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1.
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
2.
Pan Afr Med J ; 34: 13, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762882

RESUMO

The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.


Assuntos
Hipertrigliceridemia/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Feminino , Idade Gestacional , Humanos , Hipertrigliceridemia/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Índice de Gravidade de Doença
3.
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
4.
Isr Med Assoc J ; 21(7): 464-470, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507122

RESUMO

BACKGROUND: Rheumatic diseases commonly affect women of childbearing age, when women may be contemplating pregnancy or they discover an unplanned pregnancy. Therefore, specific issues about pregnancy planning and management are commonly encountered in patients during these times. Knowledge of the effect of pregnancy on disease activity is important for counseling. This review summarizes recent data on the course of different rheumatic diseases during pregnancy and the postpartum period. Rheumatoid arthritis and systemic lupus erythematosus are the most commonly investigated diseases. Data are increasing about spondyloarthritis. Sparse data are available for other rheumatic diseases. Despite the differences in these diseases and the various courses these disease take during pregnancy, a common feature is that active maternal disease in the months prior to conception increases the risk of flares during pregnancy, which in turn can lead to adverse pregnancy outcomes. Therefore, maternal and fetal health can be optimized if conception is planned when disease is inactive so that a treatment regimen can be maintained throughout pregnancy.


Assuntos
Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Doenças Reumáticas/fisiopatologia , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Período Pós-Parto , Gravidez
5.
JNMA J Nepal Med Assoc ; 57(216): 133-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31477950

RESUMO

Anti-phospholipid Antibody Syndrome or Hugh's syndrome is a heterogeneous disorder, first fully described in 1980s. The syndrome is caused by the presence of specific antibodies against phospholipid binding plasma proteins in the serum of the patient, with or without underlying autoimmune diseases, that causes prolongation of tests of coagulation. High index of clinical suspicion is required for diagnosis of Anti-phospholipid Antibody Syndrome. Stroke or myocardial infarction in young, unprovoked recurrent deep vein thrombosis and recurrent pregnancy loss are typical scenarios where Anti-Phospholipid Antibody Syndrome should be suspected. Presence of non-criteria manifestations like livedo reticularis, skin ulcers, nephropathy, valvular heart disease and thrombocytopenia adds to diagnostic clue for presence of Anti-Phospholipid Antibody Syndrome. Treatment of Anti-Phospholipid Antibody Syndrome has preventive and therapeutic aspects that usually focus on thrombotic and obstetric manifestations of the disease. Therapeutic anti-coagulation with heparin followed by warfarin is required for patients presenting with acute thrombosis. Those with venous thrombosis are given moderate intensity warfarin International Normalized Ratio, 2-3), whereas those with arterial thrombosis or recurrent venous thrombosis even on warfarin are treated with high intensity warfarin (International Normalized Ratio, 3-4). Similarly, anticoagulation with heparin is advised in patients with obstetric Anti-Phospholipid Antibody Syndrome throughout pregnancy and up to six weeks postpartum. Treatment recommendations are still not clear for asymptomatic Anti-Phospholipid Antibody Syndrome positive patients and in those with non-criteria manifestations of the disease. Steroids, intravenous immunoglobulin and immunosuppressant are reported to be effective in severe cases of catastrophic antiphospholid syndrome characterized by rapid small vessel thrombotic involvement of multiple organ systems. Studies are evaluating the efficacy of direct thrombin inhibitors in the management of refractory cases. Keywords: anticoagulants; anti-phospholipid syndrome; obstetric APS; thrombotic APS.


Assuntos
Síndrome Antifosfolipídica/terapia , Trombose/etiologia , Anticorpos Antifosfolipídeos/imunologia , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/fisiopatologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Trombose/tratamento farmacológico
6.
Lupus ; 28(11): 1312-1319, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31495267

RESUMO

OBJECTIVES: To investigate the fetal adverse pregnancy outcomes (APOs) and the predictive value of umbilical arterial Doppler ultrasonography in the third trimester in pregnant women with lupus nephritis (LN). METHODS: A retrospective cohort study enrolling 203 LN patients from 2007 to 2017 was performed. Ultrasonic parameters were recorded. RESULTS: Fetal APOs occurred in 103 patients (103/203, 50.7%). Sixty-six pregnancies (66/203, 32.5%) ended with preterm births. The incidence rate of intrauterine growth restriction (IUGR) was 18.2% (37/203). Fetal distress was noted in 23 pregnancies (23/203, 11.3%). All the Doppler parameters elevated in patients with IUGR, fetal distress, and composite conditions. Resistance index (RI) indicated the highest risk of IUGR and composite APOs. The cutoff values were 0.66 and 0.67, respectively. Sensitivities were 51.4% and 33.7%, and specificities were 87.4% and 92.1%. Peak velocity of the umbilical arteries at end-systole (Vmax, abbreviated as S) to that at end-diastole (Vmin, abbreviated as D) (S/D) ratio was also a best predictor for IUGR, with the optimal cutoff value of 2.88. Sensitivity and specificity were comparable with RI. Pulsatility index (PI) over 0.84 was an ideal indicator for fetal distress with an optimal combination of sensitivity (89.5%) and specificity (51.6%). CONCLUSIONS: Fetal complications were frequent in patients with LN. Umbilical arterial Doppler ultrasonography was a useful measure to predict late IUGR, fetal distress, and the composite APOs.


Assuntos
Nefrite Lúpica/complicações , Complicações na Gravidez/fisiopatologia , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Adolescente , Adulto , China , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Artérias Umbilicais/diagnóstico por imagem , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 662, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514743

RESUMO

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.


Assuntos
Diabetes Gestacional/terapia , Maternidades , Monitorização Fisiológica/métodos , Complicações na Gravidez/terapia , Autogestão , Telemedicina , Adulto , Diabetes Gestacional/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Irlanda do Norte , Gravidez , Complicações na Gravidez/fisiopatologia , Autogestão/estatística & dados numéricos
8.
Elife ; 82019 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-31545168

RESUMO

Prenatal exposure to ethanol induces aberrant tangential migration of corticopetal GABAergic interneurons, and long-term alterations in the form and function of the prefrontal cortex. We have hypothesized that interneuronopathy contributes significantly to the pathoetiology of fetal alcohol spectrum disorders (FASD). Activity-dependent tangential migration of GABAergic cortical neurons is driven by depolarizing responses to ambient GABA present in the cortical enclave. We found that ethanol exposure potentiates the depolarizing action of GABA in GABAergic cortical interneurons of the embryonic mouse brain. Pharmacological antagonism of the cotransporter NKCC1 mitigated ethanol-induced potentiation of GABA depolarization and prevented aberrant patterns of tangential migration induced by ethanol in vitro. In a model of FASD, maternal bumetanide treatment prevented interneuronopathy in the prefrontal cortex of ethanol exposed offspring, including deficits in behavioral flexibility. These findings position interneuronopathy as a mechanism of FASD symptomatology, and posit NKCC1 as a pharmacological target for the management of FASD.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bumetanida/administração & dosagem , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Complicações na Gravidez/prevenção & controle , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Membro 2 da Família 12 de Carreador de Soluto/metabolismo , Animais , Córtex Cerebral/efeitos dos fármacos , Modelos Animais de Doenças , Feminino , Transtornos do Espectro Alcoólico Fetal/fisiopatologia , Neurônios GABAérgicos/efeitos dos fármacos , Camundongos , Córtex Pré-Frontal/efeitos dos fármacos , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado do Tratamento , Ácido gama-Aminobutírico/metabolismo
9.
Int J Infect Dis ; 89: 84-86, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31465848

RESUMO

BACKGROUND: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. CASE DESCRIPTION: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. DISCUSSION: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. CONCLUSION: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.


Assuntos
Febre Lassa/virologia , Complicações na Gravidez/virologia , Adulto , Antivirais/uso terapêutico , Feminino , Febre/diagnóstico , Febre/tratamento farmacológico , Febre/fisiopatologia , Febre/virologia , Humanos , Recém-Nascido , Febre Lassa/diagnóstico , Febre Lassa/tratamento farmacológico , Febre Lassa/fisiopatologia , Vírus Lassa/efeitos dos fármacos , Vírus Lassa/genética , Vírus Lassa/isolamento & purificação , Masculino , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Ribavirina/uso terapêutico
10.
Medicine (Baltimore) ; 98(33): e16840, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415407

RESUMO

RATIONALE: Twin pregnancy in women with chronic kidney disease (CKD) is very rare but poses a great risk to both mother and children. In developing countries like China, advanced CKD twin pregnancies are often terminated. Here, we report a successful case and reviewed related cases, hope to facilitate further study. PATIENT CONCERNS: A 29-year-old woman with a twin pregnancy showed serum creatinine (Scr) 100 µmol/L (CKD2) at conception. During her 12th week, Scr reached 263 µmol/L (CKD4) with urine protein 3+ and hypertension. DIAGNOSES: Due to her pregnancy, renal biopsy was not considered. Lab tests showed deterioration of renal function and ultrasound detections showed small kidney size. INTERVENTIONS: The patient was given basic drug therapy to control her blood pressure and supplemental nutrition without hemodialysis. OUTCOMES: The patient delivered 2 healthy babies weighting 0.9 and 0.7 kg by cesarean section at the 28th week, but has been under maintenance hemodialysis since then. LESSONS: Despite low birth weight and preterm delivery, successful twin pregnancies in some patients with CKD could be realized under early multidisciplinary intervention, but this poses great risks for mothers and twins, especially for patients with advanced CKD and those on hemodialysis.


Assuntos
Complicações na Gravidez/fisiopatologia , Gravidez de Gêmeos , Insuficiência Renal Crônica/fisiopatologia , Adulto , Cesárea , China , Creatinina/sangue , Feminino , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Nifedipino/uso terapêutico , Prednisona/uso terapêutico , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Vasodilatadores/uso terapêutico
11.
J Perinat Med ; 47(7): 689-703, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31393835

RESUMO

Background Although pregnancy is frequently associated with mental states of happiness, hope and well-being, some physical and psychological changes can contribute to increased sleep disturbances and worsened sleep quality. Sleep quality has been linked to negative emotions, anxiety and depression. The main objective of this paper was to systematically review the impact of sleep during pregnancy on maternal mood, studying the association between objective and subjective measures of sleep quality and perinatal depression. Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which included studies published between January 2008 and April 2019, and met the following criteria: (i) studies on pregnant women assessing the effects of sleep quality variables on perinatal mood disorders, (ii) studies published in English and (iii) full paper published in a peer-reviewed scientific journal with full-text format available. Results A total of 36 studies published in the last decade met the inclusion criteria for qualitative review and eight of them were suitable for meta-analysis. Both confirmed the negative effects of poor sleep on perinatal mood. However, qualitative analysis showed that unrepresentative samples and low participation rates falling below 80% biased some of the studies. The standard random-effects meta-analysis showed a pooled size effect [ln odds ratio (OR) 1.49 (95% confidence interval [CI] 1.19, 1.79)] for perinatal depression in cases of poor prenatal sleep quality, although heterogeneity was moderate to high [Q 16.05, P ≤ 0.025, H2 2.45 (95% CI 1.01, 13.70)]. Conclusion Poor sleep quality was associated with perinatal mood disturbances. The assessment of sleep quality along the pregnancy could be advisable with a view to offering preventative or therapeutic interventions when necessary.


Assuntos
Depressão , Complicações na Gravidez , Transtornos do Sono-Vigília/psicologia , Depressão/fisiopatologia , Depressão/prevenção & controle , Feminino , Humanos , Gravidez , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia
12.
Medicina (Kaunas) ; 55(8)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31404990

RESUMO

Intrahepatic cholestasis of pregnancy (ICP) is a gestation-specific liver disorder, defined most often as the onset of pruritus, usually from the third trimester of pregnancy, associated with abnormal liver test results and/or increased total serum bile acids and spontaneous relief after delivery. The 21-year-old patient was admitted to our ward in the 11th week of pregnancy due to raised liver enzymes. The first onset of pruritus and jaundice appeared a month before hospitalization. Immunology tests and Toxoplasma gondii were negative. We excluded viral etiology, while alpha-1-antitrypsin, serum and urine copper levels, and thyroid hormones were within the reference values. The patient denied she had taken any medicines and herbal preparations before and during pregnancy. Total bile acids in the serum were significantly elevated (242 µmol/L). The abdominal ultrasound revealed a regular finding. Liver biopsy suggested a cholestatic liver disorder. After a presentation of all risks, the patient decided to stop the pregnancy. After a month, the hepatogram was within the reference values. Very rarely an ICP can occur in early pregnancy (first trimester), which calls for close monitoring. The risk of serious adverse fetal outcomes and spontaneous preterm delivery is proportional with increased levels of maternal serum bile acid.


Assuntos
Colestase Intra-Hepática/diagnóstico , Complicações na Gravidez/diagnóstico , Primeiro Trimestre da Gravidez/metabolismo , Ácidos e Sais Biliares/análise , Ácidos e Sais Biliares/sangue , Colestase Intra-Hepática/complicações , Colestase Intra-Hepática/fisiopatologia , Feminino , Humanos , Icterícia/etiologia , Icterícia/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Prurido/etiologia , Prurido/fisiopatologia , Adulto Jovem
13.
Obstet Gynecol Clin North Am ; 46(3): 431-440, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378286

RESUMO

Pregnancy complications provide insight into women's future health risks and have long term implications for maternal and child health. Obesity has been associated with adverse perinatal outcomes and is a risk factor for chronic disease. Excessive weight gain during pregnancy often translates into postpartum weight retention, increasing women's risk for obesity. Pregnancy and the postpartum period provides a unique opportunity to discuss health beyond pregnancy, emphasize interconception care, and implement appropriate prevention strategies. We aim to review the impact of obesity, gestational weight gain, postpartum weight retention, and role of nutrition and exercise on pregnancy and lifelong health.


Assuntos
Exercício/fisiologia , Promoção da Saúde/métodos , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Obesidade/complicações , Complicações na Gravidez/prevenção & controle , Índice de Massa Corporal , Aleitamento Materno , Feminino , Humanos , Recém-Nascido , Estilo de Vida , Obesidade/prevenção & controle , Complicações do Trabalho de Parto , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Diagnóstico Pré-Natal , Fatores de Risco , Ganho de Peso
14.
Eur J Obstet Gynecol Reprod Biol ; 240: 139-143, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31284087

RESUMO

Pregnancy is characterized by marked alterations in the hypothalamic-pituitary-adrenal axis and in the function of the adrenal gland. Some of those alterations have clinical characteristics that are similar to those of adrenal gland disorders. While adrenal disorders are rare among pregnant women, they harbor the potential for significant morbidity if they remain unrecognized and untreated. As the majority of patients with adrenal disorders present with clinical features that are typical of normal pregnancy - diagnosis during pregnancy is not uncommonly delayed. A high index of suspicion must be practiced for these disorders as they might carry severe obstetrical negative outcomes. In this review we will survey the normal function of adrenal glands in pregnancy and the role of adrenal hormones in pregnancy. We will outline the adrenal disorders that commonly present during pregnancy and review the literature on treatment modalities.


Assuntos
Doenças do Córtex Suprarrenal/fisiopatologia , Córtex Suprarrenal/fisiopatologia , Complicações na Gravidez/fisiopatologia , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Gravidez
15.
Medicine (Baltimore) ; 98(27): e16199, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277127

RESUMO

BACKGROUND: Clinical evidence indicates that women will benefit from regular physical activity during pregnancy. This study aimed to summarize and update the evidence on the effect of exercise on maternal gestational weight gain (GWG). METHODS: We conducted a systematic literature search of Pubmed, Embase, and Cochrane Library from inception until July, 2018 for randomized controlled trials (RCTs) that investigate the effect of physical exercises on the maternal GWG compared with that of no physical exercises or conventional medical care. We extracted data from eligible trials for study characteristics, interventions, patients' baseline characteristics and outcomes for the study populations of interest. We conducted meta-analyses using random effects models. RESULTS: From 844 citations, 23 RCTs including 4462 pregnant women met the inclusion criteria. Meta-analysis indicated that compared with that in women having conventional medical care, GWG was significantly decreased in pregnant women with physical exercise [weighted mean difference (WMD) -1.02, 95% CI -1.35 to -0.70; P < .01; I = 48.4%]. Women appeared to benefit more for gestational weight control for exercise frequency of 3 times per week (WMD -1.22, 95% CI -1.55 to -0.90; I = 40.3%) and exercise duration of 30 to 45 minutes each time (WMD -1.32, 95% CI -1.79 to -0.85; I = 1.5%). CONCLUSION: This meta-analysis provides indications that exercise intervention can reduce maternal GWG for pregnant women, especially for those with exercise frequency of 3 times per week and duration of 30 to 45 minutes each time.


Assuntos
Terapia por Exercício/métodos , Exercício/fisiologia , Ganho de Peso na Gestação/fisiologia , Sobrepeso/prevenção & controle , Complicações na Gravidez/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Feminino , Humanos , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia
16.
BMC Pregnancy Childbirth ; 19(1): 232, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277608

RESUMO

BACKGROUND: We examined whether inferior thyroid artery peak systolic velocity (ITA-PSV) predicts an increase in levothyroxine (LT4) dosage in pregnant women with Hashimoto's thyroiditis. METHODS: Twenty-two women with Hashimoto's thyroiditis who were planning and later achieved pregnancy or confirmed as pregnant were enrolled in this retrospective longitudinal observational study. ITA-PSV and thyroid volume were measured using ultrasonography. Serum concentrations of free thyroxine (F-T4), free triiodothyronine (F-T3), and thyroid stimulating hormone (TSH) were simultaneously determined. We adjusted LT4 dosage to maintain serum TSH at < 2.5 µIU/mL (1st trimester) and later at < 3 µIU/mL (2nd, 3rd trimester). RESULTS: Eighteen patients (81.8%) required an increase in LT4 dosage during pregnancy, of whom 7 (31.8%) required an increase ≥50 µg. Multivariable regression analysis showed that TSH (ß = 0.507, p = 0.008) and ITA-PSV (ß = - 0.362, p = 0.047), but not thyroid volume, F-T4, or F-T3, were independently associated with increased LT4 dosage. Receiver-operating characteristic analysis for predicting an increase in LT4 ≥ 50 µg/day showed that the area under the curve (0.905) for ITA-PSV with TSH was not significantly increased (p = 0.123) as compared to that (0.743) for TSH alone, whereas integrated discrimination improvement was significantly increased (27.9%, p = 0.009). CONCLUSIONS: In pregnant patients with Hashimoto's thyroiditis, ITA-PSV was a significant predictor of increase in LT4 dosage independent of TSH level, while ITA-PSV plus TSH showed significantly improved predictability as compared to TSH alone. These results suggest that ITA-PSV reflects residual thyroid function and is useful for evaluating the need for increased thyroid hormone production in pregnant patients with Hashimoto's thyroiditis.


Assuntos
Monitoramento de Medicamentos/métodos , Doença de Hashimoto/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/métodos , Glândula Tireoide/fisiopatologia , Tiroxina/administração & dosagem , Adulto , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Doença de Hashimoto/sangue , Doença de Hashimoto/fisiopatologia , Humanos , Estudos Longitudinais , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/fisiopatologia , Curva ROC , Estudos Retrospectivos , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/diagnóstico por imagem , Tiroxina/uso terapêutico , Ultrassonografia
17.
Obes Facts ; 12(4): 407-415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261149

RESUMO

OBJECTIVE: Timing of gestational weight gain (GWG) may influence perinatal outcomes differently. This study aimed to find associations of latent GWG patterns with risk of large for gestational age (LGA) in women with overweight or obesity. METHODS: A total of 4,438 women with overweight or obesity were included in the analyses. Latent trajectories of GWG associated with LGA were identified by trajectory analysis. GWG, risk of LGA and early pregnancy factors were compared between these identified groups. RESULTS: This study identified four distinct GWG trajectory groups associated with LGA, each group including, respectively, 78.6, 19.0, 1.4, and 0.9% of the participants. Group 1 presented a typical curve with lower GWG in early pregnancy and relatively higher GWG in mid- and late pregnancy. Women in group 2 showed sustained high GWG and high LGA prevalence than women in group 1 (48.24 vs. 21.56%, p < 0.0001). A catch-up in GWG after low weight gain did not result in significantly higher risk of LGA in group 3 compared to group 1. On the other hand, a rapid GWG in the first two-thirds of pregnancy followed by a strict weight control was associated with elevated risk of LGA in group 4 than group 1 (62.50 vs. 21.56%, p < 0.0001). CONCLUSIONS: Women affected by overweight or obesity combined with high GWG in early mid-pregnancy were at elevated risk of LGA. Early clinical recognition of a poor GWG trajectory will enable early intervention in high-risk groups.


Assuntos
Macrossomia Fetal/etiologia , Ganho de Peso na Gestação/fisiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Peso ao Nascer/fisiologia , Índice de Massa Corporal , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Ganho de Peso/fisiologia , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 19(1): 259, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331287

RESUMO

BACKGROUND: Acute Fatty Liver of Pregnancy (AFLP) is a rare, catastrophic disease affecting women in the third trimester of pregnancy or in the post-partum period. It is usually a diagnosis of exclusion and requires a strong index of suspicion for a timely diagnosis and prompt intervention. CASE PRESENTATION: We report a case of AM, an 18 year patient, in her first pregnancy at 35 weeks gestation who presented with nausea, vomiting and jaundice. She had a vaginal delivery following spontaneous preterm labour. A clinical diagnosis of acute fatty liver of pregnancy was made on the 3rd day post-delivery. The post-delivery course was complicated by a deterioration of clinical symptoms with worsening hepatorenal function and development of encephalopathy. The patient died 3 days after admission and the diagnosis was confirmed on post-mortem and histology. CONCLUSION: Delay in the diagnosis is associated with morbid complications with high mortality and this case highlights the importance of a high index of suspicion of the condition in women presenting with jaundice in pregnancy.


Assuntos
Fígado Gorduroso , Icterícia , Complicações na Gravidez , Adolescente , Deterioração Clínica , Diagnóstico Tardio , Parto Obstétrico/métodos , Diagnóstico , Diagnóstico Diferencial , Evolução Fatal , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/fisiopatologia , Fígado Gorduroso/terapia , Feminino , Humanos , Icterícia/diagnóstico , Icterícia/etiologia , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Paridade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Terceiro Trimestre da Gravidez
19.
Biomed Res Int ; 2019: 1315796, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360700

RESUMO

Objective: The exact shape of the dose-response relationship between maternal body mass index (BMI) and the risk of congenital heart defects (CHDs) in infants has not been clearly defined yet. This study aims to further clarify the relationship between maternal obesity and the risk of CHDs in infants by an overall and dose-response meta-analysis. Methods: PubMed, Embase, and Web of Science databases were searched to identify all related studies. The studies were limited to human cohort or case-control studies in English language. Random-effect models and dose-response meta-analysis were used to synthesize the results. Heterogeneity, subgroup analysis, sensitivity analysis, and publication bias were also assessed. Results: Nineteen studies with 2,416,546 participants were included in our meta-analysis. Compared with the mothers with normal weight, the pooled relative risks (RRs) of infants with CHDs were 1.08 (95% CI=1.03-1.13) in overweight and 1.23 (95% CI=1.17-1.29) in obese mothers. According to the findings from the linear meta-analysis, we observed an increased risk of infants with CHDs (RR=1.07, 95% CI=1.06-1.08) for each 5 kg/m2 increase in maternal BMI. A nonlinear relationship between maternal BMI and risk of infants with CHDs was also found (p=0.012). Conclusion: The results from our meta-analysis indicate that increased maternal BMI is related to increased risk of CHDs in infants.


Assuntos
Índice de Massa Corporal , Cardiopatias Congênitas , Obesidade , Complicações na Gravidez , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/etiologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/fisiopatologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Fatores de Risco
20.
Biomed Res Int ; 2019: 3768601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31355258

RESUMO

Objective: This study aimed to clarify the effect of gestational weight gain (GWG) on perinatal outcomes in low risk pregnancies with normal prepregnancy body mass index (BMI). Study Design: A total of 572 low-risk pregnant women with a normal prepregnancy BMI were included. GWG and inadequate or excessive weight gain were defined according to the United States Institute of Medicine updated guidelines. Adverse perinatal outcomes were compared among inadequate, normal, and excessive weight gain groups. Results: Of the 572 pregnant women enrolled, 62 belonged to inadequate GWG group, 80 to excessive GWG group, and 430 to normal GWG group. Maternal age, prepregnancy BMI, gravity, parity, and previous cesarean delivery rates were similar among groups. Adverse perinatal outcomes were not statistically significant among groups. Fetal weight was significantly lower in inadequate weight gain group compared to normal weight gain group (p<0.001) and fetal weight was significantly lower in normal weight gain group compared to excessive weight gain group (p<0.001). Additionally, low birth weight <2.5kgs, birth weight > 4.0kgs, and SGA and LGA rates were similar among groups (P = 0.765, P = 0. 711, P = 0. 702, and P = 0.414, respectively). Although gestational age at delivery was term in normal percentile it was significantly lower in the inadequate weight gain group compared to others (P=0.010). Conclusions: This study showed that an inadequate or excessive weight gain in low-risk pregnancies with a normal prepregnancy BMI did not increase the risk of adverse perinatal outcomes.


Assuntos
Peso ao Nascer , Índice de Massa Corporal , Ganho de Peso na Gestação , Sobrepeso , Complicações na Gravidez , Resultado da Gravidez , Adolescente , Adulto , Feminino , Humanos , Sobrepeso/epidemiologia , Sobrepeso/patologia , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/patologia , Complicações na Gravidez/fisiopatologia , Estudos Retrospectivos
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