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The Lancet. Child & Adolescent Health May 2021Malnutrition-consisting of undernutrition, overweight and obesity, and micronutrient deficiencies-continues to afflict millions of women and children, particularly in... (Review)
Review
Malnutrition-consisting of undernutrition, overweight and obesity, and micronutrient deficiencies-continues to afflict millions of women and children, particularly in low-income and middle-income countries (LMICs). Since the 2013 Lancet Series on maternal and child nutrition, evidence on the ten recommended interventions has increased, along with evidence of newer interventions. Evidence on the effectiveness of antenatal multiple micronutrient supplementation in reducing the risk of stillbirths, low birthweight, and babies born small-for-gestational age has strengthened. Evidence continues to support the provision of supplementary food in food-insecure settings and community-based approaches with the use of locally produced supplementary and therapeutic food to manage children with acute malnutrition. Some emerging interventions, such as preventive small-quantity lipid-based nutrient supplements for children aged 6-23 months, have shown positive effects on child growth. For the prevention and management of childhood obesity, integrated interventions (eg, diet, exercise, and behavioural therapy) are most effective, although there is little evidence from LMICs. Lastly, indirect nutrition strategies, such as malaria prevention, preconception care, water, sanitation, and hygiene promotion, delivered inside and outside the health-care sector also provide important nutritional benefits. Looking forward, greater effort is required to improve intervention coverage, especially for the most vulnerable, and there is a crucial need to address the growing double burden of malnutrition (undernutrition, and overweight and obesity) in LMICs.
Topics: Adolescent; Adult; Breast Feeding; Child; Child Nutrition Disorders; Child, Preschool; Developing Countries; Dietary Supplements; Family Planning Services; Female; Guidelines as Topic; Health Promotion; Humans; Hygiene; Infant; Infant Nutritional Physiological Phenomena; Life Style; Malnutrition; Maternal Health; Micronutrients; Nutritional Physiological Phenomena; Nutritional Status; Overnutrition; Preconception Care; Pregnancy; Sanitation; Young Adult
PubMed: 33691083
DOI: 10.1016/S2352-4642(20)30274-1 -
Obesity Reviews : An Official Journal... Nov 2019The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of... (Review)
Review
The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow-up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print-friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high-quality evidence and warrant further research. These areas are highlighted in the paper.
Topics: Bariatric Surgery; Consensus; Female; Guidelines as Topic; Humans; Obesity, Morbid; Postnatal Care; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 31419378
DOI: 10.1111/obr.12927 -
American Journal of Obstetrics and... Jun 2020Chronic hypertension and associated cardiovascular disease are among the leading causes of maternal and perinatal morbidity and death in the United States. Chronic... (Review)
Review
Chronic hypertension and associated cardiovascular disease are among the leading causes of maternal and perinatal morbidity and death in the United States. Chronic hypertension in pregnancy is associated with a host of adverse outcomes that include preeclampsia, cesarean delivery, cerebrovascular accidents, fetal growth restriction, preterm birth, and maternal and perinatal death. There are several key issues related to the diagnosis and management of chronic hypertension in pregnancy where data are limited and further research is needed. These challenges and recent guidelines for the management of chronic hypertension are reviewed. Well-timed pregnancies are of utmost importance to reduce the risks of chronic hypertension; long-acting reversible contraceptive options are preferred. Research to determine optimal blood pressure thresholds for diagnosis and treatment to optimize short- and long-term maternal and perinatal outcomes should be prioritized along with interventions to reduce extant racial and ethnic disparities.
Topics: Adrenergic alpha-2 Receptor Agonists; Adrenergic beta-Antagonists; Antihypertensive Agents; Calcium Channel Blockers; Cesarean Section; Chronic Disease; Delivery, Obstetric; Disease Management; Female; Fetal Growth Retardation; Gestational Age; Humans; Hypertension; Long-Acting Reversible Contraception; Methyldopa; Postnatal Care; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Complications, Cardiovascular; Premature Birth; Prenatal Care; Severity of Illness Index; Sodium Potassium Chloride Symporter Inhibitors; Time Factors; Vasodilator Agents
PubMed: 31715148
DOI: 10.1016/j.ajog.2019.11.1243 -
Fertility and Sterility Jun 2021This document provides the latest recommendations for the evaluation of potential sperm, oocyte, and embryo donors as well as their recipients, incorporating recent... (Review)
Review
This document provides the latest recommendations for the evaluation of potential sperm, oocyte, and embryo donors as well as their recipients, incorporating recent information about optimal screening and testing for sexually transmitted infections, genetic diseases, and psychological assessments. This revised document incorporates recent information from the US Centers for Disease Control and Prevention, US Food and Drug Administration, and American Association of Tissue Banks, which all programs offering gamete and embryo donation services must be thoroughly familiar with, and replaces the document titled "Recommendations for gamete and embryo donation: a committee opinion," last published in 2013.
Topics: Consensus; Counseling; Donor Selection; Embryo Disposition; Female; Genetic Testing; Health Status; Humans; Male; Mental Health; Oocyte Donation; Preconception Care; Pregnancy; Reproductive Medicine; Risk Assessment; Risk Factors; Semen; Tissue Donors
PubMed: 33838871
DOI: 10.1016/j.fertnstert.2021.01.045 -
Current Opinion in Obstetrics &... Jun 2020Women should enter pregnancy in the best possible health. There is increasing recognition of the importance of nutrition for reproductive health; however, key dietary... (Review)
Review
PURPOSE OF REVIEW
Women should enter pregnancy in the best possible health. There is increasing recognition of the importance of nutrition for reproductive health; however, key dietary factors in relation to optimizing fertility are nonexistent. The purpose of this review is to investigate dietary factors, preconception, and the association with fertility and later health in pregnancy.
RECENT FINDINGS
This article summarizes recent literature assessing preconception dietary intake and the association with fertility, time to pregnancy, and also the relationship with polycystic ovary syndrome and gestational diabetes; these conditions associate with each other, and also with infertility. The impact of paternal diet is also reported.
SUMMARY
There is recent interest investigating diet and time to pregnancy, suggesting higher intakes of fruit, minimal intake of fast food and sugar sweetened beverages, and a diet lower in glycemic load, may improve time to pregnancy. There is minimal recent literature on paternal diet and impact on fertility. Present advice to women with polycystic ovary syndrome is in line with international recommendations for lifestyle management to improve reproductive outcomes; and for gestational diabetes, prepregnancy may be an optimal time to improve dietary intakes, particularly through consumption of an overall healthy dietary pattern or a Mediterranean-style dietary pattern.
Topics: Diet, Healthy; Female; Fertility; Humans; Male; Nutritional Status; Preconception Care; Pregnancy; Time-to-Pregnancy
PubMed: 32324714
DOI: 10.1097/GCO.0000000000000629 -
Endocrine Practice : Official Journal... Jul 2022To review the diagnosis and management of hypothyroidism during pregnancy, in the preconception period, and in the postpartum period. (Review)
Review
OBJECTIVE
To review the diagnosis and management of hypothyroidism during pregnancy, in the preconception period, and in the postpartum period.
METHODS
A literature review of English-language papers published between 1982 and 2022, focusing on the most recent literature.
RESULTS
During pregnancy, thyroid function laboratory tests need to be interpreted with regard to gestational age. Overt hypothyroidism, regardless of the thyroid-stimulating hormone (TSH) level, should always be promptly treated when it is diagnosed before conception or during pregnancy or lactation. Most women with pre-existing treated hypothyroidism require an increase in levothyroxine (LT4) dosing to maintain euthyroidism during gestation. LT4-treated pregnant patients need close monitoring of their serum TSH levels to avoid overtreatment or undertreatment. There is no consensus about whether to initiate LT4 in women with mild forms of gestational thyroid hypofunction. However, in light of current evidence, it is reasonable to treat women with subclinical hypothyroidism with LT4, particularly if the TSH level is >10 mIU/L or thyroperoxidase antibodies are present. Women who are not treated need to be followed up to ensure that treatment is initiated promptly if thyroid failure progresses. Additional studies are needed to better understand the effects of the initiation of LT4 in early gestation in women with subclinical hypothyroidism and hypothyroxinemia and determine optimal strategies for thyroid function screening in the preconception period and during pregnancy.
CONCLUSION
The diagnosis and management of hypothyroidism in the peripregnancy period present specific challenges. While making management decisions, it is essential to weigh the risks and benefits of treatments for not just the mother but also the fetus.
Topics: Drug Monitoring; Female; Humans; Hypothyroidism; Postnatal Care; Preconception Care; Pregnancy; Pregnancy Complications; Prenatal Care; Thyroid Function Tests; Thyrotropin; Thyroxine
PubMed: 35569735
DOI: 10.1016/j.eprac.2022.05.004 -
The Lancet. Diabetes & Endocrinology Feb 2020Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses... (Review)
Review
Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, including polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan.
Topics: Adult; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Hyperandrogenism; Infertility, Female; Polycystic Ovary Syndrome; Preconception Care; Pregnancy; Reproductive Health
PubMed: 31635966
DOI: 10.1016/S2213-8587(19)30345-6 -
JPMA. the Journal of the Pakistan... Apr 2020This communication shares two frameworks which help conceptualize the vast spectrum of pre-conception care. A 3x3 rubric classifies pre-conception assessment and... (Review)
Review
This communication shares two frameworks which help conceptualize the vast spectrum of pre-conception care. A 3x3 rubric classifies pre-conception assessment and interventions into gynaeco-obstetric, biomedical and psychosocial. Yet another creative checklist uses the letters A through I to present 9 aspects of pre-conception management. The aim of this article is to simplify the vast field of pre-conception care for primary care physicians and other health care professionals.
Topics: Blood Glucose; Blood Group Antigens; Checklist; Diet; Employment; Female; Glucose Intolerance; Health Services Accessibility; Health Status; Humans; Hypertension; Life Style; Mental Health; Physical Fitness; Preconception Care; Pregnancy; Primary Health Care; Reproductive Tract Infections; Social Support; Thyroid Diseases; Vaccination
PubMed: 32296232
DOI: No ID Found -
Australian Journal of General Practice Jun 2020The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is...
BACKGROUND
The importance of interconception care - defined as care given to women, and their partners, between one pregnancy and the next to optimise their health - is increasingly important, with rising rates of overweight, obesity, diabetes and hypertension among people of reproductive age. Women frequently visit their general practitioner (GP) in the first six months postpartum. This is an opportune time to discuss ideal interpregnancy intervals (IPIs) and advise women about contraception and healthy behaviours.
OBJECTIVE
The aim of this article is to review available research and guidelines on interconception care and IPIs, and propose best-practice care for the general practice setting.
DISCUSSION
GPs are uniquely placed to deliver the different aspects of interconception care including reviewing the outcomes of the previous pregnancy, advising women on optimal IPIs and providing contraception and lifestyle guidance. Studies have found that GPs may feel they lack the time and resources to provide interconception care, but support is available through online tools and easy-to-access checklists. As the prevalence of obesity and chronic diseases increases, interconception care has the potential to reduce future adverse perinatal outcomes.
Topics: Birth Intervals; Female; Humans; Maternal Health Services; Preconception Care
PubMed: 32464729
DOI: 10.31128/AJGP-02-20-5242 -
The Surgical Clinics of North America Jun 2020For most individuals, cancer development is multifactorial; however, up to 10% of all cancers are related to an inherited genetic mutation. As health care shifts to... (Review)
Review
For most individuals, cancer development is multifactorial; however, up to 10% of all cancers are related to an inherited genetic mutation. As health care shifts to having a greater emphasis on prevention, care providers, including general surgeons, will need to play a role in identifying patients at high risk for cancer development. Genetic testing provides a tool to determine those patients with a genetic mutation and to whom appropriate preventive care and treatment may be offered. It is imperative for general surgeons to understand the role genetics plays in the care of individual patients and their relatives.
Topics: Adenomatous Polyposis Coli; Breast Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; DNA Mutational Analysis; Female; Genetic Counseling; Genetic Testing; Humans; Male; Neoplasms; Neoplastic Syndromes, Hereditary; Ovarian Neoplasms; Pedigree; Preconception Care; Risk Assessment; Stomach Neoplasms
PubMed: 32402295
DOI: 10.1016/j.suc.2020.02.012