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BMC Pregnancy and Childbirth Jan 2023Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global...
Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global health burden. Considering the widely known importance of the negative impact of adolescent pregnancy, motherhood at an early age, and adverse pregnancy outcomes, this paper aims to provide insight into correlates of teen pregnancy, adolescent motherhood and adverse pregnancy outcome. This study utilizes the data from UDAYA survey conducted in Uttar Pradesh and Bihar. The eligible sample size for the study was 4897 married adolescent girls between the ages of 15 and 19 years. Bivariate analysis with a chi-square test of association and Multivariable logistic regression analysis was performed to fulfill the aim of the study. Our study shows that a major proportion of married adolescents (61%) got pregnant before the age of 20 years and around 42% of all adolescent married women gave birth to a child before reaching the age of 20 years. Adolescents who married before the age of 18 years were 1.79 times more likely to experience pregnancy (OR: 1.79; CI: 1.39-2.30) and 3.21 times more likely to experience motherhood (OR: 3.21; CI: 2.33-4.43). In the present study, women who experienced physical violence were at higher risk for having an adverse pregnancy outcome (OR: 1.41; CI: 1.08-1.84) than those who did not experience physical violence. To conclude, regional and national level efforts focused on improving early marriage, education and empowering women and girls can be beneficial.
Topics: Adolescent; Female; Humans; Pregnancy; Young Adult; Educational Status; India; Parturition; Pregnancy in Adolescence; Pregnancy Outcome; Prevalence
PubMed: 36703105
DOI: 10.1186/s12884-023-05354-6 -
Ultrasound in Obstetrics & Gynecology :... May 2023To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST).
METHODS
MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data.
RESULTS
Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54).
CONCLUSIONS
The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy, Twin; Premature Birth; Birth Weight; Retrospective Studies; Prospective Studies; Abortion, Spontaneous; Gestational Age; Pregnancy Outcome
PubMed: 36412550
DOI: 10.1002/uog.26126 -
Frontiers in Public Health 2023Evidence linking temperature with adverse perinatal and pregnancy outcomes is emerging. We searched for literature published until 30 January 2023 in PubMed, Web of... (Review)
Review
Evidence linking temperature with adverse perinatal and pregnancy outcomes is emerging. We searched for literature published until 30 January 2023 in PubMed, Web of Science, and reference lists of articles focusing on the outcomes that were most studied like preterm birth, low birth weight, stillbirth, and hypertensive disorders of pregnancy. A review of the literature reveals important gaps in knowledge and several methodological challenges. One important gap is the lack of knowledge of how core body temperature modulates under extreme ambient temperature exposure during pregnancy. We do not know the magnitude of non-modulation of body temperature during pregnancy that is clinically significant, i.e., when the body starts triggering physiologic counterbalances. Furthermore, few studies are conducted in places where extreme temperature conditions are more frequently encountered, such as in South Asia and sub-Saharan Africa. Little is also known about specific cost-effective interventions that can be implemented in vulnerable communities to reduce adverse outcomes. As the threat of global warming looms large, effective interventions are critically necessary to mitigate its effects.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Temperature; Premature Birth; Pregnancy Outcome; Stillbirth; Hypertension
PubMed: 38026314
DOI: 10.3389/fpubh.2023.1185836 -
Frontiers in Immunology 2022Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown cause, which mainly affects women of childbearing age, especially between 15... (Review)
Review
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown cause, which mainly affects women of childbearing age, especially between 15 and 55 years of age. During pregnancy, SLE is associated with a high risk of perinatal morbidity and mortality. Among the most frequent complications are spontaneous abortion, fetal death, prematurity, intrauterine Fetal growth restriction (FGR), and preeclampsia (PE). The pathophysiology underlying obstetric mortality and morbidity in SLE is still under investigation, but several studies in recent years have suggested that placental dysfunction may play a crucial role. Understanding this association will contribute to developing therapeutic options and improving patient management thus reducing the occurrence of adverse pregnancy outcomes in this group of women. In this review, we will focus on the relationship between SLE and placental insufficiency leading to adverse pregnancy outcomes.
Topics: Adolescent; Adult; Female; Fetal Growth Retardation; Humans; Lupus Erythematosus, Systemic; Middle Aged; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Young Adult
PubMed: 36059466
DOI: 10.3389/fimmu.2022.941586 -
PloS One 2024There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents'...
BACKGROUND
There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents' desires and decisions to become pregnant.
OBJECTIVE
This study aimed to examine the relationship between specific types of mental disorders and pregnancy rates and outcome types among adolescents aged 13-19 years, using single-year age groups.
METHODS
We conducted a retrospective cohort study using data from the Merative™ MarketScan Research Databases. The study population consisted of females aged 13-19 years with continuous insurance enrollment for three consecutive calendar years between 2005 and 2015. Pregnancy incidence rates were calculated both overall and within the different categories of mental disorders. The presence of mental disorders, identified through diagnosis codes, was classified into 15 categories. Pregnancy and pregnancy outcome types were determined using diagnosis and procedure codes indicating the pregnancy status or outcome. To address potential over- or underestimations of mental disorder-specific pregnancy rates resulting from variations in age distribution across different mental disorder types, we applied age standardization using 2010 U.S. Census data. Finally, multivariable logistic regression models were used to examine the relationships between 15 specific types of mental disorders and pregnancy incidence rates, stratified by age.
RESULTS
The age-standardized pregnancy rate among adolescents diagnosed with at least one mental disorder was 15.4 per 1,000 person-years, compared to 8.5 per 1,000 person-years among adolescents without a mental disorder diagnosis. Compared to pregnant adolescents without a mental disorder diagnosis, those with a mental disorder diagnosis had a slightly but significantly higher abortion rate (26.7% vs 23.8%, P-value < 0.001). Multivariable logistic regression models showed that substance use-related disorders had the highest odds ratios (ORs) for pregnancy incidence, ranging from 2.4 [95% confidence interval (CI): 2.1-2.7] to 4.5 [95% CI:2.1-9.5] across different age groups. Overall, bipolar disorders (OR range: 1.6 [95% CI:1.4-1.9]- 1.8 [95% CI: 1.7-2.0]), depressive disorders (OR range: 1.4 [95% CI: 1.3-1.5]- 2.7 [95% CI: 2.3-3.1]), alcohol-related disorders (OR range: 1.2 [95% CI: 1.1-1.4]- 14.5 [95% CI: 1.2-178.6]), and attention-deficit/conduct/disruptive behavior disorders (OR range: 1.1 [95% CI: 1.0-1.1]- 1.8 [95% CI: 1.1-3.0]) were also significantly associated with adolescent pregnancy, compared to adolescents without diagnosed mental disorders of the same age.
CONCLUSION
This study emphasizes the elevated rates of pregnancy and pregnancy ending in abortion among adolescents diagnosed with mental disorders, and identifies the particular mental disorders associated with higher pregnancy rates.
Topics: Female; Humans; Adolescent; Pregnancy; Pregnancy Rate; Retrospective Studies; Pregnancy Outcome; Mental Disorders; Substance-Related Disorders; Attention Deficit Disorder with Hyperactivity
PubMed: 38483946
DOI: 10.1371/journal.pone.0296425 -
African Health Sciences Mar 2023Available information remains limited on inter-pregnancy interval (IPI) and its effect on maternal health and pregnancy outcome.
BACKGROUND
Available information remains limited on inter-pregnancy interval (IPI) and its effect on maternal health and pregnancy outcome.
OBJECTIVES
To determine the effect of IPI on maternal serum ferritin, haematocrit and pregnancy outcome.
MATERIALS AND METHODS
A prospective cohort study of 316 women categorized into WHO recommended IPI of ≥24 months (group I) and IPI <24 months i.e. short IPI (SIPI) as group II after matching for gestational age and social status. Serum ferritin and haematocrit levels were assayed in first and second trimesters; primary outcome measures were maternal serum ferritin, haematocrit and pregnancy outcome gestational age at delivery, birth and placental weights, APGAR scores and neonatal intensive admission). Participants were followed up until six-week post-delivery. Data analysis was with SPSS version 21.0; p<0.05 was significant.
RESULTS
Women in group I had higher mean serum ferritin (37.40±3.15 vs. 32.61±2.68; P<0.001), booking haematocrit (33.24±3.59 vs. 27.92±2.67; P<0.001) and mean birth weight (3100±310 vs. 2700±350; P<0.001). Antenatal hospital admission (P0.002), preterm delivery (P<0.001) and neonatal intensive care admission (P<0.001) were higher for group II. There was no maternal mortality; perinatal mortality was zero (group I) and 95/1000 livebirth (group II).
CONCLUSION
Low serum ferritin, haematocrit and adverse neonatal outcomes were associated with SIPI.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Outcome; Hematocrit; Prospective Studies; Birth Intervals; Nigeria; Placenta; Premature Birth; Ferritins
PubMed: 37545929
DOI: 10.4314/ahs.v23i1.35 -
Sleep Health Apr 2022To explore the prevalence of poor sleep quality in couples undergoing fertility treatment and study possible associations.
OBJECTIVES
To explore the prevalence of poor sleep quality in couples undergoing fertility treatment and study possible associations.
PARTICIPANTS
163 women and 132 partners receiving in vitro (IVF) or intracytoplasmic sperm injection (ICSI) fertility treatment.
SETTING
Three public Danish fertility clinics.
DESIGN AND MEASUREMENTS
Participants completed the Pittsburgh Sleep Quality Index (PSQI) at three time-points as part of a larger RCT. Additional data from patient records and questionnaires were included to evaluate possible associations with treatment protocol type, psychological distress, and pregnancy outcome.
RESULTS
Mean PSQI global scores before treatment were 8.1 (standard deviation = 2.3), with 91% of participants having PSQI scores > 5, indicating poor sleep quality. Scores did not differ between women and their partners and did not change during treatment. Statistically significant associations were found between sleep quality and depressive symptoms and state anxiety (p < .001). No difference in PSQI scores was found between protocol types. While there was a trend towards higher clinical pregnancy rates among women with good sleep quality (PSQI ≤ 5 = 72.7%, PSQI 6-10 = 52.6% and PSQI ≥ 11 = 42.3%), the differences did not reach statistical significance (p = .10-.21).
CONCLUSIONS
Poor sleep quality is a prevalent problem among couples undergoing fertility treatment and is associated with psychological distress and possibly with pregnancy outcomes. Success rates after fertility treatment remain moderate, and poor sleep quality, a potentially modifiable factor, could be relevant to screen for and treat among couples undergoing fertility treatment. The high prevalence of poor sleep quality calls for further investigation.
Topics: Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Psychological Distress; Sleep; Sperm Injections, Intracytoplasmic
PubMed: 34949542
DOI: 10.1016/j.sleh.2021.10.011 -
American Journal of Obstetrics &... Aug 2020During pregnancy, vaginal colonization by Candida spp is common. Some studies suggest an association between asymptomatic vaginal Candida colonization and adverse... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
During pregnancy, vaginal colonization by Candida spp is common. Some studies suggest an association between asymptomatic vaginal Candida colonization and adverse pregnancy outcomes, but the evidence is inconsistent. This review aimed to systematically review the association between asymptomatic vaginal colonization by Candida spp and adverse pregnancy outcomes, including preterm birth.
DATA SOURCES
We searched Ovid MEDLINE, Ovid Embase, and the Cochrane Central Register of Controlled Trials from inception to May 6, 2020 for published studies on vaginal Candida/yeast and pregnancy outcomes.
STUDY ELIGIBILITY CRITERIA
Cohort studies, case-control studies, and randomized controlled trials that included pregnant women who were tested for asymptomatic vaginal Candida colonization and reported on adverse pregnancy outcomes were eligible.
STUDY APPRAISAL AND SYNTHESIS METHODS
Two reviewers independently selected and extracted the data. Critical appraisal was performed using the Newcastle-Ottawa Quality Assessment Scale for cohort and case-control studies and the revised Cochrane risk-of-bias tool for randomized controlled trials.
RESULTS
We found no significant difference in preterm birth rate between Candida-positive and Candida-negative women (odds ratio, 1.10; 95% confidence interval, 0.99-1.22; I, 0%) in 15 studies among 33,321 women for either spontaneous preterm birth only (odds ratio, 1.13, 95% confidence interval, 0.97-1.31; I, 0%) or all preterm birth (odds ratio, 1.04; 95% confidence interval, 0.79-1.35; I, 21%). Subgroup analyses for a treatment strategy including only studies reporting on spontaneous preterm birth did not reveal any statistically significant associations either, although the odds ratio was increased for the untreated Candida-positive women (odds ratio, 1.28; 95% confidence interval, 0.90-1.81; I, 13%) in 3 studies among 5175 women. Asymptomatic vaginal Candida colonization was not associated with small for gestational age, perinatal mortality, or any other adverse pregnancy outcome.
CONCLUSION
Asymptomatic vaginal Candida colonization is not associated with preterm birth and other adverse pregnancy outcomes. Previous studies reported that treatment of this microorganism reduces preterm birth rate. Our results suggest that this effect is unlikely to rely on treatment of vaginal Candida.
Topics: Candida; Female; Humans; Infant, Newborn; Infant, Small for Gestational Age; Perinatal Mortality; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 33345884
DOI: 10.1016/j.ajogmf.2020.100163 -
Annals of the Rheumatic Diseases Feb 2023Describe available data on birth defects and pregnancy loss in women with systemic lupus erythematosus (SLE) exposed to belimumab.
OBJECTIVE
Describe available data on birth defects and pregnancy loss in women with systemic lupus erythematosus (SLE) exposed to belimumab.
METHODS
Data collected from belimumab clinical trials, the Belimumab Pregnancy Registry (BPR), and postmarketing/spontaneous reports up to 8 March 2020 were described. Belimumab exposure timing, concomitant medications and potential confounding factors were summarised descriptively.
RESULTS
Among 319 pregnancies with known outcomes (excluding elective terminations), 223 ended in live births from which birth defects were identified in 4/72 (5.6%) in belimumab-exposed pregnancies and 0/9 placebo-exposed pregnancies across 18 clinical trials, 10/46 (21.7%) belimumab-exposed pregnancies in the BPR prospective cohort (enrolled prior to pregnancy outcome) and 0/4 belimumab-exposed pregnancies in the BPR retrospective cohort (enrolled after pregnancy outcome), and 1/92 (1.1%) in belimumab-exposed pregnancies from postmarketing/spontaneous reports. There was no consistent pattern of birth defects across datasets. Out of pregnancies with known outcomes (excluding elective terminations), pregnancy loss occurred in 31.8% (35/110) of belimumab-exposed women and 43.8% (7/16) of placebo-exposed women in clinical trials; 4.2% (2/48) of women in the BPR prospective cohort and 50% (4/8) in the BPR retrospective cohort; and 31.4% (43/137) of belimumab-exposed women from postmarketing/spontaneous reports. All belimumab-exposed women in clinical trials and the BPR received concomitant medications and had confounding factors and/or missing data.
CONCLUSIONS
Observations reported here add to limited data published on pregnancy outcomes following belimumab exposure. Low numbers of exposed pregnancies, presence of confounding factors/other biases, and incomplete information preclude informed recommendations regarding risk of birth defects and pregnancy loss with belimumab use.
Topics: Female; Humans; Pregnancy; Abortion, Spontaneous; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Pregnancy Outcome; Prospective Studies; Registries; Retrospective Studies; Treatment Outcome; Clinical Trials as Topic
PubMed: 36198440
DOI: 10.1136/ard-2022-222505 -
American Journal of Obstetrics and... May 2023Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal...
BACKGROUND
Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal death, compared with singleton pregnancies. Carrying a fetus with severe malformations or abnormal karyotype places the remaining healthy fetus at an even higher risk of adverse outcome and pregnancy complications. Maternal medical conditions or complicated obstetrical history could, in combination with twin pregnancy, cause increased risks for both the woman and the fetuses. To our knowledge, no previous studies have evaluated and compared the outcomes of all dichorionic twin pregnancies and compared the results of reduced twins with those of nonreduced and primary singletons in a national cohort. These data are important for clinicians when counseling couples about fetal reduction and its implications.
OBJECTIVE
This study aimed to describe and compare the risks of adverse pregnancy outcomes, including the risk of pregnancy loss, in a national cohort of all dichorionic twins-reduced, nonreduced, and primary singletons. In addition, we examined the implications of gestational age at fetal reduction on gestational age at delivery.
STUDY DESIGN
This was a retrospective cohort study of all Danish dichorionic twin pregnancies, including pregnancies undergoing fetal reduction and a large proportion of randomly selected primary singleton pregnancies with due dates between January 2008 and December 2018. The primary outcome measures were adverse pregnancy outcomes (defined as miscarriage before 24 weeks, stillbirth from 24 weeks, or single intrauterine fetal death in nonreduced twin pregnancies), preterm delivery, and obstetrical pregnancy complications. Outcomes after fetal reduction were compared with those of nonreduced dichorionic twins and primary singletons.
RESULTS
In total, 9735 dichorionic twin pregnancies were included, of which 172 (1.8%) were reduced. In addition, 16,465 primary singletons were included. Fetal reductions were performed between 11 and 23 weeks by transabdominal needle-guided injection of potassium chloride, and outcome data were complete for all cases. Adverse pregnancy outcome was observed in 4.1% (95% confidence interval, 1.7%-8.2%) of reduced twin pregnancies, and 2.4% (95% confidence interval, 0.7%-6.1%) were delivered before 28 weeks, and 4.2% (95% confidence interval, 1.7%-8.5%) before 32 weeks. However, when fetal reduction was performed before 14 weeks, adverse pregnancy outcomes occurred in only 1.4% (95% confidence interval, 0.0%-7.4%), and delivery before 28 and 32 weeks diminished to 0% (95% confidence interval, 0.0%-5.0%) and 2.8% (95% confidence interval, 0.3%-9.7%), respectively. In contrast, 3.0% (95% confidence interval, 2.7%-3.4%) of nonreduced dichorionic twins had an adverse pregnancy outcome, and 1.9% (95% confidence interval, 1.7%-2.1%) were delivered before 28 weeks, and 7.3% (95% confidence interval, 6.9%-7.7%) before 32 weeks. Adverse pregnancy outcomes occurred in 0.9% (95% confidence interval, 0.7%-1.0%) of primary singletons, and 0.2% (95% confidence interval, 0.1%-0.3%) were delivered before 28 weeks, and 0.7% (95% confidence interval, 0.6%-0.9%) before 32 weeks. For reduced twins, after taking account of maternal factors and medical history, it was demonstrated that the later the fetal reduction was performed, the earlier the delivery occurred (P<.01). The overall risk of pregnancy complications was significantly lower among reduced twin pregnancies than among nonreduced dichorionic twin pregnancies (P=.02).
CONCLUSION
In a national 11-year cohort including all dichorionic twin pregnancies, transabdominal fetal reduction by needle guide for fetal or maternal indication was shown to be safe, with good outcomes for the remaining co-twin. Results were best when the procedure was performed before 14 weeks.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Pregnancy Outcome; Pregnancy, Twin; Pregnancy Reduction, Multifetal; Abortion, Spontaneous; Retrospective Studies; Stillbirth; Fetal Death; Pregnancy Complications; Gestational Age; Twins, Dizygotic; Denmark
PubMed: 36441092
DOI: 10.1016/j.ajog.2022.10.028