The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis.

INTRODUCTION: There is no guideline or clinical consensus concerning the mid-urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery. METHODS: We performed a systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis. RESULTS: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73-1.40; p = 0.96 and I2-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I2-test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77-2.01; p = 0.37 and I2-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I2-test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse. CONCLUSION: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.

Are pregnancies with lupus but without APS of good prognosis?

BACKGROUND: Pregnancies in women with systemic lupus erythematosus (SLE) are at risk of unfavorable perinatal outcomes, especially when antiphospholipid antibody syndrome (APS) is present. Their prognosis is less clear in other situations. OBJECTIVES: To assess pregnancy prognosis in women with SLE but not APS compared with a control series and determine the poor prognostic factors, if any, detectable before 15 weeks' gestation. MATERIAL AND METHODS: This retrospective case-control study included 137 women with SLE, including 114 without APS, and 274 control women. Unfavorable perinatal outcome was defined by perinatal death (≥ 22 weeks of gestation) or preterm delivery ≤35 weeks. RESULTS: Pregnancies of the 114 women with SLE but not APS were at more than twice the risk of unfavorable perinatal outcomes compared with those in the control group (18/114 (15.8%) vs 21/274 (7.7%), OR 2.3, 95% 1.1-4.7). After logistic regression, three factors detectable before 15 weeks were associated with an unfavorable perinatal outcome: i. proteinuria and/or hypertension (in 19.3% of the pregnancies) ii. lack of cutaneous lupus (26.3%), and iii. a history of thrombocytopenia-leukopenia-anemia (19.3%). When these factors were absent, the risk of a poor perinatal outcome was very low (3.3%) but increased strongly for pregnancies with one (22.2%) or at least two (44.4%) of these factors. CONCLUSION: Among women with SLE but not APS in the first trimester, only the presence of risk factors increases the likelihood of an unfavorable perinatal outcome. PRECIS: Pregnancies with SLE but not APS are at risk of unfavorable perinatal outcomes only if risk factors are present.

Maternal obesity alters the apelinergic system at the feto-maternal interface.

Apelin and its receptor APJ have been implicated in pathologies including cardiovascular disease, diabetes and obesity. Little is known about the function of the apelinergic system during gestation. We evaluated in mice this system at the feto-maternal interface in insulin-resistant obese female (HF) mice. Maternal apelinemia was decreased at term and fetal apelinemia was sixfold higher than maternal level. Ex-vivo, the placenta releases apelin at E12.5 and E18.5. In HF pregnant mice at term, apelinemia as well as placental apelin and APJ mRNA levels were increased whereas placental release of apelin was drastically reduced compared to controls.