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1.
Biomed Environ Sci ; 34(2): 130-138, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33685572

RESUMO

Objective: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before in vitro fertilization and embryo transfer (IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET. Method: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. Results: The untreated PTB group had significantly lower clinical pregnancy (31.7% vs. 38.1%) and live birth (23.8% vs. 30.6%) rates than the non-PTB group (both P < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio ( OR), 0.80; 95% confidence interval ( CI), 0.66-0.98; P = 0.028] in all patients and for increased miscarriage ( OR, 4.19; 95% CI, 1.69-10.39; P = 0.002) and decreased live birth ( OR, 0.45; 95% CI, 0.24-0.83; P = 0.011) rates in patients with unexplained infertility. Conclusions: Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.


Assuntos
Transferência Embrionária/estatística & dados numéricos , Fertilização In Vitro/estatística & dados numéricos , Infertilidade Feminina/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Tuberculose Pulmonar/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , China/epidemiologia , Feminino , Humanos , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/etiologia , Nascimento Vivo/epidemiologia , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Radiografia Torácica , Estudos Retrospectivos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Adulto Jovem
2.
Am J Gastroenterol ; 116(3): 491-504, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33657039

RESUMO

INTRODUCTION: Liver transplantation (LT) remains the gold standard for treatment of end-stage liver disease. Given the increasing number of liver transplantation in females of reproductive age, our aim was to conduct a systematic review and meta-analysis evaluating pregnancy outcomes after LT. METHODS: MEDLINE, Embase, and Scopus databases were searched for relevant studies. Study selection, quality assessment, and data extraction were conducted independently by 2 reviewers. Estimates of pregnancy-related outcomes in LT recipients were generated and pooled across studies using the random-effects model. RESULTS: A comprehensive search identified 1,430 potential studies. Thirty-eight studies with 1,131 pregnancies among 838 LT recipients were included in the analysis. Mean maternal age at pregnancy was 27.8 years, with a mean interval from LT to pregnancy of 59.7 months. The live birth rate was 80.4%, with a mean gestational age of 36.5 weeks. The rate of miscarriages (16.7%) was similar to the general population (10%-20%). The rates of preterm birth, preeclampsia, and cesarean delivery (32.1%, 12.5%, and 42.2%, respectively) among LT recipients were all higher than the rates for the general US population (9.9%, 4%, and 32%, respectively). Most analyses were associated with substantial heterogeneity. DISCUSSION: Pregnancy outcomes after LT are favorable, but the risk of maternal and fetal complications is increased. Large studies along with consistent reporting to national registries are necessary for appropriate patient counseling and to guide clinical management of LT recipients during pregnancy.


Assuntos
Aborto Espontâneo/epidemiologia , Doença Hepática Terminal/cirurgia , Transplante de Fígado/efeitos adversos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Aborto Espontâneo/etiologia , Feminino , Humanos , Incidência , Gravidez , Complicações na Gravidez/etiologia , Nascimento Prematuro/etiologia , Risco
3.
Cochrane Database Syst Rev ; 3: CD001894, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33730422

RESUMO

BACKGROUND: Failure of implantation and conception may result from inability of the blastocyst to escape from its outer coat, which is known as the zona pellucida. Artificial disruption of this coat is known as assisted hatching and has been proposed as a method for improving the success of assisted conception by facilitating embryo implantation. OBJECTIVES: To determine effects of assisted hatching (AH) of embryos derived from assisted conception on live birth and multiple pregnancy rates.  SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group Specialised Register (until May 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; until May 2020), in the Cochrane Library; MEDLINE (1966 to May 2020); and Embase (1980 to May 2020). We also searched trial registers for ongoing and registered trials (http://www.clinicaltrials.gov - a service of the US National Institutes of Health; http://www.who.int/trialsearch/Default.aspx - The World Health Organization International Trials Registry Platform search portal) (May 2020). SELECTION CRITERIA: Two review authors identified and independently screened trials. We included randomised controlled trials (RCTs) of AH (mechanical, chemical, or laser disruption of the zona pellucida before embryo replacement) versus no AH that reported live birth or clinical pregnancy data. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. Two review authors independently performed quality assessments and data extraction. MAIN RESULTS: We included 39 RCTs (7249 women). All reported clinical pregnancy data, including 2486 clinical pregnancies. Only 14 studies reported live birth data, with 834 live birth events. The quality of evidence ranged from very low to low. The main limitations were serious risk of bias associated with poor reporting of study methods, inconsistency, imprecision, and publication bias. Five trials are currently ongoing. We are uncertain whether assisted hatching improved live birth rates compared to no assisted hatching (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.92 to 1.29; 14 RCTs, N = 2849; I² = 20%; low-quality evidence). This analysis suggests that if the live birth rate in women not using assisted hatching is about 28%, the rate in those using assisted hatching will be between 27% and 34%. Analysis of multiple pregnancy rates per woman showed that in women who were randomised to AH compared with women randomised to no AH, there may have been a slight increase in multiple pregnancy rates (OR 1.38, 95% CI 1.13 to 1.68; 18 RCTs, N = 4308; I² = 48%; low-quality evidence). This suggests that if the multiple pregnancy rate in women not using assisted hatching is about 9%, the rate in those using assisted hatching will be between 10% and 14%. When all of the included studies (39) are pooled, the clinical pregnancy rate in women who underwent AH may improve slightly in comparison to no AH (OR 1.20, 95% CI 1.09 to 1.33; 39 RCTs, N = 7249; I² = 55%; low-quality evidence). However, when a random-effects model is used due to high heterogeneity, there may be little to no difference in clinical pregnancy rate (P = 0.04). All 14 RCTs that reported live birth rates also reported clinical pregnancy rates, and analysis of these studies illustrates that AH may make little to no difference in clinical pregnancy rates when compared to no AH (OR 1.07, 95% CI 0.92 to 1.25; 14 RCTs, N = 2848; I² = 45%). We are uncertain about whether AH affects miscarriage rates due to the quality of the evidence (OR 1.13, 95% CI 0.82 to 1.56; 17 RCTs, N = 2810; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS: This update suggests that we are uncertain of the effects of assisted hatching (AH) on live birth rates. AH may lead to increased risk of multiple pregnancy. The risks of complications associated with multiple pregnancy may be increased without evidence to demonstrate an increase in live birth rate, warranting careful consideration of the routine use of AH for couples undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). AH may offer a slightly increased chance of achieving a clinical pregnancy, but data quality was of low grade. We are uncertain about whether AH influences miscarriage rates.


Assuntos
Implantação do Embrião/fisiologia , Fertilização In Vitro , Taxa de Gravidez , Zona Pelúcida/fisiologia , Aborto Espontâneo/epidemiologia , Viés , Feminino , Humanos , Nascimento Vivo/epidemiologia , Gravidez , Resultado da Gravidez , Gravidez Múltipla/estatística & dados numéricos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções de Esperma Intracitoplásmicas
4.
Medicine (Baltimore) ; 100(12): e25021, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761658

RESUMO

ABSTRACT: The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes of fresh and cryopreserved sperm via microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA).From March 2016 to February 2020, a total of 244 men with NOA underwent micro-TESE at the Center for Reproductive Medicine, First Hospital of Jilin University, P. R. China. These cases included 40 patients who underwent 40 ICSI cycles with fresh spermatozoa from micro-TESE (Group A) and 30 patients who underwent 30 ICSI cycles with cryopreserved spermatozoa from micro-TESE (Group B). The characteristics, embryonic development, and ICSI outcomes of patients were compared between groups A and B.Our sperm retrieval rate (SRR) by micro-TESE in patients with NOA was 35.25%. No statistical differences in the patient characteristics and fertilization or quality embryo rates were observed between Groups A and B. Higher miscarriage rates and lower live births were observed in Group B than in Group A (both P < .05).Fresh testicular spermatozoa seem to produce better ICSI outcomes than cryopreserved testicular spermatozoa from patients with NOA in the micro-TESE-ICSI cycle.


Assuntos
Azoospermia , Criopreservação , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Aborto Espontâneo/epidemiologia , Adulto , Feminino , Humanos , Nascimento Vivo/epidemiologia , Masculino , Microdissecção , Gravidez , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Resultado do Tratamento
5.
BMJ ; 372: n530, 2021 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762255

RESUMO

OBJECTIVE: To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70). DESIGN: Prospective cohort study. SETTING: The Nurses' Health Study II (1993-2017), United States. PARTICIPANTS: 101 681 ever gravid female nurses participating in the Nurses' Health Study II. MAIN OUTCOMES MEASURES: Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models. RESULTS: During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman's reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24). CONCLUSIONS: Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.


Assuntos
Aborto Espontâneo , Causas de Morte , Mortalidade Prematura , Adulto , Idoso , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Fatores de Risco , Estados Unidos/epidemiologia
6.
Cochrane Database Syst Rev ; 2: CD011184, 2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33539543

RESUMO

BACKGROUND: In vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments conventionally consist of a fresh embryo transfer, possibly followed by one or more cryopreserved embryo transfers in subsequent cycles. An alternative option is to freeze all suitable embryos and transfer cryopreserved embryos in subsequent cycles only, which is known as the 'freeze all' strategy. This is the first update of the Cochrane Review on this comparison. OBJECTIVES: To evaluate the effectiveness and safety of the freeze all strategy compared to the conventional IVF/ICSI strategy in women undergoing assisted reproductive technology. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials from inception until 23 September 2020 for relevant studies, checked references of publications found, and contacted study authors to obtain additional data. SELECTION CRITERIA: Two review authors (TZ and MZ) independently selected studies for inclusion, assessed risk of bias, and extracted study data. We included randomised controlled trials comparing a 'freeze all' strategy with a conventional IVF/ICSI strategy including a fresh embryo transfer in women undergoing IVF or ICSI treatment. DATA COLLECTION AND ANALYSIS: The primary outcomes were cumulative live birth rate and ovarian hyperstimulation syndrome (OHSS). Secondary outcomes included effectiveness outcomes (including ongoing pregnancy rate and clinical pregnancy rate), time to pregnancy and obstetric, perinatal and neonatal outcomes. MAIN RESULTS: We included 15 studies in the systematic review and eight studies with a total of 4712 women in the meta-analysis. The overall evidence was of moderate to low quality. We graded all the outcomes and downgraded due to serious risk of bias, serious imprecision and serious unexplained heterogeneity. Risk of bias was associated with unclear blinding of investigators for preliminary outcomes of the study during the interim analysis, unit of analysis error, and absence of adequate study termination rules. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below. There is probably little or no difference in cumulative live birth rate between the 'freeze all' strategy and the conventional IVF/ICSI strategy (odds ratio (OR) 1.08, 95% CI 0.95 to 1.22; I2 = 0%; 8 RCTs, 4712 women; moderate-quality evidence). This suggests that for a cumulative live birth rate of 58% following the conventional strategy, the cumulative live birth rate following the 'freeze all' strategy would be between 57% and 63%. Women might develop less OHSS after the 'freeze all' strategy compared to the conventional IVF/ICSI strategy (OR 0.26, 95% CI 0.17 to 0.39; I2 = 0%; 6 RCTs, 4478 women; low-quality evidence). These data suggest that for an OHSS rate of 3% following the conventional strategy, the rate following the 'freeze all' strategy would be 1%. There is probably little or no difference between the two strategies in the cumulative ongoing pregnancy rate (OR 0.95, 95% CI 0.75 to 1.19; I2 = 31%; 4 RCTs, 1245 women; moderate-quality evidence).  We could not analyse time to pregnancy; by design, time to pregnancy is shorter in the conventional strategy than in the 'freeze all' strategy when the cumulative live birth rate is comparable, as embryo transfer is delayed in a 'freeze all' strategy. We are uncertain whether the two strategies differ in cumulative miscarriage rate because the evidence is very low quality (Peto OR 1.06, 95% CI 0.72 to 1.55; I2 = 55%; 2 RCTs, 986 women; very low-quality evidence) and cumulative multiple-pregnancy rate (Peto OR 0.88, 95% CI 0.61 to 1.25; I2 = 63%; 2 RCTs, 986 women; very low-quality evidence). The risk of hypertensive disorders of pregnancy (Peto OR 2.15, 95% CI 1.42 to 3.25; I2 = 29%; 3 RCTs, 3940 women; low-quality evidence), having a large-for-gestational-age baby (Peto OR 1.96, 95% CI 1.51 to 2.55; I2 = 0%; 3 RCTs, 3940 women; low-quality evidence) and a higher birth weight of the children born (mean difference (MD) 127 g, 95% CI 77.1 to 177.8; I2 = 0%; 5 RCTs, 1607 singletons; moderate-quality evidence) may be increased following the 'freeze all' strategy. We are uncertain whether the two strategies differ in the risk of having a small-for-gestational-age baby because the evidence is low quality (Peto OR 0.82, 95% CI 0.65 to 1.05; I2 = 64%; 3 RCTs, 3940 women; low-quality evidence). AUTHORS' CONCLUSIONS: We found moderate-quality evidence showing that one strategy is probably not superior to the other in terms of cumulative live birth rate and ongoing pregnancy rate. The risk of OHSS may be decreased in the 'freeze all' strategy. Based on the results of the included studies, we could not analyse time to pregnancy. It is likely to be shorter using a conventional IVF/ICSI strategy with fresh embryo transfer in the case of similar cumulative live birth rate, as embryo transfer is delayed in a 'freeze all' strategy. The risk of maternal hypertensive disorders of pregnancy, of having a large-for-gestational-age baby and a higher birth weight of the children born may be increased following the 'freeze all' strategy. We are uncertain if 'freeze all' strategy reduces the risk of miscarriage, multiple pregnancy rate or having a small-for-gestational-age baby compared to conventional IVF/ICSI.


Assuntos
Criopreservação , Transferência Embrionária/métodos , Embrião de Mamíferos , Aborto Espontâneo/epidemiologia , Viés , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro , Humanos , Nascimento Vivo/epidemiologia , Síndrome de Hiperestimulação Ovariana/epidemiologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Taxa de Gravidez , Gravidez Múltipla/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções de Esperma Intracitoplásmicas , Tempo para Engravidar
7.
Adv Exp Med Biol ; 1300: 231-257, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33523437

RESUMO

Recurrent spontaneous abortion (RSA) is usually defined as three or more spontaneous abortions prior to 20-28 weeks gestation. RSA affects approximately 2-5% of all women of childbearing age, and it brings tremendous psychological and psychiatric trauma to the women and also results in economic burden. The causes could be female age, anatomical and chromosomal abnormalities, genetic, endocrinological, placental anomalies, infection, smoking and alcohol consumption, psychological factor, exposure to environmental factors such as heavy metal, environment pollution, and radiation.


Assuntos
Aborto Habitual , Aborto Espontâneo , Aborto Habitual/epidemiologia , Aborto Habitual/etiologia , Aborto Espontâneo/epidemiologia , Consumo de Bebidas Alcoólicas , Aberrações Cromossômicas , Feminino , Idade Gestacional , Humanos , Gravidez , Fumar
8.
PLoS One ; 16(2): e0246494, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33534854

RESUMO

BACKGROUND: Technology enables the continuous monitoring of personal health parameter data during pregnancy regardless of the disruption of normal daily life patterns. Our research group has established a project investigating the usefulness of an Internet of Things-based system and smartwatch technology for monitoring women during pregnancy to explore variations in stress, physical activity and sleep. The aim of this study was to examine daily patterns of well-being in pregnant women before and during the national stay-at-home restrictions related to the COVID-19 pandemic in Finland. METHODS: A longitudinal cohort study design was used to monitor pregnant women in their everyday settings. Two cohorts of pregnant women were recruited. In the first wave in January-December 2019, pregnant women with histories of preterm births (gestational weeks 22-36) or late miscarriages (gestational weeks 12-21); and in the second wave between October 2019 and March 2020, pregnant women with histories of full-term births (gestational weeks 37-42) and no pregnancy losses were recruited. The final sample size for this study was 38 pregnant women. The participants continuously used the Samsung Gear Sport smartwatch and their heart rate variability, and physical activity and sleep data were collected. Subjective stress, activity and sleep reports were collected using a smartphone application developed for this study. Data between February 12 to April 8, 2020 were included to cover four-week periods before and during the national stay-at-home restrictions. Hierarchical linear mixed models were exploited to analyze the trends in the outcome variables. RESULTS: The pandemic-related restrictions were associated with changes in heart rate variability: the standard deviation of all normal inter-beat intervals (p = 0.034), low-frequency power (p = 0.040) and the low-frequency/high-frequency ratio (p = 0.013) increased compared with the weeks before the restrictions. Women's subjectively evaluated stress levels also increased significantly. Physical activity decreased when the restrictions were set and as pregnancy proceeded. The total sleep time also decreased as pregnancy proceeded, but pandemic-related restrictions were not associated with sleep. Daily rhythms changed in that the participants overall started to sleep later and woke up later. CONCLUSIONS: The findings showed that Finnish pregnant women coped well with the pandemic-related restrictions and lockdown environment in terms of stress, physical activity and sleep.


Assuntos
/patologia , Estilo de Vida , Gestantes , Aborto Espontâneo , Adulto , /virologia , Exercício Físico , Feminino , Finlândia , Frequência Cardíaca , Humanos , Estudos Longitudinais , Gravidez , Gestantes/psicologia , Nascimento Prematuro , Sono/fisiologia , Smartphone , Estresse Psicológico
10.
BMC Pregnancy Childbirth ; 21(1): 78, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482757

RESUMO

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) is a novel disease which has been having a worldwide affect since December 2019. Evidence regarding the effects of SARS-CoV-2 during pregnancy is conflicting. The presence of SARS-CoV-2 has been demonstrated in biological samples during pregnancy (placenta, umbilical cord or amniotic fluid); however, maternal and fetal effects of the virus are not well known. METHODS: Descriptive, multicentre, longitudinal, observational study in eight tertiary care hospitals throughout Spain, that are referral centres for pregnant women with COVID-19. All pregnant women with positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction during their pregnancy or 14 days preconception and newborns born to mothers infected with SARS-CoV-2 will be included. They will continue to be followed up until 4 weeks after delivery. The aim of the study is to investigate both the effect of COVID-19 on the pregnancy, and the effect of the pregnancy status with the evolution of the SARS-CoV-2 disease. Other samples (faeces, urine, serum, amniotic fluid, cord and peripheral blood, placenta and breastmilk) will be collected in order to analyse whether or not there is a risk of vertical transmission and to describe the behaviour of the virus in other fluids. Neonates will be followed until 6 months after delivery to establish the rate of neonatal transmission. We aim to include 150 pregnant women and their babies. Ethics approval will be obtained from all the participating centres. DISCUSSION: There is little information known about COVID-19 and its unknown effects on pregnancy. This study will collect a large number of samples in pregnant women which will allow us to demonstrate the behaviour of the virus in pregnancy and postpartum in a representative cohort of the Spanish population.


Assuntos
/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Aborto Espontâneo/epidemiologia , Adulto , Líquido Amniótico/virologia , /transmissão , Fezes/virologia , Feminino , Sangue Fetal/virologia , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Longitudinais , Leite Humano/virologia , Estudos Observacionais como Assunto , Mortalidade Perinatal , Placenta/virologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Nascimento Prematuro/epidemiologia , Espanha/epidemiologia , Urina/virologia
12.
J Gynecol Obstet Hum Reprod ; 50(3): 102064, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33453449

RESUMO

BACKGROUND: Data about obstetric complications of maternal infection by SARS-CoV-2 remain sparse. CASE: A 40-year-old pregnant woman, gravida 3 para 1 with no previous obstetric complications, presented a late miscarriage at 16 weeks of gestation on day 9 of COVID-19 disease. The results of her nasopharyngeal swab for SARS-CoV-2, tested the same day, were negative, but the placenta was infected by SARS-CoV-2 and serology was positive 11 days later. No other obstetric or infectious cause was found to explain this outcome. CONCLUSION: This case strongly suggests that SARS-CoV-2 may lead to a late miscarriage.


Assuntos
Aborto Espontâneo/virologia , Complicações Infecciosas na Gravidez/virologia , Adulto , /métodos , Feminino , Feto/virologia , Idade Gestacional , Humanos , Placenta/virologia , Gravidez , Reação em Cadeia da Polimerase em Tempo Real , /imunologia , /isolamento & purificação
13.
J Biol Regul Homeost Agents ; 35(1): 5-10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33494583

RESUMO

Interstitial cystitis/painful bladder syndrome (IC/PBS) affects mostly women and is characterized by pelvic pain or pressure and frequency of voiding in the absence of urinary tract infection. Acute stress worsens IC/PBS symptoms and bladder inflammation associated with increased number of activated mast cells. We investigated retroactively the incidence of spontaneous miscarriages and any related stress in IC/PBS patients. A questionnaire was posted on an IC/PBS website and patients visiting the site were invited to complete and file it electronically. Limitations include the lack of defined diagnosis of those responding, and of a validated stress questionnaire. There were 193 respondents (mean age = 37.3 years) over two weeks. Of those responding, 87% (mean age = 33.2 years) had received a diagnosis of IC/PBS. Of those respondents with IC/PBS, 76% reported having had miscarriages: (a) 55% had one miscarriage, (b) 26% had two, and (c) 23% had three or more. These rates are much higher than those of in the general population: 10-20% with one and 1-2% with habitual spontaneous miscarriages. The majority of patients (78%) reported experiencing significant stress. IC/PBS patients appear to have a much high incidence of spontaneous miscarriages compared to the general population. Most patients reported experiencing stress that has been associated with miscarriages. This finding may be explained via stress stimulating bladder and uterine immune cells, especially mast cells, inhibition of which by the natural flavonoid luteolin may be beneficial.


Assuntos
Aborto Espontâneo , Cistite Intersticial , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Cistite Intersticial/complicações , Cistite Intersticial/epidemiologia , Feminino , Humanos , Inflamação/epidemiologia , Gravidez , Inquéritos e Questionários , Infecções Urinárias
14.
Lancet HIV ; 8(1): e33-e41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33387477

RESUMO

BACKGROUND: Dolutegravir has been widely available in Brazil since 2017. Following the signal that infants born to women with dolutegravir exposure at conception in Botswana had a higher risk of neural tube defects (NTDs), public health leaders initiated a national investigation to evaluate periconception dolutegravir exposure among all pregnant Brazilian women with HIV and its potential association with risk of NTDs, stillbirth, or miscarriage before 22 weeks (also called spontaneous abortion). METHODS: In this retrospective, observational, national, cohort study, we identified all women with pregnancies and possible dolutegravir exposure within 8 weeks of estimated date of conception between Jan 1, 2017, and May 31, 2018, and approximately 3:1 matched pregnant women exposed to efavirenz between Jan 1, 2015, and May 31, 2018, using the Brazilian antiretroviral therapy database. We did detailed chart reviews for identified women. The primary outcomes were NTD and a composite measure of NTD, stillbirth, or miscarriage. NTD incidences were calculated with 95% CI. The composite outcome was examined with logistic regression using propensity score matching weights to balance confounders. FINDINGS: Of 1427 included women, 382 were exposed to dolutegravir within 8 weeks of estimated date of conception. During pregnancy, 183 (48%) of 382 dolutegravir-exposed and 465 (44%) of 1045 efavirenz-exposed women received folic acid supplementation. There were 1452 birth outcomes. There were no NTDs in either dolutegravir-exposed (0, 95% CI 0-0·0010) or efavirenz-exposed groups (0, 95% CI 0-0·0036). There were 23 (6%) stillbirths or miscarriages in 384 dolutegravir-exposed fetuses and 28 (3%) in the 1068 efavirenz-exposed fetuses (p=0·0037). Logistic regression models did not consistently indicate an association between dolutegravir exposure and risk of stillbirths or miscarriages. After study closure, two confirmed NTD outcomes in fetuses with periconception dolutegravir exposure were reported to public health officials. An updated estimate of NTD incidence incorporating these cases and the estimated number of additional dolutegravir-exposed pregnancies between Jan 1, 2015 and Feb 28, 2019, is 0·0018 (95% CI 0·0005-0·0067). INTERPRETATION: Neither dolutegravir nor efavirenz exposure was associated with NTDs in our national cohort; incidence of NTDs is probably well under 1% in dolutegravir-exposed HIV-positive women but still slightly above HIV-uninfected women (0·06%) in Brazil. FUNDING: The Brazilian Ministry of Health and the United States' National Institutes of Health.


Assuntos
Infecções por HIV/complicações , Inibidores de Integrase de HIV/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Defeitos do Tubo Neural/etiologia , Oxazinas/efeitos adversos , Piperazinas/efeitos adversos , Piridonas/efeitos adversos , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Brasil/epidemiologia , Comorbidade , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/administração & dosagem , Inibidores de Integrase de HIV/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/epidemiologia , Oxazinas/administração & dosagem , Oxazinas/uso terapêutico , Piperazinas/administração & dosagem , Piperazinas/uso terapêutico , Gravidez , Resultado da Gravidez , Piridonas/administração & dosagem , Piridonas/uso terapêutico , Estudos Retrospectivos , Natimorto , Adulto Jovem
15.
Environ Sci Pollut Res Int ; 28(9): 10436-10449, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33415631

RESUMO

Occupational exposure to inhalational anesthetics has been associated with health problems, including reproductive issues. Considering the scarcity and outdated nature of reviews concerning this relevant topic, which has implications for indoor pollution/environmental science/public health, this critical review aimed to systematically evaluate whether exposure to inhalational anesthetics is associated with abortion. Seven databases were searched with no language or year restrictions. Of the 3881 search results, 18 observational studies were included. Some studies demonstrated a significant association between occupational exposure to inhalational anesthetics and spontaneous abortion, especially among professionals who work for longer periods and/or in an environment without gas scavenging/ventilation systems, which may favor the occurrence of abortion in this population. Due to considerable heterogeneity and limitations, it cannot be concluded whether an association exists between occupational exposure to anesthetics and the occurrence of abortion. However, more well-designed studies should be performed, especially in less economically developed countries that do not have access to quality anesthetic gas scavenging/ventilation systems, thereby bringing this issue into sharp focus. This review highlights the need for scientific knowledge in this area and the extensive use of scavenging equipment and in the workplace to minimize exposure and reduce the risk of abortion.


Assuntos
Aborto Espontâneo , Anestésicos Inalatórios , Exposição Ocupacional , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Ar Condicionado , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Gravidez
16.
BMJ Open ; 11(1): e041247, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514576

RESUMO

INTRODUCTION: Previous novel COVID-19 pandemics, SARS and middle east respiratory syndrome observed an association of infection in pregnancy with preterm delivery, stillbirth and increased maternal mortality. COVID-19, caused by SARS-CoV-2 infection, is the largest pandemic in living memory.Rapid accrual of robust case data on women in pregnancy and their babies affected by suspected COVID-19 or confirmed SARS-CoV-2 infection will inform clinical management and preventative strategies in the current pandemic and future outbreaks. METHODS AND ANALYSIS: The pregnancy and neonatal outcomes in COVID-19 (PAN-COVID) registry are an observational study collecting focused data on outcomes of pregnant mothers who have had suspected COVID-19 in pregnancy or confirmed SARS-CoV-2 infection and their neonates via a web-portal. Among the women recruited to the PAN-COVID registry, the study will evaluate the incidence of: (1) miscarriage and pregnancy loss, (2) fetal growth restriction and stillbirth, (3) preterm delivery, (4) vertical transmission (suspected or confirmed) and early onset neonatal SARS-CoV-2 infection.Data will be centre based and collected on individual women and their babies. Verbal consent will be obtained, to reduce face-to-face contact in the pandemic while allowing identifiable data collection for linkage. Statistical analysis of the data will be carried out on a pseudonymised data set by the study statistician. Regular reports will be distributed to collaborators on the study research questions. ETHICS AND DISSEMINATION: This study has received research ethics approval in the UK. For international centres, evidence of appropriate local approval will be required to participate, prior to entry of data to the database. The reports will be published regularly. The outputs of the study will be regularly disseminated to participants and collaborators on the study website (https://pan-covid.org) and social media channels as well as dissemination to scientific meetings and journals. STUDY REGISTRATION NUMBER: ISRCTN68026880.


Assuntos
Complicações Infecciosas na Gravidez , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/virologia , /terapia , Feminino , Saúde Global , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Mortalidade Materna , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Sistema de Registros , Projetos de Pesquisa , Reino Unido
17.
BMC Pregnancy Childbirth ; 21(1): 95, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514327

RESUMO

BACKGROUND: A bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred. CASE PRESENTATION: A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required. CONCLUSIONS: Reconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.


Assuntos
Placenta Acreta/cirurgia , Complicações na Gravidez/cirurgia , Anormalidades Urogenitais/cirurgia , Hemorragia Uterina/diagnóstico , Útero/anormalidades , Útero/cirurgia , Aborto Espontâneo/etiologia , Adulto , Cesárea/efeitos adversos , Feminino , Idade Gestacional , Humanos , Histerectomia , Recém-Nascido , Placenta Prévia/cirurgia , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
18.
JAMA ; 325(2): 156-163, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33433574

RESUMO

Importance: In in vitro fertilization cycles using autologous oocytes, data have demonstrated higher live birth rates following cryopreserved-thawed embryo transfers compared with fresh embryo transfers. It remains unknown if this association exists in cycles using freshly retrieved donor oocytes. Objective: To test the hypothesis that in freshly retrieved donor oocyte cycles, a fresh embryo transfer is more likely to result in a live birth compared with a cryopreserved-thawed embryo transfer. Design, Setting, and Participants: Retrospective cohort study using national data collected from the Society for Assisted Reproductive Technology for 33 863 recipients undergoing fresh donor oocyte cycles in the US between January 1, 2014 and December 31, 2017. Exposures: Fresh embryo transfer and cryopreserved-thawed embryo transfer. Main Outcomes and Measures: The primary outcome was live birth rate; secondary outcomes were clinical pregnancy rate and miscarriage rate. Analyses were adjusted for donor age, day of embryo transfer, use of a gestational carrier, and assisted hatching. Results: Recipients of fresh and cryopreserved-thawed embryos had comparable median age (42.0 [interquartile range {IQR}, 37.0-44.0] years vs 42.0 [IQR, 36.0-45.0] years), gravidity (1 [IQR, 0-2] vs 1 [IQR, 0-3]), parity (0 [IQR, 0-1] vs 1 [IQR, 0-1]), and body mass index (24.5 [IQR, 21.9-28.7] vs 24.4 [IQR, 21.6-28.7]). Of a total of 33 863 recipients who underwent 51 942 fresh donor oocyte cycles, there were 15 308 (29.5%) fresh embryo transfer cycles and 36 634 (70.5%) cryopreserved-thawed embryo transfer cycles. Blastocysts were transferred in 92.4% of fresh embryo transfer cycles and 96.5% of cryopreserved-thawed embryo transfer cycles, with no significant difference in the mean number of embryos transferred. Live birth rate following fresh embryo transfer vs cryopreserved-thawed embryo transfer was 56.6% vs 44.0% (absolute difference, 12.6% [95% CI, 11.7%-13.5%]; adjusted relative risk [aRR], 1.42 [95% CI, 1.39-1.46]). Clinical pregnancy rates were 66.7% vs 54.2%, respectively (absolute difference, 12.5% [95% CI, 11.6%-13.4%]; aRR, 1.34; [95% CI, 1.31-1.37]). Miscarriage rates were 9.3% vs 9.4%, respectively (absolute difference, 0.2% [95% CI, -0.4% to 0.7%]); aRR, 0.98 [95% CI, 0.91-1.07]). Conclusions and Relevance: In this retrospective cohort study of women undergoing assisted reproduction using freshly retrieved donor oocytes, the use of fresh embryo transfers compared with cryopreserved-thawed embryo transfers was associated with a higher live birth rate. However, interpretation of the findings is limited by the potential for selection and confounding bias.


Assuntos
Blastocisto , Criopreservação , Transferência Embrionária , Nascimento Vivo , Oócitos , Aborto Espontâneo/epidemiologia , Adulto , Coeficiente de Natalidade , Transferência Embrionária/métodos , Feminino , Fertilização In Vitro , Humanos , Pessoa de Meia-Idade , Recuperação de Oócitos , Gravidez/estatística & dados numéricos , Estudos Retrospectivos
19.
Gene ; 767: 145173, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33007375

RESUMO

BACKGROUND: Recurrent spontaneous abortion (RSA) accounts for the most common complication of early pregnancy in humans. Matrix metalloproteinases (MMPs) play important regulatory roles in implantation and placentation to ensure a successful pregnancy. Single nucleotide polymorphisms (SNPs) have been identified in the promoters of MMP2 and MMP9 genes. However, the associations between MMP2 and MMP9 SNPs and the RSA risk remain unclear. The aim of this meta-analysis was to investigate whether MMP2 (-735C>T) and MMP9 (-1562C>T) SNPs are associated with the risk of RSA. METHODS: Literatures published before 17th April 2020 were screened to identify the eligible studies. Heterogeneity, sensitivity and publication bias analysis were analyzed by the STATA software. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by the Review Manager software with fixed effects model. RESULTS: After screening, 2 studies for MMP2 (-735C>T) (278 RSA cases and 265 controls) and 4 studies for MMP9 (-1562C>T) (520 RSA cases and 512 controls) were enrolled in this meta-analysis. Results showed that MMP2 (-735C>T) presented a statistically significant association with the risk of RSA under allelic (T vs C: OR = 1.50, 95% CI = 1.14-1.98, P = 0.004, I2 = 31%), heterozygote (CT vs CC: OR = 1.74, 95% CI = 1.22-2.50, P = 0.003, I2 = 41%) and dominant (TT + CT vs CC: OR = 1.74, 95% CI = 1.23-2.45, P = 0.002, I2 = 40%) genetic models. MMP9 (-1562C>T) in allelic (T vs C: OR = 1.34, 95% CI = 1.08-1.65, P = 0.007, I2 = 0%), heterozygote (CT vs CC: OR = 1.38, 95% CI = 1.06-1.79, P = 0.02, I2 = 0%) and dominant (TT + CT vs CC: OR = 1.41, 95% CI = 1.10-1.82, P = 0.008, I2 = 0%) genetic models were significantly correlated with the RSA risk. CONCLUSIONS: Our meta-analysis results suggest that MMP2 -735T allele and MMP9 -1562T allele have significant association with the risk of RSA.


Assuntos
Aborto Espontâneo/genética , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 9 da Matriz/genética , Alelos , Estudos de Casos e Controles , Feminino , Frequência do Gene/genética , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla/métodos , Genótipo , Humanos , Metaloproteinase 2 da Matriz/fisiologia , Metaloproteinase 9 da Matriz/fisiologia , Metaloproteinases da Matriz/genética , Razão de Chances , Polimorfismo de Nucleotídeo Único/genética , Gravidez , Regiões Promotoras Genéticas , Fatores de Risco
20.
Chemosphere ; 268: 129375, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33360147

RESUMO

Prenatal exposure to organophosphate flame retardants (OPFRs) has been associated with adverse pregnancy outcomes including low birth weight and preterm birth. However, no study has addressed the impacts of OPFRs exposure on spontaneous abortion (SAB) and fetal chromosome abnormalities. We examined whether prenatal exposure to OPFRs was associated with increased risk of SAB and fetal chromosome abnormalities. A total of 272 pregnant women, including 136 SAB cases and 136 healthy controls, were enrolled in this case-control study. Urinary concentrations of 3 OPFRs metabolites (diphenyl phosphate (DPHP), bis (1,3-dichloro-2-propyl) phosphate (BDCIPP) and bis (1-chloro-2-propyl) phosphate (BCIPP)) were measured using ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). More than 70% of the urine samples detected quantifiable levels of 3 OPFRs metabolites. Concentrations of BCIPP were significantly higher in SAB cases than in healthy controls. Higher urinary BCIPP levels were associated with increased risk of SAB. Per unit increase in ln-transformed BCIPP concentrations was associated with 103% (OR = 2.03, 95% CI, 1.57, 2.63) increase in the odds of SAB. While higher BDCIPP levels were associated with increased risk of fetal chromosome abnormalities and the corresponding OR associated with a unit increase in ln-transformed BDCIPP concentrations were 2.34 (95% CI, 1.14, 4.81). Our results suggested the potential developmental toxicity and teratogenicity of some OPFRs.


Assuntos
Aborto Espontâneo , Retardadores de Chama , Nascimento Prematuro , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Estudos de Casos e Controles , Ésteres , Feminino , Retardadores de Chama/toxicidade , Humanos , Recém-Nascido , Organofosfatos/toxicidade , Gravidez , Espectrometria de Massas em Tandem
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