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3.
Nat Rev Neurol ; 16(3): 154-170, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32080393

RESUMEN

Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.


Asunto(s)
Anomalías Inducidas por Medicamentos , Aborto Espontáneo/inducido químicamente , Factores Inmunológicos/efectos adversos , Neuromielitis Óptica/tratamiento farmacológico , Neuromielitis Óptica/inmunología , Complicaciones del Trabajo de Parto/inducido químicamente , Preeclampsia/inducido químicamente , Adulto , Femenino , Humanos , Embarazo
4.
Lancet ; 395(10221): e17, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007174
5.
Gene ; 736: 144406, 2020 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-32007580

RESUMEN

Estrogen receptor (ER) signaling is key regulator for maintaining successful pregnancy. Several research suggested that genetic variation in ER genes (ESR)1 and ESR2 is associated with the susceptibility to unexplained recurrent pregnancy loss (RPL), often with inconclusive results. In this study, we investigate the relationship between ESR1 and ESR2 polymorphisms and idiopathic RPL. A total of 444 patients with RPL, defined as three or more consecutive pregnancy losses of unknown etiology, and 446 control women were recruited to the study and their genotypes for ESR1-rs2234693, ESR1-rs3020314, and ESR2-rs928554 variants were determined using allelic exclusion method on real-time polymerase chain reaction. Minor allele frequencies (MAF) of tagging SNPs ESR1 rs2234693 and rs3020314, and ESR2 rs928554 were not significantly different between RPL cases and control women. Considerable higher frequencies of homozygous (2/2) ESR1 rs2234693 genotype carriers were seen between patients vs. control women, which maintained after controlling for age, body mass index (BMI), and menarche. ESR1 haplotype analysis demonstrated two common haplotype (rs2234693-rs3020314) with no linkage disequilibrium between both polymorphisms, and no 2-locus haplotype linked with RPL risk was revealed. The present study confirmed a significant association of specific ESR1 variant (rs2234693) with an increased risk of RPL, further supporting a role for ESR1 as an important candidate locus inducing RPL.


Asunto(s)
Aborto Habitual/genética , Aborto Espontáneo/genética , Receptor alfa de Estrógeno/genética , Receptor beta de Estrógeno/genética , Predisposición Genética a la Enfermedad/genética , Polimorfismo de Nucleótido Simple/genética , Adulto , Estudios de Casos y Controles , Estrógenos/genética , Femenino , Frecuencia de los Genes/genética , Genotipo , Humanos , Desequilibrio de Ligamiento/genética , Embarazo , Estudios Retrospectivos , Túnez
6.
Medicine (Baltimore) ; 99(5): e18731, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000376

RESUMEN

Miscarriage is the spontaneous loss of a clinically established intrauterine pregnancy before the fetus has reached viability. In order to compare the performance of traditional G banding karyotyping with next-generation sequencing (NGS) for detecting common trisomies in products of conception (POC). Chromosome abnormalities were detected by high-resolution G banding karyotyping and NGS. A total of 48 miscarriage samples, including 20 samples without karyotype result and 28 with karyotype results were selected and coded for analysis by NGS. The multiplex PCR analysis of maternal and miscarriage DNA for single nucleotide polymorphism (SNP) markers were used to simultaneously monitor maternal cell contamination (MCC), chromosomal status, and sex of the miscarriage tissue. NGS detection results of 21 chromosome abnormalities were consisted with that in karyotyping examination. These chromosome abnormalities samples included 9 chromosome 16 trisomies, 3 chromosome 22 trisomies, 2 chromosome 7 trisomies, 2 chromosome 18 trisomies, 1 chromosome 4 trisomies, one chromosome 10 trisomies, 1 chromosome 13 trisomies, 1 chromosome 15 trisomies and 1 sex chromosomal aneuploidies (45, X). Meanwhile, NGS analysis of seven chromosome normalities was adapted to the karyotyping examination. Therefore, NGS combined with multiplex PCR is an effective method to test trisomies in POC. The results mentioned above will contribute to a detailed understanding of the first-trimester spontaneous miscarriages.


Asunto(s)
Secuenciación de Nucleótidos de Alto Rendimiento/estadística & datos numéricos , Trisomía/diagnóstico , Aborto Espontáneo/genética , Femenino , Humanos , Embarazo
8.
BJOG ; 127(5): 537-547, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31912613

RESUMEN

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.


Asunto(s)
Violencia de Pareja , Mujeres Embarazadas , Aborto Espontáneo/epidemiología , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Violencia de Pareja/psicología , Muerte Perinatal , Embarazo , Mujeres Embarazadas/psicología , Nacimiento Prematuro/epidemiología
9.
Medicine (Baltimore) ; 99(4): e18383, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977842

RESUMEN

OBJECTIVE: To compare the effects of letrozole and human menopausal gonadotropin (HMG) in the treatment of patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC). METHODS: A total of 96 clomiphene resistance polycystic ovary syndrome patients infertility were randomly divided into an LE group, and HMG group (n = 48). LE group orally received letrozole at 5.0 mg/d on the 3rd-5th days of menstrual cycle for 5 consecutive days, and 75 U/d HMG was given through intramuscular injection for 5 days starting from the third day of menstrual cycle in HMG group. Number of growing and mature follicles, serum E2 (pg/mL), serum P (ng/mL), endometrial thickness, occurrence of pregnancy and miscarriage were observed. RESULTS: There was no significant difference in the number of ovulation cycles between the 2 groups (53.6% vs 64.7%, P > .05). The number of mature follicular cycles in the HMG group was higher than that of the letrozole group (P < .01). There were no significant differences in the clinical pregnancy rate (22.9% vs 27.1%, P > .05) and abortion rate (6.2% vs 10.4%, P > .05). There was no significant difference in the endometrial thickness between the 2 groups on the day of HCG injection [(9.1 ±â€Š0.2) mm vs (10.7 ±â€Š1.6) mm, P > .05]; the serum estradiol (E2) was lower in the letrozole group. The incidence of ovarian cysts was lower than that of HMG group (P < .05). There was2 ovarian hyperstimulation syndrome in the letrozole group; the incidence of ovarian hyperstimulation syndrome in the HMG group was 12.5%. CONCLUSION: Letrozole-induced ovulation can obtain ovulation rate and pregnancy rate similar to gonadotropin, but reduce the risk associated with treatment. It can be used as an effective ovulation option for patients with polycystic ovary syndrome who are resistant to clomiphene.


Asunto(s)
Infertilidad Femenina/tratamiento farmacológico , Letrozol/uso terapéutico , Menotropinas/uso terapéutico , Inducción de la Ovulación/métodos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Aborto Espontáneo/epidemiología , Adulto , Clomifeno/farmacología , Endometrio/efectos de los fármacos , Estradiol/sangre , Femenino , Humanos , Quistes Ováricos/inducido químicamente , Síndrome de Hiperestimulación Ovárica/inducido químicamente , Ovulación/efectos de los fármacos , Embarazo , Adulto Joven
10.
Acad Med ; 95(2): 275-282, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31517680

RESUMEN

PURPOSE: To characterize how residents employ rhetorical appeals (i.e., the strategic use of communication to achieve specifiable goals) when discussing unnecessary diagnostic tests with patients. METHOD: In 2015, senior hematology residents from 10 Canadian universities participating in a national formative objective structured clinical examination (OSCE) completed a resource stewardship communication station. In this communication scenario, a standardized patient (SP) portrayed a patient requesting unnecessary thrombophilia testing following early pregnancy loss. The authors performed a thematic analysis of audio transcripts using a qualitative description approach to identify residents' rhetorical appeals to logic (rational appeals), credibility, and emotion. RESULTS: For persuasive communication, residents (n = 27) relied primarily on rational appeals that fit into 3 categories (with themes) focused on medical evidence (poor utility, professional guidelines and recommendations), avoidance of harm (insurance implications, unnecessary or potentially harmful interventions, patient anxiety), and reassurance to patient (normalizing, clinical pretest probability, criteria for reconsidering testing). Appeals to credibility and emotion were rarely used. CONCLUSIONS: In an OSCE setting, residents relied predominantly on rational appeals when engaging SPs in conversations about unnecessary tests. These observations yield insights into how recent emphasis within residency education on appropriate test utilization may manifest when residents put recommendations into practice in conversations with patients. This study's framework of rational appeals may be helpful in designing communication curricula about unnecessary testing. Future studies should explore rhetoric about unnecessary testing in the clinical environment, strategies to teach and coach residents leading these conversations, and patients' preferences and responses to different appeals.


Asunto(s)
Hematología/educación , Relaciones Médico-Paciente , Procedimientos Innecesarios/psicología , Aborto Espontáneo/psicología , Canadá , Competencia Clínica , Humanos , Internado y Residencia , Guías de Práctica Clínica como Asunto , Trombofilia/diagnóstico
13.
Sci Total Environ ; 702: 134988, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31715397

RESUMEN

Miscarriage is one of the commonest complications of pregnancy. Although previous studies suggested that environmental factors were important causes of miscarriage, evidence is still inadequate. Here, we examined the association of maternal exposure to temperature with the risk of miscarriage and further assessed the modifying effects of surrounding residential greenness. A case-control study was conducted at a large hospital in Guangzhou, China. All participants' information was extracted from hospital records. An inverse distance weighted method was used to estimate the temperature exposure at each residential address, where the greenness was measured by Normalized Difference Vegetation Index (NDVI). A logistic regression model was applied to estimate the association of temperature exposure with the risk of miscarriage. A total of 2044 cases of miscarriage and 2285 controls were included in the present study. We observed a generally non-linear positive relationship between temperature exposure and the risk of miscarriage. More pronounced effects of high temperatures vs. low temperatures were found during the two months prior to hospitalization than in other periods. The odds ratio (OR) of 29.4 °C (95th centile) compared with 15 °C during the first month prior to hospitalization was 1.480 (95% CI: 1.021-2.145). Smaller effects of temperatures were seen on the risk of miscarriage among participants with moderately great surrounding greenness compared with those with less greenness. We concluded that maternal exposure to moderately high temperature during pregnancy may increase the risk of miscarriage, but the modifying effects of greenness on these associations need to be further tested in future studies.


Asunto(s)
Aborto Espontáneo/epidemiología , Exposición Materna/estadística & datos numéricos , Temperatura Ambiental , Adulto , China/epidemiología , Femenino , Humanos , Embarazo , Factores Socioeconómicos , Desarrollo Sostenible
14.
Int J Gynaecol Obstet ; 148(1): 6-13, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31691277

RESUMEN

OBJECTIVE: To assess the risk of adverse fetal outcomes after exposure to oral antifungal agents during pregnancy. SEARCH STRATEGY: PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to October 2018. SELECTION CRITERIA: Cohort studies and case-control studies investigating fetal outcomes following maternal exposure to oral antifungal agents. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies for inclusion, assessed risk of bias, and extracted data. Pooled estimates were calculated for the frequency of adverse fetal outcomes. MAIN RESULTS: Overall, eight cohort studies and one case-control study were included. The oral antifungal agents used during pregnancy were fluconazole and itraconazole. The data indicated that oral fluconazole exposure during pregnancy might slightly increase the risk of congenital heart defects and limb defects relative to the general population; oral itraconazole during pregnancy might increase the risk of eye defects. No difference was found between oral fluconazole/itraconazole exposure and non-exposure in the risk of other birth defects, spontaneous abortion, or stillbirth. CONCLUSION: Oral fluconazole or itraconazole may not increase the risk of birth defects. Nonetheless, the risk of congenital heart defects and limb defects after fluconazole exposure and eye defects after itraconazole exposure should be cautiously investigated.


Asunto(s)
Antifúngicos/efectos adversos , Fluconazol/efectos adversos , Itraconazol/efectos adversos , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Estudios de Casos y Controles , Estudios de Cohortes , Anomalías Congénitas/epidemiología , Anomalías Congénitas/etiología , Femenino , Humanos , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Mortinato/epidemiología
15.
BJOG ; 127(1): 79-86, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31483927

RESUMEN

OBJECTIVE: The present study aimed to analyse the Korean National Health Insurance Service (NHIS) cohort data to examine the safety of acupuncture therapy during pregnancy. DESIGN: Retrospective cohort. SETTING: Korea. POPULATION OR SAMPLE: Women with confirmed pregnancy between 2003 and 2012 from the 2002-13 NHIS sample cohort (n = 20 799). METHODS: Women with confirmed pregnancy were identified and divided into acupuncture or control group for comparison of their outcomes. Differences in other factors such as age, and rate of high-risk pregnancy and multiple pregnancy were examined. In the acupuncture group, the most frequent acupuncture diagnosis codes and the timing of treatment were also investigated. MAIN OUTCOME MEASURES: Incidence of full-term delivery, preterm delivery and stillbirth by pregnancy duration and among the high-risk and multiple pregnancy groups. RESULTS: Of 20 799 pregnant women analysed, 1030 (4.95%) and 19 749 were in the acupuncture and control groups, respectively. Both overall (odds ratio [OR] 1.23; 95% CI 0.98-1.54), and in the stratified analysis of high-risk pregnancies (OR 1.09; 95% CI 0.73-1.64), there was no significant difference between acupuncture and control groups in preterm deliveries. No stillbirths occurred in the acupuncture group and 0.035% of pregnancies resulted in stillbirths in the control group. CONCLUSION: No significant difference in delivery outcomes (preterm delivery and stillbirth) was observed between confirmed pregnancies in the acupuncture and control groups. Therefore, in pregnancy, acupuncture therapy may be a safe therapeutic modality for relieving discomfort without an adverse delivery outcome. TWEETABLE ABSTRACT: In pregnancy, acupuncture therapy may be a safe therapeutic modality for relieving discomfort without an adverse outcome.


Asunto(s)
Terapia por Acupuntura/efectos adversos , Complicaciones del Embarazo/etiología , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Adolescente , Adulto , Distribución por Edad , Niño , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Seguridad del Paciente , Embarazo , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , República de Corea/epidemiología , Estudios Retrospectivos , Mortinato/epidemiología , Adulto Joven
16.
BJOG ; 127(1): 39-45, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31444892

RESUMEN

OBJECTIVE: To explore the relation between famine exposure in early life and subsequent pregnancy loss, including stillbirth, and spontaneous abortion in adulthood. DESIGN: A population-based, partly ecological study. SETTING AND POPULATION: Individual data of 58 601 females born around the time of the Great Chinese Famine in 1959-1961. METHODS: Associations between the famine exposure in early life and pregnancy loss (stillbirth and spontaneous abortion) in adulthood were analysed using negative binomial regression, with the non-exposure group as reference, adjusting for region, highest education, monthly income, alcohol consumption, tobacco use, body mass index in 25-year-olds and metabolic equivalent. Further analyses were stratified by rural versus urban region. MAIN OUTCOME MEASURES: Continuous variables of times of stillbirths and spontaneous abortions were used according to the individual self-reported reproductive history. RESULTS: No association was found between famine exposure and spontaneous abortion. In contrast, females experiencing the famine during their prenatal period (incidence rate ratio = 1.15, 95% CI 1.00-1.33) or infant period (incidence rate ratio = 1.27, 95% CI 1.12-1.44) were more likely to report stillbirth in later adult life. Such an association appeared stronger in women living in rural regions. CONCLUSIONS: Early life exposure of famine was associated with an increased risk of stillbirth but not spontaneous abortion in adulthood. The strength of such an association appeared stronger in rural areas. Given the high potential for unmeasured confounding, these associations must be interpreted with caution. Regarding the potential implication that undernutrition in the fetal period is related to reproductive outcome in adulthood, fetal nutritional supply may play an important role in human reproduction. TWEETABLE ABSTRACT: Exposure to famine in early life was associated with increased pregnancy loss in adulthood.


Asunto(s)
Aborto Espontáneo/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Mortinato/epidemiología , Adulto , Anciano , Índice de Masa Corporal , China/epidemiología , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Embarazo , Salud Rural
17.
J Ethnopharmacol ; 247: 112224, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31509779

RESUMEN

ETHNO-PHARMACOLOGICAL RELEVANCE: Corchorus olitorius is reportedly used in ethno-medicine to arrest threatened miscarriage and other conditions associated with excessive uterine contractions. The plant is also used as a purgative, demulscent and an anti-inflammatory agent. AIM OF THE STUDY: Against the background of ethno-medicinal use, this current work was designed to evaluate the gastrointestinal and uterine smooth muscles relaxant and anti-inflammatory effects of Corchorus olitorius leaf extract (COLE). MATERIALS AND METHODS: Pieces of uterine and gastrointestinal tissues were suspended separately in organ baths containing ideal physiological salt solutions bubbled with air and were tested for responses to standard drugs and COLE, then repeated in the presence of antagonists. Anti-inflammatory study was carried out via the egg albumin-induced paw edema model in rats. RESULTS: The application of COLE to pieces of uterine tissue significantly decreased the amplitudes of contractions in a dose dependent manner such that the highest dose applied (666.67 µg/ml) achieved a 100% inhibitory effect. Oxytocin induced contractions were also significantly inhibited by both salbutamol and COLE. On the isolated rabbit jejunum, the effect of COLE was also inhibitory and like atropine, significantly inhibited acetylcholine induced contractions. In the in vivo study, the extract inhibited charcoal meal movement in test rats when compared with control. Anti-inflammatory effect of COLE was significant and compared favourably with that of aspirin following in vivo trials. CONCLUSIONS: COLE therefore, may be a good tocolytic, anti-diarrheal and anti-inflammatory agent and offers hope of new drug discovery for such uses.


Asunto(s)
Antiinflamatorios/farmacología , Antidiarreicos/farmacología , Corchorus/química , Extractos Vegetales/farmacología , Tocolíticos/farmacología , Aborto Espontáneo/prevención & control , Animales , Antiinflamatorios/aislamiento & purificación , Antidiarreicos/aislamiento & purificación , Aspirina/farmacología , Diarrea/tratamiento farmacológico , Modelos Animales de Enfermedad , Edema/tratamiento farmacológico , Edema/inmunología , Etnofarmacología , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Yeyuno/efectos de los fármacos , Yeyuno/fisiología , Contracción Muscular/efectos de los fármacos , Miometrio/efectos de los fármacos , Nigeria , Extractos Vegetales/aislamiento & purificación , Hojas de la Planta/química , Embarazo , Conejos , Ratas , Tocolíticos/aislamiento & purificación
18.
Int J Infect Dis ; 91: 261-263, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31863877

RESUMEN

Tick-borne relapsing fever (TBRF) borreliae are one of the main causes of fever in rural Africa and can cause miscarriages. This article reports Borrelia crocidurae as a probable cause of spontaneous miscarriage, which was detected through vaginal self-sampling. This appears to be the first such report.


Asunto(s)
Aborto Espontáneo/microbiología , Borrelia/aislamiento & purificación , Fiebre Recurrente/microbiología , Vagina/microbiología , Adulto , Borrelia/clasificación , Borrelia/genética , Femenino , Humanos , Embarazo , Fiebre Recurrente/diagnóstico , Población Rural/estadística & datos numéricos , Senegal
19.
BJOG ; 127(2): 264-274, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31573753

RESUMEN

OBJECTIVE: To characterise vaginal bacterial composition in early pregnancy and investigate its relationship with first and second trimester miscarriages. DESIGN: Nested case-control study. SETTING: Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London. POPULATION: 161 pregnancies: 64 resulting in first trimester miscarriage, 14 in second trimester miscarriage and 83 term pregnancies. METHODS: Prospective profiling and comparison of vaginal bacteria composition using 16S rRNA gene-based metataxonomics from 5 weeks' gestation in pregnancies ending in miscarriage or uncomplicated term deliveries matched for age, gestation and body mass index. MAIN OUTCOME MEASURES: Relative vaginal bacteria abundance, diversity and richness. Pregnancy outcomes defined as first or second trimester miscarriage, or uncomplicated term delivery. RESULTS: First trimester miscarriage associated with reduced prevalence of Lactobacillus spp.-dominated vaginal microbiota classified using hierarchical clustering analysis (65.6 versus 87.7%; P = 0.005), higher alpha diversity (mean Inverse Simpson Index 2.5 [95% confidence interval 1.8-3.0] versus 1.5 [1.3-1.7], P = 0.003) and higher richness 25.1 (18.5-31.7) versus 16.7 (13.4-20), P = 0.017), compared with viable pregnancies. This was independent of vaginal bleeding and observable before first trimester miscarriage diagnosis (P = 0.015). Incomplete/complete miscarriage associated with higher proportions of Lactobacillus spp.-depleted communities compared with missed miscarriage. Early pregnancy vaginal bacterial stability was similar between miscarriage and term pregnancies. CONCLUSIONS: These findings associate the bacterial component of vaginal microbiota with first trimester miscarriage and indicate suboptimal community composition is established in early pregnancy. While further studies are required to elucidate the mechanism, vaginal bacterial composition may represent a modifiable risk factor for first trimester miscarriage. TWEETABLE ABSTRACT: Vaginal bacterial composition in first trimester miscarriage is associated with reduced Lactobacillus spp. abundance and is independent of vaginal bleeding.


Asunto(s)
Aborto Espontáneo/microbiología , Microbiota/fisiología , Vagina/microbiología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Londres , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Estudios Prospectivos , ARN Ribosómico 16S
20.
Biol Lett ; 15(12): 20190529, 2019 12 24.
Artículo en Inglés | MEDLINE | ID: mdl-31795853

RESUMEN

When breeding females compete for limited resources, the intensity of this reproductive conflict can determine whether the fitness benefits of current reproductive effort exceed the potential costs to survival and future fertility. In group-living species, reproductive competition can occur through post-natal competition among the offspring of co-breeding females. Spontaneous abortion could be a response to such competition, allowing females to curtail reproductive expenditure on offspring that are unlikely to survive and to conserve resources for future breeding opportunities. We tested this hypothesis using long-term data on banded mongooses, Mungos mungo, in which multiple females within a group give birth synchronously to a communal litter that is cared for by other group members. As predicted, abortions were more likely during dry periods when food is scarce, and in breeding attempts with more intense reproductive competition. Within breeding events, younger, lighter females carrying smaller fetuses were more likely to abort, particularly those that were also of lower rank. Our results suggest that abortion may be a means by which disadvantaged females conserve resources for future breeding attempts in more benign conditions, and highlight that female reproductive competition may be resolved long before the production of offspring.


Asunto(s)
Aborto Espontáneo , Herpestidae , Animales , Cruzamiento , Femenino , Fertilidad , Humanos , Embarazo , Reproducción
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