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Endocrinology and Metabolism (Seoul,... Jun 2023Thyroid hormone plays a critical role in fetal growth and development, and thyroid dysfunction during pregnancy is associated with several adverse outcomes, such as... (Review)
Review
Thyroid hormone plays a critical role in fetal growth and development, and thyroid dysfunction during pregnancy is associated with several adverse outcomes, such as miscarriage and preterm birth. In this review, we introduce and explain three major changes in the revised Korean Thyroid Association (KTA) guidelines for the diagnosis and management of thyroid disease during pregnancy: first, the normal range of thyroid-stimulating hormone (TSH) during pregnancy; second, the treatment of subclinical hypothyroidism; and third, the management of euthyroid pregnant women with positive thyroid autoantibodies. The revised KTA guidelines adopt 4.0 mIU/L as the upper limit of TSH in the first trimester. A TSH level between 4.0 and 10.0 mIU/L, combined with free thyroxine (T4) within the normal range, is defined as subclinical hypothyroidism, and a TSH level over 10 mIU/L is defined as overt hypothyroidism regardless of the free T4 level. Levothyroxine treatment is recommended when the TSH level is higher than 4 mIU/L in subclinical hypothyroidism, regardless of thyroid peroxidase antibody positivity. However, thyroid hormone therapy to prevent miscarriage is not recommended in thyroid autoantibody-positive women with normal thyroid function.
Topics: Female; Infant, Newborn; Pregnancy; Humans; Abortion, Spontaneous; Pregnancy Complications; Premature Birth; Thyroid Diseases; Hypothyroidism; Thyrotropin; Postpartum Period; Thyroid Hormones; Republic of Korea
PubMed: 37291743
DOI: 10.3803/EnM.2023.1696 -
Journal of Feline Medicine and Surgery Mar 2022Cats are common pets worldwide. Successful breeding of cats starts with the selection of suitable breeding animals, and care should be taken to avoid inbreeding. Keeping... (Review)
Review
PRACTICAL RELEVANCE
Cats are common pets worldwide. Successful breeding of cats starts with the selection of suitable breeding animals, and care should be taken to avoid inbreeding. Keeping cats in smaller groups reduces stress and facilitates management.
CLINICAL CHALLENGES
Breeding cats is challenging in many ways. Group housing is a common scenario, and care should be taken not to have groups that are too large, because of the risk of stress and infectious diseases. Feline pregnancy and parturition both vary in length, which is one reason why it may be challenging to diagnose dystocia. In queens with pyometra, a vaginal discharge may not be evident due to their meticulous cleaning habits.
AUDIENCE
This review is aimed at clinicians in small animal practice, especially those in contact with cat breeders.
PATIENT GROUP
Reproductive emergencies occur in both intentionally and unintentionally bred cats, and more often in young or middle-aged queens. Pyometra tends to be a disease of older queens.
EVIDENCE BASE
Evidence is poor for many conditions in the breeding queen, and information is extrapolated from the dog or based on case reports and case series.
Topics: Animals; Breeding; Cat Diseases; Cats; Communicable Diseases; Dystocia; Female; Pregnancy; Pregnancy Complications; Pyometra; Reproduction
PubMed: 35209770
DOI: 10.1177/1098612X221079708 -
Reproductive Sciences (Thousand Oaks,... Oct 2022Understanding, predicting, and preventing pregnancy disorders have been a major research target. Nonetheless, the lack of progress is illustrated by research results... (Review)
Review
Understanding, predicting, and preventing pregnancy disorders have been a major research target. Nonetheless, the lack of progress is illustrated by research results related to preeclampsia and other hypertensive pregnancy disorders. These remain a major cause of maternal and infant mortality worldwide. There is a general consensus that the rate of progress toward understanding pregnancy disorders lags behind progress in other aspects of human health. In this presentation, we advance an explanation for this failure and suggest solutions. We propose that progress has been impeded by narrowly focused research training and limited imagination and innovation, resulting in the failure to think beyond conventional research approaches and analytical strategies. Investigations have been largely limited to hypothesis-generating approaches constrained by attempts to force poorly defined complex disorders into a single "unifying" hypothesis. Future progress could be accelerated by rethinking this approach. We advise taking advantage of innovative approaches that will generate new research strategies for investigating pregnancy abnormalities. Studies should begin before conception, assessing pregnancy longitudinally, before, during, and after pregnancy. Pregnancy disorders should be defined by pathophysiology rather than phenotype, and state of the art agnostic assessment of data should be adopted to generate new ideas. Taking advantage of new approaches mandates emphasizing innovation, inclusion of large datasets, and use of state of the art experimental and analytical techniques. A revolution in understanding pregnancy-associated disorders will depend on networks of scientists who are driven by an intense biological curiosity, a team spirit, and the tools to make new discoveries.
Topics: Female; Humans; Hypertension; Infant; Infant Mortality; Pre-Eclampsia; Pregnancy; Pregnancy Complications
PubMed: 35534766
DOI: 10.1007/s43032-022-00951-w -
Taiwanese Journal of Obstetrics &... Jan 2022Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and... (Review)
Review
Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and pregnancy complication such as preterm birth, LBW, SGA, stillbirth, spontaneous abortion, preeclampsia and eclampsia. This is a systematic review based on the PRISMA model that examines pregnancy disorder, pregnancy complication, and reproductive outcomes in floods. For fulfilling of the objectives of the research, related keywords were identified using Mesh and Emtree databases. Then the search was done in the electronic database of Medline, Web of Science, Embase, scopus until 2021.2.10. The search strategy in the Medline database. Database searches resulted in 823 non-duplicate records. After reading the abstracts, 808 articles were excluded. 15 abstracts were eligible for the study, which their full texts were provided. Finally based on inclusion and exclusion criteria 7 articles were included in this study. After flood, the rate of LBW birth and gestational hypertension increases. However, there is no significant difference in preterm birth rates. Pregnancy complications can be reduced or prevented by starting prenatal care early and also by controlling risk factors such as reducing smoking and alcohol consumption.
Topics: Female; Floods; Humans; Infant, Low Birth Weight; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 35181015
DOI: 10.1016/j.tjog.2021.11.005 -
Nutrients Aug 2019Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to...
Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to prevent GDM are urgently required, the management of GDM still poses many unanswered questions, and the postpartum prevention of the progression of GDM to type 2 diabetes remains a challenge. With GDM, the impact of any intervention on the offspring is always a major concern. Nutritional interventions come to the fore as one of our few levers in reducing the short-term pregnancy risk and long-term cardiometabolic risks to both mother and child. This special issue reports on the relationship between several nutrients and foods and the development and management of GDM, behavioural strategies to enhance lifestyle choices, the issues raised by prior bariatric surgery and ways to screen for GDM. The work identifies further unanswered questions over nutritional strategies to reduce the impact of GDM.
Topics: Adult; Child; Diabetes Mellitus, Type 2; Diabetes, Gestational; Diet; Female; Humans; Life Style; Nutritional Status; Obesity; Postpartum Period; Pregnancy
PubMed: 31426514
DOI: 10.3390/nu11081940 -
Transplantation Oct 2022Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had...
BACKGROUND
Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had these pregnancy-related complications and subsequently became donors. In the general population, gestational hypertension (GHtn), preeclampsia/eclampsia, and gestational diabetes (GDM) are associated with long-term risks.
METHODS
Donors with the specified predonation complication were matched to contemporary control donors with pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for gravidity, blood pressure, glucose, body mass index, age, and creatinine at donation, donation year, race, relationship with recipient, and family history of disease. Long-term incidence of hypertension, diabetes, cardiovascular disease, and reduced renal function (estimated glomerular filtration rate [eGFR] <30, eGFR <45 mL/min/1.73 m 2 ) were compared between groups using proportional hazards models.
RESULTS
Of 1862 donors with predonation pregnancies, 48 had preeclampsia/eclampsia, 49 had GHtn without preeclampsia, and 43 had GDM. Donors had a long interval between first pregnancy and donation (median, 18.5 y; interquartile range, 10.6-27.5) and a long postdonation follow-up time (median, 18.0; interquartile range, 9.2-27.7 y). GHtn was associated with the development of hypertension (hazard ratio, 1.89; 95% confidence interval, 1.26-2.83); GDM was associated with diabetes (hazard ratio, 3.04; 95% confidence interval, 1.33-6.99). Pregnancy complications were not associated with eGFR <30 or eGFR <45 mL/min/1.73 m 2 .
CONCLUSIONS
Our data suggest that women with predonation pregnancy-related complications have long-term risks even with a normal donor evaluation. Donor candidates with a history of pregnancy-related complications should be counseled about these risks.
Topics: Creatinine; Diabetes Mellitus; Eclampsia; Female; Glomerular Filtration Rate; Glucose; Humans; Hypertension; Kidney; Kidney Transplantation; Living Donors; Nephrectomy; Pre-Eclampsia; Pregnancy; Pregnancy Complications
PubMed: 35404873
DOI: 10.1097/TP.0000000000004146 -
Acta Obstetricia Et Gynecologica... Jun 2021Claims of medical negligence are universal. Unexpected adverse pregnancy outcome may trigger litigation. Such outcomes, especially with neurodevelopmental sequelae, may...
INTRODUCTION
Claims of medical negligence are universal. Unexpected adverse pregnancy outcome may trigger litigation. Such outcomes, especially with neurodevelopmental sequelae, may be compounded by a genetic disorder, congenital abnormality, or syndrome.
MATERIAL AND METHODS
This is a report of 297 cases in which a pregnancy complication, error, or incident occurred that was followed by progeny with a genetic disorder, congenital abnormality, or syndrome that spawned litigation. The author assessed, opined, and in many cases, testified about causation.
RESULTS
Pregnancies complicated by hypoxic ischemic encephalopathy were not infrequently compounded by offspring with a genetic disorder, congenital abnormality, or syndrome. Multiple cases were brought because of missed ultrasound or laboratory diagnoses, or failures in carrier detection. Teratogenic medication prescribed before or during pregnancy invited legal purview. Failure to refer (or confer) for genetic evaluation or counseling in the face of significant risk, occurred repeatedly. Ethical breaches and hubris promptly led to litigation.
CONCLUSIONS
Many lessons and recommendations emerge in this report. These include the realization that the vast majority of errors in this series involved at least two caregivers, serial ultrasound studies are important, decreased fetal movements may signal a genetic disorder, congenital abnormality, or syndrome, family history and ethnicity are vital, cognitive biases profoundly affect decision-making. Finally, the simplest of errors have the potential for causing life-long grief.
Topics: Adult; Congenital Abnormalities; Female; Humans; Liability, Legal; Malpractice; Medical Errors; Obstetrics; Patient Safety; Pregnancy; Pregnancy Complications
PubMed: 33483959
DOI: 10.1111/aogs.14095 -
Acta Medica Portuguesa May 2022Pregnancy is a period characterized by complex and significant skin changes, which can have a major impact on a woman's life. The cutaneous manifestations associated...
Pregnancy is a period characterized by complex and significant skin changes, which can have a major impact on a woman's life. The cutaneous manifestations associated with this period are usually divided into physiological changes related with pregnancy, pre-existing dermatoses modified by pregnancy, and pregnancy-specific dermatoses, with the latter being potentially associated with significant fetal morbidity. The diagnosis of dermatoses of pregnancy can be challenging due to the variability in its clinical presentation; therefore, a complete and detailed clinical history and a thorough physical examination are essential. Primary care clinicians should be able to recognize these entities and provide some therapeutic strategies, as well as to refer patients whenever there is a risk to the mother and/ or to the fetus. A multidisciplinary team is essential in the evaluation of the most complex entities, and should include dermatologists, pediatricians, obstetricians and family physicians, so that both the mother's symptomatic relief and the minimization of fetal risk can be achieved quick and concurrently.
Topics: Female; Pregnancy; Humans; Pregnancy Complications; Skin Diseases
PubMed: 36279891
DOI: 10.20344/amp.13520 -
Circulation Mar 2023Pregnancy complications are associated with increased risk of development of cardiometabolic diseases and earlier mortality. However, much of the previous research has...
BACKGROUND
Pregnancy complications are associated with increased risk of development of cardiometabolic diseases and earlier mortality. However, much of the previous research has been limited to White pregnant participants. We aimed to investigate pregnancy complications in association with total and cause-specific mortality in a racially diverse cohort and evaluate whether associations differ between Black and White pregnant participants.
METHODS
The Collaborative Perinatal Project was a prospective cohort study of 48 197 pregnant participants at 12 US clinical centers (1959-1966). The Collaborative Perinatal Project Mortality Linkage Study ascertained participants' vital status through 2016 with linkage to the National Death Index and Social Security Death Master File. Adjusted hazard ratios (aHRs) for underlying all-cause and cause-specific mortality were estimated for preterm delivery (PTD), hypertensive disorders of pregnancy, and gestational diabetes/impaired glucose tolerance (GDM/IGT) using Cox models adjusted for age, prepregnancy body mass index, smoking, race and ethnicity, previous pregnancies, marital status, income, education, previous medical conditions, site, and year.
RESULTS
Among 46 551 participants, 45% (21 107 of 46 551) were Black, and 46% (21 502 of 46 551) were White. The median time between the index pregnancy and death/censoring was 52 years (interquartile range, 45-54). Mortality was higher among Black (8714 of 21 107 [41%]) compared with White (8019 of 21 502 [37%]) participants. Overall, 15% (6753 of 43 969) of participants had PTD, 5% (2155 of 45 897) had hypertensive disorders of pregnancy, and 1% (540 of 45 890) had GDM/IGT. PTD incidence was higher in Black (4145 of 20 288 [20%]) compared with White (1941 of 19 963 [10%]) participants. The following were associated with all-cause mortality: preterm spontaneous labor (aHR, 1.07 [95% CI, 1.03-1.1]); preterm premature rupture of membranes (aHR, 1.23 [1.05-1.44]); preterm induced labor (aHR, 1.31 [1.03-1.66]); preterm prelabor cesarean delivery (aHR, 2.09 [1.75-2.48]) compared with full-term delivery; gestational hypertension (aHR, 1.09 [0.97-1.22]); preeclampsia or eclampsia (aHR, 1.14 [0.99-1.32]) and superimposed preeclampsia or eclampsia (aHR, 1.32 [1.20-1.46]) compared with normotensive; and GDM/IGT (aHR, 1.14 [1.00-1.30]) compared with normoglycemic. values for effect modification between Black and White participants for PTD, hypertensive disorders of pregnancy, and GDM/IGT were 0.009, 0.05, and 0.92, respectively. Preterm induced labor was associated with greater mortality risk among Black (aHR, 1.64 [1.10-2.46]) compared with White (aHR, 1.29 [0.97-1.73]) participants, while preterm prelabor cesarean delivery was higher in White (aHR, 2.34 [1.90-2.90]) compared with Black (aHR, 1.40 [1.00-1.96]) participants.
CONCLUSIONS
In this large, diverse US cohort, pregnancy complications were associated with higher mortality nearly 50 years later. Higher incidence of some complications in Black individuals and differential associations with mortality risk suggest that disparities in pregnancy health may have life-long implications for earlier mortality.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pre-Eclampsia; Hypertension, Pregnancy-Induced; Prospective Studies; Eclampsia; Pregnancy Complications; Diabetes, Gestational; Obstetric Labor, Premature; Premature Birth
PubMed: 36883452
DOI: 10.1161/CIRCULATIONAHA.122.062177 -
Ugeskrift For Laeger Dec 2020Night work has been associated with sleep disorders as well as cardiovascular, endocrinologic, metabolic and immunological disturbances as shown in this review. Several... (Review)
Review
Night work has been associated with sleep disorders as well as cardiovascular, endocrinologic, metabolic and immunological disturbances as shown in this review. Several night shifts in a row and more than one night shift per week is associated with increased risk of pregnancy-related complications. A dose-response pattern has been shown between the number of night shifts during pregnancy and the risk of miscarriage, hypertensive disorders and sick leave. Individual risk assessment of pregnant night workers should focus on their general health, the intensity of night shifts and other adverse working conditions.
Topics: Abortion, Spontaneous; Female; Humans; Pregnancy; Pregnancy Complications; Sleep; Sleep Wake Disorders; Work Schedule Tolerance
PubMed: 33317690
DOI: No ID Found