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1.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472784

RESUMO

BACKGROUND: Pregnant women in India are at higher risk of dying as compared to middle to high income countries. Deaths can be prevented if risk factors are identified, critical illness is diagnosed early and timely care is provided. The present research was undertaken to study the clinical profile and factors affecting the outcome of pregnant and postpartum patients in the Medical Intensive Care Unit (MICU). METHOD: A total of 75 consecutive patients of age >18 years with confirmed pregnancy or postpartum females within 42 days from date of delivery requiring admission in ICU for at least one organ dysfunction as per APACHE II criteria1 were enrolled in the study. Clinical profiles of patients and outcomes were measured till hospital discharge. RESULTS: Among 75 patients, 18(24%) patients were postpartum while 57(76%) were antepartum.The commonest symptom was fever (64%), followed by breathlessness (62.7%). Respiratory distress (58.7%) was the commonest indication for transfer to MICU. While 60(80%) patients were admitted for medical illnesses in pregnancy, 15(20%) patients were admitted for obstetric complications. Acute infections including malaria, dengue and leptospirosis were the commonest illness diagnosed in 19(25.3%) patients. Severity of illness measured using APACHE II score varied from 4 to 35 points with a mean score of 10.61.Longer duration of symptoms before seeking medical attention, lower pH, lower paO2/FiO2 ratio and serum bicarbonate, a diagnosis of tuberculosis and a higher APACHE II score were associated with a higher mortality. CONCLUSION: With institution of intensive therapy in critically ill maternal patients, 80% of patients could be saved and 61% of fetuses had uneventful outcomes.The prognosis was better for obstetric illnesses than for medical illnesses with only 3 patients dying of obstetric causes whereas 12 patients died of medical illnesses common to the general population. Even though APACHE II score was higher in the group with obstetric conditions (mean=11 vs. 8.1), the mortality was lower.


Assuntos
Unidades de Terapia Intensiva , Complicações na Gravidez , APACHE , Adolescente , Estado Terminal , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos
2.
Dan Med J ; 68(9)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34477096

RESUMO

INTRODUCTION: Although women rarely die during pregnancy and childbirth in Denmark, keeping track of the maternal mortality rate and causes of death is vital in identifying learning points for future management of critical illness among obstetric patients and in pinpointing risk factors. METHODS: We identified maternal deaths between 2002 and 2017 by linking four Danish national health registers, using death certificates and reports from hospitals. An audit group then categorised each case by cause of death before identifying any suboptimal care and learning points, which may serve as a foundation for national guidelines and educational strategies. RESULTS: Seventy women died during pregnancy or within six weeks of a pregnancy in the study period. The most frequent causes of death were cardiovascular disease (n = 14), hypertensive disorder (n = 10), suicide (n = 10) and thromboembolism (n = 7). Suboptimal care was identified in 30 of the 70 cases. CONCLUSIONS: Mortality from some of the most important causes of death decreased during the study period. No deaths from preeclampsia or thrombosis, two of the leading causes of death, were identified after 2011. In 2015-2017, suicide was the main cause of maternal death, which indicates that a stronger focus on vulnerability in pregnancy and childbirth is essential. Among the 70 deaths, 34% were potentially avoidable, indicating that it is essential continuously to focus on how to reduce severe maternal morbidity and mortality. FUNDING: none TRIAL REGISTRATION. not relevant.


Assuntos
Doenças Cardiovasculares , Morte Materna , Complicações na Gravidez , Suicídio , Causas de Morte , Estado Terminal , Feminino , Humanos , Morte Materna/etiologia , Mortalidade Materna , Gravidez
3.
Dan Med J ; 68(9)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34477097

RESUMO

INTRODUCTION: Women very rarely die during pregnancy and childbirth in Denmark. Although maternal deaths are registered worldwide, various studies indicate that underreporting does occur. This paper presents validated Danish register data for two periods between 1985 and 2017. METHODS: Maternal deaths were identified from 1985 to 1994 and from 2002 to 2017 by linking four national health registers, death certificates and notifications from maternity wards. A group of obstetricians categorised and assessed all medical records, classifying each case by cause of death. RESULTS: Linkage of four registers yielded valid data, leading to the identification of 143 maternal deaths in the abovementioned periods. From 1985-1994 there were 73 deaths and 618,021 live births, resulting in a maternal mortality rate of 11.8 per 100,000 live births with a non-significant 2% annual increase (95% confidence interval (CI): -6.0-11.0%). From 2002 to 2017 there were 70 maternal deaths and 999,206 live births, resulting in a maternal mortality rate of 7.0 per 100,000 live births (95% CI: 5.5-8.9) with a significant 9% annual decrease (95% CI: 4.0-14.0%). CONCLUSIONS: Overall maternal mortality decreased in the course of the two periods (n = 33 years), with a significant decrease during the last period. This is suggested to be a result of multiple clinical and organisational improvements as discussed in the paper. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Mortalidade Materna , Complicações na Gravidez , Causas de Morte , Dinamarca/epidemiologia , Feminino , Humanos , Registros Médicos , Gravidez
4.
JNMA J Nepal Med Assoc ; 59(233): 51-54, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34508457

RESUMO

INTRODUCTION: The function of the thyroid gland is altered during pregnancy. Thyroid disorders during pregnancy are associated with serious maternal and fetal outcomes. Universal screening for thyroid disorders is recommended in the first trimester of pregnancy. This study aims to determine the prevalence of thyroid disorder during pregnancy in women attending a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of Kathmandu Medical College and Teaching Hospital from March 2020 to August 2020 after obtaining ethical approval from the Institutional Review committee with reference number 20032020. The pregnant women >18 years of age, irrespective of their gestational age and gravida status, were included in the study by convenience sampling method. The participants were screened by estimation of thyroid function test. Data were collected, and statistical analysis was done in Statistical Packages for Social Services version 20.0. RESULTS: A total of 329 pregnant women were included in this study. The prevalence of thyroid disorders in the present study is 24.62 %. The most common thyroid disorder observed was subclinical hypothyroidism comprising 65 (19.75 %) cases followed by overt hypothyroidism 8 (2.43%) cases. CONCLUSIONS: There is a high prevalence of thyroid disorders during pregnancy in our settings. Timely screening of pregnant women helps in the early diagnosis and management of complications related to thyroid disorders.


Assuntos
Complicações na Gravidez , Glândula Tireoide , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Gestantes , Prevalência , Atenção Terciária à Saúde
5.
JNMA J Nepal Med Assoc ; 59(240): 752-756, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508469

RESUMO

INTRODUCTION: Urinary incontinence is an involuntary passage of urine. The aim of the study was to find the prevalence of urinary incontinence among pregnant women in the third trimester of pregnancy at a tertiary care center. METHODS: This descriptive cross-sectional study was conducted in a tertiary care center from March 2021 to May 2021. Ethical approval was obtained from the Institutional Review Board (reference number: 854/2077/78). Convenience sampling method was used. A descriptive analysis of socio-demographic profile and urinary incontinence symptoms were recorded on International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form questionnaire and analysis were done using Statistical Package for Social Sciences 27. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 277 pregnant women admitted in the antenatal ward, urinary incontinence was present in 26 (9.4%) (95% Confidence Interval= 5.96-12.84). Among them, stress urinary incontinence 16 (61%) was most common followed by mixed incontinence 6 (23%). Majority of them 18 (69.3%) had small leaks with almost all 25 (96.2%) having only a mild to moderate impact on the quality of life. Majority 197 (71.2%) had features of lower urinary tract syndrome. CONCLUSIONS: Our study showed similar prevalence of urinary incontinence compared to other international studies.


Assuntos
Complicações na Gravidez , Incontinência Urinária , Estudos Transversais , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Gestantes , Qualidade de Vida , Centros de Atenção Terciária , Incontinência Urinária/epidemiologia
6.
Tijdschr Psychiatr ; 63(7): 557-564, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34523708

RESUMO

BACKGROUND: Lithium use during peripartum requires careful consideration due to a risk of teratogenic effects, adverse side effects and risk of neonatal complications. However, given the effectiveness of lithium, use during the peripartum period may be indicated. AIM: To provide an overview of the current evidence regarding the clinical use of lithium during peripartum, including risk of relapse in case of (dis)continuation and evolution of lithium levels. METHOD: A review was performed in the Medline and ScienceDirect database. RESULTS: Ten studies were included. Six studies concerned the risk of relapse in case of (dis)continuation of lithium during the peripartum. Four studies concerned the evolution of lithium levels throughout the peripartum. Lithium discontinuation during pregnancy leads to an increased risk of relapse during pregnancy and postpartum. At the same dose, lithium levels are lower than preconceptual in all trimesters. CONCLUSION: Risk and benefits of lithium use during the peripartum should be carefully considered, if possible prior to conception. Close monitoring of maternal lithium levels and renal function is necessary due to significant fluctuations during peripartum.


Assuntos
Transtorno Bipolar , Complicações na Gravidez , Transtorno Bipolar/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Lítio/uso terapêutico , Período Periparto , Período Pós-Parto , Gravidez , Complicações na Gravidez/tratamento farmacológico
7.
Nihon Shokakibyo Gakkai Zasshi ; 118(8): 742-748, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34373393

RESUMO

OBJECTIVE: A few studies have focused on pregnancy and childbirth in patients with Crohn's disease (CD) who had a history of abdominal surgery. The objective of this study is to analyze the problems of pregnant patients with CD with a history of abdominal surgery. METHODS: The rates of pregnancy-related complications and adverse birth outcomes were retrospectively analyzed in 29 patients with CD (45 pregnancies) with previous intestinal surgery. RESULTS: In this study, the following outcomes were observed:normal births occurred in 55.6% of the pregnancies, preterm births in 13.3%, and spontaneous abortions in 20.0%. The vaginal birth and cesarean section rates were 45.7% and 40.0%, respectively. The rate of low-birth weight infants was 14.3%. CONCLUSION: Overall, patients with CD with previous abdominal surgery can conceive and give birth. However, care needs to be taken to avoid preterm birth, spontaneous abortion, low birth weight, and cesarean delivery.


Assuntos
Doença de Crohn , Complicações na Gravidez , Nascimento Prematuro , Cesárea/efeitos adversos , Doença de Crohn/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
8.
J Trop Pediatr ; 67(3)2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34345902

RESUMO

OBJECTIVES: The purpose of the study was to determine the clinical features of NLE and to compare the neonatal outcomes between newborns born to pregnant women with SLE and healthy pregnant women. METHODS: We conducted a retrospective cohort analysis between 2007 and 2019 in a tertiary referral hospital in Thailand. A total of 118 pregnant women with SLE with 132 neonates compared with 264 randomly selected healthy pregnant women. RESULTS: The median (interquartile range) gestational age and birth weight of 132 neonates born to women with SLE were 37 (35-38) weeks and 2687 g (2045-3160 g), respectively. The clinical features of NLE infants were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. Moreover, logistic regression analysis found that neonates born to women with SLE increased the risk of preterm birth [odd ratio (OR) 8.87, 95% confidence interval (95% CI) 4.32-18.21, p < 0.001], low birth weight (OR 10.35, 95% CI 5.08-21.08, p < 0.001), birth asphyxia (OR 2.91, 95% CI 1.26-6.73, p = 0.011) and NICU admission (OR 4.26, 95% CI 2.44-7.42, p < 0.001). SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE. CONCLUSION: The major clinical features of NLE patients were hematologic and hepatobiliary abnormalities in our study. Pregnancies with SLE dramatically increased the risk of preterm delivery and neonatal complications. LAY SUMMARY: Neonatal lupus erythematosus (NLE) is the consequence of the transplacental passage of autoantibodies to newborns during pregnancy. The clinical features of NLE infants in our study were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. We also compared the neonatal outcomes between 118 pregnant women with SLE and 264 randomly selected healthy pregnant women. Our study found that the neonates born to women with SLE increased the risk of preterm birth, low birth weight, birth asphyxia and NICU admission. Moreover, SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.


Assuntos
Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Nascimento Prematuro , Feminino , Humanos , Lactente , Recém-Nascido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gestantes , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Tailândia/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34360332

RESUMO

Stress and anxiety significantly impact the hypothalamic-pituitary axis, and in pregnancy, the subsequent maternal-fetal response can lead to poor outcomes. The objective of this study was to assess the association between psychosocial measures of pregnancy-specific anxiety and physiologic inflammatory responses. Specifically, to determine the effectiveness of the Mentors Offering Maternal Support (M-O-M-STM) program to reduce psychosocial anxiety and associated inflammatory response. In conjunction with measures of pregnancy-specific anxiety and depression, serum biomarkers (IL-2, IL-6, IL-10, IL1-B, TNF-α, CRH, CRP, and cortisol) were analyzed for each trimester throughout pregnancy. Results demonstrated that women receiving the M-O-M-STM intervention had longitudinally sustained lower TNF-α/IL-10 ratios than the control group, and it was significantly associated with psychosocial measures of anxiety, specifically for fears of labor and spouse/partner relationships. Additionally, the anxiety of spouse/partner relationships was significantly associated with IL-6/IL-10 ratios. The findings highlight the important counter-regulatory relationship between anti- and pro-inflammatory cytokines and provide insight into the distinct physiologic responses to pregnancy-specific anxiety with early prenatal intervention.


Assuntos
Depressão , Complicações na Gravidez , Ansiedade , Transtornos de Ansiedade , Biomarcadores , Feminino , Humanos , Gravidez , Estresse Psicológico
11.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371906

RESUMO

Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.


Assuntos
Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Complicações na Gravidez/etiologia , Peso ao Nascer , Brasil , Diabetes Gestacional/etiologia , Comportamento Alimentar , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Valor Nutritivo , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Nascimento Prematuro/etiologia , Medição de Risco , Fatores de Risco
12.
Zhonghua Yi Xue Za Zhi ; 101(28): 2238-2241, 2021 Jul 27.
Artigo em Chinês | MEDLINE | ID: mdl-34333938

RESUMO

To investigate risk factors associated with pulmonary embolism in women during pregnancy or peripartum. Information of 7 pregnant women diagnosed pulmonary embolism (PE) were collected from January 2018 to December 2020 in Beijing Friendship Hospital. Four non-PE pregnant women as control group were matched with each patient by age, BMI and pregnancy complications during the same period. Binary logistic regression was used to identify the potential risk factors by the comparison of difference between groups. The laboratory indices, including platelet, hemoglobin, prothrombin time, partially activated prothrombin time, D-dimer, triglyceride, total cholesterol, low density lipoprotein (LDL) and high density lipoproteinage (HDL) showed no significant difference between groups. D-dimer and HDL were found to be associated with PE during pregnancy (P<0.05). D-dimer and HDL might be associated with PE during pregnancy.


Assuntos
Complicações na Gravidez , Embolia Pulmonar , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Modelos Logísticos , Gravidez , Fatores de Risco , Triglicerídeos
13.
Eur J Anaesthesiol ; 38(9): 916-922, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397526

RESUMO

BACKGROUND: The combination of low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH) until the end of gestation are the currently the accepted standard of care for the treatment of antiphospholipid-related obstetric disorders. In refractory cases, hydroxychloroquine (HCQ) can be added to this standard of care. OBJECTIVE: To evaluate the haemostatic safety of LDA and LMWH (medium to high prophylactic doses) during pregnancy and the puerperium in women with both full-blown obstetric antiphospholipid syndrome (OAPS) (Sydney criteria) and noncriteria - incomplete - OAPS. STUDY DESIGN: Retrospective/prospective multicentre observational study. Obstetric background, laboratory categories, delivery mode, antithrombotic regimens and bleeding complications were compared. SETTING: A total of 30 tertiary European hospitals. PATIENTS: Mainly, Caucasian/Arian pregnant women were included. Other ethnicities were minimally present. Women were controlled throughout pregnancy and puerperium. MAIN OUTCOME MEASURES: The primary end-point was to evaluate the number of major and minor haemorrhagic complications in this cohort of women. Neuraxial anaesthetic bleeding complications were particularly assessed. Secondly, we aimed to compare local/general bleeding events between groups. RESULTS: We studied 1650 women, of whom 1000 fulfilled the Sydney criteria of the OAPS and 650 did not (noncriteria OAPS). Data on antithrombotic-related complications were available in 1075 cases (65.15%). Overall, 53 (4.93%) women had bleeding complications, with 34 being considered minor (3.16%) and 19 major (1.76%). Neither obstetric complications nor laboratory categories were bleeding-related. Assisted vaginal delivery and caesarean section were related to local haemorrhage. Heparin doses and platelet count were not associated with major bleeding. CONCLUSIONS: LDA and medium to high prophylactic LMWH during pregnancy in women with full-blown OAPS/noncriteria OAPS are safe. A slight increase in bleeding risk was noted in instrumental deliveries. No women who underwent spinal or epidural anaesthesia suffered bleeding complications. No haemorrhage was observed in cases where HCQ was added to standard therapy.


Assuntos
Fibrinolíticos , Complicações na Gravidez , Cesárea , Feminino , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico , Hemorragia/epidemiologia , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Gravidez , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos
14.
Wiad Lek ; 74(7): 1713-1717, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459776

RESUMO

OBJECTIVE: The aim: Improving the effects of pregnancy on the fetus and newborn through early diagnosis and timely comprehensive therapy of pregnant women with intrahepatic cholestasis. PATIENTS AND METHODS: Materials and methods: We have conducted a complex examination of 60 women who got pregnant owing to assisted reproductive technologies, with concomitant intrahepatic cholestasis, and 20 practically healthy women with a physiological course of pregnancy and labor (reference group), aged between 18 and 42. The research did not involve pregnant women with chronic liver diseases, viral hepatitis, skin diseases. Womens who underwent the suggested complex drug therapy with Ursofalc, L-arginine and Omega 3, with peroral administration for 14 days according to the following scheme: Ursofalc - 250 mg once a day, L-arginine - 5 ml 3 times a day, Omega 3 - 1 capsule a day. The complex examination of pregnant women with IHC was conducted before and after treatment. We analyzed the data of anamnesis, carried out anthropometric measurements, clinical biochemical examinations of the women with IHC, including the measurement of the levels of alanine aminotransferase, aspartate aminotransferase, total and direct bilirubin, total and placental alkaline phosphatase, leucine aminopeptidase, 5'-nucleotidase, cholic, deoxycholic and chenodeoxycholic acids as wells as their total level. RESULTS: Results: Almost 40 % of women with intrahepatic cholestasis gave birth to babies with asphyxia, including severe one in 11.1 % of cases, 1/3 of the newborns were premature, 40% had signs of hypotrophy, and 66.7 % experienced a disturbed course of early neonatal adaptation. There was also a higher level of perinatal mortality. The newborns from women who had undergone the suggested complex therapy presented no cases of hypotrophy, prenatal infection or cerebral circulation disorder. CONCLUSION: Conclusions: Thus, functional hepatic disorders in women with infertility play a certain role in the carrying of pregnancy after ART, in the development of pregnancy complications and adverse consequences for women and their newborns. The conducted research shows that early diagnosis and timely complex therapy of pregnant women with intrahepatic cholestasis makes it possible to influence the pathogenesis of perinatal complications and improve the consequences of pregnancy for the fetus and the newborn.


Assuntos
Colestase Intra-Hepática , Infertilidade , Complicações na Gravidez , Adolescente , Adulto , Colestase Intra-Hepática/complicações , Feminino , Humanos , Recém-Nascido , Placenta , Gravidez , Complicações na Gravidez/tratamento farmacológico , Técnicas de Reprodução Assistida , Adulto Jovem
16.
Int J Mol Sci ; 22(15)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34360769

RESUMO

Nitric oxide (NO) deficiency during pregnancy is a key reason for preeclampsia development. Besides its important vasomotor role, NO is shown to regulate the cell transcriptome. However, the role of NO in transcriptional regulation of developing smooth muscle has never been studied before. We hypothesized that in early ontogeny, NO is important for the regulation of arterial smooth muscle-specific genes expression. Pregnant rats consumed NO-synthase inhibitor L-NAME (500 mg/L in drinking water) from gestational day 10 till delivery, which led to an increase in blood pressure, a key manifestation of preeclampsia. L-NAME reduced blood concentrations of NO metabolites in dams and their newborn pups, as well as relaxations of pup aortic rings to acetylcholine. Using qPCR, we demonstrated reduced abundances of the smooth muscle-specific myosin heavy chain isoform, α-actin, SM22α, and L-type Ca2+-channel mRNAs in the aorta of newborn pups from the L-NAME group compared to control pups. To conclude, the intrauterine NO deficiency weakens gene expression specific for a contractile phenotype of arterial smooth muscle in newborn offspring.


Assuntos
Diferenciação Celular , Músculo Liso Vascular/metabolismo , Óxido Nítrico/deficiência , Complicações na Gravidez/metabolismo , Útero/metabolismo , Animais , Animais Recém-Nascidos , Feminino , Regulação da Expressão Gênica , Proteínas Musculares/biossíntese , Músculo Liso Vascular/patologia , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico/metabolismo , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/patologia , Ratos , Ratos Wistar , Útero/patologia
17.
Zhonghua Nei Ke Za Zhi ; 60(9): 812-816, 2021 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-34445817

RESUMO

Objective: To study clinical characteristics and pregnancy outcomes under anti-coagulation therapy of non-criteria obstetric antiphospholipid syndrome. Methods: Patients suspected of obstetric antiphospholipid syndrome(OAPS) were recruited through Chinese Rheumatism Data Center from 2015 to 2019 consecutively. Patients fulfilling 2006 Sydney revised antiphospholipid syndrome criteria were classified as OAPS. Patients fulfilling definition of non-criteria OAPS(NCOAPS) by expert consensus on diagnosis and management of obstetric antiphospholipid syndrome of China were classified as NCOAPS. Clinical characteristics and laboratory results of two groups were compared. Live birth rates and pregnancy outcomes under anti-coagulation therapy were studied. Results: A total of 88 patients were enrolled, including 56 patients (63.6%) as OAPS, 32(36.4%) as NCOAPS. Live births were only reached in 16.1% (9/56) in OAPS patients and 12.5%(4/32) in NCOAPS. Fetal losses after 10 weeks of gestation and pre-eclampsia before 34 weeks were more common in OAPS group compared to NCOAPS group [78.6%(44/56) vs. 18.8%(6/32), P<0.001; 25.0%(14/56) vs. 3.1%(1/32), P=0.020, respectively]. After enrollment, 15 pregnancies were recorded in OAPS, 10 in NCOAPS, all of whom were treated with low-dose aspirin (LDA) combined with low-molecular weight heparin (LMWH). Live birth rates saw dramatic improvements compared to baseline levels in OAPS [16.1% (9/56) vs. 11/15] along with NCOAPS [12.5% (4/32) vs. 7/10]. Conclusion: Though NCOAPS and OAPS patients differ in antiphospholipid antibody spectrum and pattern of pregnancy morbidities, both groups benefit from LDA combined with LWMH treatment, as live birth rates improve. Non-criteria OAPS patients are recommended to receive anti-coagulation therapy during pregnancy.


Assuntos
Síndrome Antifosfolipídica , Complicações na Gravidez , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/epidemiologia , Feminino , Heparina de Baixo Peso Molecular , Humanos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Estudos Retrospectivos
18.
Malawi Med J ; 33(1): 54-58, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422234

RESUMO

Background: Several studies have been published on the topic of COVID-19 and pregnancy over recent months. However, few studies have evaluated the impact of this pandemic on maternal mental health, particularly in low-resource settings. Aim: To determine the prevalence and predictors of COVID-19-related depression, anxiety and stress symptoms among pregnant women. Methods: This was a cross-sectional study that involved 456 pregnant women attending prenatal care at Abakaliki, Nigeria, during the COVID-19 lockdown. These patients were screened for psychological morbidities using the Depression Anxiety and Stress Scale-21 (DASS-21). Results: Severe and extremely severe depression were reported in 7.2% (n=33) and 6.4% (n=29) of participants, respectively. Analysis also revealed that 3.3% (n=15) and 7.7% (n=35) of women had severe and extremely severe anxiety, respectively. In total, 23% (n=105) of the participating women had severe stress while 16.7% (n=76) reported extremely severe stress. Multiparity (2-4) and occupation, such as trading and farming, were predictors of depression whereas grand-multiparity, urban residence, and trading, were identified as predictors of anxiety and stress. Conclusion: Symptoms of depression, anxiety and stress were relatively common among pregnant women during the COVID-19 lockdown in Abakaliki, Nigeria. There is a clear need to integrate screening for depression, anxiety and stress, in existing antenatal care programs so as to identify and prevent long-term adverse psychological outcomes related to the COVID-19 pandemic.


Assuntos
Transtornos de Ansiedade/epidemiologia , COVID-19/epidemiologia , Depressão/epidemiologia , Saúde Materna , Complicações na Gravidez/epidemiologia , Quarentena , Estresse Psicológico/epidemiologia , Adulto , Transtornos de Ansiedade/etiologia , COVID-19/complicações , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Nigéria/epidemiologia , Pandemias , Gravidez , Prevalência , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , SARS-CoV-2 , Estresse Psicológico/etiologia
20.
Nutrients ; 13(8)2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34444958

RESUMO

We investigated the effect of an antenatal lifestyle intervention of a low-glycaemic index (GI) diet and physical activity on energy-adjusted dietary inflammatory index (E-DIITM) and explored its relationship with maternal and child health in women with overweight and obesity. This was a secondary analysis of 434 mother-child pairs from the Pregnancy Exercise and Nutrition Study (PEARS) trial in Dublin, Ireland. E-DIITM scores were calculated for early (10-16 weeks) and late (28 weeks) pregnancy. Outcomes included lipids, inflammation markers, insulin resistance, mode of delivery, infant size, pre-eclampsia, and gestational diabetes. T-tests were used to assess changes in E-DIITM. Chi-square, correlations, and multiple regression were employed to investigate relationships with outcomes. The mean (SD) age of participants was 32.45 (4.29) years with median (IQR) BMI 28.25 (26.70, 31.34) kg/m2. There was no change in E-DIITM in the controls (-0.14 (1.19) vs. -0.07 (1.09), p = 0.465) but E-DIITM reduced by 10% after the intervention (0.01 (1.07) vs -0.75 (1.05), p < 0.001). No associations were found between early pregnancy E-DIITM and maternal and child outcomes, except for increased odds of adverse cardiometabolic phenotype in women who delivered male (OR = 2.29, p = 0.010) but not female infants (OR = 0.99, p = 0.960). A low-GI antenatal intervention can reduce the inflammatory potential of diets. Sex differences should be explored further in future research.


Assuntos
Dieta Saudável/estatística & dados numéricos , Obesidade/terapia , Sobrepeso/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Adulto , Fatores de Risco Cardiometabólico , Dieta com Restrição de Carboidratos/métodos , Exercício Físico , Feminino , Índice Glicêmico , Humanos , Recém-Nascido , Inflamação , Irlanda , Estilo de Vida , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Resultado do Tratamento
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