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1.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 654-659, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648440

RESUMO

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic ß cell function index (HOMA-ß) were used to evaluate insulin resistance and pancreatic ß cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-ß within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.


Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobinas/análise , Resistência à Insulina , Primeiro Trimestre da Gravidez/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Glicemia/metabolismo , Índice de Massa Corporal , China/epidemiologia , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Fatores de Risco
2.
Niger Postgrad Med J ; 26(4): 223-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621662

RESUMO

Context: Pre-eclampsia (PrE), a clinical syndrome characterised by elevated blood pressure arising after 20 weeks of gestation, is a leading cause of maternal death worldwide. We evaluated the role of uterine artery Doppler (UtAD) in screening for PrE among unselected, pregnant women. Methodology: This was a prospective cohort study of 170 healthy gravid women between 18 and 26 weeks of gestation recruited consecutively from the Antenatal Clinic of Braithwaite Memorial Specialist Hospital, Port-Harcourt, Nigeria, between July 2016 and June 2017. All had UtAD scans with an abnormal result defined as pulsatility index (PI), resistance index or systolic/diastolic (S/D) ratio >95th centile for gestational age or proto-diastolic notching. Outcome was obtained from antenatal records. Data were analysed using Statistical Package for Social Sciences, version 20 at statistical significance level of P < 0.05. Results: The prevalence of PrE was 7.6%. There was significant association between an abnormal PI (χ2 = 16.29, P = 0.00), S/D ratio (χ2 = 8.55, P = 0.00) and the combined result (χ2 = 11.5, P = 0.007) with subsequent PrE. The highest sensitivity (53.8%) was obtained for the combined result with specificity, negative predictive value (NPV) and positive predictive value of 86.6%, 95.8% and 25%, respectively, area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.534-0.871). A normal result had a very high NPV for all indices. The accuracy for the prediction of severe PrE was greater for all indices being highest for the combined result AUC of 0.830 (95% CI: 0.624-1.000; P = 0.01). Conclusion: Abnormal UtAD indices were associated with PrE and may be used in PrE screening.


Assuntos
Pré-Eclâmpsia/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artéria Uterina/diagnóstico por imagem , Útero/irrigação sanguínea , Adolescente , Adulto , Feminino , Idade Gestacional , Voluntários Saudáveis , Humanos , Nigéria , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Fluxo Pulsátil/fisiologia , Curva ROC , Ultrassonografia Pré-Natal , Adulto Jovem
3.
Isr Med Assoc J ; 21(10): 681-685, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599511

RESUMO

BACKGROUND: Recurrent miscarriages are associated with a high prevalence of thrombophilia. Use of a calibrated automated thrombogram (CAT) can serve as a universal test for thrombophilia. OBJECTIVES: To examine whether thrombin generation measured by CAT is elevated during the first trimester in women with unexplained recurrent miscarriages. METHODS: This study comprised 25 pregnant women with recurrent pregnancy loss referred for thrombophilia screening and treated with low-molecular-weight heparin (LMWH). Thrombin generation parameters were measured in women who had miscarriages or live births and who were diagnosed as positive or negative for thrombophilia. RESULTS: Of the pregnancies, 76% resulted in live birth and 24% ended in miscarriages. Among the women, 76% were positive for thrombophilia. Thrombin generation parameters between pregnancies that ended in miscarriage compared to live births were not significantly different, and CAT parameters failed to predict pregnancy outcome. Although the CAT parameters demonstrated a trend toward a hypercoagulable state in women with thrombophilia, there was no statistical significance (P > 0.05). CONCLUSIONS: Women with unexplained pregnancy loss demonstrated similar thrombin generation in the first trimester, regardless of the pregnancy outcome. CAT parameters failed to predict pregnancy outcome in women with recurrent unexplained pregnancy loss. Our results should be interpreted with caution due to the small number of participants.


Assuntos
Aborto Habitual/etiologia , Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombofilia/complicações , Trombofilia/diagnóstico , Adulto , Feminino , Humanos , Projetos Piloto , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Trombofilia/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
4.
Environ Pollut ; 254(Pt A): 113010, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31554142

RESUMO

Autism spectrum disorder (ASD) affects more boys than girls. Recent animal studies found that early life exposure to ambient particles caused autism-like behaviors only in males. However, there has been little study of sex-specificity of effects on ASD in humans. We evaluated ASD risk associated with prenatal and first year of life exposures to particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5) by child sex. This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California (KPSC) hospitals between 1999 and 2009. The cohort was followed from birth through age five to identify 2471 ASD cases from the electronic medical record. Ambient PM2.5 and other regional air pollution measurements (PM less than 10 µm, ozone, nitrogen dioxide) from regulatory air monitoring stations were interpolated to estimate exposure during each trimester and first year of life at each geocoded birth address. Hazard ratios (HRs) were estimated using Cox regression models to adjust for birth year, KPSC medical center service areas, and relevant maternal and child characteristics. Adjusted HRs per 6.5 µg/m3 PM2.5 were elevated during entire pregnancy [1.17 (95% confidence interval (CI), 1.04-1.33)]; first trimester [1.10 (95% CI, 1.02-1.19)]; third trimester [1.08 (1.00-1.18)]; and first year of life [1.21 (95% CI, 1.05-1.40)]. Only the first trimester association remained robust to adjustment for other exposure windows, and was specific to boys only (HR = 1.18; 95% CI, 1.08-1.27); there was no association in girls (HR = 0.90; 95% CI, 0.76-1.07; interaction p-value 0.03). There were no statistically significant associations with other pollutants. PM2.5-associated ASD risk was stronger in boys, consistent with findings from recent animal studies. Further studies are needed to better understand these sexually dimorphic neurodevelopmental associations.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Transtorno do Espectro Autista/induzido quimicamente , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , California , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Gravidez , Primeiro Trimestre da Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais
7.
BJOG ; 126(13): 1536-1544, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31471989

RESUMO

BACKGROUND: For many women, the need for multiple clinical visits is a barrier to medical abortion. OBJECTIVES: We assessed the effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home versus routine clinic follow up after medical abortion. SEARCH STRATEGY: We searched databases such as MEDLINE, Embase, and CENTRAL to find studies published in 1991-2018. SELECTION CRITERIA: Eligible studies included women of reproductive age who had undergone a medical abortion that was completed at home. The intervention and self-assessment of the outcome of medical abortion done by urine pregnancy tests kits by women at home was compared with routine medical follow up at a clinic. DATA COLLECTION AND ANALYSIS: Two researchers completed the study selection, data extraction, critical appraisal, and assessment of the evidence. The outcomes were successful complete abortions, side effects and complications, and acceptability. We performed meta-analyses when possible and GRADE to ascertain the certainty of the evidence. The protocol was registered in PROSPERO (CRD42017055316). MAIN RESULTS: Four randomised controlled trials (RCTs; n = 5493) met our inclusion criteria. The pooled analysis from all studies showed no significant difference in complete abortion rates between self-assessment and routine clinic follow up: RR = 1.00, 95% CI 0.99-1.01. The ongoing pregnancy rates were similar and the pooled results for the safety outcomes showed no significant differences between the groups. There was a significantly greater preference for self-assessment as the follow-up method. CONCLUSIONS: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home are not inferior to routine clinic follow up. TWEETABLE ABSTRACT: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion are not inferior to routine clinic follow up.


Assuntos
Abortivos/administração & dosagem , Aborto Induzido , Primeiro Trimestre da Gravidez , Feminino , Humanos , Avaliação de Resultados (Cuidados de Saúde) , Segurança do Paciente , Gravidez , Autoavaliação
8.
Hypertension ; 74(5): 1124-1135, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522621

RESUMO

Preeclampsia is a systemic syndrome that seems to originate from the placenta and is associated with an imbalance between angiogenic factors in the maternal circulation. One of the well-studied and widely used factors is PlGF (placental growth factor), the levels of which drop in women destined to develop preeclampsia. This drop is known to precede the development of actual signs and symptoms of preeclampsia, thus proving to be a useful screening tool in predicting the disease. The literature varies widely in terms of the clinical usefulness of the test. We conducted a meta-analysis to study the predictive accuracy of PlGF in asymptomatic women. Our analysis included 40 studies with 3189 cases of preeclampsia and 89 498 controls. The overall predictive odds ratio of the test was 9 (6-13). Subgroup analysis evaluating various PlGF thresholds demonstrated that the predictive values were highest for PlGF levels between 80 and 120 pg/mL with a high predictive odds ratio of 25 (7-88), a sensitivity of 0.78 (95% CI, 0.67-0.86), a specificity of 0.88 (95% CI, 0.75-0.95), a positive likelihood ratio of 6.3 (95% CI, 2.7-14.7), and a negative likelihood ratio of 0.26 (95% CI, 0.16-0.42). Additionally, the accuracy was higher when the test was performed after 14 weeks of gestation (OR, 10 [7-15]) and for prediction of early onset preeclampsia (OR, 18 [9-37]). We conclude that PlGF is a useful screening tool to predict preeclampsia. Nonetheless, its utility should be judged with caution and randomized controlled trials are warranted to explore if its implementation improves perinatal outcomes in asymptomatic women.


Assuntos
Programas de Rastreamento/métodos , Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Biomarcadores/análise , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Razão de Chances , Pré-Eclâmpsia/metabolismo , Valor Preditivo dos Testes , Gravidez , Proteínas da Gravidez/metabolismo , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Valores de Referência , Sensibilidade e Especificidade , Reino Unido
10.
Cell Biochem Funct ; 37(7): 464-473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31396989

RESUMO

We sought to explore the functions and modulated factors of NOD1 in normal decidual stromal cells (DSCs) derived from the first trimester pregnancy and whether existed different expression of NOD1 between normal and unexplained recurrent pregnancy loss (URPL) in DSCs. Twenty-six patients with normal pregnancies that required abortion and 12 URPL patients at first trimester were enrolled for the study. As a result, we found lower levels of NOD1 in the DSCs derived from URPL compared with those from normal early trimester pregnancy. Furthermore, increased NOD1 expression in the normal DSCs induced apoptosis and increased monocyte chemotactic protein-1 (MCP-1) and IL-1ß (interleukin 1 beta) secretion but decreased their invasion capacity. In addition, several cytokines such as IL-1ß, tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin-17 (IL-17) were present at the maternal-fetal interface in RPL and were found to regulate NOD1 expression in primary DSCs. Our study indicates that RPL may be associated with NOD1 aberrant expression in DSCs, which plays a significant role in maintaining pregnancy via infection control and regulation of immune responses that might affect the pregnancy outcome. We expect that our results will bring more comprehensively understanding about the connection between NOD1 and RPL for researchers.


Assuntos
Decídua/metabolismo , Proteína Adaptadora de Sinalização NOD1/metabolismo , Primeiro Trimestre da Gravidez/metabolismo , Células Estromais/metabolismo , Adulto , Apoptose/efeitos dos fármacos , Células Cultivadas , Citocinas/análise , Citocinas/metabolismo , Decídua/citologia , Decídua/efeitos dos fármacos , Ácido Diaminopimélico/análogos & derivados , Ácido Diaminopimélico/farmacologia , Feminino , Humanos , Proteína Adaptadora de Sinalização NOD1/genética , Gravidez , Primeiro Trimestre da Gravidez/efeitos dos fármacos , Células Estromais/efeitos dos fármacos
11.
BMC Public Health ; 19(1): 1094, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409306

RESUMO

BACKGROUND: Attending antenatal care (ANC) early contribute to better birth outcomes. Studies have shown that many pregnant women in Sub-Saharan Africa do not initiate ANC early (i.e. in the first trimester). This study determined the gestational age of pregnancy at first ANC attendance. It also explored factors that influence initiation of ANC. METHODS: This cross-sectional study, conducted in Ghana, used mixed methods to collect data from women aged 15-45 years who delivered 6 months prior to the study. Crosstabs, chi-square test and logistic regression were used to analyse quantitative data. Also, 33 participants were engaged in focus group discussions (FGDs). Thematic content analysis was used to develop themes from the data. RESULTS: Of the 431 participants, 8.9, 8, 25.4, 45.3 and 10.7% started ANC in the first, second, third, fourth and fifth months of pregnancy respectively. Formal education, employment and number of living children were predictors of initiating ANC early; by 12 weeks of gestation. Women who attained primary, junior high, secondary education and above had 5.6, 57.5 and 163.2 higher odds respectively of initiating ANC in the first trimester compared to women with no education (p ≤ 0.05). Women with two, three and four to nine living children were 4.1, 3 and 3.5 times respectively more likely to access ANC early compared to primigravidae women. However, women with five or more children and primigravidae women are more likely to initiate ANC late; after 12 weeks gestation. The FGD data also show that most of the participants initiated ANC late. Two themes: visible signs of pregnancy and or sickness influence ANC attendance in the first trimester. The themes that explain late initiation of ANC are: healthy, do not value the benefits of early ANC attendance, desire to avoid embarrassment associated with the pregnancy, unplanned pregnancy, indirect cost of accessing ANC and traditional rites and practices. CONCLUSION: Contextual factors influence ANC initiation. Investment in female education, intensification of health promotion activities by health workers, non-governmental organisations, community and religious leaders to sensitise communities on the benefits of initiating ANC at the onset of pregnancy is needed to improve first trimester attendance.


Assuntos
Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Grupos Focais , Idade Gestacional , Gana , Humanos , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , População Rural/estatística & dados numéricos , Adulto Jovem
12.
Sci Total Environ ; 695: 133855, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421341

RESUMO

BACKGROUND: Personal care products (PCPs), known sources of endocrine disrupting chemicals (EDCs) such as phthalates and parabens, are widely used among women of reproductive age. EDCs have been linked to pregnancy complications such as gestational diabetes (GDM), and PCP use could represent a modifiable source of exposure in this sensitive time window. Yet, to our knowledge, no study has directly evaluated the association between pregnancy use of PCP and late pregnancy glucose levels, established risk factors for complications such as GDM. METHODS: A total of 233 women from the Environment and Reproductive Health (EARTH) Study had data available on 1st and/or 2nd trimester PCP use, assessed through self-reported use over the previous 24 h, and blood glucose levels after the glucose loading test (GLT), taken at late 2nd trimester. Associations between each individual PCP and total PCP with glucose levels were evaluated in multivariable adjusted linear regression models. RESULTS: Both positive and negative differences in glucose levels were observed when comparing users vs. non-users of several PCPs including 2nd trimester use of deodorant (adjusted mean difference: 12.2 mg/dL, 95% CI: -0.6, 24.9); bar soap (6.9 mg/dL, 95% CI: -0.9, 14.7 mg/dL); and liquid soap (-13.3, 95% CI: -26.8, 0.1 mg/dL), and 1st trimester use of sunscreen (-14.6 mg/dL, 95% CI: -27.8, -1.5 mg/dL). Total number of PCPs used in the 2nd trimester was also associated with higher glucose levels, with the largest difference of 20 mg/dL when comparing individuals who used eight vs none PCPs (95% CI: 3-37). CONCLUSIONS: In a pregnancy cohort of women seeking care at a fertility clinic, we found the use of several PCPs to be positively or negatively associated with glucose levels in the late second trimester, which may reflect increased risk of GDM and subsequent perinatal outcomes. These results strengthen the role of product use as a potentially modifiable source of EDCs that may impact glucose levels.


Assuntos
Glicemia , Cosméticos , Poluentes Ambientais , Exposição Materna/estatística & dados numéricos , Autorrelato , Sabões , Adulto , Estudos de Coortes , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Parabenos , Ácidos Ftálicos , Gravidez , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fatores de Risco
13.
BJOG ; 126(13): 1546-1552, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31446677

RESUMO

BACKGROUND: Oral fluconazole is used to treat vulvovaginal candidiasis during pregnancy. However, there are concerns regarding the pregnancy outcomes following exposure to fluconazole. OBJECTIVES: To evaluate the pregnancy outcomes associated with exposure to oral fluconazole during the first trimester of pregnancy. SEARCH STRATEGY: A systematic literature search was conducted to identify relevant studies published from inception until April 2019. SELECTION CRITERIA: Relevant English-language citations using the terms oral fluconazole and pregnancy in humans. DATA COLLECTION: Two reviewers independently abstracted data and assessed study quality. MAIN RESULTS: Oral fluconazole use during the first trimester of pregnancy was marginally associated with an increased risk of congenital malformations (odds ratio [OR] 1.09, 95% CI 0.99-1.2, P = 0.088; n = 6 studies), whereas in the subgroup analysis, this association existed only for high-dose users (>150 mg) (OR 1. 19, 95% CI 1.01-1.4, P = 0.039; n = 2). Exposure to fluconazole also increased the risk of heart malformations (OR 1.31, 95% CI 1.09-1.57, P = 0.003; n = 4), cardiac septal defects (OR 1.3, 95% CI 1.1-1.67, P = 0.047; n = 3), and tetralogy of Fallot (OR 3.39 95% CI 1.71-6.74, P < 0.001; n = 2) in the offspring. In addition, exposure to fluconazole was significantly associated with an increased risk of spontaneous abortion (OR 1.99, 95% CI 1.38-2.88, P < 0.001; n = 3). CONCLUSIONS: Oral fluconazole use during the first trimester of pregnancy appears to be associated with heart malformations and spontaneous abortion, but a causal link cannot be proven. TWEETABLE ABSTRACT: Oral fluconazole during the first trimester of pregnancy may be associated with unfavourable pregnancy outcomes.


Assuntos
Antifúngicos/administração & dosagem , Candidíase Vulvovaginal/tratamento farmacológico , Anormalidades Craniofaciais/induzido quimicamente , Fluconazol/administração & dosagem , Anormalidades Induzidas por Medicamentos , Administração Oral , Antifúngicos/efeitos adversos , Feminino , Fluconazol/efeitos adversos , Humanos , Segurança do Paciente , Gravidez , Primeiro Trimestre da Gravidez
14.
Medicine (Baltimore) ; 98(33): e16822, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415400

RESUMO

Fetal cardiovascular malformations is widely focused and screened, but the accuracy of screening is not satisfactory. In this study, we compared the types of congenital heart malformation, accompanying diseases and fetal outcomes in the first and second trimesters of pregnancy to clarify the advantage of early screening.From January 2013 to June 2018, 230 fetuses were diagnosed with congenital heart malformations using ultrasound method in Qilu Hospital of Shandong University, and divided into 2 groups:the first trimester fetuses (group A) and the second trimester fetuses (group B). In addition, we collected and organized medical data of 347 cases diagnosed with congenital heart disease during 1998 to 2005 (group C). We compared the spectrum of congenital heart disease, associated comorbidities and outcome of fetuses diagnosed with congenital heart disease.There were differences in the types and incidence of cardiac malformations between the first and second trimesters of pregnancy. The number of cases of non-cardiac malformation, congenital heart disease with single ventricular circulation, fetal intrauterine death and premature pregnancy termination was significantly lower in the late stage (group A and group B) than that in the early stage (group C). More patients were screened for trisomy 21, 18, 13 syndromes and Turner syndrome in group A than group B (P <.001). More fetuses with a 22q11 deletion were screened in group B than group C.Early pregnancy screening using ultrasound diagnosis is very important for fetuses with congenital heart disease.


Assuntos
Feto/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal/estatística & dados numéricos , Aberrações Cromossômicas/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/genética , Humanos , Incidência , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
15.
BMC Public Health ; 19(1): 895, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286930

RESUMO

BACKGROUND: It is recommended that Antenatal Care (ANC) be initiated within the first trimester of pregnancy for essential interventions, such folic acid supplementation, to be effective. In Tanzania, only 24% of mothers attend their first ANC appointment during their first trimester. Studies have shown that women who have had contact with a health worker are more likely to attend their first antenatal care appointment earlier in pregnancy. Community health workers (CHWs) are in an opportune position to be this contact. This study explored CHW experiences with identifying women early in gestation to refer them to facility-based antenatal care services in Morogoro, Tanzania. METHODS: This qualitative study employed 10 semi-structured focus group discussions, 5 with 34 CHWs and 5 with 34 recently delivered women in three districts in Morogoro, Tanzania. A thematic analytical approach was used to identify emerging themes among the CHW and RDW responses. RESULTS: Study findings show CHWs play a major role in identifying pregnant women in their communities and linking them with health facilities. Lack of trust and other factors, however, affect early pregnancy identification by the CHWs. They utilize several methods to identify pregnant women, including: asking direct questions to households when collecting information on the national census, conducting frequent household visits and getting information about pregnant women from health facilities. CONCLUSIONS: We present a framework for the interaction of factors that affect CHWs' ability to identify pregnant women early in gestation. Further studies need to be conducted investigating optimal workload for CHWs, as well as reasons pregnant women might conceal their pregnancies.


Assuntos
Agentes Comunitários de Saúde/psicologia , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Agendamento de Consultas , Feminino , Grupos Focais , Instalações de Saúde/estatística & dados numéricos , Humanos , Gravidez , Primeiro Trimestre da Gravidez/psicologia , Pesquisa Qualitativa , Medição de Risco , Tanzânia
16.
Hypertension ; 74(3): 705-715, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352818

RESUMO

Commonly used in vitro fertilization protocols produce pregnancies without a corpus luteum (CL), a major source of reproductive hormones. In vitro fertilization pregnancies without a CL showed deficient gestational increases of central (aortic) arterial compliance during the first trimester and were at increased risk for developing preeclampsia. Here, we investigated whether there was generalized impairment of cardiovascular adaptation in in vitro fertilization pregnancies without a CL compared with pregnancies conceived spontaneously or through ovarian stimulation, which lead to 1 and >1 CL, respectively (n=19-26 participants per cohort). Prototypical maternal cardiovascular adaptations of gestation were serially evaluated noninvasively, initially during the follicular phase before conception, 6× in pregnancy, and then, on average, 1.6 years post-partum. The expected increases of cardiac output, left atrial dimension, peak left ventricular filling velocity in early diastole (E wave velocity), peripheral/central arterial pulse pressure ratio, and global AC, as well as decrease in augmentation index were significantly attenuated or absent during the first trimester in women who conceived without a CL, when compared with the 1 and >1 CL cohorts, which were comparable. Thereafter, these cardiovascular measures showed recovery in the 0 CL group except for E wave velocity, which remained depressed. These results provided strong support for a critical role of CL factor(s) in the transformation of the maternal cardiovascular system in early gestation. Regimens that lead to the development of a CL or replacement of missing CL factor(s) may be indicated to improve cardiovascular function and reduce preeclampsia risk in in vitro fertilization pregnancies.


Assuntos
Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/fisiopatologia , Corpo Lúteo/patologia , Fertilização In Vitro/efeitos adversos , Saúde Materna , Adulto , Análise de Variância , Débito Cardíaco/fisiologia , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Testes de Função Cardíaca , Humanos , Modelos Lineares , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Análise de Onda de Pulso
17.
Medicine (Baltimore) ; 98(26): e16203, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261566

RESUMO

RATIONALE: Essential thrombocytosis (ET) is a myeloproliferative neoplasm characterized by clonal proliferation of the megakaryocytic lineage within the bone marrow and phenotypically by an elevated platelet count in peripheral blood. Common vascular complications include thrombosis, microvascular disturbances, and hemorrhage. ET with recurrent spontaneous abortion as the primary symptom is rare. PATIENT CONCERNS: A 30-year-old pregnant woman (gestational age: 8 weeks) with a history of recurrent spontaneous abortion in the mid trimester was admitted to our hospital for further management. DIAGNOSIS: The diagnosis of ET was made based on the platelet count, bone marrow biopsy, and molecular biology testing. INTERVENTIONS: The patient was treated with interferon, heparin, and aspirin. OUTCOMES: The infant was delivered by cesarean section without complication at 28 weeks gestation due to placental abruption. The child remained healthy with no developmental abnormalities during follow-up for 2 years. LESSONS: Recurrent spontaneous abortion in the mid trimester might be associated with ET. Thus, a detailed investigation including blood routine examination to identify an abnormal platelet count is warranted for pregnant patients with such a history in order to facilitate timely treatment.


Assuntos
Aborto Espontâneo/diagnóstico , Trombocitemia Essencial/diagnóstico , Aborto Espontâneo/genética , Aborto Espontâneo/patologia , Adulto , Medula Óssea/patologia , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Trombocitemia Essencial/genética , Trombocitemia Essencial/patologia , Trombocitemia Essencial/terapia
18.
Cochrane Database Syst Rev ; 6: CD002253, 2019 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-31206170

RESUMO

BACKGROUND: In most pregnancies that miscarry, arrest of embryonic or fetal development occurs some time (often weeks) before the miscarriage occurs. Ultrasound examination can reveal abnormal findings during this phase by demonstrating anembryonic pregnancies or embryonic or fetal death. Treatment has traditionally been surgical but medical treatments may be effective, safe, and acceptable, as may be waiting for spontaneous miscarriage. This is an update of a review first published in 2006. OBJECTIVES: To assess, from clinical trials, the effectiveness and safety of different medical treatments for the termination of non-viable pregnancies. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (24 October 2018) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials comparing medical treatment with another treatment (e.g. surgical evacuation), or placebo, or no treatment for early pregnancy failure. Quasi-randomised studies were excluded. Cluster-randomised trials were eligible for inclusion, as were studies reported in abstract form, if sufficient information was available to assess eligibility. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Forty-three studies (4966 women) were included. The main interventions examined were vaginal, sublingual, oral and buccal misoprostol, mifepristone and vaginal gemeprost. These were compared with surgical management, expectant management, placebo, or different types of medical interventions were compared with each other. The review includes a wide variety of different interventions which have been analysed across 23 different comparisons. Many of the comparisons consist of single studies. We limited the grading of the quality of evidence to two main comparisons: vaginal misoprostol versus placebo and vaginal misoprostol versus surgical evacuation of the uterus. Risk of bias varied widely among the included trials. The quality of the evidence varied between the different comparisons, but was mainly found to be very-low or low quality.Vaginal misoprostol versus placeboVaginal misoprostol may hasten miscarriage when compared with placebo: e.g. complete miscarriage (5 trials, 305 women, risk ratio (RR) 4.23, 95% confidence interval (CI) 3.01 to 5.94; low-quality evidence). No trial reported on pelvic infection rate for this comparison. Vaginal misoprostol made little difference to rates of nausea (2 trials, 88 women, RR 1.38, 95% CI 0.43 to 4.40; low-quality evidence), diarrhoea (2 trials, 88 women, RR 2.21, 95% CI 0.35 to 14.06; low-quality evidence) or to whether women were satisfied with the acceptability of the method (1 trial, 32 women, RR 1.17, 95% CI 0.83 to 1.64; low-quality evidence). It is uncertain whether vaginal misoprostol reduces blood loss (haemoglobin difference > 10 g/L) (1 trial, 50 women, RR 1.25, 95% CI 0.38 to 4.12; very-low quality) or pain (opiate use) (1 trial, 84 women, RR 5.00, 95% CI 0.25 to 101.11; very-low quality), because the quality of the evidence for these outcomes was found to be very low.Vaginal misoprostol versus surgical evacuation Vaginal misoprostol may be less effective in accomplishing a complete miscarriage compared to surgical management (6 trials, 943 women, average RR 0.40, 95% CI 0.32 to 0.50; Heterogeneity: Tau² = 0.03, I² = 46%; low-quality evidence) and may be associated with more nausea (1 trial, 154 women, RR 21.85, 95% CI 1.31 to 364.37; low-quality evidence) and diarrhoea (1 trial, 154 women, RR 40.85, 95% CI 2.52 to 662.57; low-quality evidence). There may be little or no difference between vaginal misoprostol and surgical evacuation for pelvic infection (1 trial, 618 women, RR 0.73, 95% CI 0.39 to 1.37; low-quality evidence), blood loss (post-treatment haematocrit (%) (1 trial, 50 women, mean difference (MD) 1.40%, 95% CI -3.51 to 0.71; low-quality evidence), pain relief (1 trial, 154 women, RR 1.42, 95% CI 0.82 to 2.46; low-quality evidence) or women's satisfaction/acceptability of method (1 trial, 45 women, RR 0.67, 95% CI 0.40 to 1.11; low-quality evidence).Other comparisonsBased on findings from a single trial, vaginal misoprostol was more effective at accomplishing complete miscarriage than expectant management (614 women, RR 1.25, 95% CI 1.09 to 1.45). There was little difference between vaginal misoprostol and sublingual misoprostol (5 trials, 513 women, average RR 0.84, 95% CI 0.61 to 1.16; Heterogeneity: Tau² = 0.10, I² = 871%; or between oral and vaginal misoprostol in terms of complete miscarriage at less than 13 weeks (4 trials, 418 women), average RR 0.68, 95% CI 0.45 to 1.03; Heterogeneity: Tau² = 0.13, I² = 90%). However, there was less abdominal pain with vaginal misoprostol in comparison to sublingual (3 trials, 392 women, RR 0.58, 95% CI 0.46 to 0.74). A single study (46 women) found mifepristone to be more effective than placebo: miscarriage complete by day five after treatment (46 women, RR 9.50, 95% CI 2.49 to 36.19). However the quality of this evidence is very low: there is a very serious risk of bias with signs of incomplete data and no proper intention-to-treat analysis in the included study; and serious imprecision with wide confidence intervals. Mifepristone did not appear to further hasten miscarriage when added to a misoprostol regimen (3 trials, 447 women, RR 1.18, 95% CI 0.95 to 1.47). AUTHORS' CONCLUSIONS: Available evidence from randomised trials suggests that medical treatment with vaginal misoprostol may be an acceptable alternative to surgical evacuation or expectant management. In general, side effects of medical treatment were minor, consisting mainly of nausea and diarrhoea. There were no major differences in effectiveness between different routes of administration. Treatment satisfaction was addressed in only a few studies, in which the majority of women were satisfied with the received intervention. Since the quality of evidence is low or very low for several comparisons, mainly because they included only one or two (small) trials; further research is necessary to assess the effectiveness, safety and side effects, optimal route of administration and dose of different medical treatments for early fetal death.


Assuntos
Morte Fetal , Mifepristona , Misoprostol , Ocitócicos , Parto Obstétrico , Feminino , Humanos , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Gravidez , Primeiro Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Environ Pollut ; 252(Pt A): 330-335, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158661

RESUMO

Aluminum is a widely distributed metal that has been reported to have embryotoxicity and fetotoxicity in animal studies. However, there has been no study of the association between prenatal aluminum exposure and newborn mitochondrial DNA copy number (mtDNAcn). We aimed to investigate the effect of prenatal aluminum exposure on newborn mtDNAcn. A total of 762 mother-newborn pairs were recruited between November 2013 and March 2015 in Wuhan city, China. We measured maternal urinary aluminum concentrations at three trimesters of pregnancy. Relative mtDNAcn was measured in DNA extracted from umbilical cord blood samples. We used generalized estimating equations to assess the relationship between prenatal aluminum exposure and newborn mtDNAcn. The geometric means of creatinine corrected aluminum concentrations were 31.0 µg/g Cr (95% CI: 27.6, 34.7), 40.9 µg/g Cr (95% CI: 35.7, 46.8) and 58.4 µg/g Cr (95% CI: 51.2, 67.4) for the first, second and third trimesters, respectively. After adjustment for potential confounding factors, a doubling of maternal urinary aluminum concentrations during the second and third trimesters was related to 3.16% (95% CI: 0.88, 5.49) and 4.20% (95% CI: 1.64, 6.81) increases in newborn mtDNAcn, respectively, while the association between maternal urinary aluminum concentration during the first trimester and newborn mtDNAcn was not significant (percent difference: 0.70%, 95% CI: -2.25, 3.73). Prenatal aluminum exposure during the second and third trimesters was positively associated with newborn mtDNAcn. Further studies are essential to elucidate on the potential health consequences of newborn mtDNAcn.


Assuntos
Alumínio/toxicidade , Variações do Número de Cópias de DNA/efeitos dos fármacos , DNA Mitocondrial/genética , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/genética , Adulto , Alumínio/urina , China , Cidades , Variações do Número de Cópias de DNA/genética , Feminino , Humanos , Recém-Nascido , Masculino , Mitocôndrias/genética , Gravidez , Primeiro Trimestre da Gravidez
20.
Int J Mol Sci ; 20(12)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31216670

RESUMO

The aim of the study was to verify if quantification of placental specific C19MC microRNAs in plasma exosomes would be able to differentiate during the early stages of gestation between patients subsequently developing pregnancy-related complications and women with the normal course of gestation and if this differentiation would lead to the improvement of the diagnostical potential. The retrospective study on singleton Caucasian pregnancies was performed within 6/2011-2/2019. The case control study, nested in a cohort, involved women that later developed GH (n = 57), PE (n = 43), FGR (n = 63), and 102 controls. Maternal plasma exosome profiling was performed with the selection of C19MC microRNAs with diagnostical potential only (miR-516b-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, and miR-525-5p) using real-time RT-PCR. The down-regulation of miR-517-5p, miR-520a-5p, and miR-525-5p was observed in patients with later occurrence of GH and PE. Maternal plasma exosomal profiling of selected C19MC microRNAs also revealed a novel down-regulated biomarker during the first trimester of gestation (miR-520a-5p) for women destinated to develop FGR. First trimester circulating plasma exosomes possess the identical C19MC microRNA expression profile as placental tissues derived from patients with GH, PE and FGR after labor. The predictive accuracy of first trimester C19MC microRNA screening (miR-517-5p, miR-520a-5p, and miR-525-5p) for the diagnosis of GH and PE was significantly higher in the case of expression profiling of maternal plasma exosomes compared to expression profiling of the whole maternal plasma samples.


Assuntos
MicroRNA Circulante , Exossomos , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/diagnóstico , Hipertensão Induzida pela Gravidez/sangue , Hipertensão Induzida pela Gravidez/diagnóstico , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Biomarcadores , Exossomos/metabolismo , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Prognóstico , Curva ROC
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