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European Journal of Heart Failure Dec 2021
Topics: Cardiomyopathies; Female; Heart Failure; Humans; Peripartum Period; Pre-Eclampsia; Pregnancy; Puerperal Disorders
PubMed: 34263509
DOI: 10.1002/ejhf.2300 -
MCN. the American Journal of Maternal...
Topics: Female; Humans; Posttraumatic Growth, Psychological; Psychotic Disorders; Puerperal Disorders; Postpartum Period
PubMed: 37840211
DOI: 10.1097/NMC.0000000000000963 -
European Heart Journal Aug 2023
Topics: Female; Humans; Pregnancy; Peripartum Period; Socioeconomic Disparities in Health; Cardiomyopathies; Puerperal Disorders; Pregnancy Complications, Cardiovascular
PubMed: 37313596
DOI: 10.1093/eurheartj/ehad385 -
Best Practice & Research. Clinical... Jul 2020Subclinical autoimmune thyroiditis exacerbates after delivery through immune rebound mechanisms and results in 5 types of thyroid dysfunction. The prevalence of... (Review)
Review
Subclinical autoimmune thyroiditis exacerbates after delivery through immune rebound mechanisms and results in 5 types of thyroid dysfunction. The prevalence of postpartum thyroid dysfunction is around 5% in mothers in the general population. Typically, an exacerbation induces destructive thyrotoxicosis followed by transient hypothyroidism, known as postpartum thyroiditis. Late development of permanent hypothyroidism is found frequently and patients should be followed up once every one to two years. Destructive thyrotoxicosis in postpartum thyroiditis should carefully be differentiated from post-partum Graves' disease. Postpartum thyroiditis typically occurs 1-4 months after parturition whereas Graves' disease develops at 4-12 months postpartum. Anti-TSH receptor antibodies (TRAb) are typically positive and thyroid blood flow is high in Graves' disease, whereas these features are absent in postpartum thyroiditis. Postpartum Graves' disease should be treated with antithyroid drugs.
Topics: Antithyroid Agents; Breast Feeding; Female; Graves Disease; Humans; Hypothyroidism; Lactation; Pregnancy; Puerperal Disorders; Thyroid Diseases; Thyrotoxicosis
PubMed: 32651061
DOI: 10.1016/j.beem.2020.101438 -
American Journal of Obstetrics and... Mar 2021Women with polycystic ovary syndrome are at a higher risk of cardiometabolic and psychiatric comorbidities and preconception and antepartum complications, but the impact...
BACKGROUND
Women with polycystic ovary syndrome are at a higher risk of cardiometabolic and psychiatric comorbidities and preconception and antepartum complications, but the impact of polycystic ovary syndrome during the postpartum period is unknown.
OBJECTIVE
This study aimed to investigate the risk of postpartum cardiovascular disease complications and perinatal and postpartum depression.
STUDY DESIGN
This was a retrospective cohort study conducted using a United States insurance claims database. Women with and without polycystic ovary syndrome aged 18 to 50 years enrolled continuously in a single health plan during the preconception, antepartum, and postpartum periods between 2000 and 2016 were included. The primary outcome was postpartum cardiovascular disease and depression (perinatal and postpartum). Multivariable logistic regression was used to adjust for covariates including age, geographic location, preterm delivery, assisted reproductive technology use, multiple births, prepregnancy depression, prepregnancy diabetes, prepregnancy hypertension, gestational diabetes, gestational hypertension, obesity, history of hyperlipidemia, smoking, and race.
RESULTS
We identified 42,391 unique women with polycystic ovary syndrome and 795,480 women without polycystic ovary syndrome. In multivariable models, women with polycystic ovary syndrome had significantly higher odds of cardiovascular disease complications, including postpartum preeclampsia (adjusted odds ratio, 1.30; 95% confidence interval, 1.17-1.45), eclampsia (adjusted odds ratio, 1.45; 95% confidence interval, 1.14-1.86) cardiomyopathy (adjusted odds ratio, 1.26; 95% confidence interval, 1.03-1.54), hypertensive heart disease (adjusted odds ratio, 1.32: 95% confidence interval, 1.07-1.64), thrombotic disease (adjusted odds ratio, 1.50; 95% confidence interval, 1.20-1.87), congestive heart failure (adjusted odds ratio, 1.35; 95% confidence interval, 1.13-1.61), and cerebrovascular accidents (adjusted odds ratio, 1.21; 95% confidence interval, 1.14-1.29), than those without polycystic ovary syndrome, as well as both perinatal (adjusted odds ratio, 1.27; 95% confidence interval, 1.22-1.33) and postpartum depression (adjusted odds ratio, 1.46; 95% confidence interval, 1.36-1.57). Nonobese women with polycystic ovary syndrome had higher odds of postpartum eclampsia (adjusted odds ratio 1.72; 95% confidence interval, 1.31-2.26), peripartum cardiomyopathy (adjusted odds ratio, 1.43; 95% confidence interval, 1.14-1.79), and cerebrovascular accidents (adjusted odds ratio, 1.28; 95% confidence interval, 1.19-1.38) than nonobese women without polycystic ovary syndrome. In the group of women without prepregnancy depression, the odds of perinatal depression (adjusted odds ratio, 1.32; 95% confidence interval, 1.26-1.39) and postpartum depression (adjusted odds ratio, 1.50; 95% confidence interval, 1.39-1.62) were higher in women with polycystic ovary syndrome than those without polycystic ovary syndrome.
CONCLUSION
In a large United States cohort, our study found that women with polycystic ovary syndrome are at increased risk of both cardiovascular and psychiatric complications during the postpartum period. Polycystic ovary syndrome should be recognized as an at-risk condition; our findings underscore the need for routine screening and early interventions for these major comorbidities.
Topics: Adolescent; Adult; Cardiovascular Diseases; Cohort Studies; Depression; Depression, Postpartum; Female; Humans; Middle Aged; Polycystic Ovary Syndrome; Pregnancy; Pregnancy Complications; Puerperal Disorders; Retrospective Studies; Risk Assessment; Young Adult
PubMed: 32835722
DOI: 10.1016/j.ajog.2020.08.048 -
General Hospital Psychiatry 2019Bipolar disorder affects 2-8% of pregnant and postpartum women; untreated illness is associated with poor outcomes. This study aimed to describe bipolar disorder...
OBJECTIVE
Bipolar disorder affects 2-8% of pregnant and postpartum women; untreated illness is associated with poor outcomes. This study aimed to describe bipolar disorder screening rates in obstetric settings and associated characteristics.
METHOD
Women were recruited during pregnancy through three months postpartum from 14 obstetric clinics in Massachusetts. The Mood Disorder Questionnaire (MDQ) was used to screen for bipolar disorder; a subset previously diagnosed with bipolar was also examined. Differences in characteristics by screening outcome were tested using chi-square and t-tests.
RESULTS
Of 574 participating women, 18.8% screened positive for bipolar disorder. Compared to those with negative, those with positive bipolar screens had 18.5-times the prevalence of positive substance use screens (11.1% vs. 0.6%, p < 0.001) and 3.4-times reported feeling they were not receiving adequate psychiatric help (24.0 vs. 7.0%, p < 0.001). Less than half of those with positive bipolar screens (42.0%) and 61.3% with pre-existing bipolar reported receiving current psychiatric care.
CONCLUSIONS
Almost one in five perinatal women screened positive for bipolar disorder. Positive screenings were associated with comorbid substance use and low treatment rates. This study highlights the importance of screening for bipolar disorder during the perinatal period and the need for systematic approaches to ensure adequate assessment and follow-up.
CLINICAL TRIALS REGISTRATION
ClinicalTrials.gov identifier: NCT02760004.
Topics: Adolescent; Adult; Bipolar Disorder; Female; Hospitals, Maternity; Humans; Longitudinal Studies; Massachusetts; Middle Aged; Pregnancy; Pregnancy Complications; Puerperal Disorders; Young Adult
PubMed: 31710859
DOI: 10.1016/j.genhosppsych.2019.09.002 -
Journal of Inherited Metabolic Disease Nov 2019Urea cycle disorders (UCD) are a group of rare inherited metabolic conditions of amino acid catabolism caused by an enzyme deficiency within the hepatic ammonia... (Review)
Review
Urea cycle disorders (UCD) are a group of rare inherited metabolic conditions of amino acid catabolism caused by an enzyme deficiency within the hepatic ammonia detoxification pathway. The presentation of these disorders ranges from life-threatening intoxication in the neonate to asymptomatic status in adults. Late-onset UCDs can present for the first time in adulthood and may mimic other causes of acute confusion or psychiatric diseases, and are often associated with neurological symptoms. Late-onset UCDs may become apparent during periods of metabolic stress such as rapid weight loss, gastric bypass surgery, chronic starvation or the postpartum period. Early diagnosis is critical for effective treatment and to prevent long-term complications of hyperammonemia. The challenges of management of adults include for example: (a) poor compliance to dietary and medical treatment which can result in recurrent hospital admissions; (b) severe neurological dysfunction; (c) the management of pregnancy and the postpartum period; and (d) access to multidisciplinary care peri-operatively. In this review, we highlight a number of challenges in the diagnosis and management of adult patient with late-onset UCDs and suggest a systematic management approach.
Topics: Adult; Age Factors; Age of Onset; Diagnosis, Differential; Female; Humans; Hyperammonemia; Infant, Newborn; Male; Neurocognitive Disorders; Ornithine Carbamoyltransferase Deficiency Disease; Pregnancy; Puerperal Disorders; Treatment Outcome; Urea Cycle Disorders, Inborn
PubMed: 30932189
DOI: 10.1002/jimd.12096 -
Journal of the American Heart... Jul 2020Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify...
Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS. Methods and Results This review was registered in PROSPERO (CRD42018108142). MEDLINE, Embase, and CINAHL were searched for case reports, case series, and studies reporting cases of ECLS during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of ECLS during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for ECLS overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%). Conclusions Reported rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.
Topics: Adult; Extracorporeal Membrane Oxygenation; Female; Humans; Infant; Infant, Newborn; Maternal Mortality; Perinatal Mortality; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 32578471
DOI: 10.1161/JAHA.119.016072 -
European Journal of Obstetrics,... Nov 2022To determine the association between early pregnancy glycaemia, as measured by glycosylated haemoglobin A1c (HbA1c) at the first prenatal visit, and persistent...
OBJECTIVE
To determine the association between early pregnancy glycaemia, as measured by glycosylated haemoglobin A1c (HbA1c) at the first prenatal visit, and persistent postpartum diabetes mellitus (DM).
STUDY DESIGN
All women first diagnosed with DM during pregnancy who had both HbA1c prior to 24 weeks and postpartum DM testing were included. The proportions of women with normal (<5.7%), prediabetic (5.7-6.4%) and elevated (≥6.5%) early HbA1c who tested positive for postpartum DM were compared. Test characteristics of HbA1c to predict persistent postpartum DM were calculated.
RESULTS
One hundred and twenty-one women met the study inclusion criteria. HbA1c was obtained at a median gestational age of 9 weeks. Twenty-two women (18.2%) had persistent postpartum DM, which was highly correlated with early HbA1c: 16 (73%) women had an elevated HbA1c, five (22.7%) women had a prediabetic HbA1c and only one (4.5%) woman had a normal HbA1c. Of 65 women with gestational DM and a normal early HbA1c, only one (1.5%) had persistent DM within the first year (negative predictive value 98.5%). Sixteen of 18 women with an elevated early HbA1c had persistent postpartum DM (positive predictive value 88.9%). These percentages were significant overall and between groups (p < 0.001). No clinical or demographic factors were highly predictive of postpartum DM.
CONCLUSIONS
Early pregnancy glycaemia, as measured by HbA1c at the first prenatal visit, is highly predictive of persistent postpartum DM, and may allow clinically important risk stratification to prioritize postpartum testing and care. Postpartum DM is rare amongst women with gestational DM who begin the pregnancy with a normal HbA1c, while postpartum DM is highly likely for those with an elevated HbA1c in early pregnancy. Nearly three-quarters of women who tested positive for DM post partum had an elevated HbA1c in early pregnancy, indicating that they had undiagnosed DM prior to conception.
Topics: Female; Humans; Infant; Pregnancy; Blood Glucose; Diabetes, Gestational; Glycated Hemoglobin; Postpartum Period; Prediabetic State; Pregnancy in Diabetics; Puerperal Disorders
PubMed: 36181752
DOI: 10.1016/j.ejogrb.2022.09.022 -
Current Problems in Cardiology Aug 2023Peripartum cardiomyopathy (PPCM) is a relatively rare, potentially life-threatening, idiopathic form of cardiomyopathy that affects previously healthy young women during... (Review)
Review
Peripartum cardiomyopathy (PPCM) is a relatively rare, potentially life-threatening, idiopathic form of cardiomyopathy that affects previously healthy young women during late pregnancy or in the early postpartum period and is characterized by left ventricular systolic dysfunction in the absence of any other identifiable cardiac causes. Morbidity and mortality with PPCM are remarkably high and it continues to be one of the leading causes of maternal death. Although remarkable advances have been made in our understanding of PPCM in the last few decades, unanswered questions remain regarding its pathophysiology, diagnostic workup, and management options. In this article, we will complete an updated, comprehensive review of PPCM, including the epidemiology and risk factors, proposed etiology, presentation and complications, management, prognostic indicators and outcomes. In addition, we will identify current challenges and gaps in knowledge.
Topics: Pregnancy; Female; Humans; Peripartum Period; Pregnancy Complications, Cardiovascular; Cardiomyopathies; Puerperal Disorders; Prognosis
PubMed: 36972860
DOI: 10.1016/j.cpcardiol.2023.101716