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Current Oncology Reports Aug 2020Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and... (Review)
Review
PURPOSE OF REVIEW
Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and fetal risks associated with treatment or delayed intervention. Herein, we review the current literature for the diagnosis, management, and supportive care strategies for PAL.
RECENT FINDINGS
Establishment of a multidisciplinary team, including hematology-oncology, maternal-fetal medicine, and neonatology, is critical in the management of PAL. For staging, ultrasound and MRI are preferred modalities with use of computerized tomography in select situations. Data for the safety and effectiveness of therapy for PAL is largely based on retrospective studies. The timing of lymphoma-directed antenatal systemic therapy depends on the trimester, gestational age, lymphoma subtype and aggressiveness, and patient wishes. Therapy in the first trimester is usually not advocated, while treatment in the second and third trimesters appears to result in similar outcomes for PAL compared with non-pregnant patients with lymphoma. An overarching goal in most PAL cases should be to plan for delivery at term (i.e., gestational age > 37 weeks). For supportive care, most antiemetics, including agents such as neurokinin-1 receptor antagonists, have been used safely during pregnancy. For prevention or treatment of infections, particular antibiotics (i.e., macrolides, cephalosporins, penicillins, metronidazole), antivirals (i.e., acyclovir, valacyclovir, famciclovir), and antifungals (amphotericin B) have demonstrated safety and with use of growth factors reserved for treatment of neutropenia (vs. primary prophylaxis). Therapy for PAL should be individualized with goals of care that balance maternal and fetal well-being, which should include a multidisciplinary care team and overall intent for term delivery in most cases.
Topics: Female; Humans; Lymphoma; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimesters
PubMed: 32804274
DOI: 10.1007/s11912-020-00972-1 -
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 -
International Journal of Gynaecology... Mar 2021To estimate physical activity (PA) in healthy women before and during pregnancy and to evaluate the features associated with moderate PA (MPA).
OBJECTIVE
To estimate physical activity (PA) in healthy women before and during pregnancy and to evaluate the features associated with moderate PA (MPA).
METHODS
A prospective cohort study was conducted on women selected 14 weeks of pregnancy during 2013-2015 in primary public health service centers in southern Spain. Type, duration, and frequency of PA (IPAQ questionnaire in first, second, and third trimesters [T1, T2, T3]) were measured. Variables associated with MPA were evaluated using multiple logistic regressions controlling for age, pre-pregnancy obesity, level of education, number of living children, pre-pregnancy PA, and adherence to Mediterranean diet (AMD).
RESULTS
Out of 463 women, MPA was estimated in 64% pre-pregnancy, and 54%, 61%, and 59% in T1, T2, and T3, respectively. MPA was associated with greater AMD in T2 (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] 1.04-1.33) and T3 (aOR 1.16, 95% CI 1.02-1.31), previous PA (aOR 13.5, 95% CI 8.12-22.5 in T1; aOR 2.61, 95% CI 1.72-3.96 in T2; aOR 2.59, 95% CI 1.65-4.05 in T3), and pre-pregnancy obesity (aOR 2.97, 95% CI 1.28-6.89 in T1; aOR 2.69, 95% CI 1.23-3.60 in T3).
CONCLUSION
PA decreased at the beginning of pregnancy, but compliance remained over 50%. MPA was associated with diet, pre-pregnancy PA, and obesity.
Topics: Adolescent; Adult; Cohort Studies; Exercise; Female; Humans; Middle Aged; Obesity; Pregnancy; Pregnancy Complications; Pregnancy Trimesters; Prenatal Care; Prospective Studies; Spain; Surveys and Questionnaires; Young Adult
PubMed: 32978781
DOI: 10.1002/ijgo.13387 -
Clinical Laboratory Sep 2019Urine sediment parameters of pregnant women are different from those of non-pregnant women, and it is necessary to establish reference intervals for pregnant women. The... (Review)
Review
BACKGROUND
Urine sediment parameters of pregnant women are different from those of non-pregnant women, and it is necessary to establish reference intervals for pregnant women. The aim of this study was to establish reference intervals of white blood cell (WBC), red blood cell (RBC), bacteria (BACT), squamous epithelial cell (EC), small round epithelial cell (SRC), and mucous strands (MUS) for urine sediment test of pregnant women using a UF-1000i analyzer as the detection device. The differences between pregnant women and non-pregnant women in terms of the aforementioned parameters as well as the differences of such parameters in different trimesters of pregnancy were clarified.
METHODS
The experimental subjects were divided into two groups: the experiment group (612 healthy pregnant women) and the control group (582 healthy non-pregnant women). Subjects of both groups are women between the age of 22 and 46. The urine specimens were analyzed using the Sysmex UF-1000i analyzer, followed by manual correction. A statistical analysis was performed by SPSS 22.0. Results were considered significant at p < 0.01.
RESULTS
The pregnancy reference intervals of WBC, RBC, BACT, EC, SRC, and MUS were 0 ~ 30/µL, 0 ~ 23/µL, 0 ~ 698/µL, 0 ~ 28/µL, 0 ~ 8/µL, and 0 ~ 3/µL, respectively. In the experiment group, the concentrations of WBC, BACT, EC, and SRC were significantly higher than those of the control group (p < 0.01), while the concentrations of RBC and MUS were significantly lower than those of the control group (p < 0.01). The inter-trimester differences in terms of the concentrations of WBC, BACT, EC, and SRC were statistically indistinguishable (p > 0.05). However, the concentration of RBC was significantly lower with the increase of trimester of pregnancy (the comparison between the first trimester with the second trimester: p = 0.000 < 0.01; the comparison between the second trimester and the third trimester: p = 0.004 < 0.01). The WBC, BACT, EC, and SRC had moderate intercorrelations (0.569 ~ 0.681, p < 0.01).
CONCLUSIONS
There were significant differences in the aforementioned parameters between the two groups. The intervals of WBC, RBC, BACT, EC, SRC, and MUS for urine sediment analysis of healthy pregnant women using a UF-1000i should be established.
Topics: Adult; Erythrocyte Count; Female; Humans; Leukocyte Count; Middle Aged; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimesters; Reference Values; Reproducibility of Results; Urinalysis; Urine; Young Adult
PubMed: 31532100
DOI: 10.7754/Clin.Lab.2019.181234 -
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 -
JPMA. the Journal of the Pakistan... Feb 2021To investigate the relationship between vitamin C intake and IL-6 level as a biomarker of oxidative stress during pregnancy.
OBJECTIVE
To investigate the relationship between vitamin C intake and IL-6 level as a biomarker of oxidative stress during pregnancy.
METHODS
Fourty pregnant women during third trimester were grouped into preeclampsia and non-preeclampsia, and surveyed using a Food Frequency Questionnaire. The ELISA assay for IL-6 expression was performed. Univariate and bivariate analyses were conducted using SPSS software ver. 20.
RESULTS
Subjects in preeclampsia group were shown to consume slightly more vitamin C than the non-preeclampsia group, with median values of 76.37 (28.05 - 96.88) mg and 68.87 (8.57 - 198.53) mg, respectively (p = 0.36). A nonparametric correlation test showed no significant association between vitamin C and total IL-6 level, with p = 0.36 and r = -0.15. There was also no difference between vitamin C consumption and IL-6 level for each group, with r = -0.14 and r = -0.20, respectively.
CONCLUSIONS
There was no statistically significant association between vitamin C intake and IL-6 level in women during third trimester of pregnancy (p = 0.36).
Topics: Ascorbic Acid; Case-Control Studies; Female; Humans; Interleukin-6; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Vitamins
PubMed: 33785949
DOI: No ID Found -
Reproductive Biomedicine Online Sep 2020Does the length of the anogenital distance (AGD), an anthropometric biomarker of fetal androgen exposure, change across pregnancy? It has been suggested that AGD remains...
RESEARCH QUESTION
Does the length of the anogenital distance (AGD), an anthropometric biomarker of fetal androgen exposure, change across pregnancy? It has been suggested that AGD remains stable during adulthood with no changes across the menstrual cycle. No studies, however, have been carried out during pregnancy, during which women are exposed to important hormonal and anthropometric variations.
DESIGN
A cohort study of 186 singleton pregnant women recruited in the first trimester of pregnancy. Measurements from the anterior clitoral surface to the upper verge of the anus (AGD), and from the posterior fourchette to the upper verge of the anus (AGD) and body mass index (BMI) were obtained in each trimester. Generalized linear model for repeated measures was carried out to assess differences in AGDs and BMI across the three trimesters of the pregnancy.
RESULTS
In crude analyses, AGD was progressively and significantly longer as the pregnancy developed (first trimester: 87.69 ± 13.14mm; second trimester: 89.69 ± 13.47mm; third trimester: 91.95 ± 13.25 mm; P < 0.001), whereas AGD did not significantly change throughout pregnancy (first trimester: 28.37 ± 6.94 mm; second trimester: 28.09 ± 7.66 mm; third trimester: 28.94 ± 6.7 mm). In the multivariable mixed-effect models for fixed effect (trimester) and time-covariate (BMI), AGDs did not show significant associations with trimesters of pregnancy when BMI was included in the model.
CONCLUSIONS
Our results suggest that AGD and AGD, when adjusted by BMI, do not change throughout gestation despite maternal anthropometric variations during pregnancy. AGD may be a meaningful measurement at any time during pregnancy without considering BMI. Therefore, maternal AGD may be used as a prenatal biomarker of the mother's in-uteru hormonal exposure even during pregnancy.
Topics: Adult; Anal Canal; Anthropometry; Biomarkers; Body Mass Index; Case-Control Studies; Female; Genitalia, Female; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Third
PubMed: 32586732
DOI: 10.1016/j.rbmo.2020.05.009 -
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 -
International Journal of Gynaecology... Oct 2023To perform a longitudinal assessment of B-type natriuretic peptide (BNP) and its association with cardiac function in low-risk pregnant women and in pregnant women with...
OBJECTIVE
To perform a longitudinal assessment of B-type natriuretic peptide (BNP) and its association with cardiac function in low-risk pregnant women and in pregnant women with congenital heart disease (CHD).
METHODS
Longitudinal study in low-risk pregnancy and pregnancy in women with CHD seen at 10-14, 18-22, and 30-34 weeks of pregnancy for BNP quantification and exercise studies using impedance cardiography (ICG).
RESULTS
Forty-three low-risk women with longitudinal samples (129 samples, 43 in each trimester) and 30 pregnant women with CHD with convenience samples (first trimester, five samples; second trimester, 20 samples; third trimester, 21 samples) were included. Women with CHD delivered earlier by 6 days (P = 0.002) and their newborns had lower birth weight independent of gestational age (birth weight centile 30.0 vs 55.0, P = 0.005). In low-risk women, BNP levels were lower in the third trimester (P < 0.001). There were no statistically significant differences in BNP concentrations across trimesters in the CHD group, no differences in BNP concentrations between the two groups, and no significant correlations between BNP concentration in each trimester with cardiac output, stroke volume, or heart rate (at rest/with exercise).
CONCLUSION
This study assessed BNP longitudinally in the first, second and third trimesters in singleton low-risk pregnancy, and showed that BNP concentration decreased with advancing gestational age, with no participants with levels greater than 40.0 pg/mL in the third trimester. BNP concentrations were similar in women with and without congenital heart disease. We found no correlation between circulating levels of BNP and maternal hemodynamics at rest or with exercise measured by ICG to support its use as a marker of cardiac function.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Natriuretic Peptide, Brain; Longitudinal Studies; Birth Weight; Heart Defects, Congenital; Pregnancy Trimester, Third
PubMed: 37185795
DOI: 10.1002/ijgo.14807 -
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