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Magnetic Resonance Imaging Clinics of... Aug 2024Medical imaging, particularly fetal MR imaging, has undergone a transformative shift with the introduction of 3 Tesla (3T) clinical MR imaging systems. The utilization... (Review)
Review
Medical imaging, particularly fetal MR imaging, has undergone a transformative shift with the introduction of 3 Tesla (3T) clinical MR imaging systems. The utilization of higher static magnetic fields in these systems has resulted in remarkable advancements, including superior soft tissue contrast, improved spatial and temporal resolution, and reduced image acquisition time. Despite these notable benefits, safety concerns have emerged, stemming from the elevated static magnetic field strength, amplified acoustic noise, and increased radiofrequency power deposition. This article provides an overview of fetal MR imaging at 3T, its benefits and drawbacks, and the potential safety issues.
Topics: Humans; Magnetic Resonance Imaging; Pregnancy; Prenatal Diagnosis; Female; Patient Safety; Fetal Diseases
PubMed: 38944429
DOI: 10.1016/j.mric.2024.02.007 -
American Heart Journal Jun 2024Hypertensive disorders of pregnancy (HDP) are associated with increased long-term risk for cardiometabolic risk factors (chronic hypertension [HTN], obesity, diabetes)...
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are associated with increased long-term risk for cardiometabolic risk factors (chronic hypertension [HTN], obesity, diabetes) and heart failure. Exercise capacity is a known predictor of heart failure in patients with normal resting cardiac filling pressures. In this prospective observational cohort study, we sought to identify predictors of reduced postpartum exercise capacity in participants with normotensive vs. preeclamptic pregnancies.
METHODS
Preeclampsia (PreE) and normotensive subjects were enrolled to undergo bedside echocardiography within 48 hours of delivery, and rest/exercise echocardiography 12 weeks postpartum.
RESULTS
Recruited subjects (n=68) were grouped according to their blood pressure as: a) normotensive pregnancy n=15; b) PreE with normotensive postpartum (PreE-Resolved, n=36); c) PreE with persistent postpartum HTN (PreE-HTN, n=17). At enrollment, a significantly higher percentage of subjects in the PreE-HTN group were Black. Compared to normotensive and PreE-Resolved subjects, those with PreE-HTN demonstrated higher resting systolic blood pressure (SBP, 112 [normotensive] vs 112 [PreE-Resolved] vs 134 [PreE-HTN], p<0.001) and diastolic blood pressure (DBP, 70.0 vs 72.5 vs 85.0, p<0.001), and significantly less postpartum weight loss (9.6% vs 13.6% vs 3.8%, p<0.001). Following Bruce protocol stress testing, PreE-HTN subjects demonstrated achieved significantly lower exercise duration (10.4 vs 10.2 vs 7.9 minutes, p = 0.001). Subjects with PreE-HTN also demonstrated evidence of exercise-induced diastolic dysfunction as assessed by peak exercise lateral e' (18.0 vs 18.0 vs 13.5, p=0.045) and peak exercise tricuspid regurgitation velocity (TR Vm, 2.4 vs 3.0 vs 3.1, p = 0.045). Exercise duration was negatively associated with gravidity (R=-0.27, p=0.029) and postpartum LV mass index (R=-0.45, p<0.001), resting average E/e' (R=-0.51, p<0.001), BMI (R=-0.6, p<0.001) and resting SBP (R=-0.51, p<0.001).
CONCLUSIONS
Postpartum exercise stress testing capacity is related to readily available clinical markers including pregnancy factors, echocardiographic parameters and unresolved cardiometabolic risk factors.
PubMed: 38944263
DOI: 10.1016/j.ahj.2024.06.002 -
Fertility and Sterility Jun 2024
PubMed: 38944178
DOI: 10.1016/j.fertnstert.2024.06.018 -
American Journal of Obstetrics &... Jun 2024Having a potentially traumatic birth experience (PTBE) is a known risk factor for postpartum depression (PPD) and postpartum anxiety (PPA). PTBE-related PPA or PPD can...
Association between potentially traumatic birthing experience and worsening postpartum depression or anxiety trajectories among participants in perinatal collaborative care model.
BACKGROUND
Having a potentially traumatic birth experience (PTBE) is a known risk factor for postpartum depression (PPD) and postpartum anxiety (PPA). PTBE-related PPA or PPD can peak long after six weeks postpartum, when typical screening for PPD and PPA typically occurs, leaving many of these individuals disconnected from care. Collaborative care models (CCMs) have been shown to reduce PPD and PPA via collaboration between care managers, obstetric clinicians, and mental health professionals. Whether participating in a CCM mitigates the risk of worsening PPD or PPA after PTBE is unknown.
OBJECTIVE
To examine trajectories of PPD and PPA among those who experienced a PTBE and participated in a CCM.
STUDY DESIGN
This secondary analysis of a prospective cohort study included people enrolled in COMPASS, a CCM program embedded within all Northwestern Medicine prenatal clinics. All pregnant or postpartum people with a history of a mental health conditions or current mental health symptoms during pregnancy or within a year postpartum are eligible for COMPASS referral. Those who enroll in COMPASS are screened every two to four weeks for depression and anxiety symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. For this secondary analysis, COMPASS participants were stratified into two groups based on whether they had a PTBE, defined as postpartum hemorrhage, maternal intensive care unit (ICU) admission, or preterm birth <35 weeks (the gestational age cut-off for required Neonatal Intensive Care Unit (NICU) admission at this medical center). PTBE was evaluated as a composite and as its individual subcomponents. The primary outcomes were worsening trajectories for PPD or PPA, defined by a score increase of ≥1 standard deviation on the PHQ-9 or GAD-7, respectively, on at least two assessments for up to one year postpartum. A propensity score was used in multivariable models to control for covariates that significantly differed in bivariable analysis.
RESULTS
Among 2,312 COMPASS participants, 413 (17.9%) had PTBE. Compared to those without a PTBE, those with PTBE were more likely to have a pregnancy conceived via IVF, public insurance, or be diagnosed with preexisting diabetes, preexisting hypertension, or obesity. Among 736 and 282 participants with at least two PPD and PPA assessments, 65 (2.8%) and 27 (1.2%) had worsening PPD or PPA trajectories, respectively. After using propensity scores to control for differences identified between groups, PTBE was not associated with worsening trajectories for PPD [aOR 0.92 (95% CI 0.36, 2.38)] or PPA [(aOR 0.64 (95% CI 0.12, 3.26)]. There was no association between individual conditions within the PTBE composite and worsening PPD or PPA trajectories.
CONCLUSIONS
Among those enrolled in COMPASS, worsening PPD or PPA trajectories were uncommon, and PTBE were not associated with worsening trajectories. Given the abundance of literature suggesting that PTBE are associated with worse PPD and PPA symptoms, these findings suggest that enrollment in a CCM may be associated with mitigation of the negative impact of PTBE.
PubMed: 38944114
DOI: 10.1016/j.ajogmf.2024.101418 -
The Lancet. Oncology Jun 2024There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for...
BACKGROUND
There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer.
METHODS
The Teenage and Young Adult Cancer Survivor Study (TYACSS)-a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15-39 years from England and Wales-was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population.
FINDINGS
Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67-0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater.
INTERPRETATION
Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer.
FUNDING
Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.
PubMed: 38944050
DOI: 10.1016/S1470-2045(24)00269-9 -
International Journal of Surgery Case... May 2024Congenital gangrene of the limb in a newborn child is an extremely rare pathology with polyetiological causes that has not been fully studied. Therefore, each case of...
INTRODUCTION AND IMPORTANCE
Congenital gangrene of the limb in a newborn child is an extremely rare pathology with polyetiological causes that has not been fully studied. Therefore, each case of this pathology has its own characteristics of manifestations and allows you to get closer to solving this problem.
CASE PRESENTATION
We present a clinical case of congenital gangrene of the right upper limb in a newborn child. Analysis of the newborn baby's medical history indicated gestational hypertension and pyelonephritis during pregnancy in the mother, hemostasis disorders in the newborn. Computed tomography (CT) of the vessels of the right upper limb and thoracic segment confirmed brachial artery thrombosis. At the initial stage, conservative treatment was carried out, which included preventive antibacterial therapy and local care of the affected area. Only after a clear delineation of the dead tissue, the amputation of the segment of the right upper limb was performed. Amputation was performed with preservation of the proximal growth zone in order to provide an adequate stump for subsequent prosthetics.
CLINICAL DISCUSSION
Adverse factors during pregnancy can cause increased thrombosis. Through fetal communications, blood clots from the right atrium can enter the left atrium, the left ventricle and further into the large circulatory circle and cause thrombosis of the artery of the right upper limb. Another factor of increased thrombosis is congenital intrauterine infection of the newborn. Conservative treatment is carried out after diagnosis until the final determination of the boundaries of gangrene. When performing amputation, it is important to preserve the proximal bone growth zone in order to form an adequate stump for prosthetics.
CONCLUSION
Congenital gangrene of the limb in a newborn child is an extremely rare pathology. Irreversible changes in the upper limb in the child were caused by a combination of two factors: gestational hypertension and pyelonephritis in a pregnant woman and hemostasis disorders in a newborn due to intrauterine infection. Therefore, the preparation of women for pregnancy, examination for intrauterine infection and treatment of extragenital pathology are important in the prevention of this disease.
PubMed: 38943943
DOI: 10.1016/j.ijscr.2024.109738 -
Social Science & Medicine (1982) Jun 2024The ongoing Black maternal health crisis necessitates a closer examination of how Black women in the United States utilize communication to mitigate the dangers racism...
The ongoing Black maternal health crisis necessitates a closer examination of how Black women in the United States utilize communication to mitigate the dangers racism poses for pregnancy, delivery and the postpartum period. Previous studies have highlighted the importance of supportive networks to Black women's wellbeing during pregnancy. However, few studies utilize a qualitative network approach to explore communication about pregnancy and related risks within a social network. Twenty-eight Black women from 12 US states who self-identified as previously, currently or recently pregnant, were recruited to participate in this study. Following data collection, participants' networks and related commentary from the interview were qualitatively analyzed for composition and context of networks (who is in the network and why?) and the content of communication (what is discussed and how?). This study found that Black women's perceptions of pregnancy risk and enactment of agency in response to risk was influenced by communication with individuals within their communication networks. The findings of this study also demonstrate that emotional support and guidance for navigating the dangers of the healthcare system constituted an important component of communication with strong ties, including partners, family members and close friends. Additionally, Black women enacted agency in response to pregnancy risk by leaning on trusted experts (healthcare providers) within their networks. However, this study also found limitations to the role of pregnancy communication networks. First, negative ties (relations) with alters (individuals with whom Black women have communication ties) and unwanted advice or guidance was found to be a source of stress. Furthermore, although mothers were an essential source of support for many women, differences related to generation, culture and the circumstances of pregnancy limited the relevance of the advice Black women receive from their mothers. Finally, immigrant women faced an additional challenge, as their support networks were sometimes geographically distant from them.
PubMed: 38943860
DOI: 10.1016/j.socscimed.2024.117028 -
Peptides Jun 2024This paper is the forty-sixth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles... (Review)
Review
This paper is the forty-sixth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2023 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug and alcohol abuse (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
PubMed: 38943841
DOI: 10.1016/j.peptides.2024.171268 -
Psychiatry Research Jun 2024
PubMed: 38943786
DOI: 10.1016/j.psychres.2024.116045 -
The Journal of Clinical Endocrinology... Jun 2024The study aimed to explore the causal effect of body mass index (BMI) on polycystic ovarian syndrome (PCOS).
OBJECTIVE
The study aimed to explore the causal effect of body mass index (BMI) on polycystic ovarian syndrome (PCOS).
METHODS
Genome-wide association data for BMI and PCOS were sourced from the Mendelian randomization (MR) base platform. Significantly associated single nucleotide polymorphisms (SNPs) for BMI served as instrumental variables in bidirectional two-sample MR analyses to investigate the causal relationship between BMI and PCOS. Analytical techniques utilized encompassed the inverse-variance weighted (IVW) method, weighted median estimator, and MR-Egger regression.
RESULTS
We identified 427 SNPs significantly associated with BMI (P < 5 × 10-8; linkage disequilibrium r2 < 0.001). Various methods consistently revealed a positive association between BMI and PCOS (IVW: odds ratio (OR) 2.027, 95% confidence interval (CI) 1.599-2.596; weighted median estimator: OR 2.368, 95% CI 1.653-3.392; MR-Egger Method: OR 3.610, 95% CI 1.795-7.263), indicating that higher BMI correlates with an increased risk of PCOS. Additionally, we observed a causal effect of genetic predisposition to PCOS on BMI (IVW: OR 1.020, 95% CI (1.019-1.022); weighted median estimator: OR 1.017, 95% CI (1.015-1.019); MR-Egger Method: OR 1.000, 95% CI (0.995-1.005)).
CONCLUSION
The MR analysis furnished compelling evidence suggesting a causal relationship between elevated BMI and the risk of PCOS, as well as indicating that the severity of PCOS may contribute to elevated BMI levels.
PubMed: 38943662
DOI: 10.1210/clinem/dgae446