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Pharmacoepidemiology and Drug Safety Aug 2022Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period...
PURPOSE
Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset.
METHODS
We used data from a validated pregnant cohort aged 15-49 years from 2002 to 2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: nonusers, users only during prepregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to primary care practitioners visits, obesity, smoking, HTA, diabetes with 95% confidence intervals were calculated.
RESULTS
Compared with nonusers, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13-1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04-1.37) and 1.30 (1.13-1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08-1.51) for antidepressants and 1.25 (1.13-1.39) for anxiolytics.
CONCLUSIONS
Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications.
Topics: Abortion, Spontaneous; Anti-Anxiety Agents; Antidepressive Agents; Female; Humans; Hypnotics and Sedatives; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 35689300
DOI: 10.1002/pds.5488 -
Journal of Patient Safety Dec 2020The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types.
OBJECTIVE
The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types.
METHODS
A retrospective cohort study compared miscarriage treatment-related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within 6 weeks of miscarriage treatment. Secondary outcomes were major events and infections.
RESULTS
A total of 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. A total of 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference between ASCs and office-based settings was no longer significant for miscarriages treated with procedures.
CONCLUSIONS
Although there seem to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.
Topics: Abortion, Spontaneous; Adult; Ambulatory Care Facilities; Ambulatory Surgical Procedures; Female; Humans; Kaplan-Meier Estimate; Medical Office Buildings; Morbidity; Pregnancy; Retrospective Studies
PubMed: 30516583
DOI: 10.1097/PTS.0000000000000553 -
The Cochrane Database of Systematic... Mar 2012Miscarriage is a common complication of early pregnancy that can have both medical and psychological consequences such as depression and anxiety. The need for routine... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Miscarriage is a common complication of early pregnancy that can have both medical and psychological consequences such as depression and anxiety. The need for routine surgical evacuation with miscarriage has been questioned because of potential complications such as cervical trauma, uterine perforation, hemorrhage, or infection.
OBJECTIVES
To compare the safety and effectiveness of expectant management versus surgical treatment for early pregnancy failure.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 February 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 4 of 4), PubMed (2005 to 11 January 2012), POPLINE (inception to 11 January 2012), LILACS (2005 to 11 January 2012) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomized trials comparing expectant care and surgical treatment (vacuum aspiration or dilation and curettage) for miscarriage were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial quality and extracted data. We contacted study authors for additional information. For dichotomous data, we calculated the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI). For continuous data, we computed the mean difference (MD) and 95% CI. We entered additional data such as medians into 'Other data' tables.
MAIN RESULTS
We included seven trials with 1521 participants in this review. The expectant-care group was more likely to have an incomplete miscarriage by two weeks (RR 3.98; 95% CI 2.94 to 5.38) or by six to eight weeks (RR 2.56; 95% CI 1.15 to 5.69). The need for unplanned surgical treatment was greater for the expectant-care group (RR 7.35; 95% CI 5.04 to 10.72). The mean percentage needing surgical management in the expectant-care group was 28%, while 4% of the surgical-treatment group needed additional surgery. The expectant-care group had more days of bleeding (MD 1.59; 95% CI 0.74 to 2.45). Further, more of the expectant-care group needed transfusion (RR 6.45; 95% CI 1.21 to 34.42). The mean percentage needing blood transfusion was 1.4% for expectant care compared with none for surgical management. Results were mixed for pain. Diagnosis of infection was similar for the two groups (RR 0.63; 95% CI 0.36 to 1.12), as were results for various psychological outcomes. Pregnancy data were limited. Costs were lower for the expectant-care group (MD -499.10; 95% CI -613.04 to -385.16; in UK pounds sterling).
AUTHORS' CONCLUSIONS
Expectant management led to a higher risk of incomplete miscarriage, need for unplanned (or additional) surgical emptying of the uterus, bleeding and need for transfusion. Risk of infection and psychological outcomes were similar for both groups. Costs were lower for expectant management. Given the lack of clear superiority of either approach, the woman's preference should be important in decision making. Pharmacological ('medical') management has added choices for women and their clinicians and has been examined in other reviews.
Topics: Abortion, Incomplete; Abortion, Spontaneous; Anti-Bacterial Agents; Bed Rest; Dilatation and Curettage; Female; Humans; Pregnancy; Pregnancy Trimester, First; Randomized Controlled Trials as Topic; Ultrasonography; Vacuum Curettage; Watchful Waiting
PubMed: 22419288
DOI: 10.1002/14651858.CD003518.pub3 -
PloS One 2022This paper draws on individual-level data from the National Study of Family Growth (NSFG) to identify likely underreporters of abortion and miscarriage and examine their...
This paper draws on individual-level data from the National Study of Family Growth (NSFG) to identify likely underreporters of abortion and miscarriage and examine their characteristics. The NSFG asks about abortion and miscarriage twice, once in the computer-assisted personal interviewing (CAPI) part of the questionnaire and the other in the audio computer-assisted self-interviewing (ACASI) part. We used two different methods to identify likely underreporters of abortion and miscarriage: direct comparison of answers obtained from CAPI and ACASI and latent class models. The two methods produce very similar results. Although miscarriages are just as prone to underreporting as abortions, characteristics of women underreporting abortion differ somewhat from those misreporting miscarriages. Underreporters of abortions tended to be older, poorer, less likely to be Hispanic or Black, and more likely to have no religion. They also reported more traditional attitudes toward sexual behavior. By contrast, underreporters of miscarriage also tended to be older, poorer, and more likely to be Hispanic or Black, but were also more likely to have children in the household, had fewer pregnancies, and held less traditional attitudes toward marriage.
Topics: Abortion, Induced; Abortion, Spontaneous; Child; Family Characteristics; Female; Humans; Marriage; Pregnancy; Sexual Behavior
PubMed: 35921280
DOI: 10.1371/journal.pone.0271288 -
BMJ (Clinical Research Ed.) Nov 2004Enthusiasm for new treatments aimed at natural killer cells in women with reproductive failure is unfortunately not backed up by the science (Review)
Review
Enthusiasm for new treatments aimed at natural killer cells in women with reproductive failure is unfortunately not backed up by the science
Topics: Abortion, Spontaneous; Female; Humans; Infertility, Female; Killer Cells, Natural; Pregnancy; Uterus
PubMed: 15564263
DOI: 10.1136/bmj.329.7477.1283 -
Chinese Medical Journal Oct 2015Genetic factors are the main cause of early miscarriage. This study aimed to investigate aneuploidy in spontaneous abortion by fluorescence in situ hybridization (FISH)...
BACKGROUND
Genetic factors are the main cause of early miscarriage. This study aimed to investigate aneuploidy in spontaneous abortion by fluorescence in situ hybridization (FISH) using probes for 13, 16, 18, 21, 22, X and Y chromosomes.
METHODS
A total of 840 chorionic samples from spontaneous abortion were collected and examined by FISH. We analyzed the incidence and type of abnormal cases and sex ratio in the samples. We also analyzed the relationship between the rate of aneuploidy and parental age, the rate of aneuploidy between recurrent abortion and sporadic abortion, the difference in incidence of aneuploidy between samples from previous artificial abortion and those from no previous induced abortion.
RESULTS
A total of 832 samples were finally analyzed. 368 (44.23%) were abnormal, in which 84.24% (310/368) were aneuploidies and 15.76% (58/368) were polyploidies. The first was trisomy 16 (121/310), followed by trisomy 22, and X monosomy. There was no significant difference in the rate of aneuploidy in the advanced maternal age group (≥ 35 years old) and young maternal age group (<35 years old). However, the rate of trisomy 22 and the total rate of trisomies 21, 13, and 18 (the number of trisomy 21 plus trisomy 13 and trisomy 18 together) showed significantly different in two groups. We found no skewed sex ratio. There was no significant difference in the rate of aneuploidy between recurrent miscarriage and sporadic abortion or between the samples from previous artificial abortion and those from no previous artificial abortion.
CONCLUSIONS
Aneuploidy is a principal factor of miscarriage and total parental age is a risk factor. There is no skewed sex ratio in spontaneous abortion. There is also no difference in the rate of aneuploidy between recurrent abortion and sporadic abortion or between previous artificial abortion and no previous induced abortion.
Topics: Abortion, Habitual; Abortion, Spontaneous; Adult; Aneuploidy; Female; Humans; In Situ Hybridization; Middle Aged; Pregnancy; Sex Ratio
PubMed: 26481744
DOI: 10.4103/0366-6999.167352 -
BMC Women's Health Jan 2022Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the...
BACKGROUND
Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the social support received after a pregnancy is lost.
METHOD
42 people who had experienced at least one miscarriage took part in an Asynchronous Remote Community (ARC) study. The study involved 16 activities (discussions, creative tasks, and surveys) in two closed, secret Facebook groups over eight weeks. Descriptive statistics were used to analyse quantitative data, and content analysis was used for qualitative data.
RESULTS
There were two main miscarriage care networks, formal (health care providers) and informal (friends, family, work colleagues). The formal care network was the most trusted informational support source, while the informal care network was the main source of tangible support. However, often, participants' care networks were unable to provide sufficient informational, emotional, esteem, and network support. Peers who also had experienced miscarriage played a crucial role in addressing these gaps in social support. Technology use varied greatly, with smartphone use as the only common denominator. While there was a range of online support sources, participants tended to focus on only a few, and there was no single common preferred source.
DISCUSSION
We propose a Miscarriage Circle of Care Model (MCCM), with peer advisors playing a central role in improving communication channels and social support provision. We show how the MCCM can be used to identify gaps in service provision and opportunities where technology can be leveraged to fill those gaps.
Topics: Abortion, Spontaneous; Emotions; Female; Humans; Peer Group; Pregnancy; Social Networking; Social Support
PubMed: 35090452
DOI: 10.1186/s12905-022-01597-1 -
Obstetrics and Gynecology Dec 2017To assess whether interpregnancy interval length after a pregnancy loss is associated with risk of repeat miscarriage.
OBJECTIVE
To assess whether interpregnancy interval length after a pregnancy loss is associated with risk of repeat miscarriage.
METHODS
This analysis includes pregnant women participating in the Right From the Start (2000-2012) community-based prospective cohort study whose most recent pregnancy before enrollment ended in miscarriage. Interpregnancy interval was defined as the time between a prior miscarriage and the last menstrual period of the study pregnancy. Miscarriage was defined as pregnancy loss before 20 weeks of gestation. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios and 95% CIs for the association between different interpregnancy interval lengths and miscarriage in the study pregnancy. Adjusted models included maternal age, race, parity, body mass index, and education.
RESULTS
Among the 514 study participants who reported miscarriage as their most recent pregnancy outcome, 15.7% had a repeat miscarriage in the study pregnancy (n=81). Median maternal age was 30 years (interquartile range 27-34) and 55.6% of participants had at least one previous livebirth (n=286). When compared with women with interpregnancy intervals of 6-18 months (n=136), women with intervals of less than 3 months (n=124) had the lowest risk of repeat miscarriage (7.3% compared with 22.1%; adjusted hazard ratio 0.33, 95% CI 0.16-0.71). Neither maternal race nor parity modified the association. Attempting to conceive immediately was not associated with increased risk of miscarriage in the next pregnancy.
CONCLUSION
An interpregnancy interval after pregnancy loss of less than 3 months is associated with the lowest risk of subsequent miscarriage. This implies counseling women to delay conception to reduce risk of miscarriage may not be warranted.
Topics: Abortion, Spontaneous; Adult; Birth Intervals; Cohort Studies; Female; Humans; Maternal Age; Parity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Tennessee
PubMed: 29112656
DOI: 10.1097/AOG.0000000000002318 -
Ugeskrift For Laeger Apr 2022Ectopic pregnancy results in an urgent, sometimes lifethreatening condition and always leads to pregnancy loss. We conducted a literature search on mental health after...
Ectopic pregnancy results in an urgent, sometimes lifethreatening condition and always leads to pregnancy loss. We conducted a literature search on mental health after ectopic pregnancy. The level of anxiety, depression, posttraumatic stress and grief was high, comparable to the level after miscarriage. Several interventions such as good communication, information or follow-up counselling sessions improved mental health. We recommend that clinicians focus on these aspects during admission and follow-up at the general practitioners.
Topics: Abortion, Spontaneous; Anxiety; Female; Grief; Humans; Mental Health; Pregnancy; Pregnancy, Ectopic
PubMed: 35485793
DOI: No ID Found -
The Cochrane Database of Systematic... Apr 2005Miscarriage is pregnancy loss before 23 weeks of gestational age and it happens in 10% to 15% of pregnancies depending on maternal age and parity. It is associated with... (Review)
Review
BACKGROUND
Miscarriage is pregnancy loss before 23 weeks of gestational age and it happens in 10% to 15% of pregnancies depending on maternal age and parity. It is associated with chromosomal defects in about a half or two thirds of cases. Many interventions have been used to prevent miscarriage but bed rest is probably the most commonly prescribed especially in cases of threatened miscarriage and history of previous miscarriage. Since the etiology of miscarriage in most of the cases is not related to an excess of activity, it is unlikely that bed rest could be an effective strategy to reduce spontaneous miscarriage.
OBJECTIVES
To evaluate the effect of prescription of bed rest during pregnancy to prevent miscarriage in women at high risk of miscarriage.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register (July 2004). In addition, we searched The Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, POPLINE, LILACS and EMBASE.
SELECTION CRITERIA
We included all published, unpublished and ongoing randomized trials with reported data which compare clinical outcomes in pregnant women who were prescribed bed rest in hospital or at home for preventing miscarriage compared with alternative care or no intervention.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed the methodological quality of included trials using the methods described in the Cochrane Reviewers' Handbook. Studies were included irrespective of their methodological quality.
MAIN RESULTS
Only two studies including 84 women were identified. There was no statistically significant difference in the risk of miscarriage in the bed rest group versus the no bed rest group (placebo or other treatment) (relative risk (RR) 1.54, 95% confidence interval (CI) 0.92 to 2.58). Neither bed rest in hospital nor bed rest at home showed a significant difference in the prevention of miscarriage. There was a higher risk of miscarriage in those women in the bed rest group than in those in the human chorionic gonadotrophin therapy group with no bed rest (RR 2.50, 95% CI 1.22 to 5.11). It seems that the small number of participants included in these studies is a main factor to make this analysis inconclusive.
AUTHORS' CONCLUSIONS
There is insufficient evidence of high quality that supports a policy of bed rest in order to prevent miscarriage in women with confirmed fetal viability and vaginal bleeding in first half of pregnancy.
Topics: Abortion, Spontaneous; Bed Rest; Female; Humans; Pregnancy; Pregnancy, High-Risk; Randomized Controlled Trials as Topic
PubMed: 15846669
DOI: 10.1002/14651858.CD003576.pub2