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1.
Einstein (Sao Paulo) ; 18: eAO4851, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31721895

RESUMO

OBJECTIVE: To analyze the pregestational body mass index and weight gain during pregnancy, and to associate data to perinatal outcomes of pregnant women from a Prenatal Care Program. METHODS: A retrospective study was carried out with 151 patients seen at the Healthy Gestation Program of Hospital Israelita Albert Einstein . Data were collected from a medical chart review of the patients seen between March 2015 and March 2016. RESULTS: The chance of developing gestational diabetes for obese patients in early gestation was estimated at 7.5-fold as compared to patients with low or normal body mass index. CONCLUSION: There was a significant association between obesity in early pregnancy and the occurrence of gestational diabetes mellitus in this population.


Assuntos
Sobrepeso/epidemiologia , Complicações na Gravidez/etiologia , Ganho de Peso , Adulto , Índice de Massa Corporal , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco
2.
BJOG ; 127(1): 8-16, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529594

RESUMO

BACKGROUND: With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. OBJECTIVES: To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. SEARCH STRATEGY: Five databases and the grey literature were systematically searched (2000-2019). SELECTION CRITERIA: Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high-income countries. DATA COLLECTION AND ANALYSIS: Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. MAIN RESULTS: Forty-one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min-max: 0.24-22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre- and post-legalisation periods. CONCLUSION: Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. TWEETABLE ABSTRACT: Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.


Assuntos
Uso da Maconha/efeitos adversos , Complicações na Gravidez/etiologia , Países Desenvolvidos , Métodos Epidemiológicos , Feminino , Idade Gestacional , Humanos , Renda , Recém-Nascido de Baixo Peso , Terapia Intensiva Neonatal/estatística & dados numéricos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Saúde Materna , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia
4.
BJOG ; 127(1): 79-86, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31483927

RESUMO

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.


Assuntos
Terapia por Acupuntura/efeitos adversos , Complicações na Gravidez/etiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Segurança do Paciente , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Natimorto/epidemiologia , Adulto Jovem
5.
Khirurgiia (Mosk) ; (12): 100-105, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825349

RESUMO

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.


Assuntos
Ascite Quilosa/cirurgia , Peritonite/cirurgia , Complicações na Gravidez/cirurgia , Ascite Quilosa/diagnóstico , Ascite Quilosa/etiologia , Ascite Quilosa/fisiopatologia , Feminino , Humanos , Laparoscopia , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/fisiopatologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Primeiro Trimestre da Gravidez
6.
Rev Med Chil ; 147(8): 1078-1081, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859975

RESUMO

Acute pancreatitis during pregnancy is uncommon and usually associated with gallstones. However other etiologies must be considered. We report a 24 years old woman with a 32 weeks pregnancy consulting for abdominal pain, nausea and vomiting. She had elevated lipase and amylase levels, a corrected serum calcium of 13.1 mg/dl and a serum phosphate of 1.6 mg/dl. A magnetic resonance colangiopancreatography showed an enlarged pancreas with inflammatory changes and a normal Wirsung duct. A parathyroid nodule was found on cervical ultrasonography. The patient was treated initially with cinacalcet with partial response. A parathyroidectomy was performed at 39 weeks of pregnancy with a good maternal and fetal evolution.


Assuntos
Hipercalcemia/complicações , Pancreatite/etiologia , Complicações na Gravidez/etiologia , Dor Abdominal/etiologia , Adenoma/diagnóstico por imagem , Colangiopancreatografia por Ressonância Magnética/métodos , Feminino , Humanos , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Paratireoidectomia/métodos , Gravidez , Complicações na Gravidez/cirurgia , Resultado do Tratamento , Adulto Jovem
7.
PLoS Med ; 16(12): e1003009, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31887140

RESUMO

BACKGROUND: Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III. METHODS AND FINDINGS: We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04-1.21, p = 0.004, and AOR 1.17, 95% CI 1.04-1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12-1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01-1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years. CONCLUSIONS: In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.


Assuntos
Idade Gestacional , Ganho de Peso na Gestação/fisiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Adulto , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Obesidade/complicações , Sobrepeso/complicações , Gravidez , Estudos Retrospectivos , Fatores de Risco , Washington , Adulto Jovem
8.
Rev Med Chil ; 147(6): 709-717, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859823

RESUMO

BACKGROUND: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. AIM: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. MATERIALS AND METHODS: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. RESULTS: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 [625-1,575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29-36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14-25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29-34] weeks. Neonatal median hospitalization length was 4 [4-32] days, with 18% of neonatal deaths. CONCLUSIONS: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential.


Assuntos
Complicações na Gravidez , Resultado da Gravidez , Diálise Renal/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Gravidez , Complicações na Gravidez/etiologia , Diálise Renal/efeitos adversos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
9.
Afr Health Sci ; 19(2): 1930-1937, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656476

RESUMO

Background: Stillbirth is a death before the complete expulsion or extraction from the mother. The burden is severe and high in developing countries. Risk factors for stillbirth are not yet studied in Ethiopia. Objective: To identify risk factors of stillbirth among mothers delivered in public hospitals of Central Zone Tigray, Ethiopia. Methods: A case-control study design was used. Data collection period was from January to April 2018. Study subjects 63 cases and 252 controls were selected using systematic random sampling technique from respective hospitals. The interviewer-administered questionnaire, observational, and chart analysis were used to collect the data. A binary logistic regression model was employed. Results were presented at significance level P-value <0.05. Results: Maternal hypertension [AOR=12.83; 95% CI 3.38, 48.83], low birth weight [AOR=5.6; 95% CI 2.39, 13.38], pre-term [AOR=2.6;95%CI 1.12,6.16], alcohol intake [AOR=7.56; 95% CI 1.68, 34.04], polyhydramnios [AOR=13.43; 95% CI 3.63, 49.67], and meconium stained amniotic fluid [AOR=7.88; 95% CI 1.73, 8.18] were risk factors of stillbirth. Conclusion: The risk of stillbirth is increased with increasing maternal complication like maternal hypertension, alcohol consumption, polyhydramnios, and meconium-stained amniotic fluid. The occurrence of preterm and low birth weight of the fetus had an effect on the risk of stillbirth.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Mães , Poli-Hidrâmnios/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Med Sci Monit ; 25: 7715-7719, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31609961

RESUMO

BACKGROUND A belief has existed for many years that severe myopia is a direct indication for cesarean section or an instrumental vaginal delivery, although many academic papers negated this opinion. The aim of this study was to analyze the mode of delivery of myopic patients in the years 1990, 2000, and 2010. MATERIAL AND METHODS Medical records of 3027 women in labor from the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw were analyzed in 3 time periods: year 1990 - group 1 (G1), year 2000 - group 2 (G2), and 2010 - group 3 (G3). Maternal age, severity and proportion of myopia, ophthalmological consultations, and mode of delivery were assessed. RESULTS In G1 there were 992 patients, in G2 there were 1010 patients, and in G3 there were 1025 patients. Myopic women in labor accounted for 20% of G1, 12% of G2, and 20% of G3. The mean maternal age was ±29.4 years in G1, ±30 years in G2, and ±31.5 years in G3. Myopia was divided into 3 levels of severity depending on the degree of refractive error: low myopia -6 DS. The number of ophthalmological examinations needed in myopic patients to decide on the mode of delivery showed an increasing tendency over the evaluated years, but the rates of referrals for cesarean section/assisted delivery decreased. CONCLUSIONS The proportion of myopic women in labor receiving ophthalmological consultations showed an increasing trend over time. Despite publication of the Ophthalmology-Obstetrics Consensus of the Polish Society of Ophthalmology guidelines, myopia still remains an indication for cesarean section (cesarian section), but not to shorten the second stage of delivery.


Assuntos
Parto Obstétrico/tendências , Miopia/complicações , Complicações na Gravidez/etiologia , Adulto , Cesárea , Parto Obstétrico/métodos , Feminino , Humanos , Trabalho de Parto/fisiologia , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/fisiopatologia , Polônia , Gravidez , Estudos Retrospectivos
11.
Mayo Clin Proc ; 94(10): 1951-1959, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31585579

RESUMO

OBJECTIVE: To investigate the effect of supervised moderate to vigorous exercise on gestational weight gain, its related risks (gestational diabetes [GD]), macrosomia, and type of delivery), and the preventive effects on women who exceed the weight gain recommendations. PATIENTS AND METHODS: We conducted a single-center, 2-armed, randomized controlled trial between October 1, 2009, and June 30, 2011, in which 678 women were assessed and 345 were randomized by a central computer system to an intervention group (N=115) or a standard care group (N=230). The intervention exercise program consisted of 70 to 78 sessions (24 weeks, 3 times per week, 60-65 minutes per session, moderate to vigorous intensity). The standard care group received usual care. Excessive gestational weight (EGW) gain was calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations. RESULTS: Of the 345 women randomized for treatment, 44 were lost to follow-up, leaving 301 women for analysis (intervention, 100; standard care, 201). Fewer women in the intervention group exceeded IOM recommendations (22 [22.0%] vs 69 [34.3%]; P=.03), including overweight and obese women (15 of 35 [42.9%] vs 40 of 50 [80.0%]; P=.001). Analysis of women exceeding weight recommendations revealed that the 3 main related risks were directly related to EGW gain in the standard care group (GD, P=.003; macrosomia, P<.001; type of delivery, P<.001) but not in the intervention group (GD, P>.99; macrosomia, 0%; type of delivery, P=.46). CONCLUSION: Supervised moderate to vigorous exercise performed throughout gestation was effective in the prevention of EGW gain even for women with a pregestational body mass index greater than 25 kg/m2. It also prevented its related risks (GD, macrosomia, and type of delivery) including for women exceeding the IOM recommendations, so we suggest that being active outweighs the effect of possible weight gain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01477372.


Assuntos
Exercício , Ganho de Peso na Gestação , Complicações na Gravidez/prevenção & controle , Adulto , Feminino , Humanos , Sobrepeso/complicações , Gravidez , Complicações na Gravidez/etiologia
12.
World J Gastroenterol ; 25(36): 5423-5433, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576090

RESUMO

The impact of a chronic disease such as inflammatory bowel disease (IBD) on sexual functioning and body image can significantly impair the quality of life of patients. This review considers the sexual and fertility aspects of IBD patients and their daily management. Modern IBD healthcare management should include appropriate communication on sexuality and consider psychological, physiological, and biological issues. Patients with IBD have less children than the general population, and voluntary childlessness is frequent. The most influential factors reported by IBD patients who experience fertility alteration are psychological and surgery-related problems. Pregnancy is a major concern for patients, and any pregnancy for IBD patients should be closely followed-up to keep the chronic disease in a quiescent state. Preconceptional consultation is of great help.


Assuntos
Fertilidade/fisiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Complicações na Gravidez/prevenção & controle , Disfunções Sexuais Fisiológicas/fisiopatologia , Saúde Sexual , Doença Crônica/psicologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/psicologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Qualidade de Vida , Comportamento Reprodutivo/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Exacerbação dos Sintomas
13.
BMC Pregnancy Childbirth ; 19(1): 337, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533649

RESUMO

BACKGROUND: To investigate the trends and changes in the incidence and overall outcome of twin pregnancies in Finland, a retrospective study was conducted with emphasis on maternal complications, covering a 28-year study period. METHODS: All 23,498 twin pregnancies with 46,363 live born and 633 stillborn children in Finland during 1987-2014 were included in the study. Data were collected from the national Medical Birth Register and the Care Register on Hospital Care (Finnish Institute for Health and Welfare, Finland) regarding the parturients' characteristics and incidences of several pregnancy and childbirth complications. The incidences of twin pregnancies and maternal complications during pregnancy and childbirth are the main outcome measures of the study. The results are expressed in percentages, means, medians, ranges and standard deviations (SD), when appropriate. RESULTS: Twins comprised 1.4% of all births in Finland in 1987-2014. Parturients' mean age has remained stable, but the share of over 35 year-old parturients is increasing. The incidences of pre-eclampsia, intrahepatic cholestasis of pregnancy, gestational diabetes and postpartum haemorrhage have risen during the study period. Almost half (44.9%) of twins were born preterm, almost half via Caesarean section (47.1%), and 27.7% of twin labours were induced. CONCLUSIONS: Several pregnancy complications increased during the study period. Advanced maternal age among twin parturients has risen, enhancing the risks for developing complications in a pregnancy already of a high-risk category, and predisposing to preterm delivery. National and international guidelines are necessary to improve the overall outcome of twin pregnancies.


Assuntos
Complicações do Trabalho de Parto , Complicações na Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adulto , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos
14.
Int J Gynaecol Obstet ; 147(3): 292-300, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520411

RESUMO

BACKGROUND: Betel nut is the fourth most commonly abused substance worldwide and has been associated with significant adverse health outcomes. Little is known about its effects on the fetus. OBJECTIVE: To perform a systematic review of studies investigating prenatal betel nut use and adverse perinatal outcomes. SEARCH STRATEGY: Pubmed, Embase, and Cochrane databases were searched from inception until July 2018 using the terms areca, betel nut, pregnancy, pregnancy complications, and infection. SELECTION CRITERIA: Eligible studies included case-control, cohort, and randomized control studies involving pregnant women. DATA COLLECTION AND ANALYSIS: Where appropriate, bivariate meta-analysis was performed, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. MAIN RESULTS: In total, 28 studies were screened and eight studies (including 15 270 women) were included in the review and meta-analysis. Preterm birth, low birthweight, and anemia were most commonly investigated. Meta-analysis revealed a significant association between betel nut use and low birthweight, with a pooled OR of 1.75 (95% CI, 1.35-2.27). CONCLUSIONS: The review identified only eight eligible studies, all based in the Asia-Pacific region. There was a significant association between low birthweight and betel nut exposure in pregnancy. Further prospective studies are needed to confirm this association.


Assuntos
Areca/efeitos adversos , Nascimento Prematuro/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/etiologia , Transtornos Relacionados ao Uso de Substâncias , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos
15.
Int J Surg ; 71: 72-78, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31546031

RESUMO

BACKGROUND: Though uncommon, acute biliary pancreatitis in pregnancy carries a potential of serious and life threatening complications to mother and foetus. The management of acute pancreatitis in pregnancy is challenging due to the complexity of physiological and anatomical changes. This becomes even more challenging when invasive interventions are urgently needed. Therefore, there have been various debates among clinicians on the type and timing of these interventions. We systematically reviewed the evidences that looked into these debates to formulate a list of recommendations for clinical practice. METHODS: An electronic literature search of the databases (Medline/Pubmed, EMBASE, Cochrane database, NICE guidelines and Google Scholar) using the keywords "pancreatitis, pancreatitis in pregnancy, biliary pancreatitis, laparoscopy in pregnancy, and gall stones in pregnancy" was conducted. The relevant studies were screened and full text versions were retrieved. The references to all the retrieved texts were searched for further relevant studies. All studies were systematically reviewed and critically analysed. CONCLUSION: The available published literature on management of gall stones induced acute pancreatitis in pregnancy was solely based on retrospective studies and case series. The management of biliary induced pancreatitis in pregnant patients is challenging and complex, and it should involve the input of highly skilled clinicians from different specialities. Each case should be individually and thoroughly assessed by weighing the risks against the benefits. The authors have formulated a list of recommendations for clinical practice that is based on this comprehensive review of the literature.


Assuntos
Cálculos Biliares/complicações , Pancreatite/etiologia , Complicações na Gravidez/etiologia , Doença Aguda , Adulto , Gerenciamento Clínico , Feminino , Humanos , Gravidez , Estudos Retrospectivos
16.
Transplant Proc ; 51(8): 2718-2723, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477424

RESUMO

BACKGROUND: Kidney transplantation (KT) has been shown to improve fertility rates among women post-transplant. However, despite the favorable outcome, the impact of pregnancy on the graft and the graft's effect on the fetus should be considered. In addition, these patients are exposed to anti-rejection medications that could affect the fetus. OBJECTIVE: To describe the graft and pregnancy outcomes among KT recipients. METHODOLOGY: Descriptive study of 32 post-KT recipients who were pregnant from January 1, 2001 to December 31, 2016 and were followed up 3 months post-partum. Each pregnancy was considered as an event. RESULTS: Among the 32 post-KT patients there were 38 pregnancies. Mean age at conception was 34 years, with a mean interval between KT and pregnancy of 4.8 years. Around 84% took cyclosporine-based immunosuppression. The mean pre-natal serum creatinine was 1.15 mg/dL, 5.3% had ≥ 1.5 mg/dL pre-natal creatinine, and the rejection rate was 10.5%. The results of the pregnancies were as follows: 94% resulted in live births, 18.42% of mothers had pre-eclampsia, 3% had eclampsia, 3% ended in abortion, and 3% were stillbirth. Sixty-eight percent of the pregnancies were unplanned, and more complications were observed among these patients. CONCLUSION: The maternal and fetal outcomes and complications in this study were comparable with other studies. However, most of these complications were observed with unplanned pregnancies. Counselling prior to pregnancy should therefore be emphasized.


Assuntos
Transplante de Rim , Complicações na Gravidez , Resultado da Gravidez , Adulto , Feminino , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Transplante de Rim/efeitos adversos , Filipinas , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia
18.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383679

RESUMO

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Asma/diagnóstico , Bócio Subesternal/diagnóstico , Complicações na Gravidez/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Diagnóstico Diferencial , Feminino , Bócio Subesternal/complicações , Humanos , Gravidez , Complicações na Gravidez/etiologia
19.
Acta Med Indones ; 51(2): 102-109, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31383824

RESUMO

BACKGROUND: systemic lupus erythematosus (SLE) is still a challenging autoimmune disease, especially in pregnancy setting. An early risk factors awareness of poor pregnancy outcome is important to optimize the outcome of pregnancy in SLE patients. This study was conducted to describe pregnancy outcome and determine the risk factors associated with poor pregnancy outcome in SLE patients. METHODS: a retrospective case-control study of SLE patients with poor and normal pregnancy outcome was performed. Pregnancy histories were reviewed from Dr. Hasan Sadikin General Hospital lupus registry study. The case group was pregnancy with poor outcome, defined as abortion, premature birth, stillbirth, intrauterine growth restriction (IUGR) and neonatal death. The control group was pregnancy with good outcome, defined as live birth and full term. RESULTS: a total of 84 SLE patients were enrolled in this study with 109 pregnancies after SLE diagnosis. The median age of subjects at the time of pregnancy was 28 (25-32) years old. Poor pregnancy outcome comprising 22.9% abortion, 14.7% premature birth, 5.5% stillbirth, 1.8% IUGR and 4.6% neonatal death. There was a significant difference in the number of planned pregnancy (P=0.011) between groups with poor and good outcome. Clinical variables significantly associated with poor pregnancy outcome were lupus nephritis (OR = 4.813, 95% CI 1.709 - 13.557, P = 0.003) and neuropsychiatric SLE (OR = 5.045, 95% CI 1.278 - 19.920, P = 0.021). CONCLUSION: the pregnancy in SLE patient should be planned to have better outcome. Lupus nephritis and neuropsychiatric (NP) SLE were risk factors for poor pregnancy outcome in SLE patient.


Assuntos
Nefrite Lúpica/complicações , Vasculite Associada ao Lúpus do Sistema Nervoso Central/complicações , Complicações na Gravidez/etiologia , Resultado da Gravidez , Aborto Espontâneo/etiologia , Adulto , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Indonésia , Recém-Nascido , Modelos Logísticos , Análise Multivariada , Morte Perinatal/etiologia , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco
20.
BMC Pregnancy Childbirth ; 19(1): 305, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438891

RESUMO

BACKGROUND: Pelvic alignment changes during pregnancy and post-childbirth. Pelvic belts exert external forces that compress and stabilize the joints, and therefore, could influence pelvic alignment. However, limited information is available regarding this potential effect. Therefore, the purpose of this study is to investigate the influence of pelvic belt use on pelvic alignment during and after pregnancy. METHODS: Data of 201 pregnant women in late pregnancy and 1 month after childbirth were used. Pelvic alignment measurements, including anterior and posterior pelvic width, pelvic asymmetry, and pelvic belt use during and after pregnancy were investigated. Participants were divided into four groups according to pelvic belt use: before and after childbirth (BAC), before childbirth only (BC), after childbirth only (AC), and non-use (NU). Then, an initial one-way ANOVA was conducted to compare the amount of change in pelvic alignment from late pregnancy to post-childbirth between the groups. After the initial analysis, a multivariate regression analysis was performed to determine the statistically significant differences between the groups to consider other factors that influenced pelvic alignment such as age, BMI, number of previous childbirths, vaginal delivery and pelvic asymmetry in late pregnancy. Next, a cutoff point for subgroup stratification based on the weekly duration of pelvic belt use and inter-group changes in pelvic alignment were compared. RESULTS: As the result of the initial one-way ANOVA, the decrease in pelvic asymmetry from during pregnancy to postpartum for BAC was greater than that for AC. Moreover, multiple regression analysis showed that the effect of pelvic belt that was revealed in the initial analysis was statistical significance even after adjustment for other factors. Moreover, pelvic asymmetry in the BAC group decreased, compared to being increased or unchanged in the NU and AC groups when the group cutoff time was 7 h per week. CONCLUSIONS: Continuous and extended use of pelvic belts during and after pregnancy might be related to modifications of pelvic asymmetry in the perinatal period. Therefore, the instruction of correct and comfortable usage and the recommendation of continuous use of pelvic belt especially during pregnancy are required for prevention of some discomforts related to pelvic malalignment.


Assuntos
Mau Alinhamento Ósseo/prevenção & controle , Dispositivos de Fixação Ortopédica , Dor da Cintura Pélvica/prevenção & controle , Complicações na Gravidez/prevenção & controle , Adulto , Mau Alinhamento Ósseo/etiologia , Feminino , Humanos , Estudos Longitudinais , Parto/fisiologia , Dor da Cintura Pélvica/etiologia , Pelve/fisiopatologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/etiologia , Cuidado Pré-Natal/métodos , Estudos Prospectivos
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