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Frontiers in Endocrinology 2023Progesterone (P4) is essential for pregnancy. A controlled ovarian stimulation (COS) leads to a iatrogenic luteal defect that indicates a luteal phase support (LPS) at...
Progesterone (P4) is essential for pregnancy. A controlled ovarian stimulation (COS) leads to a iatrogenic luteal defect that indicates a luteal phase support (LPS) at least until pregnancy test day. Some clinicians continue the LPS until week 8 or later, when P4 is mainly secreted by syncytiotrophoblast cells.Measuring serum P4 on pregnancy test day after a fresh embryo transfer could help to identify women who might benefit from prolonged LPS. In women with LPS based on P4 administered by the rectal route, P4 concentration on pregnancy test day was significantly higher in patients with ongoing pregnancy than in patients with abnormal pregnancy.This monocentric retrospective study used data on 99 consecutive cycles of COS, triggered with human chorionic gonadotropin, followed by fresh embryo transfer resulting in a positive pregnancy test (>100 IU/L) (from November 2020 to November 2022). Patients undergoing preimplantation genetic screening or with ectopic pregnancy were excluded. All patients received standard luteal phase support (i.e. micronized vaginal progesterone 600 mg per day for 15 days). The primary endpoint was P4 concentration at day 15 after oocyte retrieval (pregnancy test day) in women with ongoing pregnancy for >12 weeks and in patients with miscarriage before week 12 of pregnancy.The median P4 concentration [range] at pregnancy test day was higher in women with ongoing pregnancy than in women with miscarriage (55.9 ng/mL [11.6; 290.6] versus 18.1 ng/mL [8.3; 140.9], p = 0.002). A P4 concentration ≥16.5 ng/mL at pregnancy test day was associated with higher ongoing pregnancy rate (OR = 12.5, 95% CI 3.61 - 43.33, p <0.001). A P4 concentration ≥16.5 ng/mL at pregnancy test day was significantly associated with higher live birth rate (OR = 11.88, 95% CI 3.30-42.71, p <0.001).After COS and fresh embryo transfer, the risk of miscarriage is higher in women who discontinue luteal support after 15 days, as recommended, but with P4 concentration <16.5 ng/mL. The benefit of individualized prolonged luteal phase support should be evaluated.
Topics: Pregnancy; Humans; Female; Progesterone; Abortion, Spontaneous; Fertilization in Vitro; Retrospective Studies; Lipopolysaccharides; Embryo Transfer; Pregnancy Tests; Ovulation Induction
PubMed: 37455896
DOI: 10.3389/fendo.2023.1191648 -
Clinical Radiology Dec 2022Venous thromboembolic disease (VTE) is the leading cause of maternal death throughout the developed world. International and national guidance for the diagnosis and... (Review)
Review
Venous thromboembolic disease (VTE) is the leading cause of maternal death throughout the developed world. International and national guidance for the diagnosis and management of VTE in pregnancy is varied and limited, which can result in problems in clinical practice. The imaging challenges of VTE in the general population are challenging but become more complex in pregnancy due to the physiological changes in the circulatory system, which alter clinical judgment and test performance. As an additional factor, the relative radiation risks to the mother and fetus arising from diagnostic tests need to be assessed and communicated to the patient in a clear and understandable way. The purpose of this review is fourfold. We propose to review and summarise the current imaging guidelines available for this condition; critically review the evidence base within the current literature; address the issues of test performance of imaging examinations used for VTE in pregnancy; and address the question of radiation risk and how to communicate this information to patients.
Topics: Pregnancy; Female; Humans; Venous Thromboembolism; Venous Thrombosis; Diagnostic Imaging; Risk Factors; Anticoagulants
PubMed: 36123200
DOI: 10.1016/j.crad.2022.08.122 -
Clinical Chemistry and Laboratory... Dec 2020
Topics: Chorionic Gonadotropin; Female; Humans; Pregnancy; Pregnancy Tests
PubMed: 33554533
DOI: 10.1515/cclm-2020-1797 -
International Journal of Laboratory... Jun 2022To evaluate, using longitudinal laboratory data, potential care gaps, and the prevalence of anemia in pregnant women residing in New Mexico, USA.
OBJECTIVE
To evaluate, using longitudinal laboratory data, potential care gaps, and the prevalence of anemia in pregnant women residing in New Mexico, USA.
METHODS
A total of 985 pregnant women aged 13-60 were included from December 1, 2018 to December 1, 2019. Parameters included frequency of CBC, iron studies, reticulocyte panel, prevalence of anemia, iron deficiency anemia (IDA), iron deficiency (ID), anemia change throughout pregnancy, and ICD-10 codes utilization.
RESULTS
CBC was completed in 896/985 (91%) of the sample population in the first trimester and 528/985 (53.6%) in the third trimester. Two hundred and fifty-two (25.6%) women had anemia at any given point during pregnancy. ID was prevalent in 1.3% of women in the first trimester and 1.0% in the third, while IDA was prevalent in 0.4% in their first trimester and 5.5% in the third. Data also show an overall worsening of anemia from first to third trimester (2.8% and 40.9%, respectively, p < .0001). A positive correlation was found between mean corpuscular volume (MCV) and reticulocyte hemoglobin (RET-He) (r = .8592, 95% CI 0.7475 to 0.9237).
CONCLUSION
Test utilization for anemia screening during pregnancy can be improved to guide patient management to reduce anemia rate and potential anemia-associated complications.
Topics: Anemia; Anemia, Iron-Deficiency; Female; Hemoglobins; Humans; Iron; Iron Deficiencies; Pregnancy
PubMed: 35029326
DOI: 10.1111/ijlh.13797 -
PLOS Global Public Health 2023Early detection of pregnancy status may help women initiate earlier antenatal care and healthy pregnancy behaviors, which could lead to healthier mothers and infants....
Early detection of pregnancy status may help women initiate earlier antenatal care and healthy pregnancy behaviors, which could lead to healthier mothers and infants. Pregnancy tests are inexpensive and easy to use; meanwhile, little attention has been given to understanding women's knowledge and use of home pregnancy tests, especially in developing countries. We analyze cross-sectional data collected from 1,008 women ages 18-35, living in Northern Uganda in 2019, who are most likely to be uncertain about their pregnancy status. The survey asked women if they had knowledge of or had ever used a home pregnancy test kit, and barriers to purchasing a home pregnancy test kit. Among the 1,008 women, 65 percent report knowledge of home pregnancy test kits, and 29 percent report having ever used a test kit. Women who have heard of pregnancy test kits have higher levels of education, are in higher wealth quintiles, are more likely to have a salaried occupation and live closer to a health facility. Among women who report knowledge of home pregnancy test kits (N = 657), 90 percent report needing to ask their husband or partner for money to purchase a test kit, seven percent report they would hide the purchase, and 31 percent report that their husband or partner would not support the purchase. Women who report a lack of support from their husband or partner tend to be older, are more likely to have had prior pregnancies, are less likely to have a salaried occupation, are less likely to want a/another child, and are more likely to have a husband or partner desiring more children than herself. Future research aimed at understanding how and whether these barriers affect the utilization of home pregnancy test kits could help inform policymakers on how to increase the use of home pregnancy test kits. Trial registration: NCT03975933. Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933.
PubMed: 37440465
DOI: 10.1371/journal.pgph.0002165 -
Advances in Experimental Medicine and... 2022Biosensors have a great impact on our society to enhance the life quality, playing an important role in the development of Point-of-Care (POC) technologies for rapid...
Biosensors have a great impact on our society to enhance the life quality, playing an important role in the development of Point-of-Care (POC) technologies for rapid diagnostics, and monitoring of disease progression. COVID-19 rapid antigen tests, home pregnancy tests, and glucose monitoring sensors represent three examples of successful biosensor POC devices. Biosensors have extensively been used in applications related to the control of diseases, food quality and safety, and environment quality. They can provide great specificity and portability at significantly reduced costs. In this chapter are described the fundamentals of biosensors including the working principles, general configurations, performance factors, and their classifications according to the type of bioreceptors and transducers. It is also briefly illustrated the general strategies applied to immobilize biorecognition elements on the transducer surface for the construction of biosensors. Moreover, the principal detection methods used in biosensors are described, giving special emphasis on optical, electrochemical, and mass-based methods. Finally, the challenges for biosensing in real applications are addressed at the end of this chapter.
Topics: Biosensing Techniques; Blood Glucose; Blood Glucose Self-Monitoring; COVID-19; Humans
PubMed: 35760986
DOI: 10.1007/978-3-031-04039-9_1 -
The American Journal of Emergency... Jul 2022First-trimester bleeding and pregnancy loss are common reasons for presentation to emergency departments. Women of childbearing age frequently receive urine and serum...
BACKGROUND
First-trimester bleeding and pregnancy loss are common reasons for presentation to emergency departments. Women of childbearing age frequently receive urine and serum pregnancy tests, which are thought to be reliable markers of pregnancy.
CASE PRESENTATION
We report a case of a 34-year-old woman who presented to an emergency department with vaginal bleeding and abdominal pain and was found to have negative urine and serum markers of pregnancy. A transvaginal ultrasound detected non-viable fetal tissue and the patient underwent an uncomplicated spontaneous abortion.
CONCLUSIONS
Physicians should consider the use of ultrasonography to assess for pregnancy or retained fetal products in the appropriate patient, even with negative serum or urine markers of pregnancy.
Topics: Abortion, Missed; Abortion, Spontaneous; Adult; Biomarkers; Female; Humans; Pregnancy; Pregnancy Trimester, First; Ultrasonography; Uterine Hemorrhage
PubMed: 35489989
DOI: 10.1016/j.ajem.2022.04.028 -
Chemtexts 2022Microchemistry, i.e., the chemistry performed at the scale of a microgram or less, has its roots in the late eighteenth and early nineteenth centuries. In the first half...
Microchemistry, i.e., the chemistry performed at the scale of a microgram or less, has its roots in the late eighteenth and early nineteenth centuries. In the first half of the twentieth century a wide range of spot tests have been developed. For didactic reasons, they are still part of the curriculum of chemistry students. However, they are even highly important for applied analyses in conservation of cultural heritage, food science, forensic science, clinical and pharmacological sciences, geochemistry, and environmental sciences. Modern pregnancy tests, virus tests, etc. are the most recent examples of sophisticated spot tests. The present contribution aims to provide an overview of the past and present of this analytical methodology.
PubMed: 34976574
DOI: 10.1007/s40828-021-00152-z -
The Cochrane Database of Systematic... Sep 2023Many factors influence fertility, one being the timing of intercourse. The 'fertile window' describes a stage in the cycle when conception can occur and is approximately... (Review)
Review
BACKGROUND
Many factors influence fertility, one being the timing of intercourse. The 'fertile window' describes a stage in the cycle when conception can occur and is approximately five days before to several hours after ovulation. 'Timed intercourse' is the practice of prospectively identifying ovulation and, thus, the fertile window to increase the likelihood of conception. Methods of predicting ovulation include urinary hormone measurement (luteinising hormone (LH) and oestrogen), fertility awareness-based methods (FABM) (including tracking basal body temperatures, cervical mucus monitoring, calendar charting/tracking apps), and ultrasonography. However, there are potentially negative aspects associated with ovulation prediction, including stress, time consumption, and cost implications of purchasing ovulation kits and app subscriptions. This review considered the evidence from randomised controlled trials (RCTs) evaluating the use of timed intercourse (using ovulation prediction) on pregnancy outcomes.
OBJECTIVES
To evaluate the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register, CENTRAL, MEDLINE, and Embase in January 2023. We also checked the reference lists of relevant studies and searched trial registries for any additional trials.
SELECTION CRITERIA
We included RCTs that compared methods of timed intercourse using ovulation prediction to other forms of ovulation prediction or intercourse without ovulation prediction in couples trying to conceive.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures recommended by Cochrane to select and analyse studies in this review. The primary review outcomes were live birth and adverse events (such as depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or positive urinary pregnancy test not yet confirmed by ultrasound), time to pregnancy, and quality of life. We assessed the overall quality of the evidence for the main comparisons using GRADE methods.
MAIN RESULTS
This review update included seven RCTs involving 2464 women or couples. Four of the five studies from the previous review were included in this update, and three new studies were added. We assessed the quality of the evidence as moderate to very low, the main limitations being imprecision, indirectness, and risk of bias. Urinary ovulation tests versus intercourse without ovulation prediction Compared to intercourse without ovulation prediction, urinary ovulation detection probably increases the chance of live birth in couples trying to conceive (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.02 to 1.81, 1 RCT, n = 844, moderate-quality evidence). This suggests that if the chance of a live birth without urine ovulation prediction is 16%, the chance of a live birth with urine ovulation prediction is 16% to 28%. However, we are uncertain whether timed intercourse using urinary ovulation detection resulted in a difference in stress (mean difference (MD) 1.98, 95% CI -0.87 to 4.83, I² = 0%, P = 0.17, 1 RCT, n = 77, very low-quality evidence) or clinical pregnancy (RR 1.09, 95% CI 0.51 to 2.31, I² = 0%, 1 RCT, n = 148, low-quality evidence). Similar to the live birth result, timed intercourse using urinary ovulation detection probably increases the chances of clinical pregnancy or positive urine pregnancy test (RR 1.28, 95% CI 1.09 to 1.50, I² = 0, 4 RCTs, n = 2202, moderate-quality evidence). This suggests that if the chance of a clinical pregnancy or positive urine pregnancy test without ovulation prediction is assumed to be 18%, the chance following timed intercourse with urinary ovulation detection would be 20% to 28%. Evidence was insufficient to determine the effect of urine ovulation tests on time to pregnancy or quality of life. Fertility awareness-based methods (FABM) versus intercourse without ovulation prediction Due to insufficient evidence, we are uncertain whether timed intercourse using FABM resulted in a difference in live birth rate compared to intercourse without ovulation prediction (RR 0.95, 95% CI 0.76 to 1.20, I² = 0%, 2 RCTs, n = 157, low-quality evidence). We are also uncertain whether FABM affects stress (MD -1.10, 95% CI -3.88 to 1.68, 1 RCT, n = 183, very low-quality evidence). Similarly, we are uncertain of the effect of timed intercourse using FABM on anxiety (MD 0.5, 95% CI -0.52 to 1.52, P = 0.33, 1 RCT, n = 183, very low-quality evidence); depression (MD 0.4, 95% CI -0.28 to 1.08, P = 0.25, 1 RCT, n = 183, very low-quality evidence); or erectile dysfunction (MD 1.2, 95% CI -0.38 to 2.78, P = 0.14, 1 RCT, n = 183, very low-quality evidence). Evidence was insufficient to detect a benefit of timed intercourse using FABM on clinical pregnancy (RR 1.13, 95% CI 0.31 to 4.07, 1 RCT, n = 17, very low-quality evidence) or clinical or positive pregnancy test rates (RR 1.08, 95% CI 0.89 to 1.30, 3 RCTs, n = 262, very low-quality evidence). Finally, we are uncertain whether timed intercourse using FABM affects the time to pregnancy (hazard ratio 0.86, 95% CI 0.53 to 1.38, 1 RCT, n = 140, low-quality evidence) or quality of life. No studies assessed the use of timed intercourse with pelvic ultrasonography.
AUTHORS' CONCLUSIONS
The new evidence presented in this review update shows that timed intercourse using urine ovulation tests probably improves live birth and pregnancy rates (clinical or positive urine pregnancy tests but not yet confirmed by ultrasound) in women under 40, trying to conceive for less than 12 months, compared to intercourse without ovulation prediction. However, there are insufficient data to determine the effects of urine ovulation tests on adverse events, clinical pregnancy, time to pregnancy, and quality of life. Similarly, due to limited data, we are uncertain of the effect of FABM on pregnancy outcomes, adverse effects, and quality of life. Further research is therefore required to fully understand the safety and effectiveness of timed intercourse for couples trying to conceive. This research should include studies reporting clinically relevant outcomes such as live birth and adverse effects in fertile and infertile couples and utilise various methods to determine ovulation. Only with a comprehensive understanding of the risks and benefits of timed intercourse can recommendations be made for all couples trying to conceive.
Topics: Male; Female; Humans; Pregnancy; Odds Ratio; Pregnancy, Multiple; Uncertainty; Anxiety; Anxiety Disorders; Drug-Related Side Effects and Adverse Reactions
PubMed: 37709293
DOI: 10.1002/14651858.CD011345.pub3 -
Thyroid : Official Journal of the... Apr 2021Compared with singletons, a twin pregnancy is associated with a larger thyroid hormone demand and an increased stimulation of gestational thyroid function due to higher... (Comparative Study)
Comparative Study
Compared with singletons, a twin pregnancy is associated with a larger thyroid hormone demand and an increased stimulation of gestational thyroid function due to higher concentrations of human chorionic gonadotropin. However, such effects have been sparsely quantified. The aim of this study was to evaluate thyroid function and thyroid function test abnormalities in twin pregnancies during early and late pregnancy compared with singletons. We included 1208 twin pregnancies and 46,834 singleton pregnancies with thyroid function tests available. Thyroid function test abnormalities were defined using population-based reference ranges. The analyses were adjusted for potential confounders including maternal age and body mass index. Compared with singletons, a twin pregnancy was associated with a lower thyrotropin (TSH) (β = -0.46 [95% confidence interval, CI -0.49 to -0.44], < 0.001) and a higher free thyroxine (fT4) (β = 0.91 [CI 0.69-1.16], < 0.001) during early pregnancy. During late pregnancy, a twin pregnancy was associated with a higher TSH (β = 0.35 [CI 0.29-0.42], < 0.001) while fT4 did not differ (β = -0.11 [CI -0.22 to 0.01], = 0.065). During early pregnancy, a twin pregnancy was associated with a higher risk of overt hyperthyroidism (odds ratio, OR = 7.49 [CI 6.02-9.33], < 0.001), subclinical hyperthyroidism (OR = 5.26 [CI 4.17-6.64], < 0.001), and isolated hypothyroxinemia (OR = 1.89 [CI 1.43-2.49], < 0.001), but with a lower risk of subclinical hypothyroidism (OR = 0.27 [CI 0.13-0.54], < 0.001). In late pregnancy, a twin pregnancy was associated with a higher risk of subclinical hypothyroidism (OR = 4.05 [CI 3.21-5.11], < 0.001), isolated hypothyroxinemia (OR = 1.48 [CI 1.04-2.10], = 0.028), and subclinical hyperthyroidism (OR = 1.76 [CI 1.27-2.43], < 0.001). During early pregnancy, a twin pregnancy was associated with a higher thyroid function and a higher risk of (subclinical) hyperthyroidism, as well as a higher risk of isolated hypothyroxinemia. During late pregnancy, a twin pregnancy was associated with a higher TSH concentration and a higher risk of subclinical hypothyroidism, as well as a persistently higher risk of isolated hypothyroxinemia and subclinical hyperthyroidism. The study was approved by Chinese Clinical Trial Registry (registration no. ChiCTR1800014394).
Topics: Adult; Asymptomatic Diseases; Biomarkers; Female; Gestational Age; Humans; Hyperthyroidism; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Prospective Studies; Risk Assessment; Risk Factors; Thyroid Function Tests; Thyroid Hormones
PubMed: 32746748
DOI: 10.1089/thy.2020.0348