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BMC Pregnancy and Childbirth Dec 2023Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births... (Review)
Review
OBJECTIVE
Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies.
METHODS
This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing.
RESULTS
Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins.
CONCLUSION
The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant; Premature Birth; Pregnancy, Twin; Cesarean Section; Retrospective Studies; Thailand; Pregnancy, Multiple; Pregnancy Outcome
PubMed: 38110899
DOI: 10.1186/s12884-023-06186-0 -
Epilepsy & Behavior : E&B Dec 2021To show the impact of drug-drug interactions (DDIs) associated with co-administration of enzyme-inducing (EI) antiseizure medications and oral contraceptives (OCs) on...
PURPOSE
To show the impact of drug-drug interactions (DDIs) associated with co-administration of enzyme-inducing (EI) antiseizure medications and oral contraceptives (OCs) on the annual number of unintended pregnancies, their outcomes, and their associated costs in the United States (US).
METHODS
A Microsoft Excel pregnancy-outcomes model was developed to determine the impact of DDIs in women who take an OC as well as an EI antiseizure medication known to lower the effectiveness of the OC in preventing pregnancy. The model compared the number of unintended pregnancies, the expected pregnancy outcomes, and associated costs in women taking an OC and an EI medication with a matched cohort of women who took an OC and an enzyme-neutral (EN) antiseizure medication that is known not to interact with OCs. The model perspectives were patients and third-party payers in the US. Unintended pregnancy rates, pregnancy outcomes, and cost inputs for the model were taken from published studies.
RESULTS
The results of the analysis showed an estimated increase in the annual number of unintended pregnancies in the US of 503 (a change from 1151 to 1654), an increase of 44.7%, for the estimated 71,922 women currently taking an OC plus an EI medication in the US when compared with a matched cohort taking an OC plus an EN medication. This resulted in an estimated annual healthcare cost increase of $3 million, which is an increase of 5.5% in the annual costs for contraception and pregnancy care. A scenario analysis showed that the annual number of unintended pregnancies could be lower (575 vs 1654) for a matched cohort of women taking EI medications and using a copper intrauterine device, a highly effective and nonhormonal form of contraception, rather than an OC.
CONCLUSIONS
Physicians treating women of reproductive age for epilepsy who wish to avoid pregnancy should consider the potential for DDIs that might result in unintended pregnancies. Thus, physicians should alert women using EI medications for epilepsy control to the increased potential for unintended pregnancies if they use OCs for contraception.
Topics: Contraception; Contraceptives, Oral; Drug Interactions; Female; Humans; Pharmaceutical Preparations; Pregnancy; Pregnancy Outcome; United States
PubMed: 34775242
DOI: 10.1016/j.yebeh.2021.108368 -
Reproduction & Fertility Jul 2022The use of intracytoplasmic sperm injection (ICSI) has recently increased worldwide. The live birth rate per ICSI cycle is low, and over half of infertile couples remain...
UNLABELLED
The use of intracytoplasmic sperm injection (ICSI) has recently increased worldwide. The live birth rate per ICSI cycle is low, and over half of infertile couples remain childless. Chromosomal polymorphisms are up to five times more common in couples with infertility compared to the general population. We aimed to investigate the association between chromosomal polymorphisms and reproductive outcomes in couples undergoing ICSI treatment. We analysed 942 ICSI fresh and frozen embryo transfer cycles in 697 women who underwent karyotyping analysis using Giemsa-Trypsin-Leishman banding prior to assisted conception at the Fertility Centre of Lanka Hospitals, Sri Lanka, between 2016 and 2018. The primary outcomes were pregnancy, miscarriage, and live birth rates. We compared outcomes according to the presence or absence of chromosomal polymorphism in females, males and couples. There were 294 pregnancies (31.2%) recorded in the study; 130 suffered a miscarriage (13.8%), 13 were ectopic pregnancies (1.3%) and 151 resulted in a live birth (16.0%). The evidence from univariable and multivariable analyses (adjusted for age, BMI, ovarian reserve and treatment type) did not confidently identify a difference in pregnancy, miscarriage or live birth rates between couples with no chromosomal polymorphisms compared to couples where the female, male or both partners were carriers of a chromosomal polymorphism. Further, we did not identify a clear association between the presence of chromosomal polymorphisms and reproductive outcomes compared to participants without chromosomal polymorphisms. Wide CIs precluded the identification of clinically meaningful associations.
LAY SUMMARY
Infertility affects approximately one in eight couples worldwide. The use of intracytoplasmic sperm injection (ICSI), where the sperm is directly injected into an egg using a micromanipulator outside the body, has become particularly popular in recent years. However, the success rate remains low. In human cells, the genetic material is arranged in structures called chromosomes. Chromosomal polymorphism is a normal variation where the genetic material is arranged differently to the average individual and is more common in infertile couples compared to the general population. We analysed data from 942 ICSI cycles in 697 couples who underwent karyotyping analysis to assess the changes in chromosomes between 2016 and 2018. The pregnancy rate was 31.2%, with 16.0% of participants experiencing a live birth, while 13.8% of pregnancies resulted in a miscarriage and 1.3% were outside the womb cavity (ectopic). The evidence did not identify a clear association between the chromosomal polymorphism and the outcome of treatment.
Topics: Abortion, Spontaneous; Chromosomes; Female; Fertilization in Vitro; Humans; Infertility; Male; Pregnancy; Semen
PubMed: 35928675
DOI: 10.1530/RAF-21-0116 -
Infant Mental Health Journal May 2021This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are...
This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy.
Topics: Adult; Female; Humans; Infant; Infant, Newborn; Mother-Child Relations; Object Attachment; Pregnancy; Pregnancy, Unplanned; Pregnant Women; Prenatal Care; Young Adult
PubMed: 33860552
DOI: 10.1002/imhj.21919 -
BMC Pregnancy and Childbirth Apr 2018Antiepileptic drugs (AEDs) are used by pregnant women to manage conditions such as epilepsy and bipolar disorder even though they pose a risk to the developing foetus....
BACKGROUND
Antiepileptic drugs (AEDs) are used by pregnant women to manage conditions such as epilepsy and bipolar disorder even though they pose a risk to the developing foetus. This study aimed to determine the overall use of AEDs by women during their childbearing years and women who are pregnant and the association between AED use and rates of pregnancy termination and spontaneous abortion.
METHODS
Retrospective population based cohort study using administrative databases in New Zealand between 2008 and 2014. Women who had been pregnant were identified by the National Minimum Dataset and were linked to the Pharmaceutical Collection to obtain information on use of AEDs. Women aged between 15 and 45 years dispensed AEDs were identified in the Pharmaceutical Collection.
RESULTS
There was an increase in the number of women of child-bearing potential prescribed AEDs, from 9 women per 1000 women in 2008 to 11.4 women per 1000 women in 2014. Women who had been dispensed an AED had an increased rate of spontaneous abortion 8.97 spontaneous abortions per 100 pregnancies, compared with, 6.31 per 100 pregnancies (risk ratio 1.42, 95% CI 1.40 to 1.44), and a decreased rate of pregnancy termination, 18.51 terminations per 100 pregnancies compared with 19.58 per 100 pregnancies (risk ratio 1.95, 95% CI 0.94-0.96).
CONCLUSION
Use of newer AEDs is increasing in women of child-bearing potential in New Zealand leading to an overall increase in AED use in this group despite a fall in the use of older AEDs. AED use is this study was associated with an increased risk of spontaneous abortion and decreased rate of pregnancy termination, however confounding by indication could not be excluded.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Anticonvulsants; Databases, Factual; Female; Humans; Maternal Exposure; Middle Aged; New Zealand; Odds Ratio; Pregnancy; Pregnancy Outcome; Retrospective Studies; Young Adult
PubMed: 29625554
DOI: 10.1186/s12884-018-1728-y -
Contraception Mar 2016This study has two aims. The first is to assess the proportion of unplanned pregnancies among women attending antenatal clinics (ANCs) and those undergoing induced...
OBJECTIVE
This study has two aims. The first is to assess the proportion of unplanned pregnancies among women attending antenatal clinics (ANCs) and those undergoing induced abortion (IA). The second is to assess both their previous contraceptive use and contraceptive intention, with particular focus on the use or consideration of any long-acting reversible contraceptives in Hull and East Riding in order to inform service redesign.
STUDY DESIGN
Consecutive women attending their first ANC appointment and women attending a gynecology clinic undergoing IA were asked to complete a two-page questionnaire that contained a validated pregnancy intendedness questionnaire [the London Measure of Unplanned Pregnancy (LMUP)] and questions to establish contraceptive use and access prior to this index pregnancy.
RESULTS
The overall response rate was 69%. We received 648 evaluable questionnaires for women undergoing IA. Of these pregnancies, 75.8% [95% confidence interval (CI), 72.3%-79.0%] were unplanned (LMUP, score 0-3). We received 1001 evaluable questionnaires from women booking at ANCs. Of these pregnancies, 5.5% (95% CI, 4.2%-7.0%) were unplanned. Among those with unplanned pregnancies who were not using contraception, 31% reported that they were unable to obtain the method they wanted. Among those using a method immediately prior to the index unplanned pregnancy, 33% stated that it was not the method they wanted; of these, 75% would have preferred sterilization, the implant, injectable or intrauterine contraceptive.
CONCLUSION
Unplanned pregnancies in this population are common among women undergoing IA but are uncommon among women attending an ANC. About a third of women not using contraception reported that they were unable to obtain the method they wanted, and about a third of women using contraception stated that they were not using the method they would have preferred.
IMPLICATIONS
Opportunities to prevent unplanned pregnancies are missed when staff in primary and secondary care looking after women do not knowledgeably inform, discuss and offer contraception in a timely manner, particularly the most effective long-acting reversible contraceptive methods. Services should be deliverable where women are: this includes within pregnancy care services. Seeking patient experience is an essential component of service redesign.
Topics: Abortion, Induced; Contraception; Contraception Behavior; England; Female; Humans; Pregnancy; Pregnancy, Unplanned; Prenatal Care; Surveys and Questionnaires
PubMed: 26519645
DOI: 10.1016/j.contraception.2015.10.004 -
Medicina (Kaunas, Lithuania) Jun 2023Twin pregnancies demonstrate a 2-3-fold higher chance of developing PE compared to singletons, and recent evidence has demonstrated that the sFLT1/PIGF ratio is strongly... (Review)
Review
Twin pregnancies demonstrate a 2-3-fold higher chance of developing PE compared to singletons, and recent evidence has demonstrated that the sFLT1/PIGF ratio is strongly associated with PE, adverse pregnancy outcomes, as well as imminent deliveries due to PE complications. The primary objective of this systematic review was to summarise the available data on the levels of sFLT1, PlGF and their ratios in twin pregnancies and to investigate their association with the development of PE, adverse pregnancy outcomes and the timing of the delivery. A systematic search of Ovid Embase, Web of Science, Science Direct, PubMed, Ovid Medline, Google Scholar and CINAHL was carried out. sFLT1 levels and the sFLT1/PIGF ratio appeared higher in twins compared to singleton pregnancies, especially in the third trimester, while PlGF levels appeared higher up until the third trimester, with their values showing no difference or being even lower than in singletons thereafter. The sFLT1/PIGF ratio has been reported to be an independent marker of adverse outcomes related to pre-eclampsia and is associated with the mean time until delivery in an inverse manner. Further research is required in order to establish the optimal sFLT1/PIGF cut-off values and to stratify the risk of adverse outcomes in twin pregnancies.
Topics: Female; Humans; Pregnancy; Biomarkers; Placenta Growth Factor; Pre-Eclampsia; Pregnancy, Twin; Vascular Endothelial Growth Factor Receptor-1
PubMed: 37512044
DOI: 10.3390/medicina59071232 -
BMC Public Health Aug 2022One of the outcomes of sexual violence is unintended pregnancy. In Zambia, 15% of married women age 15-49 years had experienced sexual violence from their husband or...
BACKGROUND
One of the outcomes of sexual violence is unintended pregnancy. In Zambia, 15% of married women age 15-49 years had experienced sexual violence from their husband or partner. The prevalence of unintended pregnancies among women age 15-49 years has risen from 33% in 1992 to 38% in 2018. The link between sexual violence and unintended pregnancy in Zambia was investigated in this study.
METHODS
This study used the women's dataset from the 2018 Zambia Demographic and Health Survey, a cross-sectional survey. The study looked at a weighted sample size of 4,465 women age 15 - 49 years. Unintended pregnancy was measured by combining response categories of mistimed and unwanted pregnancy. Multivariate binary logistic regression was performed to establish the net effects of sexual violence and each explanatory variable on unintended pregnancy.
RESULTS
The findings suggest that sexual violence does have a role in unintended pregnancies (AOR 1.74; CI 1.38-2.19). Ever use of contraception is also a significant predictor of unintended pregnancy (AOR 1.48; CI 1.16-1.88), even when other characteristics are taken into account. Results have shown that a woman who had ever used contraception and had experienced sexual violence was more likely to have an unintended pregnancy.
CONCLUSION
Spousal sexual violence is highly associated with unintended pregnancies in Zambia. Addressing intimate partner sexual violence is among the ways to prevent unintended pregnancies. It is also important to sensitize women on reporting acts of sexual violence to relevant authorities as this will not only prevent reoccurrence of sexual violence but also reduce unintended pregnancies and associated long-term effects.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Intimate Partner Violence; Middle Aged; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted; Sex Offenses; Sexual Partners; Young Adult; Zambia
PubMed: 35927643
DOI: 10.1186/s12889-022-13881-8 -
International Journal of Molecular... May 2021Angiogenesis is one of the main processes that coordinate the biological events leading to a successful pregnancy, and its imbalance characterizes several... (Review)
Review
Angiogenesis is one of the main processes that coordinate the biological events leading to a successful pregnancy, and its imbalance characterizes several pregnancy-related diseases, including preeclampsia. Intracellular interactions via extracellular vesicles (EVs) contribute to pregnancy's physiology and pathophysiology, and to the fetal-maternal interaction. The present review outlines the implications of EV-mediated crosstalk in the angiogenic process in healthy pregnancy and its dysregulation in preeclampsia. In particular, the effect of EVs derived from gestational tissues in pro and anti-angiogenic processes in the physiological and pathological setting is described. Moreover, the application of EVs from placental stem cells in the clinical setting is reported.
Topics: Animals; Extracellular Vesicles; Female; Humans; Neovascularization, Pathologic; Placenta; Pre-Eclampsia; Pregnancy
PubMed: 34065595
DOI: 10.3390/ijms22105402 -
The Cochrane Database of Systematic... Apr 2015Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This... (Review)
Review
BACKGROUND
Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This condition is rare and affects about one in 10,000 pregnancies overall. Monoamniotic twin pregnancies are susceptible to complications including cord entanglement, increased congenital anomalies, intrauterine growth restriction, twin-to-twin transfusion syndrome and increased perinatal mortality. All twin pregnancies also carry additional maternal risks including pre-eclampsia, anaemia, antepartum haemorrhage, postpartum haemorrhage and operative delivery.The optimal timing for the delivery of monoamniotic twins is not known. The options include 'planned early delivery' between 32 and 34 weeks, or alternatively awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation), unless there is a specific indication for earlier delivery.
OBJECTIVES
To assess whether routine early delivery in monoamniotic twin pregnancies improves fetal, neonatal or maternal outcomes compared with 'expectant management'. Expectant management means awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation in many centres), unless a specific indication for delivery occurs in the meantime, e.g. for non-reassuring antenatal testing.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015).
SELECTION CRITERIA
Published and unpublished randomised controlled trials (including cluster-randomised trials) comparing outcomes for women and infants who were randomised to planned early delivery of a monoamniotic twin pregnancy with outcomes for women and infants who were randomised to either planned term delivery or expectant management. However, we did not identify any trials for inclusion in this review.Quasi-randomised controlled trials, trials published in abstract form only, and trials using a cross-over design are not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
No trials were identified by the search strategy.
MAIN RESULTS
No trials were identified by the search strategy.
AUTHORS' CONCLUSIONS
Monoamniotic twins are rare, and there is insufficient randomised controlled evidence on which to draw strong conclusions about the best management. In their absence, we can refer to historical case series and expert consensus. Management plans should take into consideration the availability of high-quality neonatal care if early delivery is chosen. Women and their families should be involved in the decision making about these high-risk pregnancies.Ongoing, multicentre audits of maternal and perinatal outcomes for monoamniotic twins are needed in order to inform families and clinicians about up-to-date perinatal outcomes with contemporary obstetric practice. Research should consider the social and economic implications of planned interventions, as well as the perinatal outcomes.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy, Twin; Twins, Monozygotic; Watchful Waiting
PubMed: 25906204
DOI: 10.1002/14651858.CD008820.pub2