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Journal of Acquired Immune Deficiency... Dec 2014We evaluated the pharmacokinetics (PK) of raltegravir in HIV-infected women during pregnancy and postpartum. (Clinical Trial)
Clinical Trial
OBJECTIVE
We evaluated the pharmacokinetics (PK) of raltegravir in HIV-infected women during pregnancy and postpartum.
METHODS
International Maternal Pediatric Adolescent AIDS Clinical Trials 1026s is an ongoing prospective study of antiretroviral PK during pregnancy (NCT00042289). Women receiving 400 mg raltegravir twice daily in combination antiretroviral therapy had intensive steady-state 12-hour PK profiles performed during pregnancy and at 6- to 12-week postpartum. Targets were trough concentration above 0.035 μg/mL, the estimated 10th percentile in nonpregnant historical controls.
RESULTS
Median raltegravir area under the curve was 6.6 μg·h/mL for second trimester (n = 16), 5.4 μg·h/mL for third trimester (n = 41), and 11.6 μg·h/mL postpartum (n = 38) (P = 0.03 postpartum vs second trimester, P = 0.001 pp vs third trimester). Trough concentrations were above the target in 69%, 80%, and 79% of second trimester, third trimester, and postpartum subjects, respectively, with wide variability (<0.010-0.917 μg/mL), and no significant difference between third trimester and postpartum trough concentrations was detected. The median ratio of cord blood/maternal raltegravir concentrations was 1.5. HIV RNA levels were <400 copies per milliliter in 92% of women at delivery. Adverse events included elevated liver transaminases in 1 woman and vomiting in 1. All infants with known status are HIV uninfected.
CONCLUSIONS
Median raltegravir area under the curve was reduced by approximately 50% during pregnancy; trough concentrations were frequently below target both during late pregnancy and postpartum. Raltegravir readily crossed the placenta. High rates of viral suppression at delivery and the lack of a clear relationship between raltegravir concentration and virologic effect in nonpregnant adults suggest that despite the decreased exposure during pregnancy, a higher dose is not necessary.
Topics: Adult; Female; HIV Infections; HIV Integrase Inhibitors; Humans; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimesters; Pyrrolidinones; Raltegravir Potassium; Young Adult
PubMed: 25162818
DOI: 10.1097/QAI.0000000000000318 -
Medicina (Kaunas, Lithuania) Feb 2022There is consistent evidence that many of the pregnancy complications that occur late in the second and third trimester can be predicted from an integrated 11-13 weeks... (Review)
Review
There is consistent evidence that many of the pregnancy complications that occur late in the second and third trimester can be predicted from an integrated 11-13 weeks visit, where a maternal and fetal assessment are comprehensively performed. The traditional aims of the 11-13 weeks visit have been: establishing fetal viability, chorionicity and dating of the pregnancy, and performing the combined screening test for common chromosomal abnormalities. Recent studies have shown that the first trimester provides important information that may help to predict pregnancy complications, such as preeclampsia and fetal growth restriction, stillbirth, preterm birth, gestational diabetes mellitus and placenta accreta spectrum disorder. The aim of this manuscript is to review the methods available to identify pregnancies at risk for adverse outcomes after screening at 11-13 weeks. Effective screening in the first trimester improves pregnancy outcomes by allowing specific interventions such as administering aspirin and directing patients to specialist clinics for regular monitoring.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy Trimester, Third; Premature Birth
PubMed: 35334508
DOI: 10.3390/medicina58030332 -
Maternal pregnancy-related anxiety and children's physical growth: the Ma'anshan birth cohort study.BMC Pregnancy and Childbirth May 2023Epidemiological studies have identified maternal antenatal anxiety and several adverse birth outcomes, but limited studies have focused on the relationship with the...
BACKGROUND
Epidemiological studies have identified maternal antenatal anxiety and several adverse birth outcomes, but limited studies have focused on the relationship with the long-term physical growth of children. The study aimed to assess the influence of maternal pregnancy-related anxiety on physical growth in children at different exposure periods during pregnancy.
METHODS
3,154 mother-child pairs were included based on the Ma'anshan birth cohort study. Maternal prenatal anxiety was obtained by administering a questionnaire using the pregnancy-related anxiety questionnaire (PRAQ) scale during the 1st, 2nd and 3rd trimesters of pregnancy. Body fat (BF) (48 to 72 months) and Body Mass Index (BMI) (birth to 72 months) were collected repeatedly for children. Group-based trajectory models were applied to fit the different trajectories of BMI and BF.
RESULTS
Maternal anxiety in the 2nd (OR = 0.81; 95% CI: 0.68 to 0.98; P < 0.025) and 3rd (OR = 0.80; 95% CI: 0.67 to 0.97; P = 0.020) trimesters was associated with a decreased risk of rapid weight gain (RWG) in the first year of life. Children aged 48 to 72 months of mothers with anxiety in the 3rd trimester had lower BMI (β = -0.161; 95% CI, -0.293 to -0.029; P = 0.017) and BF (β = -0.190; 95% CI, -0.334 to -0.046; P = 0.010), and these children were less likely to develop a very high BMI trajectory (OR = 0.54; 95% CI: 0.34 to 0.84; P = 0.006), and a high BF trajectory (OR = 0.72; 95% CI: 0.53 to 0.99; P = 0.043). Similar associations were found between maternal anxiety in both 2nd and 3rd trimesters and children's physical growth.
CONCLUSIONS
Offspring of mothers with prenatal anxiety in the 2nd and 3rd trimesters predicts poorer growth in infancy and preschool age. Early improvement and treatment of prenatal anxiety could benefit physical health and development in early childhood.
Topics: Female; Pregnancy; Humans; Child, Preschool; Cohort Studies; Mothers; Pregnancy Trimester, Third; Body Mass Index; Anxiety; Parturition; Prenatal Exposure Delayed Effects
PubMed: 37231487
DOI: 10.1186/s12884-023-05711-5 -
Prostaglandins, Leukotrienes, and... Apr 2020Fatty acids are essential for feto-placental growth and development. Maternal fatty acids and their metabolites are involved in every stage of pregnancy by supporting... (Review)
Review
Fatty acids are essential for feto-placental growth and development. Maternal fatty acids and their metabolites are involved in every stage of pregnancy by supporting cell growth and development, cell signaling, and modulating other critical aspects of structural and functional processes. Early placentation process is critical for placental growth and function. Several fatty acids modulate angiogenesis as observed by increased tube formation and secretion of angiogenic growth factors in first-trimester human placental trophoblasts. Long-chain fatty acids stimulate angiogenesis in these cells via vascular endothelium growth factor (VEGF), angiopoietin-like protein 4 (ANGPTL4), fatty acid-binding proteins (FABPs), or eicosanoids. Inadequate placental angiogenesis and trophoblast invasion of the maternal decidua and uterine spiral arterioles leads to structural and functional deficiency of placenta, which contributes to preeclampsia, pre-term intrauterine growth restriction, and spontaneous abortion and also affects overall fetal growth and development. During the third trimester of pregnancy, placental preferential transport of maternal plasma long-chain polyunsaturated fatty acids is of critical importance for fetal growth and development. Fatty acids cross the placental microvillous and basal membranes by mainly via plasma membrane fatty acid transport system (FAT, FATP, p-FABPpm, & FFARs) and cytoplasmic FABPs. Besides, a member of the major facilitator superfamily-MFSD2a, present in the placenta is involved in the supply of DHA to the fetus. Maternal factors such as diet, obesity, endocrine, inflammation can modulate the expression and activity of the placental fatty acid transport activity and thereby impact feto-placental growth and development. In this review, we discuss the maternal dietary fatty acids, and placental transport and metabolism, and their roles in placental growth and development.
Topics: Angiopoietin-Like Protein 4; Cell Membrane; Dietary Fats; Fatty Acid-Binding Proteins; Fatty Acids; Female; Fetal Development; Humans; Neovascularization, Physiologic; Placenta; Placentation; Pregnancy; Pregnancy Trimesters; Trophoblasts; Vascular Endothelial Growth Factor A
PubMed: 32120190
DOI: 10.1016/j.plefa.2020.102080 -
Environment International Apr 2024Evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases risk of high blood pressure (BP) during pregnancy. Prior studies did not examine...
BACKGROUND
Evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases risk of high blood pressure (BP) during pregnancy. Prior studies did not examine associations with BP trajectory parameters (i.e., overall magnitude and velocity) during pregnancy, which is linked to adverse pregnancy outcomes.
OBJECTIVES
To estimate associations of multiple plasma PFAS in early pregnancy with BP trajectory parameters across the second and third trimesters. To assess potential effect modification by maternal age and parity.
METHODS
In 1297 individuals, we quantified six PFAS in plasma collected during early pregnancy (median gestational age: 9.4 weeks). We abstracted from medical records systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery. BP trajectory parameters were estimated via Super Imposition by Translation and Rotation modeling. Subsequently, Bayesian Kernel Machine Regression (BKMR) was employed to estimate individual and joint associations of PFAS concentrations with trajectory parameters - adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index, income, parity, smoking status, and seafood intake. We evaluated effect modification by age at enrollment and parity.
RESULTS
We collected a median of 13 BP measurements per participant. In BKMR, higher concentration of perfluorooctane sulfonate (PFOS) was independently associated with higher magnitude of overall SBP and DBP trajectories (i.e., upward shift of trajectories) and faster SBP trajectory velocity, holding all other PFAS at their medians. In stratified BKMR analyses, participants with ≥ 1 live birth had more pronounced positive associations between PFOS and SBP velocity, DBP magnitude, and DBP velocity - compared to nulliparous participants. We did not observe significant associations between concentrations of the overall PFAS mixture and either magnitude or velocity of the BP trajectories.
CONCLUSION
Early pregnancy plasma PFOS concentrations were associated with altered BP trajectory in pregnancy, which may impact future cardiovascular health of the mother.
Topics: Humans; Female; Pregnancy; Adult; Fluorocarbons; Blood Pressure; Environmental Pollutants; Pregnancy Trimester, Third; Pregnancy Trimester, First; Pregnancy Trimester, Second; Young Adult; Maternal Exposure; Alkanesulfonic Acids
PubMed: 38583297
DOI: 10.1016/j.envint.2024.108628 -
Sleep Health Aug 2019Despite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete....
BACKGROUND
Despite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete. Moreover, predictors of differential patterns of sleep quality across the perinatal period are poorly defined.
METHODS
This study examined subjective sleep quality using the Pittsburgh Sleep Quality Index during each trimester of pregnancy and at 4-11 weeks postpartum among 133 women inclusive of nulliparous and multiparous African Americans and Whites.
RESULTS
At any given assessment, 53%-71% of women reported poor overall sleep quality (Pittsburgh Sleep Quality Index total score > 5). Moreover, 92% reported poor overall sleep quality during at least 1 assessment, including 88% at some time during gestation. Compared to nulliparous women, multiparous women reported poorer overall sleep quality, shorter sleep duration, and poorer sleep efficiency during the first trimester; poorer overall sleep quality and longer sleep latency in the second trimester; and more frequent sleep disturbances (eg, night time and early morning awakenings) during the third trimester. Among nulliparous as well as multiparous women, specific aspects of sleep (eg, subjective sleep quality, sleep disturbances, sleep efficiency) were poorer in African American compared to White women at different time points during pregnancy. No effects of race or parity were observed on sleep parameters at postpartum.
CONCLUSIONS
Poor sleep quality during pregnancy as well as early postpartum is highly prevalent among both African American and White women. Both multiparous status and African American race are associated with more disturbed sleep at some time points during pregnancy. These individual differences should be considered in future research and clinical efforts to promote perinatal sleep health.
Topics: Adult; Black or African American; Female; Humans; Parity; Postpartum Period; Pregnancy; Pregnancy Trimesters; Risk Factors; Sleep Wake Disorders; White People; Young Adult
PubMed: 31122875
DOI: 10.1016/j.sleh.2019.03.005 -
Archives of Endocrinology and Metabolism May 2021As pregnant women are susceptible to changes in iodine, which can cause miscarriage, goiter, thyroid nodules, hypothyroidism, in addition to fetal neurological... (Review)
Review
As pregnant women are susceptible to changes in iodine, which can cause miscarriage, goiter, thyroid nodules, hypothyroidism, in addition to fetal neurological impairment or development. The aim of this study was to verify the implications of the iodine alteration in each gestational trimester and its consequences of physiological justification. The review was based on PRISMA. Searching for articles that took place in March 2020 without delimiting data. As bases consulted were the Clinical Trials, Cochrane Library, Lilacs and Medline (PubMed). The descriptors were combined as follows: "pregnancy" AND "iodine deficiency". Articles that addressed iodine deficiency and its implications were included. The selection followed the steps of reading the titles, abstracts and full articles. To assess the methodological quality of the studies, the STROBE Instruction instrument was used. The research resulted in 1,266 studies and 11 were included. In assessing methodological quality, the lowest score was and the maximum 20. According to studies, the fourth most affected by iodine loss are the second and third, it is possible to increase the volume and pneumatic nodules, subclinical hypothyroidism, pre-eclampsia, among others. The damages caused by iodine deficiency in the first or second trimester are still reversible, therefore, they need to be diagnosed early, to guarantee an iodic homeostasis and prevent damage to the health of the mother-child binomial.
Topics: Child; Female; Goiter; Humans; Hypothyroidism; Iodine; Pregnancy; Pregnancy Complications; Pregnancy Trimesters
PubMed: 34033289
DOI: 10.20945/2359-3997000000289 -
Asia Pacific Journal of Clinical... 2020Thyroid disease in pregnancy can have devastating effect on the fetus. In Harbin, China, there is insufficient knowledge about the incidence of and contributing factors...
BACKGROUND AND OBJECTIVES
Thyroid disease in pregnancy can have devastating effect on the fetus. In Harbin, China, there is insufficient knowledge about the incidence of and contributing factors to thyroid disease in pregnancy. This study investigates whether urine iodine concentration (UIC), as a proxy for iodine intake, affects the thyroid structure and/or function during each trimester.
METHODS AND STUDY DESIGN
Data of 24000 pre-pregnant women were collected from January 2017 to August 2019. Serum thyroid hormone levels were measured, and thyroid ultrasonography was performed. If thyroid ultrasonography and thyroid function findings were normal before pregnancy and were abnormal after pregnancy, the current gestational age was recorded and the UIC was measured. Finally, a total of 500 participants were included in the study.
RESULTS
There were significant differences in the incidence of abnormal thyroid structure and function between trimester groups (p<0.05). Thyroid nodular lesions were the most common abnormal ultrasound finding, and positive thyroid peroxide antibodies (TPOAb) were the most common abnormal thyroid function test results. There were significant differences in the median UIC between trimester groups (p<0.001); the median UIC decreased with increasing gestational age. The incidence of abnormal thyroid structure or function was not significantly different across UIC groups (p>0.05).
CONCLUSIONS
In women from Harbin, thyroid structural or functional abnormalities commonly occur in the second and third trimesters of pregnancy. Thyroid nodular lesions and positive TPOAb are the commonest thyroid abnormalities. The median UIC significantly declines with increasing gestational age. Pregnant women in Harbin have iodine-deficient states.
Topics: China; Female; Humans; Iodine; Pregnancy; Pregnancy Trimesters; Thyroid Function Tests; Thyroid Gland
PubMed: 33377373
DOI: 10.6133/apjcn.202012_29(4).0014 -
Epidemiologic Reviews Jan 2022In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as "ever exposed" versus "never exposed" within each trimester or even over the... (Review)
Review
In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as "ever exposed" versus "never exposed" within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and does not to incorporate important aspects such as dosage, timing of exposure, and treatment duration. Alternative exposure modeling methods can better summarize complex, individual-level medication use trajectories or time-varying exposures from information on medication dosage, gestational timing of use, and frequency of use. We provide an overview of commonly used methods for more refined definitions of real-world exposure to medication use during pregnancy, focusing on the major strengths and limitations of the techniques, including the potential for method-specific biases. Unsupervised clustering methods, including k-means clustering, group-based trajectory models, and hierarchical cluster analysis, are of interest because they enable visual examination of medication use trajectories over time in pregnancy and complex individual-level exposures, as well as providing insight into comedication and drug-switching patterns. Analytical techniques for time-varying exposure methods, such as extended Cox models and Robins' generalized methods, are useful tools when medication exposure is not static during pregnancy. We propose that where appropriate, combining unsupervised clustering techniques with causal modeling approaches may be a powerful approach to understanding medication safety in pregnancy, and this framework can also be applied in other areas of epidemiology.
Topics: Cluster Analysis; Female; Humans; Pharmacoepidemiology; Pregnancy; Pregnancy Trimesters
PubMed: 34100086
DOI: 10.1093/epirev/mxab002 -
Acta Obstetricia Et Gynecologica... Oct 2023Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative...
INTRODUCTION
Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy.
MATERIAL AND METHODS
Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis.
RESULTS
A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores.
CONCLUSIONS
When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.
Topics: Pregnancy; Child; Female; Humans; Pregnancy Trimester, Third; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pelvic Pain
PubMed: 37771202
DOI: 10.1111/aogs.14670