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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 -
BMC Medicine Feb 2024Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension,... (Review)
Review
BACKGROUND
Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension.
METHODS
Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines.
RESULTS
Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)).
CONCLUSIONS
GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.
Topics: Female; Humans; Pregnancy; Diabetes Mellitus, Type 2; Diabetes, Gestational; Hypertension; Parity; Pre-Eclampsia; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 38355631
DOI: 10.1186/s12916-024-03284-4 -
Acta Obstetricia Et Gynecologica... Nov 2016Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We... (Review)
Review
INTRODUCTION
Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management.
MATERIAL AND METHODS
Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews that provided comprehensive overviews were included, too.
RESULTS
New research on the pathophysiological mechanisms of PPCM points towards a two-hit multifactorial cause involving genetic factors and an antiangiogenic hormonal environment of late gestation with high levels of prolactin and sFlt-1. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis. Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy.
CONCLUSIONS
PPCM has a huge impact on cardiovascular health and reproductive life perspective. New insights into genetics, molecular pathophysiological mechanisms and clinical studies have resulted in potential disease-specific therapies, but many questions remain unanswered.
Topics: Cardiomyopathies; Echocardiography; Female; Heart Failure; Humans; Magnetic Resonance Imaging; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders
PubMed: 27545093
DOI: 10.1111/aogs.13005 -
The American Journal of Clinical... Sep 2021Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower...
BACKGROUND
Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. However, their associations with common pregnancy complications are unclear.
OBJECTIVES
This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks.
METHODS
The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons. Women responded to an FFQ at 8-13 gestational weeks, and they performed a 24-h dietary recall at 16-22 and 24-29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records.
RESULTS
Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16-22 wk and GDM risk [adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend = 0.002]; DASH score reported at both 8-13 [adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend = 0.04] and 16-22 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend = 0.01] and gestational hypertension risk; AHEI score reported at 24-29 wk and preeclampsia risk [adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend = 0.03]; AMED score reported at 8-13 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend = 0.03] and DASH score reported at 24-29 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend = 0.03] and preterm delivery risk.
CONCLUSIONS
Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.This study was registered at ClinicalTrials.gov as NCT00912132.
Topics: Adult; Diet, Healthy; Female; Humans; Pregnancy; Pregnancy Complications; Risk Factors; Young Adult
PubMed: 34075392
DOI: 10.1093/ajcn/nqab145 -
Archives of Gynecology and Obstetrics Mar 2024Obesity is recognized by the World Health Organization (WHO) as a disease in its own right. Moreover, obesity is an increasingly concerning public health issue across... (Review)
Review
Obesity is recognized by the World Health Organization (WHO) as a disease in its own right. Moreover, obesity is an increasingly concerning public health issue across the world and its prevalence is rising amongst women of reproductive age. The fertility of over-weight and obese women is reduced and they experience a higher rate of miscarriage. In pregnant women obesity not only increases the risk of antenatal complications, such as preeclampsia and gestational diabetes, but also fetal abnormalities, and consequently the overall feto-maternal mortality. Ultrasound is one of the most valuable methods to predict and evaluate pregnancy complications. However, in overweight and obese pregnant women, the ultrasound examination is met with several challenges, mainly due to an impaired acoustic window. Overall obesity in pregnancy poses special challenges and constraints to the antenatal care and increases the rate of pregnancy complications, as well as complications later in life for the mother and child.
Topics: Child; Female; Pregnancy; Humans; Obesity; Overweight; Diabetes, Gestational; Pregnancy Complications; Prenatal Care
PubMed: 37861742
DOI: 10.1007/s00404-023-07251-x -
The American Journal of Clinical... Dec 2017Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation.... (Review)
Review
Pregnant women are particularly vulnerable to iron deficiency and related adverse pregnancy outcomes and, as such, are routinely recommended for iron supplementation. Emerging evidence from both animal and population-based studies, however, has raised potential concerns because significant associations have been observed between greater iron stores and disturbances in glucose metabolism, including increased risk of type 2 diabetes among nonpregnant individuals. Yet, the evidence is uncertain regarding the role of iron in the development of gestational diabetes mellitus (GDM), a common pregnancy complication which has short-term and long-term adverse health ramifications for both women and their children. In this review, we critically and systematically evaluate available data examining the risk of GDM associated with dietary iron, iron supplementation, and iron status as measured by blood concentrations of several indicators. We also discuss major methodologic concerns regarding the available epidemiologic studies on iron and GDM.
Topics: Diabetes, Gestational; Diet; Dietary Supplements; Female; Ferritins; Hepcidins; Humans; Iron; Iron Deficiencies; Iron, Dietary; Meta-Analysis as Topic; Observational Studies as Topic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Randomized Controlled Trials as Topic; Receptors, Transferrin
PubMed: 29070554
DOI: 10.3945/ajcn.117.156034 -
Journal of Assisted Reproduction and... Aug 2021To review the impact of tyrosine kinase inhibitors (TKIs) on fertility in men and women, embryo development, and early pregnancy, and discuss considerations for... (Review)
Review
PURPOSE
To review the impact of tyrosine kinase inhibitors (TKIs) on fertility in men and women, embryo development, and early pregnancy, and discuss considerations for fertility preservation in patients taking TKIs.
METHODS
A comprehensive literature search using the PubMed database was performed through February 2021 to evaluate the current literature on imatinib, nilotinib, dasatinib, and bosutinib as it relates to fertility and reproduction. Published case series were analyzed for pregnancy outcomes.
RESULTS
TKIs adversely affect oocyte and sperm maturation, gonadal function, and overall fertility potential in a self-limited manner. There are insufficient studies regarding long-term consequences on fertility after discontinuation of TKIs. A total of 396 women and 236 men were on a first- or second-generation TKI at the time of conception. Of the women with detailed pregnancy and delivery outcomes (n = 361), 51% (186/361) resulted in a term birth of a normal infant, 4.3% (16/361) of pregnancies had a pregnancy complication, and 5% (20/361) of pregnancies resulted in the live birth of an infant with a congenital anomaly. About 22% of pregnant women (87/396) elected to undergo a termination of pregnancy, while 16% (63/396) of pregnancies ended in a spontaneous abortion. In contrast, of the 236 men, 87% conceived pregnancies which resulted in term deliveries of normal infants. Elective terminations, miscarriage rate, pregnancy complication rate, and incidence of a congenital malformation were all less than those seen in females (4%, 3%, 2%, and 2.5%, respectively).
CONCLUSION
Women should be advised to avoid conception while taking a TKI. Women on TKIs who are considering pregnancy should be encouraged to plan the pregnancy to minimize inadvertent first trimester exposure. In women who conceive while taking TKIs, the serious risk of relapse due to discontinuation of TKI should be balanced against the potential risks to the fetus. The risk of teratogenicity to a fathered pregnancy with TKI use is considerably lower. Fertility preservation for a woman taking a TKI can be considered to plan a pregnancy with a minimal TKI-free period. With careful monitoring, providers may consider a TKI washout period followed by controlled ovarian stimulation to cryopreserve oocytes or embryos, with a plan to resume TKIs until ready to conceive or to transfer an embryo to achieve pregnancy quickly. Fertility preservation is also indicated if a patient on TKI is requiring a gonadotoxic therapy or reproductive surgery impacting fertility.
Topics: Female; Fertility; Fertility Preservation; Humans; Molecular Targeted Therapy; Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Protein Kinase Inhibitors
PubMed: 33826052
DOI: 10.1007/s10815-021-02181-6 -
Neurologia Medico-chirurgica 2013Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important... (Review)
Review
Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important morbidity and mortality during pregnancy. This study reviewed reports of ruptured IA during pregnancy and the puerperium, and our own cases of ruptured IA in pregnant women. Hemorrhage occurred predominantly during the third trimester of pregnancy, when maternal cardiac output and blood volume increase and reach maximum. Physiological and hormonal changes in pregnancy are likely to affect the risk of IA rupture. Ruptured IAs during pregnancy should be managed based on neurosurgical considerations, and the obstetrical management of women with ruptured IAs should be decided according to the severity of SAH and the gestational age. Emergent cesarean section followed by clipping or coiling of aneurysms is indicated if the maternal condition and the gestational age allow such interventions. Although SAH during pregnancy can result in disastrous outcomes, the necessity of intracranial screening for high-risk pregnant women is still controversial.
Topics: Adult; Aneurysm, Ruptured; Cesarean Section; Cooperative Behavior; Embolization, Therapeutic; Female; Humans; Interdisciplinary Communication; Intracranial Aneurysm; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Third; Puerperal Disorders; Risk Factors; Subarachnoid Hemorrhage; Surgical Instruments; Young Adult
PubMed: 23979051
DOI: 10.2176/nmc.53.549 -
Journal de Gynecologie, Obstetrique Et... Dec 2013Prevention of intrauterine growth restriction (IUGR) should be addressed before conception ideally for all women, or at least for those with a medical risk factor or... (Review)
Review
AIM
Prevention of intrauterine growth restriction (IUGR) should be addressed before conception ideally for all women, or at least for those with a medical risk factor or with a history of poor perinatal outcome or obstetrical complication. The aim of this section is to assess available evidence on IUGR prevention and elaborate clinical guidelines.
PATIENTS AND METHOD
Bibliographic research on PubMed and Cochrane Database.
RESULTS
Maternal age above 40 increases the risk of IUGR (Experts opinion). Encouraging women to start pregnancy when their Body Mass Index (BMI) is between extremes (grade B) and aiming for recommended weight gain according to their preconceptional BMI (professional consensus) reduce the risk of IUGR. When possible, avoiding multiple pregnancies (grade A), stabilizing chronic diseases that can influence placenta vascularization (professional consensus), stopping smoking as soon as possible before or at the beginning of pregnancy (grade A), limiting hypoglycemia during pregnancy (grade C) and tolerating mild maternal hypertension throughout pregnancy (professional consensus) also limit the risks of IUGR. In women with a prior preeclampsia<34 WG or an IUGR <5th centile due to placental dysfunction, aspirin given ideally in the second part of the day (grade B) can be a useful option and should be started before 16 WG (grade A).
CONCLUSIONS
There are few methods to prevent IUGR, and some simple recommendations seem useful. Aspirin seems a useful option in women identified as at risk of IUGR. More research is needed on prevention of IUGR.
Topics: Body Weight; Chronic Disease; Female; Fetal Growth Retardation; Humans; Maternal Age; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Care; Smoking
PubMed: 24216303
DOI: 10.1016/j.jgyn.2013.09.022 -
Biomedicine & Pharmacotherapy =... Dec 2022Placental complication arises due to various risk factors occurring during the pregnancy period, leading to an increased morbidity rate. Placenta related disorders are... (Review)
Review
Placental complication arises due to various risk factors occurring during the pregnancy period, leading to an increased morbidity rate. Placenta related disorders are one of primary reason for pregnancy related complications and the clinical incidences are seen to be on the rise. Most of the common disorders associated with placenta are pre-eclampsia, recurrent spontaneous abortions, intra-uterine growth restriction etc. Several studies have been done to understand the genetics and immunological attributes leading to the development of placenta associated complications. In the recent years, studies were able to establish and identify ncRNAs found specifically in foetal tissues such as the placenta. The aberrant expression patterns of ncRNA associated with placenta has been linked to disorders such as pre-eclampsia. Since ncRNA play a major role in regulating biological processes like trophoblast growth, migration and invasion, their aberrant expression could very well lead to complications like spontaneous pregnancy loss. This review article focuses on the association of ncRNAs - miRNAs, lncRNAs, CircRNAs in placenta associated complications as well as the different ncRNA based therapies. Deciphering the exact mechanism involved in the regulation and development of placenta through ncRNA will help in using it as a biomarker for early diagnosis. Understanding the therapeutic opportunities of ncRNAs in placental disorders will result in better treatment strategies.
Topics: Female; Pregnancy; Humans; Pre-Eclampsia; Placenta; Abortion, Spontaneous; RNA, Untranslated; RNA, Long Noncoding; Pregnancy Complications
PubMed: 36411641
DOI: 10.1016/j.biopha.2022.113964