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La Tunisie Medicale Nov 2023Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.
INTRODUCTION
Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.
AIM
To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome.
METHODS
We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.
RESULTS
The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01), small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51).
CONCLUSION
Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Pregnancy Outcome; Fetal Movement; Retrospective Studies; Fetal Growth Retardation; Cardiotocography; Gestational Age; Ultrasonography, Prenatal
PubMed: 38468581
DOI: No ID Found -
Circulation May 2021This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes,...
Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association.
This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing subsequent CVD (including fatal and nonfatal coronary heart disease, stroke, peripheral vascular disease, and heart failure). This statement highlights the importance of recognizing APOs when CVD risk is evaluated in women, although their value in reclassifying risk may not be established. A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk. Lactation and breastfeeding may lower a woman's later cardiometabolic risk. Black and Asian women experience a higher proportion APOs, with more severe clinical presentation and worse outcomes, than White women. More studies on APOs and CVD in non-White women are needed to better understand and address these health disparities. Future studies of aspirin, statins, and metformin may better inform our recommendations for pharmacotherapy in primary CVD prevention among women who have had an APO. Several opportunities exist for health care systems to improve transitions of care for women with APOs and to implement strategies to reduce their long-term CVD risk. One proposed strategy includes incorporation of the concept of a fourth trimester into clinical recommendations and health care policy.
Topics: American Heart Association; Cardiovascular Diseases; Female; Humans; Pregnancy; Pregnancy Outcome; Risk Factors; United States
PubMed: 33779213
DOI: 10.1161/CIR.0000000000000961 -
Clinical Obstetrics and Gynecology Mar 2022As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have... (Review)
Review
As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have been a population of interest given that they may be at risk of more severe infection and adverse pregnancy outcomes. The purpose of this review is to assess current epidemiology and outcomes research related to COVID-19 for the obstetric population. This review covers the epidemiology of COVID-19, symptomatology, transmission, and current knowledge gaps related to outcomes for the obstetric population.
Topics: COVID-19; Female; Humans; Pregnancy; Pregnancy Outcome; SARS-CoV-2
PubMed: 35045034
DOI: 10.1097/GRF.0000000000000674 -
Human Reproduction Update Sep 2020Although spontaneous miscarriage is the most common complication of human pregnancy, potential contributing factors are not fully understood. Advanced maternal age has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although spontaneous miscarriage is the most common complication of human pregnancy, potential contributing factors are not fully understood. Advanced maternal age has long been recognised as a major risk factor for miscarriage, being strongly related with fetal chromosomal abnormalities. The relation between paternal age and the risk of miscarriage is less evident, yet it is biologically plausible that an increasing number of genetic and epigenetic sperm abnormalities in older males may contribute to miscarriage. Previous meta-analyses showed associations between advanced paternal age and a broad spectrum of perinatal and paediatric outcomes. This is the first systematic review and meta-analysis on paternal age and spontaneous miscarriage.
OBJECTIVE AND RATIONALE
The aim of this systematic review and meta-analysis is to evaluate the effect of paternal age on the risk of spontaneous miscarriage.
SEARCH METHODS
PubMed, Embase and Cochrane databases were searched to identify relevant studies up to August 2019. The following free text and MeSH terms were used: paternal age, father's age, male age, husband's age, spontaneous abortion, spontaneous miscarriage, abortion, miscarriage, pregnancy loss, fetal loss and fetal death. PRISMA guidelines for systematic reviews and meta-analysis were followed. Original research articles in English language addressing the relation between paternal age and spontaneous miscarriage were included. Exclusion criteria were studies that solely focused on pregnancy outcomes following artificial reproductive technology (ART) and studies that did not adjust their effect estimates for at least maternal age. Risk of bias was qualitatively described for three domains: bias due to confounding, information bias and selection bias.
OUTCOMES
The search resulted in 975 original articles. Ten studies met the inclusion criteria and were included in the qualitative synthesis. Nine of these studies were included in the quantitative synthesis (meta-analysis). Advanced paternal age was found to be associated with an increased risk of miscarriage. Pooled risk estimates for miscarriage for age categories 30-34, 35-39, 40-44 and ≥45 years of age were 1.04 (95% CI 0.90, 1.21), 1.15 (0.92, 1.43), 1.23 (1.06, 1.43) and 1.43 (1.13, 1.81) respectively (reference category 25-29 years). A second meta-analysis was performed for the subgroup of studies investigating first trimester miscarriage. This showed similar pooled risk estimates for the first three age categories and a slightly higher pooled risk estimate for age category ≥45 years (1.74; 95% CI 1.26, 2.41).
WIDER IMPLICATIONS
Over the last decades, childbearing at later ages has become more common. It is known that frequencies of adverse reproductive outcomes, including spontaneous miscarriage, are higher in women with advanced age. We show that advanced paternal age is also associated with an increased risk of spontaneous miscarriage. Although the paternal age effect is less pronounced than that observed with advanced maternal age and residual confounding by maternal age cannot be excluded, it may have implications for preconception counselling of couples comprising an older aged male.
Topics: Abortion, Spontaneous; Adult; Aged; Fathers; Female; Humans; Male; Maternal Age; Middle Aged; Paternal Age; Pregnancy; Pregnancy Outcome; Prenatal Care; Risk Factors; Young Adult
PubMed: 32358607
DOI: 10.1093/humupd/dmaa010 -
Nursing For Women's Health Feb 2023The normal physiologic changes of pregnancy are known to increase susceptibility to respiratory illness. Individuals who are pregnant are more likely to acquire a...
The normal physiologic changes of pregnancy are known to increase susceptibility to respiratory illness. Individuals who are pregnant are more likely to acquire a SARS-CoV-2 infection and develop COVID-19 than the general population; they are at increased risk for hospitalization; ventilator-assisted breathing; and other subsequent maternal, fetal, and neonatal health issues. Although the incidence of infection and subsequent morbidity is increased in pregnancy, mortality does not seem to be increased. Individuals who are vaccinated against COVID-19 before childbirth can pass antibodies to their fetuses via the placenta during pregnancy and to their infants during breastfeeding. It is important for health care providers to be cognizant of the potential impacts of COVID-19 on pregnant individuals and their offspring.
Topics: Pregnancy; Infant; Infant, Newborn; Female; Humans; COVID-19; SARS-CoV-2; Pregnancy Complications, Infectious; Parturition; Delivery, Obstetric; Pregnancy Outcome
PubMed: 36528073
DOI: 10.1016/j.nwh.2022.11.004 -
Trends in Parasitology Apr 2021As an immune-privileged organ, the placenta can tolerate the introduction of antigens without inducing a strong inflammatory response that would lead to abortion.... (Review)
Review
As an immune-privileged organ, the placenta can tolerate the introduction of antigens without inducing a strong inflammatory response that would lead to abortion. However, for the control of intracellular pathogens, a strong Th1 response characterized by the production of interferon-γ is needed. Thus, invasion of the placenta by intracellular parasites puts the maternal immune system in a quandary: The proinflammatory response needed to eliminate the pathogen can also lead to abortion. Toxoplasma is a highly successful parasite that causes lifelong chronic infections and is a major cause of abortions in humans and livestock. Here, we discuss how Toxoplasma strain type and parasite effectors influence host cell signaling pathways, and we speculate about how this might affect the outcome of gestation.
Topics: Abortion, Spontaneous; Animals; Female; Host-Parasite Interactions; Humans; Placenta; Pregnancy; Pregnancy Outcome; Protozoan Proteins; Signal Transduction; Toxoplasma
PubMed: 33234405
DOI: 10.1016/j.pt.2020.10.013 -
Obstetrics and Gynecology Dec 2022To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. (Observational Study)
Observational Study
OBJECTIVE
To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes.
METHODS
This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes.
RESULTS
Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA.
CONCLUSION
High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Pregnancy Outcome; Allostasis; Stillbirth; Prospective Studies; Premature Birth; Pre-Eclampsia; Fetal Growth Retardation; Infant, Newborn, Diseases
PubMed: 36357956
DOI: 10.1097/AOG.0000000000004971 -
JBRA Assisted Reproduction Jun 2024To evaluate the impact of possible maternal and paternal prognostic factors and ovarian stimulation protocols on clinical pregnancy and live birth rates in intrauterine... (Observational Study)
Observational Study
OBJECTIVE
To evaluate the impact of possible maternal and paternal prognostic factors and ovarian stimulation protocols on clinical pregnancy and live birth rates in intrauterine insemination (IUI) cycles.
METHODS
Retrospective observational study of 341 IUI cycles performed from January 2016 to November 2020 at the Assisted Reproduction Service of the Clinics Hospital of the Ribeirão Preto Medical School, University of São Paulo. Clinical pregnancy and live birth rates and their potential prognostic factors were evaluated. Wilcoxon's non-parametric test was used to compare quantitative variables, and the chi-square test to compare qualitative variables, adopting a significance level of p<0.05. A logistic regression model was performed to verify which exploratory variables are predictive factors for pregnancy outcome.
RESULTS
The ovulation induction protocol using gonadotropins plus letrozole (p=0.0097; OR 4.3286, CI 1.3040 - 14.3684) and post-capacitation progressive sperm ≥ 5million/mL (p=0.0253) showed a statistically significant correlation with the live birth rate. Female and male age, etiology of infertility, obesity, multifollicular growth, endometrial thickness ≥ 7 mm, and time between human chorionic gonadotropin administration and IUI performance were not associated with the primary outcomes. In the group of patients with ideal characteristics (women aged< 40 years, BMI < 30 kg/m2, antral follicle count ≥ 5, partner aged< 45 years, and post-capacitation semen with progressive spermatozoa ≥ 5 million/mL), the rate of clinical pregnancy was 14.8%, while that of live birth, 9.9%.
CONCLUSIONS
In this study, the ovulation induction protocol with gonadotropins plus letrozole and post-capacitation progressive sperm ≥ 5 million/mL were the only variables that significantly correlated with intrauterine insemination success.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Adult; Male; Ovulation Induction; Prognosis; Insemination, Artificial; Pregnancy Rate; Pregnancy Outcome
PubMed: 38546118
DOI: 10.5935/1518-0557.20240017 -
Paediatric and Perinatal Epidemiology Nov 2022Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few...
BACKGROUND
Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity.
OBJECTIVES
We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women.
METHODS
Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors.
RESULTS
Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes.
CONCLUSIONS
While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.
Topics: Pregnancy; Female; Humans; Adolescent; Young Adult; Adult; Endometriosis; Pregnancy Outcome; Infertility, Female; Laparoscopy; Live Birth; Abortion, Spontaneous
PubMed: 35570746
DOI: 10.1111/ppe.12887 -
Acta Obstetricia Et Gynecologica... Jun 2023
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Premature Birth; Pregnancy Complications
PubMed: 37212520
DOI: 10.1111/aogs.14548