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American Journal of Surgery Jan 2019Consensus lacks concerning management of ventral hernia in women who are, or might become pregnant. The aim of this systematic review was to examine the risk of...
BACKGROUND
Consensus lacks concerning management of ventral hernia in women who are, or might become pregnant. The aim of this systematic review was to examine the risk of recurrence following pre-pregnancy ventral hernia repair, and secondly the prevalence of ventral hernia during pregnancy and the risk of surgical repair pre- and post-partum.
DATA SOURCES
PubMed, Embase, CINAHL, Cochrane Library and Web of Science were systematically searched for randomized controlled trials, case-control, cohort studies and larger case-series on ventral (umbilical, epigastric or incisional) hernia repair in relation to pregnancy.
CONCLUSIONS
If possible, elective ventral repair should be postponed until after last pregnancy. A non-mesh repair seems appropriate for smaller primary ventral hernia in women who plan future pregnancies. Umbilical hernia during pregnancy seems very rare and seldom requires repair pre- and post-partum. Routine practice of umbilical hernia repair in combination with cesarean section cannot be recommended.
PROSPERO
CRD42017073736.
Topics: Female; Hernia, Ventral; Herniorrhaphy; Humans; Pregnancy; Pregnancy Complications; Prevalence; Recurrence
PubMed: 29798763
DOI: 10.1016/j.amjsurg.2018.04.016 -
The Journal of Maternal-fetal &... May 2013To systematically review the literature on the use of probiotics in pregnancy and their impact on maternal outcomes. (Review)
Review
OBJECTIVES
To systematically review the literature on the use of probiotics in pregnancy and their impact on maternal outcomes.
METHODS
Online databases were searched in April 2012 using the following terms to identify eligible studies: "probiotics", "pregnancy", "maternal outcomes" and "metabolism". Primary outcomes of selected studies were maternal fasting glucose during pregnancy and rates of gestational diabetes mellitus (GDM). Secondary outcomes were rates of pre-eclampsia, maternal inflammatory markers and lipid profiles and gestational weight gain. Studies whose primary outcomes were bacterial vaginosis, pre-term delivery and infant atopy were excluded. Only English-language articles were included. The limited number of eligible studies and varying outcomes precluded formal meta-analysis of these data.
RESULTS
Initially, 189 articles were identified and screened. Seven articles met inclusion criteria and are included in the present review. Results demonstrated that probiotic use in pregnancy could significantly reduce maternal fasting glucose, incidence of GDM and pre-eclampsia rates and levels of C-reactive protein.
CONCLUSIONS
Probiotics hold potential as a safe therapeutic tool for the prevention of pregnancy complications and adverse outcomes related to maternal metabolism. Further randomised controlled trials are urgently required, particularly among those at high risk of metabolic disorders, such as overweight and obese pregnant women.
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Probiotics; Randomized Controlled Trials as Topic
PubMed: 23205866
DOI: 10.3109/14767058.2012.755166 -
Haemophilia : the Official Journal of... Sep 2011Glanzmann Thrombasthenia (GT) is a rare autosomal recessive disorder which usually manifests as severe mucocutaneous bleeding and is caused by deficiency of the platelet... (Review)
Review
Glanzmann Thrombasthenia (GT) is a rare autosomal recessive disorder which usually manifests as severe mucocutaneous bleeding and is caused by deficiency of the platelet glycoprotein IIb-IIIa. Pregnancy in women with GT presents particular challenges as there is increased risk of both maternal and foetal bleeding. To improve understanding and clarify the optimum management of pregnancy in this disorder, we performed a systematic review of the world literature of pregnancy and GT. This identified three single-centre case series of patients with GT that included brief descriptions of women in pregnancy and 31 detailed case reports of 40 pregnancies in 35 women that resulted in 38 live births. Among the detailed case reports, ante-natal bleeding was described in 50% of pregnancies but was usually mild and occurred at mucocutaneous sites. Primary postpartum haemorrhage (PPH) was reported in 34% of pregnancies and secondary PPH in 24%. PPH was frequently severe and occurred up to 20 days after delivery. There was a wide variation in approach to prevention and treatment of PPH but most women received platelet transfusion, sometimes with additional recombinant FVIIa and anti-fibrinolytics. Maternal alloimmunization against platelet antigens was reported in 73% of pregnancies and was associated with four neonatal deaths. These data emphasize the need for multidisciplinary management of pregnancy in women with GT. Delivery plans should recognize the need for prevention and aggressive treatment of PPH and should minimize foetal bleeding risk in pregnancies complicated by alloimmunization.
Topics: Antifibrinolytic Agents; Disease Management; Factor VIIa; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Platelet Transfusion; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; Recombinant Proteins; Thrombasthenia
PubMed: 21457404
DOI: 10.1111/j.1365-2516.2011.02516.x -
American Journal of Obstetrics &... Aug 2023Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes. Fetal cardiac dysfunction may be 1 part of the pathophysiology of pregnancies... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes. Fetal cardiac dysfunction may be 1 part of the pathophysiology of pregnancies complicated by intrahepatic cholestasis of pregnancy. This systematic review and meta-analysis aimed to evaluate the association between intrahepatic cholestasis of pregnancy and fetal cardiac dysfunction.
DATA SOURCES
Systematic searches were performed on the databases of Medline, Embase, and Cochrane Library (up to March 2, 2023) for studies evaluating fetal cardiac function in pregnancies complicated by intrahepatic cholestasis of pregnancy in addition to the reference lists of included studies.
STUDY ELIGIBILITY CRITERIA
Studies were eligible for inclusion if they assessed the fetal cardiac function by fetal echocardiography in women with intrahepatic cholestasis of pregnancy (mild or severe) and compared with fetuses of healthy pregnant women. The studies published in English were included.
METHODS
The quality of the retrieved studies was assessed using the Newcastle-Ottawa Scale. Data on fetal myocardial performance index, E wave/A wave peak velocities ratio, and PR interval were pooled for the meta-analysis using random-effects models. The results were presented as weighted mean differences and 95% confidence intervals. This meta-analysis was registered with the International Prospective Register of Systematic Reviews (registration number: CRD42022334801).
RESULTS
A total of 14 studies were included in this qualitative analysis. Of note, 10 studies that reported data on fetal myocardial performance index, E wave/A wave peak velocities ratio, and PR interval were included in the quantitative analysis and showed a significant association between intrahepatic cholestasis of pregnancy and fetal cardiac dysfunction. Significantly higher fetal left ventricular myocardial performance index values (weighted mean difference, 0.10; 95% confidence interval, 0.04-0.16) and longer fetal PR intervals (weighted mean difference, 10.10 ms; 95% confidence interval, 7.34-12.86) were revealed in pregnancies complicated by intrahepatic cholestasis of pregnancy. Compared with the situation in pregnancies complicated by mild intrahepatic cholestasis of pregnancy, PR intervals were even longer in pregnancies complicated by severe intrahepatic cholestasis of pregnancy (weighted mean difference, 5.98 ms; 95% confidence interval, 0.20-11.77). There was no significant difference in fetal E wave/A wave peak velocities ratio between the group with intrahepatic cholestasis of pregnancy and the healthy pregnant group (weighted mean difference, 0.01; 95% confidence interval, -0.03 to 0.05).
CONCLUSION
Our findings supported the idea that intrahepatic cholestasis of pregnancy is associated with overall impaired fetal myocardial performance and impaired fetal cardiac conduction system. However, current evidence about the association between fetal cardiac dysfunction and intrahepatic cholestasis of pregnancy-induced stillbirth is lacking. Further studies are needed to reveal the relationship between fetal cardiac dysfunction and adverse perinatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy.
Topics: Pregnancy; Female; Humans; Pregnancy Complications; Stillbirth; Cholestasis, Intrahepatic; Fetus
PubMed: 37023984
DOI: 10.1016/j.ajogmf.2023.100952 -
Fertility and Sterility Feb 2013To assess current studies on the relationship between cell-derived microparticles (cMP) and recurrent miscarriages (RM) and pre-eclampsia (PE), and review the... (Review)
Review
OBJECTIVE
To assess current studies on the relationship between cell-derived microparticles (cMP) and recurrent miscarriages (RM) and pre-eclampsia (PE), and review the relationships between cMP and inflammatory and clot pathways, antiphospholipid antibodies (aPL), cytokines, and pregnancy complications.
DESIGN
Systematic and comprehensive review of the literature from January 2000 to January 2012.
SETTING
Vall d'Hebron University Hospital.
PATIENT(S)
Women with recurrent miscarriages or PE, healthy nonpregnant women, and healthy pregnant women.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Comparison of cMP numbers and types among groups.
RESULT(S)
Platelet and endothelial cMP are increased in women with normal pregnancies compared with nonpregnant healthy women. Only five case-control studies regarding cMP and RM and 16 on cMP and PE were found to match our objective. Three of five articles referring to RM showed differences in cMP numbering, and 13 of 16 on cMP and PE showed differences in some type of cMP compared with controls.
CONCLUSION(S)
Cell-derived microparticles were raised in normal pregnancy. Recurrent miscarriage seems to be related to endothelial and platelet cell activation and/or consumption. An increase in almost all cMP types was observed in PE. A relationship between cMP and endothelial activation and proinflammatory status seems to exist.
Topics: Abortion, Habitual; Biomarkers; Cell-Derived Microparticles; Comorbidity; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prevalence; Risk Factors; Spain
PubMed: 23122952
DOI: 10.1016/j.fertnstert.2012.10.009 -
Clinical Infectious Diseases : An... Dec 2017Maternal and fetal outcomes associated with botulism and botulinum antitoxin use during pregnancy and the postpartum period have not been systematically reviewed.
BACKGROUND
Maternal and fetal outcomes associated with botulism and botulinum antitoxin use during pregnancy and the postpartum period have not been systematically reviewed.
METHODS
We searched Global Health, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Medline databases from inception to May 2015 for studies published on botulism or botulinum antitoxin use during pregnancy and the postpartum period, as well as the Centers for Disease Control and Prevention National Botulism Surveillance database. Our search identified 4517 citations.
RESULTS
Sixteen cases of botulism during pregnancy (11 in the third trimester) and 1 case during the postpartum period were identified. Ten cases were associated with confirmed or likely foodborne exposure; 2 cases were attributed to wound contamination related to heroin use, and the source of 5 cases was unknown. Eleven women with botulism had progressive neurologic deterioration and respiratory failure, requiring intensive care unit admission. Four women had adverse outcomes, including 2 deaths and 2 women who remained in a persistent vegetative state. No neonatal losses or cases of congenital botulism were reported. Among the 12 cases that reported neonatal data, 6 neonates were born preterm. No adverse maternal or neonatal events were identified as associated with botulinum antitoxin therapy among 11 patients who received it.
CONCLUSIONS
Our review of 17 cases of botulism in pregnant/postpartum women found that more than half required ventilator support, 2 women died, and 6 infants were born prematurely. A high level of clinical suspicion is key for early diagnosis and treatment of botulism. Care of pregnant women or new mothers with botulism can include preparation for possible intubation.
Topics: Botulinum Antitoxin; Botulism; Female; Fetal Diseases; Humans; Immunologic Factors; Pregnancy; Pregnancy Complications, Infectious; Puerperal Infection
PubMed: 29293925
DOI: 10.1093/cid/cix813 -
The American Journal of Gastroenterology Mar 2021Liver transplantation (LT) remains the gold standard for treatment of end-stage liver disease. Given the increasing number of liver transplantation in females of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Liver transplantation (LT) remains the gold standard for treatment of end-stage liver disease. Given the increasing number of liver transplantation in females of reproductive age, our aim was to conduct a systematic review and meta-analysis evaluating pregnancy outcomes after LT.
METHODS
MEDLINE, Embase, and Scopus databases were searched for relevant studies. Study selection, quality assessment, and data extraction were conducted independently by 2 reviewers. Estimates of pregnancy-related outcomes in LT recipients were generated and pooled across studies using the random-effects model.
RESULTS
A comprehensive search identified 1,430 potential studies. Thirty-eight studies with 1,131 pregnancies among 838 LT recipients were included in the analysis. Mean maternal age at pregnancy was 27.8 years, with a mean interval from LT to pregnancy of 59.7 months. The live birth rate was 80.4%, with a mean gestational age of 36.5 weeks. The rate of miscarriages (16.7%) was similar to the general population (10%-20%). The rates of preterm birth, preeclampsia, and cesarean delivery (32.1%, 12.5%, and 42.2%, respectively) among LT recipients were all higher than the rates for the general US population (9.9%, 4%, and 32%, respectively). Most analyses were associated with substantial heterogeneity.
DISCUSSION
Pregnancy outcomes after LT are favorable, but the risk of maternal and fetal complications is increased. Large studies along with consistent reporting to national registries are necessary for appropriate patient counseling and to guide clinical management of LT recipients during pregnancy.
Topics: Abortion, Spontaneous; End Stage Liver Disease; Female; Humans; Incidence; Liver Transplantation; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Risk
PubMed: 33657039
DOI: 10.14309/ajg.0000000000001105 -
Liver Transplantation : Official... Jun 2012Approximately 14,000 women of reproductive age are currently living in the United States after liver transplantation (LT), and another 500 undergo LT each year. Although... (Meta-Analysis)
Meta-Analysis Review
Approximately 14,000 women of reproductive age are currently living in the United States after liver transplantation (LT), and another 500 undergo LT each year. Although LT improves reproductive function in women with advanced liver disease, the associated pregnancy outcomes and maternal-fetal risks have not been quantified in a broad manner. To obtain more generalizable inferences, we performed a systematic review and meta-analysis of articles that were published between 2000 and 2011 and reported pregnancy-related outcomes for LT recipients. Eight of 578 unique studies met the inclusion criteria, and these studies represented 450 pregnancies in 306 LT recipients. The post-LT live birth rate [76.9%, 95% confidence interval (CI) = 72.7%-80.7%] was higher than the live birth rate for the US general population (66.7%) but was similar to the post-kidney transplantation (KT) live birth rate (73.5%). The post-LT miscarriage rate (15.6%, 95% CI = 12.3%-19.2%) was lower than the miscarriage rate for the general population (17.1%) but was similar to the post-KT miscarriage rate (14.0%). The rates of pre-eclampsia (21.9%, 95% CI = 17.7%-26.4%), cesarean section delivery (44.6%, 95% CI = 39.2%-50.1%), and preterm delivery (39.4%, 95% CI = 33.1%-46.0%) were higher than the rates for the US general population (3.8%, 31.9%, and 12.5%, respectively) but lower than the post-KT rates (27.0%, 56.9%, and 45.6%, respectively). Both the mean gestational age and the mean birth weight were significantly greater (P < 0.001) for LT recipients versus KT recipients (36.5 versus 35.6 weeks and 2866 versus 2420 g). Although pregnancy after LT is feasible, the complication rates are relatively high and should be considered during patient counseling and clinical decision making. More case and center reports are necessary so that information on post-LT pregnancy outcomes and complications can be gathered to improve the clinical management of pregnant LT recipients. Continued reporting to active registries is highly encouraged at the center level.
Topics: Female; Humans; Liver Failure; Liver Transplantation; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 22344967
DOI: 10.1002/lt.23416 -
Clinical Epigenetics 2016Epigenetic mechanisms are important for the regulation of gene expression and differentiation in the fetus and the newborn child. Symptoms of maternal depression and... (Review)
Review
INTRODUCTION
Epigenetic mechanisms are important for the regulation of gene expression and differentiation in the fetus and the newborn child. Symptoms of maternal depression and antidepressant use affects up to 20 % of pregnant women, and may lead to epigenetic changes with life-long impact on child health. The aim of this review is to investigate whether there is an association between exposure to maternal antidepressants during pregnancy and epigenetic changes in the newborn.
MATERIAL AND METHODS
Systematic literature searches were performed in MEDLINE and EMBASE combining MeSH terms covering epigenetic changes, use of antidepressant medication, pregnancy and newborns. A keyword search was also performed. We included studies on pregnant women and their children where there was a history of maternal depressed mood or anxiety, a reported use of antidepressant medication, and measurements of epigenetic changes in umbilical cord blood. Studies using genome-wide or candidate-based epigenetic analyses were included. Citations and references from the included articles were investigated to locate further relevant articles. The completeness of reporting as well as the risk of bias and confounding was assessed.
RESULTS
Six studies were included. They all investigated methylation changes. Genome-wide methylation changes were examined in 184 children and methylation status in specific genes was examined in 96 children exposed to antidepressant medication. Three of the studies found an association between use of antidepressant medication during pregnancy and methylation status at various CpG sites measured in cord blood of the newborn. One of these studies found an association in African-Americans, but not Caucasians. The remaining three studies found associations between maternal mood and epigenetic changes in umbilical cord blood but no association between epigenetic changes and maternal use of antidepressant medication.
CONCLUSION
The included studies have not established a clear association between use of antidepressant medication during pregnancy and epigenetic changes in the cord blood. Future studies using newer, more wide-ranging epigenetic methods could discover possible new differentially methylated sites. Larger sample sizes and good validity of exposures are warranted in order to adjust for level of maternal depression, other maternal illness, maternal use of other types of medication, and maternal ethnicity. PROSPERO registration number: CRD42015026575.
Topics: Antidepressive Agents; DNA Methylation; Depression; Epigenesis, Genetic; Female; Fetal Blood; Humans; Maternal Exposure; Pregnancy; Pregnancy Complications
PubMed: 27610205
DOI: 10.1186/s13148-016-0262-x -
Acta Reumatologica Portuguesa 2011To review available data regarding the safety of biological therapies during pregnancy, focusing on agents used in rheumatology. (Review)
Review
AIM
To review available data regarding the safety of biological therapies during pregnancy, focusing on agents used in rheumatology.
METHODS
A systematic literature search was carried out to identify all studies with human data on fetal and/or child outcomes following exposure to biologic agents during pregnancy.
RESULTS
A total of 65 publications out of 745 identified references were included in the review.
CONCLUSIONS
Experience with pregnancy exposure to anti-TNF agents has been slowly accumulating. Although the numbers are small and with few controlled studies the reviewed data suggest that the overall risk of TNF antagonists is relatively low and benefits may outweigh the risks of drug exposure to the fetus. Information on other biologic agents is still very limited. Large controlled studies with longer follow-up periods will be necessary before firm conclusions about the safety of biologics du-ring conception and pregnancy can be drawn.
Topics: Biological Therapy; Female; Humans; Pregnancy; Pregnancy Complications; Rheumatic Diseases; Tumor Necrosis Factor Inhibitors
PubMed: 22113598
DOI: No ID Found