldwide. We present a rare first reported case of combined deficiency of factor V and factor X where the patient developed secondary postpartum haemorrhage in first pregnancy, after which she was diagnosed to have this rare disorder and her subsequent pregnancy was then successfully managed.

  20. Allopurinol Use during Pregnancy - Outcome of 31 Prospectively Ascertained Cases and a Phenotype Possibly Indicative for Teratogenicity

    PubMed Central

    Hoeltzenbein, Maria; Stieler, Katja; Panse, Mary; Wacker, Evelin; Schaefer, Christof

    2013-01-01

    Allopurinol is a purine analogue that inhibits xanthine oxidase. It is mainly used for the treatment of hyperuricemia in patients with gout or tumor lysis syndrome. Experience with allopurinol in pregnancy is scarce. In 2011, Kozenko et al. reported on a child with multiple malformations after maternal treatment with allopurinol throughout pregnancy. Possible teratogenicity of allopurinol was proposed due to the similarity of the pattern of malformations in children with mycophenolate embryopathy. A possible common mechanism of both drugs, i.e. disruption of purine synthesis, was discussed. We report on the outcome of 31 prospectively ascertained pregnancies with allopurinol exposure at least during first trimester. Pregnancy outcomes were 2 spontaneous abortions, 2 elective terminations of pregnancy and 27 live born children. The overall rate of major malformations (3.7%) and of spontaneous abortions (cumulative incidence 11%, 95%-CI 3–40) were both within the normal range. However, there was one child with severe malformations including microphthalmia, cleft lip and palate, renal hypoplasia, low-set ears, hearing deficit, bilateral cryptorchidism, and micropenis. The striking similarity of the anomalies in this child and the case described by Kozenko et al. might be considered as a signal for teratogenicity. Thus, we would recommend caution with allopurinol treatment in the first trimester, until further data are available. PMID:23840514

  1. Evidence for No Significant Impact of Müllerian Anomalies on Reproductive Outcomes of Twin Pregnancy in Korean Women.

    PubMed

    Shim, Sohyun; Hur, Yoon-Mi; Kim, Da Hee; Seong, Seok Ju; Kim, Mi-La; Shin, Joong Sik

    2016-04-01

    The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis. In total, 1,422 women with twin pregnancy were eligible for data analysis, including 17 (1.2%) who had a known congenital MA (septate uterus, bicornuate uterus, arcuate uterus, and unicornuate uterus). Except for the mode of conception, baseline demographics were similar between women with MA and those without MA. No significant differences were found in pregnancy outcomes of gestational age at delivery (p = .86), birth weight of smaller and larger twins (p = .54 and p = .65), and number of twins with birth weight <5th percentile for gestational age (p = .43).The rates of obstetrical complications such as pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, cerclage, IUFD, and postpartum hemorrhage were not significantly different between the two groups either. We concluded that the presence of congenital MA may not increase obstetrical risks in outcomes of pregnancy of twins delivered after 24 gestational weeks.

  2. Systematic Review of Chromium and Nickel Exposure During Pregnancy and Impact on Child Outcomes.

    PubMed

    McDermott, Suzanne; Salzberg, Deborah C; Anderson, Anna Paige; Shaw, Timothy; Lead, Jamie

    2015-01-01

    Some forms of chromium (Cr) and nickel (Ni) are toxic, especially with chronic elevated exposure, and certain forms such as hexavalent chromium or nickel carbonyl were labeled as carcinogens. Since both metals are naturally occurring, and used in industrial processes, individuals may be exposed through ingestion of contaminated food or water, inhalation, or dermal contact. This study focused on the impact of toxic forms of Cr and Ni during pregnancy and outcomes in newborn and young children. A systematic literature review following "The Navigation Guide" was applied, and 16 reports that satisfied the inclusion criteria were scored. Six papers studied birth weight, prematurity, or gestational age: one found an association between Ni and small for gestational age, while another linked Ni with low birth weight; however, four reported no marked associations. Of six studies that examined birth defects, three found no significant associations; one noted an association between Ni and neural tube defects; one showed an association between Ni and structural birth defects; and one reported a weak effect for Cr exposure and musculoskeletal defects. In the remaining four studies, weak associations were found for hexavalent Cr and neuroblastoma, Ni and autism spectrum disorder, Cr and Ni and DNA damage, and Cr and lymphocyte damage. Among the studies that were rated as good for execution and reliability, there was weak evidence of an association between Ni and autism spectrum disorder and small for gestational age, but no significant association between Cr and a child outcome. PMID:26571332

  3. Pregnancy outcomes in patients with autoimmune diseases and anti-Ro/SSA antibodies.

    PubMed

    Brucato, Antonio; Cimaz, Rolando; Caporali, Roberto; Ramoni, Véronique; Buyon, Jill

    2011-02-01

    Anti-Ro/SSA antibodies are associated with neonatal lupus (congenital heart block (CHB), neonatal transient skin rash, hematological and hepatic abnormalities), but do not negatively affects other gestational outcomes, and the general outcome of these pregnancies is now good, when followed by experienced multidisciplinary teams. The prevalence of CHB, defined as an atrioventricular block diagnosed in utero, at birth, or within the neonatal period (0-27 days after birth), in the offspring of an anti-Ro/SSA-positive women is 1-2%, of neonatal lupus rash around 10-20%, while laboratory abnormalities in asymptomatic babies can be detected in up to 27% of cases. The risk of recurrence of CHB is ten times higher. Most of the mothers are asymptomatic at delivery and are identified only by the birth of an affected child. Half of these asymptomatic women develop symptoms of a rheumatic disease, most commonly arthralgias and xerophtalmia, but few develop lupus nephritis. A standard therapy for CHB is still matter of investigation, although fluorinated corticosteroids have been reported to be effective for associated cardiomyopathy. Serial echocardiograms and obstetric sonograms, performed at least every 1-2 weeks starting from the 16th week of gestational age, are recommended in anti-Ro/SSA-positive pregnant women to detect early fetal abnormalities that might be a target of preventive therapy.

  4. Pregnancy outcomes in Benghazi, Libya, before and during the armed conflict in 2011.

    PubMed

    Bodalal, Z; Agnaeber, K; Nagelkerke, N; Stirling, B; Temmerman, M; Degomme, O

    2014-03-01

    Stressful life events experienced by pregnant women may lead to adverse obstetric outcomes. This study in Benghazi compared the rates of preterm, low-birth-weight and caesarean-section births at Al-Jamhouria hospital in the months before and during the armed conflict in Libya in 2011. Data were collected on all women admitted to the delivery ward during February to May 2011 (the months of the most active fighting in the city) (n = 7096), and October to December 2010 (the months immediately before the war) (n = 5935). Compared with the preceding months there was a significant rise during the conflict in the rate of deliveries involving preterm (3.6% versus 2.5%) and low-birth-weight (10.1% versus 8.5%) infants and caesarean sections (26.9% versus 25.3%). Psychosocial stress may have been a factor (among others) in an increase in negative pregnancy outcomes, and obstetric hospitals should be aware of these issues in times of war. PMID:24950075

  5. Pregnancy outcomes in Benghazi, Libya, before and during the armed conflict in 2011.

    PubMed

    Bodalal, Z; Agnaeber, K; Nagelkerke, N; Stirling, B; Temmerman, M; Degomme, O

    2014-03-01

    Stressful life events experienced by pregnant women may lead to adverse obstetric outcomes. This study in Benghazi compared the rates of preterm, low-birth-weight and caesarean-section births at Al-Jamhouria hospital in the months before and during the armed conflict in Libya in 2011. Data were collected on all women admitted to the delivery ward during February to May 2011 (the months of the most active fighting in the city) (n = 7096), and October to December 2010 (the months immediately before the war) (n = 5935). Compared with the preceding months there was a significant rise during the conflict in the rate of deliveries involving preterm (3.6% versus 2.5%) and low-birth-weight (10.1% versus 8.5%) infants and caesarean sections (26.9% versus 25.3%). Psychosocial stress may have been a factor (among others) in an increase in negative pregnancy outcomes, and obstetric hospitals should be aware of these issues in times of war.

  6. Impact of Radiotherapy on Fertility, Pregnancy, and Neonatal Outcomes in Female Cancer Patients

    SciTech Connect

    Wo, Jennifer Y.; Viswanathan, Akila N.

    2009-04-01

    Purpose: Radiation has many potential long-term effects on cancer survivors. Female cancer patients may experience decreased fertility depending on the site irradiated. Oncologists should be aware of these consequences and discuss options for fertility preservation before initiating therapy. Methods and Materials: A comprehensive review of the existing literature was conducted. Studies reporting the outcomes for female patients treated with cranio-spinal, abdominal, or pelvic radiation reporting fertility, pregnancy, or neonatal-related outcomes were reviewed. Results: Cranio-spinal irradiation elicited significant hormonal changes in women that affected their ability to become pregnant later in life. Women treated with abdomino-pelvic radiation have an increased rate of uterine dysfunction leading to miscarriage, preterm labor, low birth weight, and placental abnormalities. Early menopause results from low-dose ovarian radiation. Ovarian transposition may decrease the rates of ovarian dysfunction. Conclusions: There is a dose-dependent relationship between ovarian radiation therapy (RT) and premature menopause. Patients treated with RT must be aware of the impact of treatment on fertility and explore appropriate options.

  7. The effect of maternal exposure to psychosocial job strain on pregnancy outcomes and child development.

    PubMed