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BMC Pregnancy and Childbirth Jan 2022Cardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in... (Observational Study)
Observational Study
BACKGROUND
Cardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in women with heart disease is important for planning resources to reduce maternal mortality. Prospective data on outcomes and risk predictors of mortality in pregnant women with heart disease (PWWHD) from low- and middle-income countries are scarce.
METHODS
The Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR) is a prospective, multicentric and multidisciplinary registry of PWWHD from 29 participating sites including both public and private sectors, across the state of Tamil Nadu in India. The TNPHDR is aimed to provide data on incidence of maternal and fetal outcomes, adverse outcome predictors, applicability of the modified World Health Organization (mWHO) classification of maternal cardiovascular risk and the International risk scoring systems (ZAHARA and CARPREG I & II) in Indian population and identify possible gaps in the existing management of PWWHD. Pregnancy and heart teams will be formed in all participating sites. Baseline demographic, clinical, laboratory and imaging parameters, data on counselling received, antenatal triage and management, peripartum management and postpartum care will be collected from 2500 eligible participants as part of the TNPHDR. Participants will be followed up at one, three and six-months after delivery/termination of pregnancy to document study outcomes. Predictors of maternal and foetal outcome will be identified.
DISCUSSION
The TNPHDR will be the first representative registry from low- and middle-income countries aimed at providing crucial information on pregnancy outcomes and risk predictors in PWWHD. The results of TNPHDR could help to formulate steps for improved care and to generate a customised and practical guideline for managing pregnancy in women with heart disease in limited resource settings.
TRIAL REGISTRATION
The TNPHDR is registered under Clinical Trials Registry-India ( CTRI/2020/01/022736 ).
Topics: Female; Heart Diseases; Humans; India; Maternal Mortality; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Registries; Risk Factors
PubMed: 35093002
DOI: 10.1186/s12884-021-04305-3 -
Kathmandu University Medical Journal... 2022Background Intimate partner violence (IPV) is an abuse or harm that occurs in a close relationship. The World Health Organization (WHO) estimated that, globally, 35% of...
Background Intimate partner violence (IPV) is an abuse or harm that occurs in a close relationship. The World Health Organization (WHO) estimated that, globally, 35% of women living in industrialized and developed countries have experienced exposure to intimate partner violence and during pregnancy it is associated with low birth weight, preterm birth, and even death of the baby. Objective To find out proportion of intimate partner violence and adverse pregnancy outcome among postnatal mothers who recently delivered their baby. Method A cross-sectional study was conducted among 220 postnatal mothers using a structured questionnaire based on 13-item WHO Violence against women instrument in Nepali language. Face-to-face interview technique was used to collect data using consecutive sampling technique at Kathmandu Medical College teaching Hospital. The data were analyzed using SPSS version 20. Result In recent pregnancy, 32.7% of women had experienced intimate partner violence at least once, which has been categorized as physical 28.6%, psychological 30.9%, and 22.7% sexual violence. Among them, 36% had low birth weight babies, 24% had preterm, 2.8% had dead baby, and 35% reported abortion in previous pregnancy. In the binary logistic regression, intimate partner violence was significantly associated with preterm baby (OR-1.143, 95% CI- 0.386-3.384, p=0.002), low-birth weight (OR0.237, 95% CI- 0.093-0.602, p ≤ 0.001), and abortion (OR-0.021, 95% CI- 0.003-0.175, p ≤ 0.001). Conclusion One in three women experienced intimate partner violence during their recent pregnancy and is associated with adverse pregnancy outcomes. Programs targeting screening of intimate partner violence against women should therefore be emphasized during reproductive health services such that adverse pregnancy outcomes can be prevented.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Pregnancy Outcome; Cross-Sectional Studies; Premature Birth; Intimate Partner Violence; Abortion, Spontaneous
PubMed: 37042368
DOI: No ID Found -
The Journal of Clinical Endocrinology... Feb 2024Cardiovascular disease (CVD) is the leading cause of death among women. Adverse pregnancy outcomes (APOs) are cardiovascular risk factors that are unique to women and... (Review)
Review
Cardiovascular disease (CVD) is the leading cause of death among women. Adverse pregnancy outcomes (APOs) are cardiovascular risk factors that are unique to women and include gestational diabetes (GDM) and preeclampsia. While these risk factors emerge during the reproductive years and allow for early risk reduction counseling, they are often overlooked and not elicited by providers. This mini-review focuses primarily on GDM and preeclampsia, their relationship with CVD, mechanisms by which these conditions lead to CVD, and management, pharmacological and nonpharmacological, for the clinician who is caring for a woman with a history of an APO.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Cardiovascular Diseases; Pre-Eclampsia; Diabetes, Gestational; Risk Factors
PubMed: 37933906
DOI: 10.1210/clinem/dgad600 -
Irish Journal of Medical Science Oct 2023Recurrent miscarriage affects 1-2% of the population, and the literature has focussed on causes, treatment, and live birth rate.
BACKGROUND
Recurrent miscarriage affects 1-2% of the population, and the literature has focussed on causes, treatment, and live birth rate.
AIM
This study aimed to assess the reproductive outcomes for patients who attended a specialist recurrent miscarriage clinic for investigation and treatment.
METHODS
Prospective analysis of all patients who attended a recurrent miscarriage clinic from January 2014 to January 2021.
RESULTS
Of the 488 patients who attended a specialist clinic, 318 had a further pregnancy with 299 included in this study. The median age was 37 years, with 55.6% having a previous live birth. The subsequent live birth rate was 75.3%, 22.0% had a further pregnancy loss, 1.7% had an ongoing pregnancy, and 1% attended another institution after the second trimester. The rate of preeclampsia was 2.2%, pregnancy-induced hypertension was 2.2%, fetal growth restriction was 5.3%, preterm birth ≤ 34 weeks was 1.8%, and preterm birth > 34 weeks < 37 weeks was 6.6%.
CONCLUSION
Patients who attend a dedicated recurrent miscarriage clinic for investigation and treatment have a high live birth rate in a subsequent pregnancy. A subsequent pregnancy following recurrent pregnancy loss does not appear to be associated with an increased risk of adverse pregnancy outcomes.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Adult; Pregnancy Outcome; Premature Birth; Abortion, Habitual; Live Birth; Pre-Eclampsia
PubMed: 36757518
DOI: 10.1007/s11845-023-03305-w -
The Journal of Maternal-fetal &... May 2022The new SARS-CoV-2 originated from Wuhan, China is spreading rapidly worldwide. A number of SARS-CoV-2 positive pregnant women have been reported. However, more... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The new SARS-CoV-2 originated from Wuhan, China is spreading rapidly worldwide. A number of SARS-CoV-2 positive pregnant women have been reported. However, more information is still needed on the pregnancy outcome and the neonates regarding COVID-19 pneumonia.
MATERIAL AND METHODS
A systematic search was done and nine articles on COVID-19 pneumonia and SARS-CoV-2 positive pregnant women were extracted. Some maternal-fetal characteristics were extracted to be included in the meta-analysis
RESULTS
The present meta-analysis was conducted on 87 SARS-CoV-2 positive pregnant women. Almost 65% of the patients reported a history of exposure to an infected person, 78% suffered from mild or moderate COVID-19, 99.9% had successful termination, 86% had cough, and 68% had fever ( = .022 and < .001). The overall proportions of vertical transmission, still birth, and neonatal death were zero, 0.002, and, 0.002, respectively ( = 1, = .86, and = .89, respectively). The means of the first- and fifth-minute Apgar scores were 8.86 and 9, respectively ( < .001 for both). The confounding role of history of underlying diseases with an estimated overall proportion of 33% ( = .03) resulted in further investigations due to sample size limitation. A natural history of COVID-19 pneumonia in the adult population was presented, as well.
CONCLUSION
Currently, no evidence of vertical transmission has been suggested at least in late pregnancy. No hazards have been detected for fetuses or neonates. Although pregnant women are at an immunosuppressive state due to the physiological changes during pregnancy, most patients suffered from mild or moderate COVID-19 pneumonia with no pregnancy loss, proposing a similar pattern of the clinical characteristics of COVID-19 pneumonia to that of other adult populations.
Topics: Adult; COVID-19; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; SARS-CoV-2
PubMed: 32429786
DOI: 10.1080/14767058.2020.1763952 -
Journal of Diabetes Research 2021Microbiota composition is progressively being connected to different physiologic effects, such as glucose metabolism, and also to different pathologies, such as... (Review)
Review
Microbiota composition is progressively being connected to different physiologic effects, such as glucose metabolism, and also to different pathologies, such as gestational diabetes mellitus (GDM). GDM is a public health concern that affects an important percentage of pregnancies and is correlated with many adverse maternal and neonatal outcomes. An increasing number of studies are showing some connections between specific microbial composition of the gut microbiota and development of GDM and adverse outcomes in mothers and neonates. The aim of this review is to analyze the available data on microbial changes that characterize healthy pregnancies and pregnancies complicated by GDM and to understand the correlation of these changes with adverse maternal outcomes; this review will also discuss the consequences of these maternal gut microbiome alterations on neonatal microbiota composition and neonatal long-term outcomes.
Topics: Adult; Diabetes, Gestational; Female; Humans; Infant Health; Infant, Newborn; Microbiota; Pregnancy; Pregnancy Outcome; Time
PubMed: 34869780
DOI: 10.1155/2021/9994734 -
International Journal of Environmental... Feb 2022Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a... (Review)
Review
BACKGROUND
Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes.
METHODS
A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures.
RESULTS
A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis.
CONCLUSION
Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.
Topics: Extreme Heat; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Premature Birth; Stillbirth; Temperature
PubMed: 35206601
DOI: 10.3390/ijerph19042412 -
Current Opinion in Obstetrics &... Oct 2023This review introduces the recognized body of evidence on social determinants of health, which continue to show that a person's health is determined by their broader... (Review)
Review
PURPOSE OF REVIEW
This review introduces the recognized body of evidence on social determinants of health, which continue to show that a person's health is determined by their broader environmental and social context and that societal inequities harm health and healthcare outcomes. An area of inequity is race, which, although a social construct, has a significant impact on a person's morbidity and mortality as well as their access and experience of healthcare. Racial disparities in maternal and perinatal outcomes are widely recognized. Therefore, this review focuses on the less commonly addressed early pregnancy setting.
RECENT FINDINGS
Health inequities are present in the early pregnancy setting, as racial disparities exist in early pregnancy presentations and outcomes. Black women have a higher incidence of miscarriage, ectopic pregnancy and poorer survival rates from gestational trophoblastic neoplasms. Asian women have a statistically significantly higher incidence of gestational trophoblastic disease.
SUMMARY
The findings support the need for more consistent and detailed research on the impact of race on early pregnancy outcomes and increasing ethnic diversity among study populations for trials to ensure meaningful and applicable data. Raising awareness of this racial health inequity in early pregnancy is the first step clinicians can take to tackle this issue.
Topics: Female; Humans; Pregnancy; Abortion, Spontaneous; Black People; Delivery of Health Care; Gestational Trophoblastic Disease; Healthcare Disparities; Pregnancy Outcome; Pregnancy, Ectopic; Asian People
PubMed: 37581257
DOI: 10.1097/GCO.0000000000000900 -
American Journal of Obstetrics and... Mar 2023In 2016, the US Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding the...
BACKGROUND
In 2016, the US Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding the characteristics and outcomes of embryo donation cycles could benefit patients and providers during counseling and decision making.
OBJECTIVE
This study aimed to examine the trends in the utilization of embryo donation, pregnancy rates, and live birth rates per transfer between 2004 and 2019 and to describe the recipients of donated embryos and outcomes of frozen donated embryo transfer cycles during the most recent time period, that is, 2016 to 2019.
STUDY DESIGN
We conducted a retrospective, population-based cohort study of frozen donated embryo transfer cycles in United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2004 to 2019. The trends in the annual number and proportion of frozen donated embryo transfers, pregnancy rates, and live birth rates from 2004 to 2019 were described. During 2016 to 2019, the rates of cycle cancellation, pregnancy, miscarriage, live birth, singleton birth, and good perinatal outcome (delivery ≥37 weeks, birthweight ≥2500 g) of frozen donated embryo transfers were also calculated. Transfer and pregnancy outcomes stratified by oocyte source age at the time of oocyte retrieval were also described.
RESULTS
From 2004 to 2019, there were 21,060 frozen donated embryo transfers in the United States, resulting in 8457 live births. During this period, the annual number and proportion of frozen donated embryo transfers with respect to all transfers increased, as did the pregnancy rate and live birth rate. Among all initiated cycles during 2016 to 2019, the cancellation rate was 8.2%. Among 8773 transfers with known outcomes, 4685 (53.4%) resulted in pregnancy and 3820 (43.5%) in live birth. Among all pregnancies, 814 (17.4%) resulted in miscarriage. Among all live births, 3223 (84.4%) delivered a singleton, of which 2474 (76.8%) had a good perinatal outcome. The clinical pregnancy rate and live birth rate per frozen donated embryo transfer decreased with increasing age of oocyte source.
CONCLUSION
The outcomes of embryo donation cycles reported in this national cohort may aid patients and providers when considering the use of donated embryos.
Topics: Pregnancy; Humans; Female; United States; Abortion, Spontaneous; Embryo Disposition; Retrospective Studies; Cohort Studies; Pregnancy Outcome; Pregnancy Rate; Live Birth; Fertilization in Vitro
PubMed: 36368430
DOI: 10.1016/j.ajog.2022.10.045 -
Fertility and Sterility Nov 2023Infections with certain pathogens can lead to perinatal complications. Several infections have been also associated with an increased likelihood of miscarriage. This... (Review)
Review
Infections with certain pathogens can lead to perinatal complications. Several infections have been also associated with an increased likelihood of miscarriage. This manuscript discusses these infections, their modes of transmission, the evidence linking them to an increased risk of miscarriage, and whether prevention or treatment strategies are available.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Pregnancy Outcome
PubMed: 37625478
DOI: 10.1016/j.fertnstert.2023.08.719