Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy.

Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 × 10(9)/L vs corticosteroids 77 × 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 × 10(9)/L and 18 (9%) had platelet counts <50 × 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 × 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP.

Recruitment of HIV-Positive Women in Research: Discussing Barriers, Facilitators, and Research Personnel's Knowledge.

BACKGROUND: Women have historically been under-represented in HIV research, partly due to ineffective recruitment strategies. OBJECTIVE: To improve the existing understanding of recruitment for HIV-positive women based on a province-wide cross-sectional study. METHODS: A survey was emailed to all site coordinators who recruited participants in a study involving 490 HIV-positive women living in Ontario, Canada. The survey consisted of questions regarding the important recruitment barriers and successes. Quantitative data were then contextualized within extensive knowledge from research personnel and team members. RESULTS: Completed surveys were received from (89%) site coordinators (34/38) and 98% (31/34) were women. The highest ranked recruitment barriers identified were: sensitivity of the research topic (59%), time/availability constraints (59%), language barriers (53%), HIV disclosure/stigma issues (47%), lack of trust of research personnel (41%), fear of research (41%) and inaccessibility to child care and transportation (41%). The respondents felt that the most important personal attributes for recruitment were research personnel who were respectful (97%), skilled (91%), flexible (88%) and empathetic (88%) and had good communication skills (88%). The most successful recruitment strategies identified were: developing a strong rapport (88%) that was facilitated by an empathetic relationship (100%), acknowledging the sensitive nature of the research topic (94%), providing cash financial compensation (88%), and developing recruitment strategies unique to women (88%). CONCLUSION: There are differences in the approaches needed for the recruitment of HIV-positive women in research. For successful recruitment of HIV-positive women, a strong rapport between the research personnel and study participants is important. This rapport is facilitated by having study personnel who are respectful, trustworthy, empathetic, and flexible. Population-specific recruitment strategies are important to ensure adequate recruitment of minority groups in research with greater gender consideration for women requiring specific attention.

Human maternal and umbilical cord blood concentrations of polybrominated diphenyl ethers.

Polybrominated diphenyl ethers (PBDEs), widely used as flame retardants in commercial products, have become ubiquitous environmental contaminants. Although adult human exposure to PBDEs is well documented, developmental exposure is less well characterized. The objectives of this study were to measure maternal and fetal exposure to nine PBDE congeners and to investigate potential associations with birth weight. PBDE congeners were quantified in maternal serum at 24-28 weeks of pregnancy, delivery, and umbilical cord serum (UCS) by gas chromatography-mass spectrometry (GC/MS/MS). Complete blood sample sets were obtained from 97 pregnant women (mean age 33.1±0.5 years). PBDE-28, -47 and -99 were quantified in all samples tested and PBDE-47 was the most abundant congener measured in both maternal (mid-pregnancy and delivery samples geometric mean=26.9 and 26.9, respectively) and UCS (GM=56.0 ng g(-1) lipid). The UCS concentration for all congeners with the exception of PBDE-153 was higher vs. maternal delivery samples (p<0.001). Only the UCS concentration of PBDE-17 and -99 were significantly associated (ß=-49.860, p=0.032, and ß=-3.645, p=0.05) with birth weight. However, after adjustment for potential confounders only the association between PBDE-99 and birth weight remained significant (ß=-3.951 and p=0.016). We conclude that: the fetus is exposed to PBDEs from at least the second trimester of pregnancy onward; PBDE congeners are higher in UCS compared to maternal serum samples collected at delivery; and that developmental PBDE exposure is potentially associated with lower birth weight.