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Pregnancy Hypertension Jun 2024Cardiovascular disease (CVD) is globally the leading cause of death and disability. Sex-specific causes of female CVD are under-investigated. Pregnancy remains an... (Review)
Review
Cardiovascular disease (CVD) is globally the leading cause of death and disability. Sex-specific causes of female CVD are under-investigated. Pregnancy remains an underinvestigated sex-specific stress test for future CVD and a hitherto missed opportunity to initiate prevention of CVD at a young age. Population-based studies show a strong association between female CVD and hypertensive disorders of pregnancy. This association is also present after other pregnancy complications that are associated with placental dysfunction, including fetal growth restriction, preterm delivery and gestational diabetes mellitus. Few women are, however, offered systematic cardio-preventive follow-up after such pregnancy complications. These women typically seek help from the health system at first clinical symptom of CVD, which may be decades later. By this time, morbidity is established and years of preventive opportunities have been missed out. Early identification of modifiable risk factors starting postpartum followed by systematic preventive measures could improve maternal cardiovascular health trajectories, promoting healthier societies. In this non-systematic review we briefly summarize the epidemiological associations and pathophysiological hypotheses for the associations. We summarize current clinical follow-up strategies, including some proposed by international and national guidelines as well as user support groups. We address modifiable factors that may be underexploited in the postpartum period, including breastfeeding and blood pressure management. We suggest a way forward and discuss the remaining knowledge gaps and barriers for securing the best evidence-based follow-up, relative to available resources after a hypertensive pregnancy complication in order to prevent or delay onset of premature CVD.
Topics: Humans; Female; Pregnancy; Postnatal Care; Hypertension, Pregnancy-Induced; Cardiovascular Diseases; Postpartum Period; Heart Disease Risk Factors; Risk Factors
PubMed: 38643570
DOI: 10.1016/j.preghy.2024.101127 -
Ugeskrift For Laeger Apr 2017
Topics: Female; Humans; Pre-Eclampsia; Pregnancy
PubMed: 28416065
DOI: No ID Found -
International Journal of Molecular... Oct 2022Briefly, 25-hydroxyvitamin D (25(OH)D) plays an essential role in embryogenesis and the course of intra- and postnatal periods and is crucially involved in the... (Review)
Review
Briefly, 25-hydroxyvitamin D (25(OH)D) plays an essential role in embryogenesis and the course of intra- and postnatal periods and is crucially involved in the functioning of the mother-placenta-fetus system. The low quantity of 25(OH)D during pregnancy can lead to an elevated risk for preeclampsia occurrence. Despite the numerous studies on the association of 25(OH)D deficiency and preeclampsia development, the current research on this theme is contradictory. In this review, we summarize and analyze study data on the effects of 25(OH)D deficiency and supplementation on pregnancy, labor, and fetal and neonatal outcomes.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Vitamin D Deficiency; Pre-Eclampsia; Vitamin D; Dietary Supplements; Pregnancy Complications
PubMed: 36361738
DOI: 10.3390/ijms232112935 -
Fertility and Sterility Oct 2015The risk of pregnancy and neonatal complications in women with endometriosis and adenomyosis is debatable. A literature review looking at rates, presentation, and... (Review)
Review
The risk of pregnancy and neonatal complications in women with endometriosis and adenomyosis is debatable. A literature review looking at rates, presentation, and management of spontaneous hemoperitoneum, enlargement, abscess, and rupture of an endometrioma, uterine rupture, and bowel perforation in pregnant women with endometriosis was conducted. Moreover, studies addressing differences in early pregnancy (miscarriage), late pregnancy (gestational diabetes mellitus, preeclampsia, prematurity, placenta previa, placental abruption, cesarean section, hemorrhages) and neonatal outcomes (weight at birth) between endometriosis and adenomyosis patients versus control subjects were reviewed. The overall prevalence of endometriosis-related spontaneous hemoperitoneum in pregnancy is estimated to be ∼0.4%. Only four cases of endometrioma rupture in pregnancy have been reported. Although during pregnancy there is no way to anticipate the onset of complications from preexisting endometriosis, it is important, when a specific abdominal pain occurs, to suspect rare but potentially life-threating events. Population-based studies suggest a possible association of endometriosis with preterm birth and placenta previa. Limits of the published studies are noted and discussed.
Topics: Adenomyosis; Endometriosis; Female; Hemoperitoneum; Humans; Infant, Newborn; Infertility; Ovarian Diseases; Peritoneal Diseases; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 26348274
DOI: 10.1016/j.fertnstert.2015.08.030 -
Cardiovascular Journal of Africa 2016Valvular heart disease may be a pre-existing complication of pregnancy or it may be diagnosed for the first time during pregnancy. Accurate diagnosis, tailored therapy... (Review)
Review
Valvular heart disease may be a pre-existing complication of pregnancy or it may be diagnosed for the first time during pregnancy. Accurate diagnosis, tailored therapy and an understanding of the physiology and pathophysiology of pregnancy are necessary components of management, best achieved through the use of multidisciplinary clinics. This review outlines the management of specific lesions, with particular reference to post-rheumatic valvular heart disease.
Topics: Disease Management; Female; Heart Valve Diseases; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Rheumatic Heart Disease; Risk Assessment
PubMed: 27213859
DOI: 10.5830/CVJA-2016-052 -
Public Health Nutrition Jul 2016To investigate associations of maternal periconceptional shellfish, lean fish and fatty fish intake with risk of pregnancy complications.
OBJECTIVE
To investigate associations of maternal periconceptional shellfish, lean fish and fatty fish intake with risk of pregnancy complications.
DESIGN
In this prospective cohort study, we collected information on intake of seafood subtypes using FFQ. We categorized seafood intake into frequencies of 1 servings/week. We ascertained gestational hypertension, pre-eclampsia, gestational diabetes and preterm birth diagnoses from medical records. Using generalized linear models with a log link, the Poisson family and robust standard errors, we estimated risk ratios and 95 % confidence intervals across seafood intake categories.
SETTING
The Omega study, a study of risk factors for pregnancy complications among women recruited from prenatal clinics in Washington State, USA, 1996-2008.
SUBJECTS
The current study included 3279 participants from the Omega study.
RESULTS
Median (interquartile range) shellfish, lean fish and fatty fish intake was 0·3 (0-0·9), 0·5 (0-1·0) and 0·5 (0·1-1·0) servings/week, respectively. Lean fish intake of >1 servings/week (v. <0·2 servings/month) was associated with a 1·55-fold higher risk of preterm birth (95 % CI 1·04, 2·30) and was not associated with the other pregnancy complications. Higher intake of seafood (total or other subtypes) was not associated with pregnancy complications (separately or combined).
CONCLUSIONS
Higher intake of lean fish, but not fatty fish or shellfish, was associated with a higher risk of preterm birth; these findings may have significance for preterm birth prevention. Studies of mechanisms and potential contributing factors (including seafood preparation and nutrient/contaminant content) are warranted.
Topics: Adult; Animals; Diabetes, Gestational; Diet; Fatty Acids, Omega-3; Female; Humans; Hypertension, Pregnancy-Induced; Maternal Nutritional Physiological Phenomena; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Prospective Studies; Seafood; Washington
PubMed: 26626702
DOI: 10.1017/S136898001500316X -
The Western Journal of Emergency... Mar 2015Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous... (Review)
Review
Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy.
Topics: Decision Trees; Emergency Service, Hospital; Emergency Treatment; Female; Headache; Humans; Pregnancy; Pregnancy Complications
PubMed: 25834672
DOI: 10.5811/westjem.2015.1.23688 -
Journal of Korean Medical Science Jul 2021Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy...
BACKGROUND
Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery.
METHODS
Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models.
RESULTS
Data from 4,439,778 women were collected for this study. From 2006-2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81-2.23), LBW (HR, 1.62; 95% CI, 1.46-1.79), C/S (HR, 1.13; 95% CI, 1.08-1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18-1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40-0.95).
CONCLUSION
Non-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.
Topics: Adnexa Uteri; Adult; Cesarean Section; Diabetes, Gestational; Female; Fetal Growth Retardation; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Laparoscopy; Laparotomy; Pelvis; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Republic of Korea; Treatment Outcome; Young Adult
PubMed: 34313034
DOI: 10.3346/jkms.2021.36.e192 -
Reproductive Sciences (Thousand Oaks,... Apr 2019Maternal mortality remains one of the leading causes of death in women of reproductive age in developing countries, and a major concern in some developed countries. It... (Review)
Review
Maternal mortality remains one of the leading causes of death in women of reproductive age in developing countries, and a major concern in some developed countries. It is puzzling why such a condition has not been reduced in frequency, if not eliminated, in the course of evolution. Maternal mortality is a complex phenomenon caused by several physiological and physical factors. Among the physical factors, maternal mortality due to fetopelvic disproportion remains controversial. Several explanations including evolution of bipedal locomotion, rapid brain growth, and nutritional changes and life style changes in settler communities have been proposed. The influences of human reproductive biology and sexual selection have rarely been considered to explain why maternal mortality persisted through human evolution. We entertain the hypothesis that irrespective of the causes, the risks of all factors causing maternal mortality would be aggravated by disassortative mating, specifically male preference for younger females who are generally small statured and at higher risk of obstetric complications. Maternal mortality arising due to sexual selection and mate choice would have the long-term effect of driving widowers toward younger women, often resulting in "child marriage," which still remains a significant cause of maternal mortality globally. Evolutionarily, such a male driven mating system in polygamous human populations would have prolonged the persistence of maternal mortality despite selection acting against it. The effects may extend beyond maternal mortality because male-mate choice driven maternal mortality would reduce average reproductive life spans of women, thus influencing the evolution of menopause.
Topics: Biological Evolution; Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications; Reproduction; Risk Factors; Sexual Behavior
PubMed: 30545276
DOI: 10.1177/1933719118812730 -
Journal of Diabetes Research 2020Gestational diabetes mellitus is a progressive and complex pregnancy complication, which threatens both maternal and fetal health. It is urgent to screen for specific... (Review)
Review
Gestational diabetes mellitus is a progressive and complex pregnancy complication, which threatens both maternal and fetal health. It is urgent to screen for specific biomarkers for early diagnosis and precise treatment, as well as to identify key moleculars to better understand the pathogenic mechanisms. In the present review, we comprehensively summarized recent studies of gestational diabetes using mass spectrometry-based proteomic technologies. Focused on the entire experimental design and proteomic results, we showed that these studies have covered a broad range of research contents in terms of sampling time, sample types, and outcome associations. Although most of the studies only stayed in the stage of initial discovery, several proteins were further verified to be efficient for disease diagnosis. Functional analysis of all the combined significant proteins also showed that a small number of proteins are known to be involved in the regulation of insulin or indirect signaling pathways. However, many factors such as diagnostic criteria, sample processing, proteomic method, and statistical method can greatly affect the identification of reproducible and reliable protein candidates. Thus, we further provided constructive suggestions and recommendations for carrying out proteomic or follow-up studies of gestational diabetes or other pregnancy complications in the future.
Topics: Biomarkers; Diabetes, Gestational; Female; Humans; Pregnancy; Proteome; Proteomics
PubMed: 32724825
DOI: 10.1155/2020/6450352