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Nutrients Aug 2019Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to...
Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to prevent GDM are urgently required, the management of GDM still poses many unanswered questions, and the postpartum prevention of the progression of GDM to type 2 diabetes remains a challenge. With GDM, the impact of any intervention on the offspring is always a major concern. Nutritional interventions come to the fore as one of our few levers in reducing the short-term pregnancy risk and long-term cardiometabolic risks to both mother and child. This special issue reports on the relationship between several nutrients and foods and the development and management of GDM, behavioural strategies to enhance lifestyle choices, the issues raised by prior bariatric surgery and ways to screen for GDM. The work identifies further unanswered questions over nutritional strategies to reduce the impact of GDM.
Topics: Adult; Child; Diabetes Mellitus, Type 2; Diabetes, Gestational; Diet; Female; Humans; Life Style; Nutritional Status; Obesity; Postpartum Period; Pregnancy
PubMed: 31426514
DOI: 10.3390/nu11081940 -
Seminars in Hematology Jul 2013Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that... (Review)
Review
Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This review discusses specifically the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations; however, care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist, and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy, and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored.
Topics: Anemia; Blood Coagulation Disorders; Female; Humans; Pregnancy; Pregnancy Complications, Hematologic; Thrombocytopenia; Thromboembolism
PubMed: 23953339
DOI: 10.1053/j.seminhematol.2013.06.004 -
ARP Rheumatology 2022Takayasu arteritis (TA), a form of vasculitis affecting large-and medium-sized vessels; it mainly affects women of reproductive age. Although cardiovascular and... (Review)
Review
OBJECTIVE
Takayasu arteritis (TA), a form of vasculitis affecting large-and medium-sized vessels; it mainly affects women of reproductive age. Although cardiovascular and hemodynamic changes during pregnancy represent a potential risk for TA, findings regarding risk in maternal and fetal outcomes are inconsistent. This study aimed to describe the prevalence and outcomes of pregnancies in patients with TA, along with a literature review of comparable studies on the subject matter.
METHODS
This cross-sectional study was conducted between January and March 2020. We evaluated 20 women diagnosed with TA according to clinical and angiographic findings.
RESULTS
The median age of the participants was 38 years. The median age at TA diagnosis was 26 years. Thirteen of the 20 participants reported at least one pregnancy. There were 38 pregnancies, including 26 deliveries (20 vaginal and six cesarean deliveries) and 12 abortions. The most common obstetric complication was spontaneous abortion (25%), followed by prematurity (7.89%), and eclampsia/preeclampsia (5.26%). Only one of our patients gave birth without any complications after being diagnosed with TA. In this case, the disease remained inactive throughout the pregnancy and postpartum periods.
CONCLUSIONS
The most common obstetric complication encountered was spontaneous abortion. The maternal and fetal outcome findings were similar to those of previously published studies. The literature shows that patients with stable pregestational TA generally have a good prognosis.
Topics: Pregnancy; Humans; Female; Adult; Pregnancy Outcome; Abortion, Spontaneous; Cross-Sectional Studies; Takayasu Arteritis; Retrospective Studies; Pregnancy Complications, Cardiovascular
PubMed: 36617313
DOI: No ID Found -
Women's Health (London, England) Jul 2015Progression of retinopathy and nephropathy in women with diabetes occurs, at least temporarily, during pregnancy and postpartum. However, normotensive pregnancy seems to... (Review)
Review
Progression of retinopathy and nephropathy in women with diabetes occurs, at least temporarily, during pregnancy and postpartum. However, normotensive pregnancy seems to have no detrimental effects regarding the long-term progression of any microvascular complication. Increased risk from pregnancy induced hypertension without proteinuria and with proteinuria (pre-eclampsia) relates mainly to the association with kidney disease in diabetes, and poor glycemic control. A history of pre-eclampsia or pregnancy induced hypertension is an important prognostic factor for micro- and macro-vascular complications later in life. Data regarding the long-term effects of hypertensive pregnancies on late complications of diabetes suggest that women with diabetes should be monitored regularly and nephroprotective treatment initiated early.
Topics: Adult; Diabetes Mellitus, Type 2; Diabetes, Gestational; Diabetic Nephropathies; Diabetic Retinopathy; Eye Diseases; Female; Health Status; Humans; Hypertension; Kidney Diseases; Mothers; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Proteinuria; Women's Health
PubMed: 26258813
DOI: 10.2217/WHE.15.29 -
Journal of Thrombosis and Haemostasis :... May 2022Thrombomodulin (TM) is a transmembrane glycoprotein expressed on the endothelial cell functioning as a cofactor in the anticoagulation system. However, aside from... (Review)
Review
BACKGROUND
Thrombomodulin (TM) is a transmembrane glycoprotein expressed on the endothelial cell functioning as a cofactor in the anticoagulation system. However, aside from anticoagulation, recent studies have revealed its multiple organ protective roles such as anti-inflammation, angiogenesis, and cell proliferation, which may redefine the function of TM. Although TM is predominantly expressed on placental trophoblasts, the physiological role of TM during pregnancy remains unclear. Because the understanding of TM function has drastically progressed, these new discoveries shed light on the unknown activities of placental TM. Moreover, the clinical application of recombinant TM (rTM) has opened the possibility of TM as a therapeutic target for pregnancy complications.
OBJECTIVES
Here, we comprehensively review the studies elucidating the role of TM during pregnancy from both classic and newly discovered perspectives, and seek for its potential as a therapeutic target for pregnancy complications.
METHODS
Basic research using trophoblast cells and transgenic mice, as well as cohort studies of inherited TM deficiency and clinical trials of rTM were summarized, which led us to further discuss the clinical application of rTM as a novel therapeutic for pregnancy complications.
RESULTS AND CONCLUSION
Accumulating evidence suggest the relevance of placental TM deficiency in pregnancy complications such as miscarriage, fetal growth restriction, and preeclampsia. Most importantly, promising results in animal studies and clinical trials further assure the possibility of rTM as an optimal therapeutic for such conditions. The therapeutic potential of TM raised throughout this review could drastically change the clinical approach to pregnancy complication and improve maternal outcomes.
Topics: Animals; Anti-Inflammatory Agents; Anticoagulants; Female; Humans; Mice; Placenta; Pre-Eclampsia; Pregnancy; Thrombomodulin
PubMed: 35191182
DOI: 10.1111/jth.15680 -
Ugeskrift For Laeger Nov 2022Intrauterine growth restriction (IUGR) is a potential complication associated with maternal SARS-CoV-2 infection. Danish guidelines recommend ultrasound follow-up from...
Intrauterine growth restriction (IUGR) is a potential complication associated with maternal SARS-CoV-2 infection. Danish guidelines recommend ultrasound follow-up from gestational age (GA) 24+0 in SARS-CoV-2-positive pregnant women who experience reduced fetal movements. This is a case report of severe IUGR (-51%) after maternal infection at GA 22+1 in a healthy unvaccinated 28-year-old woman. Positive PCR-tests for SARS-CoV-2 from placenta and child, along with massive placental inflammatory findings, suggested IUGR caused by maternal infection. This implies that follow-up from earlier GA may be warranted.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; COVID-19; Fetal Growth Retardation; Mothers; Placenta; SARS-CoV-2; Pregnancy Complications, Infectious
PubMed: 36426816
DOI: No ID Found -
Current Rheumatology Reports Aug 2020In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life... (Review)
Review
PURPOSE OF REVIEW
In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides.
RECENT FINDINGS
Successful pregnancies in patients with vasculitides are possible, especially when conception is planned, and the disease is in remission. The risk of vasculitis flare is highly dependent on the type of vasculitis, but overall limited. The most frequent complication associated with large-vessel vasculitis (mainly Takayasu arteritis) is hypertension and preeclampsia. Preterm deliveries and intrauterine growth restriction occur more frequently with small- and medium-vessel vasculitis. Pregnancies in patients with vasculitis should be considered high risk and followed by a multidisciplinary team with expertise in the field. Flares should be managed as in the non-pregnant population, while avoiding medications with unknown safety in pregnancy or known teratogens. Although commonly prescribed for the prevention of preeclampsia, there is limited evidence supporting the use of low-dose aspirin for pregnant women with vasculitis. Prospective registries or studies are needed, to better assess the value of aspirin, the place and long-term impact of new biologics and, to identify predictors of pregnancy outcomes other than disease status at conception.
Topics: Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Systemic Vasculitis; Vasculitis
PubMed: 32845412
DOI: 10.1007/s11926-020-00940-5 -
Clinical Research in Cardiology :... Jul 2022Pregnancy-related acute myocardial infarction is a rare and potentially life-threatening cardiovascular event, the incidence of which is growing due to the heightened... (Review)
Review
Pregnancy-related acute myocardial infarction is a rare and potentially life-threatening cardiovascular event, the incidence of which is growing due to the heightened prevalence of several risk factors, including increased maternal age. Its main aetiology is spontaneous coronary artery dissection, which particularly occurs in pregnancy and may engender severe clinical scenarios. Therefore, despite frequently atypical and deceptive presentations, early recognition of such a dangerous complication of gestation is paramount. Notwithstanding diagnostic and therapeutic improvements, pregnancy-related acute myocardial infarction often carries unfavourable outcomes, as emergent management is difficult owing to significant limitations in the use of ionising radiation-e.g. during coronary angiography, potentially harmful to the foetus even at low doses. Notably, however, maternal mortality has steadily decreased in recent decades, indicating enhanced awareness and major medical advances in this field. In our paper, we review the recent literature on pregnancy-related acute myocardial infarction and highlight the key points in its management.
Topics: Coronary Angiography; Coronary Vessel Anomalies; Female; Humans; Myocardial Infarction; Pregnancy; Pregnancy Complications, Cardiovascular; Vascular Diseases
PubMed: 34510263
DOI: 10.1007/s00392-021-01937-5 -
Transplantation Oct 2022Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had...
BACKGROUND
Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had these pregnancy-related complications and subsequently became donors. In the general population, gestational hypertension (GHtn), preeclampsia/eclampsia, and gestational diabetes (GDM) are associated with long-term risks.
METHODS
Donors with the specified predonation complication were matched to contemporary control donors with pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for gravidity, blood pressure, glucose, body mass index, age, and creatinine at donation, donation year, race, relationship with recipient, and family history of disease. Long-term incidence of hypertension, diabetes, cardiovascular disease, and reduced renal function (estimated glomerular filtration rate [eGFR] <30, eGFR <45 mL/min/1.73 m 2 ) were compared between groups using proportional hazards models.
RESULTS
Of 1862 donors with predonation pregnancies, 48 had preeclampsia/eclampsia, 49 had GHtn without preeclampsia, and 43 had GDM. Donors had a long interval between first pregnancy and donation (median, 18.5 y; interquartile range, 10.6-27.5) and a long postdonation follow-up time (median, 18.0; interquartile range, 9.2-27.7 y). GHtn was associated with the development of hypertension (hazard ratio, 1.89; 95% confidence interval, 1.26-2.83); GDM was associated with diabetes (hazard ratio, 3.04; 95% confidence interval, 1.33-6.99). Pregnancy complications were not associated with eGFR <30 or eGFR <45 mL/min/1.73 m 2 .
CONCLUSIONS
Our data suggest that women with predonation pregnancy-related complications have long-term risks even with a normal donor evaluation. Donor candidates with a history of pregnancy-related complications should be counseled about these risks.
Topics: Creatinine; Diabetes Mellitus; Eclampsia; Female; Glomerular Filtration Rate; Glucose; Humans; Hypertension; Kidney; Kidney Transplantation; Living Donors; Nephrectomy; Pre-Eclampsia; Pregnancy; Pregnancy Complications
PubMed: 35404873
DOI: 10.1097/TP.0000000000004146 -
Seizure May 2015Better knowledge of risk factors for women with epilepsy giving birth. (Review)
Review
PURPOSE
Better knowledge of risk factors for women with epilepsy giving birth.
METHOD
Investigating all studies reporting complications in pregnancy and deliveries in women with epilepsy during the last 15 years.
RESULTS
Studies have observed that women with epilepsy have a higher risk of preeclampsia, gestational hypertension, bleeding in pregnancy, caesarean delivery (CD), excessive bleeding postpartum, preterm birth, and small for gestational age. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs (AED), or the combination of both factors. Recent studies strongly indicate an association between AED use, and complications in pregnancy and labour.
CONCLUSION
Newer drugs commonly used in treatment of epilepsy are associated with an increased risk of pregnancy complications, as well as complication during labour and delivery.
Topics: Anticonvulsants; Epilepsy; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors
PubMed: 25843764
DOI: 10.1016/j.seizure.2015.02.018