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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 -
International Journal of Epidemiology Dec 2023COVID-19 vaccines have been shown to protect pregnant individuals against mild and severe COVID-19 outcomes. However, limited safety data are available for inactivated...
BACKGROUND
COVID-19 vaccines have been shown to protect pregnant individuals against mild and severe COVID-19 outcomes. However, limited safety data are available for inactivated (CoronaVac) and mRNA (BNT162b2) vaccines during pregnancy regarding their effect on birth outcomes and neonatal mortality, especially in low- and middle-income countries.
METHODS
We conducted a retrospective population-based cohort study in Rio de Janeiro, Brazil, with 17 513 singleton live births conceived between 15 May 2021 and 23 October 2021. The primary exposure was maternal vaccination with CoronaVac or mRNA BNT162b2 vaccines and sub-analyses were performed by the gestational trimester of the first dose and the number of doses given during pregnancy. The outcomes were pre-term birth (PTB), small for gestational age (SGA), low birthweight (LBW), low Apgar 5 and neonatal death. We used the Cox model to estimate the hazard ratio (HR) with a 95% CI and applied the inverse probability of treatment weights to generate adjusted HRs.
RESULTS
We found no significant increase in the risk of PTB (HR: 0.98; 95% CI 0.88, 1.10), SGA (HR: 1.09; 95% CI 0.96, 1.27), LBW (HR: 1.00; 95% CI 0.88, 1.14), low Apgar 5 (HR: 0.81; 95% CI 0.55, 1.22) or neonatal death (HR: 0.88; 95% CI 0.56, 1.48) in women vaccinated with CoronaVac or BNT162b2 vaccines. These findings were consistent across sub-analyses stratified by the gestational trimester of the first dose and the number of doses given during pregnancy. We found mild yet consistent protection against PTB in women who received different vaccine platforms during the third trimester of pregnancy (any vaccines, HR: 0.78; 95% CI 0.63, 0.98; BNT162b2, HR: 0.75; 95% CI 0.59, 0.99).
CONCLUSIONS
This study provides evidence that COVID-19 vaccination in all trimesters of pregnancy, irrespective of the vaccine type, is safe and does not increase the risk of adverse birth outcomes or neonatal deaths.
Topics: Female; Humans; Infant, Newborn; Pregnancy; BNT162 Vaccine; Brazil; Cohort Studies; COVID-19; COVID-19 Vaccines; Infant Mortality; Perinatal Death; Pregnancy Complications, Infectious; Premature Birth; Retrospective Studies
PubMed: 37690066
DOI: 10.1093/ije/dyad120 -
The American Journal of Case Reports Aug 2023BACKGROUND Tubal heterotopic pregnancy is an extremely rare complication of pregnancy, in which there is a simultaneous presence of a pregnancy in the uterine cavity and... (Review)
Review
BACKGROUND Tubal heterotopic pregnancy is an extremely rare complication of pregnancy, in which there is a simultaneous presence of a pregnancy in the uterine cavity and in an ectopic location, most commonly in the fallopian tube. The management of such cases is not clearly established. In the case of a desire to maintain an intrauterine pregnancy, the surgical procedure consisting of a salpingectomy or salpingostomy is the most common. Such a procedure is effective, but it involves potential complications typical of surgeries, so, in some cases, it seems reasonable to apply the expectant management. CASE REPORT A 31-year-old woman was admitted to the clinic due to pain in the right lower abdomen. An ultrasound examination revealed a gestational sac in the uterine cavity corresponding to 5 weeks of pregnancy with a yolk sac. A twin sac was found in the right fallopian tube. Due to the patient's mild symptoms, absence of bleeding into the peritoneal cavity, concerns about the safety of the embryo and the pregnant woman in case of surgery, conservative management was decided. On the 20th day, the patient was discharged from the clinic with a viable intrauterine pregnancy and a partially absorbed ectopic pregnancy. CONCLUSIONS In the case of an ectopic tubal pregnancy, if there are no symptoms of bleeding into the peritoneal cavity, it is possible to adopt a safe conservative approach with strict patient observation.
Topics: Pregnancy; Female; Humans; Adult; Pregnancy, Heterotopic; Conservative Treatment; Pregnancy, Tubal; Fallopian Tubes; Salpingostomy
PubMed: 37550961
DOI: 10.12659/AJCR.940111 -
Epilepsy & Behavior : E&B Nov 2023To trace (i) changes in Australian Pregnancy Register (APR) records concerning antiseizure medications (ASMs) prescribed for women with epilepsy (WWE) over the course of...
OBJECTIVES
To trace (i) changes in Australian Pregnancy Register (APR) records concerning antiseizure medications (ASMs) prescribed for women with epilepsy (WWE) over the course of 24 years and correlate the changes with (ii) rates of occurrence of pregnancies involving foetal malformations, (iii) the body organs involved in the malformations, and (iv) freedom from epileptic seizures.
RESULTS
Use of valproate and carbamazepine decreased progressively, use of lamotrigine remained relatively static, and the use of levetiracetam increased progressively, whereas the use of topiramate first increased and then fell again, associated with a temporary increase in malformation-associated pregnancy rate. More serious malformations, such as spina bifida, became less frequent, whereas more trivial ones tended to increase, whereas epileptic seizure freedom rates improved.
CONCLUSIONS
The increasing use of newer ASMs in pregnant women has been associated with overall advantages in relation to the frequency and severity of foetal malformation and with advantages in relation to freedom from epileptic seizures.
Topics: Female; Pregnancy; Humans; Australia; Epilepsy; Anticonvulsants; Seizures; Lamotrigine; Valproic Acid; Pregnancy Complications
PubMed: 37839246
DOI: 10.1016/j.yebeh.2023.109482 -
Briefings in Bioinformatics Nov 2023Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which has significant adverse effects on both the mother and fetus. The incidence of GDM is...
Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which has significant adverse effects on both the mother and fetus. The incidence of GDM is increasing globally, and early diagnosis is critical for timely treatment and reducing the risk of poor pregnancy outcomes. GDM is usually diagnosed and detected after 24 weeks of gestation, while complications due to GDM can occur much earlier. Copy number variations (CNVs) can be a possible biomarker for GDM diagnosis and screening in the early gestation stage. In this study, we proposed a machine-learning method to screen GDM in the early stage of gestation using cell-free DNA (cfDNA) sequencing data from maternal plasma. Five thousand and eighty-five patients from north regions of Mainland China, including 1942 GDM, were recruited. A non-overlapping sliding window method was applied for CNV coverage screening on low-coverage (~0.2×) sequencing data. The CNV coverage was fed to a convolutional neural network with attention architecture for the binary classification. The model achieved a classification accuracy of 88.14%, precision of 84.07%, recall of 93.04%, F1-score of 88.33% and AUC of 96.49%. The model identified 2190 genes associated with GDM, including DEFA1, DEFA3 and DEFB1. The enriched gene ontology (GO) terms and KEGG pathways showed that many identified genes are associated with diabetes-related pathways. Our study demonstrates the feasibility of using cfDNA sequencing data and machine-learning methods for early diagnosis of GDM, which may aid in early intervention and prevention of adverse pregnancy outcomes.
Topics: Female; Pregnancy; Humans; Diabetes, Gestational; DNA Copy Number Variations; Deep Learning; Pregnancy Outcome; Cell-Free Nucleic Acids; beta-Defensins
PubMed: 38168840
DOI: 10.1093/bib/bbad492 -
Journal of Obstetrics and Gynaecology... Jun 2024The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (AMA) (over age 50 years) in Calgary. The secondary objective is to...
OBJECTIVES
The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (AMA) (over age 50 years) in Calgary. The secondary objective is to determine if there is a role in protocolizing complex care plans for patients at extreme AMAs.
METHODS
A retrospective chart review was conducted of all pregnancies ≥20 weeks gestation in patients over the age of 50 years that delivered in Calgary between January 2007 and December 2021. Pregnancy data were collected, including maternal age, pre-existing medical conditions, mode and timing of delivery, neonatal outcomes, neonatal intensive care unit (NICU) and adult intensive care unit (ICU) admissions, postpartum complications, and maternal or neonatal death. Data were extracted for maternity patients as well as neonatal ICU databases. Maternal and neonatal outcomes were assessed until discharge from hospital.
RESULTS
All 23 pregnancies identified were achieved through assisted reproductive technologies. Comorbidities varied, but the most common comorbidities included hypertension and gestational diabetes. Cesarean delivery was the most common form of delivery. Three cases involved postpartum maternal ICU admission. Neonatal outcomes included gestational ages of 22-39 weeks and birth weights of 486-3593 g, with 8 confirmed NICU admissions. The most common neonatal complications were jaundice and small for gestational age.
CONCLUSIONS
Extremely AMA patients are more likely to have pre-existing comorbidities and develop comorbidities during pregnancy. The potential for adverse maternal and fetal outcomes is greater for these pregnancies; however, the complications are diverse and developing a universal complex care plan is difficult.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Pregnancy Outcome; Middle Aged; Pregnancy Complications; Infant, Newborn; Maternal Age; Alberta
PubMed: 38423466
DOI: 10.1016/j.jogc.2024.102418 -
Revista Da Associacao Medica Brasileira... 2023This study aimed to investigate prenatal education and its relationship with anxiety and stress in pregnant women. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed to investigate prenatal education and its relationship with anxiety and stress in pregnant women.
METHODS
This research was carried out between July 1, 2022, and December 1, 2023, at Giresun Gynecology and Pediatrics Training and Research Hospital. Women aged >18 years at >20 weeks of pregnancy were included. Patients were randomized into two groups, and one group received a 4 week training on meditation, breathing exercises, and pregnancy-related health issues. A questionnaire was applied to both groups to analyze sociodemographic characteristics, pregnancy, birth, medical history, the Pregnancy Stress Rating Scale, and the State Trait Anxiety Inventory.
RESULT
The groups were similar in terms of age, educational status, anthropometric characteristics, occupation, economic status, and gestational week. There was no difference between the trained and nontrained groups in terms of the Pregnancy Stress Rating Scale score and the State Trait Anxiety Inventory-state score. The State Trait Anxiety Inventory-trait was significantly lower in the trained group (p=0.033). There were weak positive correlations between Pregnancy Stress Rating Scale score and medication use and between State Trait Anxiety Inventory-state score and age. A negative correlation was found between the State Trait Anxiety Inventory-state score and working status, showing that employed women had lower anxiety scores irrespective of training. Another weak positive correlation was found between the State Trait Anxiety Inventory-trait score and the presence of comorbidities.
CONCLUSION
State Trait Anxiety Inventory-trait anxiety was lower in pregnant women who received training on prenatal meditation, exercise, and pregnancy health; however, State Trait Anxiety Inventory-state and Pregnancy Stress Rating Scale scores were similar in the two groups. Unemployed pregnant women and those with chronic diseases appear to need closer follow-up to reduce anxiety levels.
Topics: Child; Pregnancy; Female; Humans; Mothers; Pregnancy Complications; Anxiety; Schools; Hospitals
PubMed: 37585990
DOI: 10.1590/1806-9282.20230279 -
Environmental Research Dec 2023Leakage of fire-fighting foam from an airfield caused contamination of the drinking water supplied to a third of the population in Ronneby, resulting in very high serum...
BACKGROUND
Leakage of fire-fighting foam from an airfield caused contamination of the drinking water supplied to a third of the population in Ronneby, resulting in very high serum levels of predominantly perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). The results of studies investigating the association between exposure to perfluorinated alkyl substances (PFAS) and pregnancy complications are inconsistent, and studies at high exposures of PFOS and PFHxS are lacking.
OBJECTIVES
To investigate the association between exposure to high levels of PFAS and gestational hypertension and preeclampsia, and gestational diabetes mellitus.
METHODS
We retrieved data on 27 292 childbirths between 1995 and 2013 from the National Medical Birth Register for women that had a residential address in Blekinge county for at least one year before delivery. Residential history was used as a proxy for exposure by categorizing women into high-, intermediate-, or background exposed based on their residential address during the five-year period before childbirth. Data on confounders were retrieved from administrative registers. The outcomes were defined based on International Classification of Diseases codes. We used logistic regression to estimate odds ratios (OR) for gestational hypertension and preeclampsia, and gestational diabetes mellitus. We also investigated effect modification by fetal sex.
RESULTS
We found no evidence of increased risk of gestational hypertension and preeclampsia (OR 0.80; CI 0.63-1.03), nor gestational diabetes (OR 1.03; CI 0.67-1.58) after high PFAS exposure. There was no effect modification by fetal sex.
DISCUSSION
This was the first study to investigate the association between high exposure to PFOS and PFHxS and pregnancy complications. The results from this study add important knowledge to public health management as new hotspots with high levels of PFAS are continuously discovered.
Topics: Pregnancy; Female; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Diabetes, Gestational; Drinking Water; Sweden; Alkanesulfonates; Fluorocarbons
PubMed: 37805182
DOI: 10.1016/j.envres.2023.117316 -
European Psychiatry : the Journal of... Jul 2023Body Mass Index (BMI) is an informative factor on body fatness which has been associated to higher levels of Perinatal Depression (PD) and complications during...
BACKGROUND
Body Mass Index (BMI) is an informative factor on body fatness which has been associated to higher levels of Perinatal Depression (PD) and complications during pregnancy. We aimed to explore the impact of pre-pregnancy and postnatal BMI on the risk of Perinatal Depression and pregnancy outcomes among women recruited at their third trimester of pregnancy.
METHODS
We report on findings from a large multi-centre study conducted in the South of Italy and involving 1611 women accessing three urban gynaecological departments from July to November 2020. Pregnant women were assessed at their third trimester of pregnancy (T0) and after the childbirth (T1) ;The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time (T0 and T1) as well as other standardized measures for neuroticism, resilience, and quality of life at baseline. BMI (T0 and T1) and other socio-demographic and clinical characteristics have been collected.
RESULTS
Over-weight and obesity (higher levels of BMI) were associated with higher risk of PD (higher scores of EPDS), higher neuroticism and poorer subjective psychological well-being among enrolled women. Also, obesity and over-weight were associated with lower education, higher number of physical comorbidities, medical treatments and complications during pregnancy.
CONCLUSIONS
Over-weight and obesity may impact on mental health and pregnancy outcome of women enrolled. Psycho-educational interventions aimed to improve the management of physical and emotional issues may reduce the risk of PD and complications during pregnancy.
Topics: Pregnancy; Female; Humans; Depression; Depression, Postpartum; Pregnancy Outcome; Body Mass Index; Quality of Life; Obesity; Overweight; Italy; Pregnancy Complications
PubMed: 37466073
DOI: 10.1192/j.eurpsy.2023.2412 -
PeerJ 2023This study examined the associated risk factors of adverse pregnancy outcomes among Chinese females and furnished some fundamental principles and recommendations for...
OBJECTIVE
This study examined the associated risk factors of adverse pregnancy outcomes among Chinese females and furnished some fundamental principles and recommendations for enhanced prevention of adverse pregnancy and preservation of women's well-being.
METHODS
A systematic review was conducted by retrieving the MEDLINE (The National Library of Medicine), Embase, PubMed, and Cochrane databases. The relevant risk factors for adverse pregnancy in Chinese women were retrieved from May 2017 to April 2023. Use Review Manager for data analysis. Calculate the merge effect based on data attributes using mean difference (MD) or odds ratio (or) and 95% confidence interval (CI). The meta-analysis was registered at INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols, 202340090).
RESULTS
A total of 15 articles were included, with a total of 946,818 Chinese pregnant women. Moreover, all the literature was scored by the NOS (Newcastle-Ottawa Scale), and all literatures were ≥7 points, which were evaluated as high quality. There are seven risk factors related to adverse pregnancy in Chinese women: parity, pregnancy frequency, education level, smoking, gestational diabetes, gestational weeks, and age. Moreover, the main risk factors for adverse pregnancy are pregnancy frequency, education level, gestational diabetes mellitus, and age.
CONCLUSION
The pregnancy frequency, education level, gestational diabetes mellitus, and age were significantly associated with the adverse pregnancy in Chinese women, whereas gestational weeks, smoking, and parity had no significant effect on adverse pregnancy.
Topics: Female; Humans; Pregnancy; Diabetes, Gestational; East Asian People; Pregnancy Outcome; Risk Factors; Pregnancy Complications; China
PubMed: 37719120
DOI: 10.7717/peerj.15965