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1.
Medicine (Baltimore) ; 100(41): e27505, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731133

RESUMO

OBJECTIVE: To analyze the level of vitamin D and its influencing factors in pregnant women, and to explore the influence of vitamin D deficiency on common adverse pregnancy outcomes in pregnant women, providing evidence for prevention and intervention of vitamin D deficiency in pregnant women. METHODS: The basic data and blood samples of pregnant women in our hospital from January 2019 to June 2020 were collected, and the 25-(OH) D levels of the serum samples were detected. Then the vitamin D levels and its influencing factors were analyzed, and the relationships between vitamin D levels and common adverse pregnancy outcomes in the pregnant women as well as the incidence of small-for-gestational-age newborns were analyzed. RESULTS: The vitamin D deficiency rate, insufficiency rate and sufficiency rate of pregnant women were 83.28%, 15.36%, and 1.36% respectively, with vast majority of the pregnant women in a state of vitamin D deficiency. Analysis of the influencing factors on the vitamin D level of pregnant women showed "28 weeks ≤ gestational age ≤32 weeks, summer and autumn, high school education and above, weekly time outdoors ≥10 hours, supplement of vitamin D and trace elements during pregnancy" were protective factors for vitamin D sufficiency in pregnant women. Linear correlation analysis showed the vitamin D level of pregnant women was highly positively correlated with temperature, the higher the temperature, the higher the vitamin D level (r = 0.907, t = 6.818, P < .001). The level of vitamin D in pregnant women was related to the occurrence of spontaneous abortion and small-for-gestational age (SGA), with the incidence of spontaneous abortion and SGA in the "vitamin D deficiency group" higher than those of other groups (P = .018, P = .016). CONCLUSIONS: The vitamin D level of pregnant women in this area is relatively low, which is affected by multiple factors such as gestational age, season, education level of pregnant women, weekly time outdoors, vitamin D and trace element supplement during pregnancy. Low vitamin D levels can increase the risk of spontaneous abortion and SGA in pregnant women, so relevant measures should be adopted to improve the vitamin D status of pregnant women.


Assuntos
Aborto Espontâneo/etiologia , Retardo do Crescimento Fetal/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Escolaridade , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Fatores de Risco , Estações do Ano , Vitamina D/análogos & derivados , Deficiência de Vitamina D/prevenção & controle , Adulto Jovem
2.
BMJ Open ; 11(8): e047949, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389570

RESUMO

INTRODUCTION: Pregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin-thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect 'correcting' the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women. METHODS AND ANALYSIS: This is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks' gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level. ETHICAL APPROVAL: Ethical approval has been granted by the Health Research and Ethics committees of the recruiting hospitals and the National Health Research and Ethics Committee. Study findings will be presented at conferences and published appropriately. TRAIL REGISTRATION NUMBER: PACTR202001787519553; Pre-results.


Assuntos
Anemia Falciforme , Pré-Eclâmpsia , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Aspirina , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/prevenção & controle , Humanos , Nigéria , Placenta , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Resultado da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
J Pediatr ; 238: 153-160.e4, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34216627

RESUMO

OBJECTIVE: To determine whether maternal preeclampsia is an independent risk factor for poorer academic school performance in offspring, taking into account important perinatal and child factors. STUDY DESIGN: A population-based cohort study using record-linkage of state-wide data was undertaken. We evaluated children born at 28+ weeks of gestation in New South Wales, Australia who had grade 3 record-linked education outcomes via the National Assessment Program-Literacy and Numeracy (NAPLAN) between 2009 and 2014. Children with in utero preeclampsia exposure were compared with those without exposure. Robust multivariable Poisson models were used to determine adjusted relative risks. RESULTS: Crude models demonstrated an increased risk of scoring below the national minimal standard in all 5 domains (reading, writing, spelling, grammar and punctuation, and numeracy) for children exposed to preeclampsia, ranging from a relative risk (RR) of 1.13 (95% CI, 1.04-1.24) for reading to 1.19 (95% CI, 1.09-1.30) for numeracy. These differences were attenuated once adjusted for perinatal and child factors (RR, 1.07 [95% CI, 0.97-1.18] to 1.11 (95% CI, 0.99-1.22]), with combined perinatal and childhood factors mediating between 35.7% (writing) to 55.1% (spelling) of the association. Gestational age at birth was the most important perinatal factor, explaining 10.5% (grammar and punctuation) to 20.6% (writing) of the association between preeclampsia and poor school performance, followed by small for gestational age. CONCLUSION: The poorer educational performance experienced by children born to women with preeclampsia appears largely attributable to perinatal and childhood factors, suggesting an opportunity to improve school performance in children exposed to preeclampsia by optimizing these perinatal factors, particularly gestational age at birth.


Assuntos
Desempenho Acadêmico/estatística & dados numéricos , Pré-Eclâmpsia/epidemiologia , Adulto , Estudos de Casos e Controles , Causalidade , Criança , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Masculino , New South Wales , Gravidez
4.
Sci Rep ; 11(1): 15016, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294801

RESUMO

Low birth weight (< 2500 g; LBW) and macrosomia (> 4000 g) are both adverse birth outcomes with high health risk in short- or long-term period. However, national prevalence estimates of LBW and macrosomia varied partially due to methodology limits in China. The aim of this study is to estimate the prevalence of LBW and macrosomia after taking potential birth weight heaping into consideration in Chinese children under 6 years in 2013. The data were from a nationally representative cross-sectional survey in mainland China in 2013, which consists of 32,276 eligible records. Birth weight data and socio-demographic information was collected using standard questionnaires. Birth weight distributions were examined and LBW and macrosomia estimates were adjusted for potential heaping. The overall prevalence of LBW of Chinese children younger than 6 years was 5.15% in 2013, with 4.57% in boys and 5.68% in girls. LBW rate was higher for children who were minority ethnicity, had less educated mothers, mothers aged over 35 years or under 20 years, or were in lower income household than their counterparts. The overall prevalence of macrosomia of Chinese children younger than 6 years was 7.35% in 2013, with 8.85% in boys and 5.71% in girls. The prevalence of macrosomia increased with increasing maternal age, educational level and household income level. Both LBW and macrosomia varied among different regions and socio-economic groups around China. It is found that estimates based on distribution adjustment might be more accurate and could be used as the foundation for policy-decision and health resource allocation. It would be needed to take potential misclassification of birth weight data arising from heaping into account in future studies.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Recém-Nascido de Baixo Peso , Peso ao Nascer , Pré-Escolar , China/epidemiologia , Suscetibilidade a Doenças , Feminino , Retardo do Crescimento Fetal/etiologia , Macrossomia Fetal/etiologia , Humanos , Lactente , Masculino , Prevalência , Vigilância em Saúde Pública
5.
J Korean Med Sci ; 36(29): e192, 2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34313034

RESUMO

BACKGROUND: Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery. METHODS: Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models. RESULTS: Data from 4,439,778 women were collected for this study. From 2006-2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81-2.23), LBW (HR, 1.62; 95% CI, 1.46-1.79), C/S (HR, 1.13; 95% CI, 1.08-1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18-1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40-0.95). CONCLUSION: Non-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.


Assuntos
Anexos Uterinos/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Pelve/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Cesárea/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , República da Coreia , Resultado do Tratamento , Adulto Jovem
6.
Epidemiology ; 32(6): 860-867, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34270495

RESUMO

BACKGROUND: Fetal growth restriction is commonly defined using small for gestational age (SGA) birth (birthweight < 10th percentile) as a proxy, but this approach is problematic because most SGA infants are small but healthy. In this proof-of-concept study, we sought to develop a new approach for identifying fetal growth restriction at birth that combines information on multiple, imperfect measures of fetal growth restriction in a probabilistic manner. METHODS: We combined information on birthweight, placental weight, placental malperfusion lesions, maternal disease, and fetal acidemia using latent profile analysis to classify fetal growth in births at the Royal Victoria Hospital in Montreal, Canada, 2001-2009. We examined the clinical characteristics and health outcomes of infants classified as growth-restricted and nongrowth-restricted by our model, and among the subgroup of growth-restricted infants who had a birthweight ≥10th percentile (i.e., would have been missed by the conventional SGA proxy). RESULTS: Among 26,077 births, 345 (1.3%) were classified as growth-restricted by our latent profile model. Growth-restricted infants were more likely than nongrowth-restricted infants to have an Apgar score <7 (10% vs. 2%), have hypoglycemia at birth (17% vs. 3%), require neonatal intensive care unit admission (59% vs. 6%), die in the perinatal period (3.8% vs. 0.2%), and require an emergency cesarean delivery (42% vs. 15%). Risks remained elevated in growth-restricted infants who were not SGA, suggesting our model identified at-risk infants not detected using the SGA proxy. CONCLUSIONS: Latent profile analysis is a promising strategy for classifying growth restriction at birth in fetal growth restriction research.


Assuntos
Retardo do Crescimento Fetal , Placenta , Peso ao Nascer , Feminino , Desenvolvimento Fetal , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez
7.
PLoS One ; 16(6): e0253796, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34170973

RESUMO

BACKGROUND: Prior studies have demonstrated an increased stillbirth rate. It was suggested that the COVID-19 pandemic may have impacted on attendances for reduced fetal movements. Thus, we sought to ascertain the impact of the pandemic on attendances for reduced fetal movements (RFM) in our unit, ultrasound provision for reduced fetal movements, and the stillbirth rate. METHODS: This was a single site retrospective cohort study involving all women complaining of a 1st episode of reduced fetal movements between 01/03/2020-30/04/2020 (COVID) to 01/03/2019-30/04/2019 (Pre-COVID). Data were retrieved from computerised hospital records and statistical analyses were performed using GraphPad Prism and SPSS. RESULTS: 22% (179/810) of women presented with a 1st episode of reduced fetal movements Pre-COVID compared to 18% (145/803) during COVID (p = 0.047). Primiparous women were significantly over-represented in this population with a 1.4-fold increase in attendances during COVID (67% vs 48%, p = 0.0005). Neither the total stillbirth rate nor the stillbirth rate amongst women who presented with reduced fetal movements changed during COVID. Ultrasound provision was not impacted by COVID with 95% of the scans performed according to local guidelines, compared to Pre-COVID (74%, p = 0.0001). CONCLUSIONS: There is a significant decrease in 1st attendances for reduced fetal movements during COVID-19 pandemic. Primiparous women were 1.4 times more likely to attend with RFM. Women should be reassured that COVID-19 has not resulted in a decreased provision of care for RFM, and has not impacted on the stillbirth rate.


Assuntos
COVID-19/epidemiologia , Retardo do Crescimento Fetal , Movimento Fetal , SARS-CoV-2 , Natimorto/epidemiologia , Ultrassonografia Pré-Natal , Adulto , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos
8.
Nutrients ; 13(6)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067270

RESUMO

BACKGROUND: Plasma albumin (ALB) reflects protein nutritional status in rats, but it is not clear whether it is associated with dietary protein insufficiency in pregnant women and/or their risk of low birth weight delivery. This study aimed to investigate whether maternal serum ALB redox state reflects maternal protein nutritional status and/or is associated with infant birth weights. METHODS: The relationship between the serum reduced ALB ratio and infant birth weight was examined in an observational study of 229 Japanese pregnant women. A rat model simulating fetal growth restriction, induced by protein-energy restriction, was used to elucidate the relationship between maternal nutritional status, maternal serum ALB redox state, and birth weight of the offspring. RESULTS: In the human study, serum reduced ALB ratio in the third trimester was significantly and positively correlated with infant birth weight. In the rat study, serum reduced ALB ratio and birth weight in the litter decreased as the degree of protein-energy restriction intensified, and a significant and positive correlation was observed between them in late pregnancy. CONCLUSIONS: Maternal serum reduced ALB ratio in the third trimester is positively associated with infant birth weight in Japanese pregnant women, which would be mediated by maternal protein nutritional status.


Assuntos
Peso ao Nascer , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Albumina Sérica/análise , Adulto , Animais , Proteínas na Dieta/administração & dosagem , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Japão , Oxirredução , Gravidez , Terceiro Trimestre da Gravidez/sangue , Gestantes , Ratos , Ratos Wistar
9.
Epidemiology ; 32(5): 664-671, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34086648

RESUMO

BACKGROUND: Being born small for gestational age (SGA, <10th percentile) is a risk factor for worse neurodevelopmental outcomes. However, this group is a heterogeneous mix of healthy and growth-restricted babies, and not all will experience poor outcomes. We sought to determine whether fetal growth trajectories can distinguish who will have the worst neurodevelopmental outcomes in childhood among babies born SGA. METHODS: The present analysis was conducted in Generation R, a population-based cohort in Rotterdam, the Netherlands (N = 5,487). Using group-based trajectory modeling, we identified fetal growth trajectories for weight among babies born SGA. These were based on standard deviation scores of ultrasound measures from mid-pregnancy and late pregnancy in combination with birth weight. We compared child nonverbal intelligence quotient (IQ) and attention deficit hyperactivity disorder (ADHD) symptoms at age 6 between SGA babies within each growth trajectory to babies born non-SGA. RESULTS: Among SGA individuals (n = 656), we identified three distinct fetal growth trajectories for weight. Children who were consistently small from mid-pregnancy (n = 64) had the lowest IQ (7 points lower compared to non-SGA babies, 95% confidence interval [CI] = -11.0, -3.5) and slightly more ADHD symptoms. Children from the trajectory that started larger but were smaller at birth showed no differences in outcomes compared to children born non-SGA. CONCLUSIONS: Among SGA children, those who were smaller beginning in mid-pregnancy exhibited the worst neurodevelopmental outcomes at age 6. Fetal growth trajectories may help identify SGA babies who go on to have poor neurodevelopmental outcomes.


Assuntos
Desenvolvimento Fetal , Recém-Nascido Pequeno para a Idade Gestacional , Peso ao Nascer , Criança , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez
10.
Obstet Gynecol Clin North Am ; 48(2): 267-279, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972065

RESUMO

Abnormal fetal growth (growth restriction and overgrowth) is associated with perinatal morbidity, mortality, and lifelong risks to health. To describe abnormal growth, "small for gestational age" and "large for gestational age" are commonly used terms. However, both are statistical definitions of fetal size below or above a certain threshold related to a reference population, rather than referring to an abnormal condition. Fetuses can be constitutionally small or large and thus healthy, whereas fetuses with seemingly normal size can be growth restricted or overgrown. Although golden standards to detect abnormal growth are lacking, understanding of both pathologic conditions has improved significantly.


Assuntos
Desenvolvimento Fetal , Retardo do Crescimento Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Macrossomia Fetal/diagnóstico por imagem , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Placenta/diagnóstico por imagem , Insuficiência Placentária/diagnóstico por imagem , Insuficiência Placentária/epidemiologia , Gravidez , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/diagnóstico por imagem
11.
Obstet Gynecol Clin North Am ; 48(2): 297-310, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972067

RESUMO

Fetal growth restriction (FGR) is a common clinical manifestation of placental insufficiency. As such, FGR is a risk factor for stillbirth. This association has been demonstrated in numerous studies but is prone to overestimation because of the possibility of prolonged in utero retention before the recognition of the fetal death. Stillbirth risk reduction by optimizing maternal medical conditions and exposures and appropriate antenatal testing and delivery timing are essential to pregnancies affected by FGR. It is important to evaluate stillbirths with FGR with fetal autopsy, placental pathology, genetic testing, and assessment of antiphospholipid antibodies and fetal-maternal hemorrhage.


Assuntos
Desenvolvimento Fetal , Retardo do Crescimento Fetal/epidemiologia , Natimorto/epidemiologia , Autopsia/métodos , Feminino , Morte Fetal , Feto , Testes Genéticos/métodos , Idade Gestacional , Humanos , Placenta/patologia , Insuficiência Placentária/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Fatores de Risco
12.
Obstet Gynecol Clin North Am ; 48(2): 311-323, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972068

RESUMO

Fetal growth restriction (FGR) describes a fetus' inability to attain adequate weight gain based on genetic potential and gestational age and is the second most common cause of perinatal morbidity and mortality after prematurity. Infants who have suffered fetal growth restriction are at the greatest risks for short- and long-term complications. This article specifically details the neurologic and cardiometabolic sequalae associated with fetal growth restriction, as well as the purported mechanisms that underlie their pathogenesis. We end with a brief discussion about further work that is needed to gain a more complete understanding of fetal growth restriction.


Assuntos
Doenças Cardiovasculares/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Síndrome Metabólica/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Doenças Cardiovasculares/complicações , Epigenômica/métodos , Feminino , Retardo do Crescimento Fetal/genética , Peso Fetal , Feto , Expressão Gênica , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Síndrome Metabólica/complicações , Doenças do Sistema Nervoso/complicações , Gravidez , Fatores de Risco
13.
Obstet Gynecol Clin North Am ; 48(2): 401-417, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972074

RESUMO

Multifetal gestation pregnancies present a clinical challenge due to unique complications including growth issues, prematurity, maternal risk, and pathologic processes, such as selective intrauterine growth restriction (sIUGR), twin-to-twin transfusion syndrome (TTTS), and twin anemia-polycythemia sequence. If sIUGR is found, then management may involve some combination of increased surveillance, fetal procedures, and/or delivery. The combination of sIUGR with TTTS or other comorbidities increases the risk of pregnancy complications. Multifetal pregnancy reduction is an option when a problem is confined to a single fetus or when weighing the risks and benefits of a multifetal gestation in comparison to a singleton pregnancy.


Assuntos
Desenvolvimento Fetal , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/terapia , Gravidez de Gêmeos , Anemia/epidemiologia , Comorbidade , Parto Obstétrico/métodos , Feminino , Retardo do Crescimento Fetal/epidemiologia , Transfusão Feto-Fetal/epidemiologia , Humanos , Policitemia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Redução de Gravidez Multifetal/métodos , Fatores de Risco , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos
14.
Obstet Gynecol Clin North Am ; 48(2): 419-436, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33972075

RESUMO

Fetal growth restriction (FGR) is a common obstetric complication that predisposes to mortality across the lifespan. Women with a prior pregnancy affected by FGR have a 20% to 30% risk of recurrence, but effective preventive strategies are lacking. Pharmacologic interventions to prevent FGR are lacking. Low-dose aspirin may be somewhat effective, but low-molecular-weight heparin and sildenafil are not. Surveillance in a subsequent pregnancy may consist of serial ultrasonography with timing and frequency determined by the clinical severity in the index pregnancy. Once FGR is diagnosed, the principal management strategy consists of close surveillance and carefully timed delivery.


Assuntos
Retardo do Crescimento Fetal/prevenção & controle , Retardo do Crescimento Fetal/terapia , Adulto , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Parto Obstétrico/métodos , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Pessoa de Meia-Idade , Pré-Eclâmpsia/terapia , Gravidez , Resultado da Gravidez , Recidiva , Fatores de Risco , Fumar/epidemiologia , Natimorto/epidemiologia , Ultrassonografia Pré-Natal/métodos
15.
Obstet Gynecol ; 137(6): e128-e144, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34011890

RESUMO

Obstetrician-gynecologists are the leading experts in the health care of women, and obesity is the most common medical condition in women of reproductive age. Obesity in women is such a common condition that the implications relative to pregnancy often are unrecognized, overlooked, or ignored because of the lack of specific evidence-based treatment options. The management of obesity requires long-term approaches ranging from population-based public health and economic initiatives to individual nutritional, behavioral, or surgical interventions. Therefore, an understanding of the management of obesity during pregnancy is essential, and management should begin before pregnancy and continue through the postpartum period. Although the care of the obese woman during pregnancy requires the involvement of the obstetrician or other obstetric care professional, additional health care professionals, such as nutritionists, can offer specific expertise related to management depending on the comfort level of the obstetric care professional. The purpose of this Practice Bulletin is to offer an integrated approach to the management of obesity in women of reproductive age who are planning a pregnancy.


Assuntos
Parto Obstétrico/normas , Obesidade Materna/epidemiologia , Cuidado Pós-Natal/normas , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Anestesia Obstétrica/normas , Ácidos Nucleicos Livres/análise , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Morte Fetal/prevenção & controle , Retardo do Crescimento Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Humanos , Obesidade Materna/complicações , Obesidade Materna/prevenção & controle , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/normas , Natimorto , Ultrassonografia Pré-Natal , Ganho de Peso
16.
Lupus ; 30(7): 1031-1038, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33840282

RESUMO

INTRODUCTION: Pregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN). PATIENTS AND METHODS: The study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section. RESULTS: Women with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035). CONCLUSIONS: Lupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Nefrite Lúpica/complicações , Pré-Eclâmpsia/etiologia , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Humanos , Incidência , Lúpus Eritematoso Sistêmico/diagnóstico , Nefrite Lúpica/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia
17.
Am J Obstet Gynecol ; 225(4): 413.e1-413.e11, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33812813

RESUMO

BACKGROUND: Placental pathologic lesions suggesting maternal or fetal vascular malperfusion are common among pregnancies complicated by intrauterine growth restriction. Data on the relationship between pathologic placental lesions and subsequent infant neurodevelopmental outcomes are limited. OBJECTIVE: This study aimed to assess the relationship between placental pathologic lesions and infant neurodevelopmental outcomes at 2 years of age in a cohort of pregnancies complicated by intrauterine growth restriction. STUDY DESIGN: An observational cohort study included singleton intrauterine growth restriction pregnancies delivered at ≤34 weeks' gestation and with a birthweight of ≤1500 g at a single institution in the period between 2007 and 2016. Maternal and neonatal data were collected at discharge from the hospital. Infant neurodevelopmental assessment was performed every 3 months during the first year of life and every 6 months in the second year. Penalized logistic regression was used to test the association of maternal vascular malperfusion and fetal vascular malperfusion with infant outcomes adjusting for confounders. RESULTS: Of the 249 pregnancies enrolled, neonatal mortality was 8.8% (22 of 249). Severe and overall maternal vascular malperfusion were 16.1% (40 of 249) and 31.7% (79 of 249), respectively. Severe maternal vascular malperfusion was associated with an increased risk of neonatal mortality (adjusted odds ratio, 3.3; 95% confidence interval, 1.2-9.5). Among the 198 survivors after a 2-year neurodevelopmental follow-up evaluation, the rate of major and minor neurodevelopmental sequelae was 57.1% (4 of 7) among severe fetal vascular malperfusion (adjusted odds ratio, 24.5; 95% confidence interval, 4.1-146), 44.8% (13 of 29) among overall fetal vascular malperfusion (adjusted odds ratio, 5.8; 95% confidence interval, 5.1-16.2), and 7.1% (12 of 169) in pregnancies without fetal vascular malperfusion. Infants born from pregnancies with fetal vascular malperfusion also had lower 2-year general quotient, personal-social, hearing and speech, and performance subscales scores than those without fetal vascular malperfusion. Finally, in the presence of fetal vascular malperfusion, the likelihood of a 2-year infant survival with normal neurodevelopmental outcomes was reduced by more than 70% (adjusted odds ratio, 0.29; 95% confidence interval, 0.14-0.63). Noticeably, 10 of the 20 subjects with a 2-year major neurodevelopmental impairment (3 of 4 with severe fetal vascular malperfusion) had little or no abnormal neurologic findings at discharge from neonatal intensive care unit. CONCLUSION: In preterm intrauterine growth restriction, placental fetal vascular malperfusion is correlated with an increased risk of abnormal infant neurodevelopmental outcomes at 2 years of age even in the absence of brain lesions or neurologic abnormalities at discharge from the neonatal intensive care unit. In the case of a diagnosis of fetal vascular malperfusion, pediatricians and neurologists should be alerted to an increased risk of subsequent infant neurodevelopmental problems.


Assuntos
Retardo do Crescimento Fetal/patologia , Transtornos do Neurodesenvolvimento/epidemiologia , Placenta/patologia , Circulação Placentária , Adulto , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Lactente , Mortalidade Infantil , Modelos Logísticos , Razão de Chances , Gravidez , Nascimento Prematuro , Índice de Gravidade de Doença , Adulto Jovem
18.
Medicina (Kaunas) ; 57(3)2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33807607

RESUMO

Background and Objectives: COVID-19, a disease caused by SARS-CoV-2, is a public health emergency. Data on the effect of the virus on pregnancy are limited. Materials and Methods: We carried out a retrospective descriptive study, in order to evaluate the obstetric results on pregnant women in which SARS-CoV-2 was detected through RT-PCR of the nasopharyngeal swab, at admission to the maternity hospital. Results: From 16 March to 31 July 2020, 12 SARS-CoV-2 positive pregnant women have been hospitalized. Eleven were hospitalized for initiation or induction of labor, corresponding to 0.64% of deliveries in the maternity hospital. One pregnant woman was hospitalized for threatened abortion, culminating in a stillbirth at 20 weeks of gestation. Regarding the severity of the disease, nine women were asymptomatic and three had mild illness (two had associated cough and one headache). Three had relevant environmental exposure and a history of contact with infected persons. None had severe or critical illness due to SARS-CoV-2. There were no maternal deaths. The following gestational complications were observed: one stillbirth, one preterm labor, one preterm prelabor rupture of membranes, and one fetal growth restriction. Four deliveries were eutocic, two vacuum-assisted deliveries and five were cesarean sections. The indications for cesarean section were obstetric. Conclusions: SARS-CoV-2 infection was found in a minority of hospitalized pregnant women in this sample. Most are asymptomatic or have mild illness, from gestational complications to highlight stillbirth and preterm birth. There were no cases of vertical transmission by coronavirus.


Assuntos
COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , COVID-19/fisiopatologia , Cesárea , Tosse/fisiopatologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Cefaleia/fisiopatologia , Hospitalização , Maternidades , Humanos , Trabalho de Parto Induzido , Trabalho de Parto Prematuro/epidemiologia , Portugal/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Natimorto/epidemiologia , Vácuo-Extração
19.
JAMA Netw Open ; 4(4): e217491, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33885772

RESUMO

Importance: Women and families constitute the fastest-growing segments of the homeless population. However, there is limited evidence on whether women experiencing homelessness have poorer childbirth delivery outcomes and higher costs of care compared with women not experiencing homelessness. Objective: To compare childbirth delivery outcomes and costs of care between pregnant women experiencing homelessness vs those not experiencing homelessness. Design, Setting, and Participants: This cross-sectional study included 15 029 pregnant women experiencing homelessness and 308 242 pregnant women not experiencing homelessness who had a delivery hospitalization in 2014. The study used statewide databases that included all hospital admissions in 3 states (ie, Florida, Massachusetts, and New York). Delivery outcomes and delivery-associated costs were compared between pregnant women experiencing homelessness and those not experiencing homelessness cared for at the same hospital (analyzed using the overlap propensity-score weighting method and multivariable regression models with hospital fixed effects). The Benjamini-Hochberg false discovery rate procedure was used to account for multiple comparisons. Data were analyzed from January 2020 through May 2020. Exposure: Housing status at delivery hospitalization. Main Outcomes and Measures: Outcome variables included obstetric complications (ie, antepartum hemorrhage, placental abnormalities, premature rupture of the membranes, preterm labor, and postpartum hemorrhage), neonatal complications (ie, fetal distress, fetal growth restriction, and stillbirth), delivery method (ie, cesarean delivery), and delivery-associated costs. Results: Among 15 029 pregnant women experiencing homelessness (mean [SD] age, 28.5 [5.9] years) compared with 308 242 pregnant women not experiencing homelessness (mean [SD] age, 29.4 [5.8] years) within the same hospital, those experiencing homelessness were more likely to experience preterm labor (adjusted probability, 10.5% vs 6.7%; adjusted risk difference [aRD], 3.8%; 95% CI, 1.2%-6.5%; adjusted P = .03) and had higher delivery-associated costs (adjusted costs, $6306 vs $5888; aRD, $417; 95% CI, $156-$680; adjusted P = .02) compared with women not experiencing homelessness. Those experiencing homelessness also had a higher probability of placental abnormalities (adjusted probability, 4.0% vs 2.0%; aRD, 1.9%; 95% CI, 0.4%-3.5%; adjusted P = .053), although this difference was not statistically significant. Conclusions and Relevance: This study found that women experiencing homelessness, compared with those not experiencing homelessness, who had a delivery and were admitted to the same hospital were more likely to experience preterm labor and incurred higher delivery-associated costs. These findings suggest wide disparities in delivery-associated outcomes between women experiencing homelessness and those not experiencing homelessness in the US. The findings highlight the importance for health care professionals to actively screen pregnant women for homelessness during prenatal care visits and coordinate their care with community health programs and social housing programs to make sure their health care needs are met.


Assuntos
Cesárea/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Trabalho de Parto Prematuro/epidemiologia , Adulto , Estudos de Casos e Controles , Cesárea/economia , Parto Obstétrico/economia , Feminino , Sofrimento Fetal/economia , Sofrimento Fetal/epidemiologia , Retardo do Crescimento Fetal/economia , Retardo do Crescimento Fetal/epidemiologia , Ruptura Prematura de Membranas Fetais/economia , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/economia , Complicações do Trabalho de Parto/epidemiologia , Trabalho de Parto Prematuro/economia , Parto , Doenças Placentárias/economia , Doenças Placentárias/epidemiologia , Hemorragia Pós-Parto/economia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/economia , Complicações Cardiovasculares na Gravidez/epidemiologia , Natimorto/economia , Natimorto/epidemiologia , Hemorragia Uterina/economia , Hemorragia Uterina/epidemiologia , Adulto Jovem
20.
Am J Obstet Gynecol ; 225(4): 420.e1-420.e13, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33872592

RESUMO

BACKGROUND: Gestational diabetes mellitus is associated with accelerated fetal growth in singleton pregnancies but may affect twin pregnancies differently because of the slower growth of twin fetuses during the third trimester of pregnancy and their greater predisposition to fetal growth restriction. OBJECTIVE: This study aimed to evaluate the association of gestational diabetes mellitus with longitudinal fetal growth in twin pregnancies and to compare this association with that observed in singleton pregnancies. STUDY DESIGN: This was a retrospective cohort study of all women with a singleton or twin pregnancy who were followed up at a single tertiary referral center between January 2011 and April 2020. Data on estimated fetal weight and individual fetal biometric indices were extracted from ultrasound examinations of eligible women. Generalized linear models were used to model and compare the change in fetal weight and individual biometric indices as a function of gestational age between women with and without gestational diabetes mellitus in twin pregnancies and between women with and without gestational diabetes mellitus in singleton pregnancies. The primary outcome was estimated fetal weight as a function of gestational age. The secondary outcomes were longitudinal growth of individual fetal biometric indices and the rate of small for gestational age and large for gestational age at birth. RESULTS: A total of 26,651 women (94,437 ultrasound examinations) were included in the analysis: 1881 with a twin pregnancy and 24,770 with a singleton pregnancy. The rate of gestational diabetes mellitus in the twin and singleton groups was 9.6% (n=180) and 7.6% (n=1893), respectively. The estimated fetal weight in singleton pregnancies with gestational diabetes mellitus was significantly higher than that in pregnancies without gestational diabetes mellitus (P<.001) starting at approximately 30 weeks of gestation. The differences remained similar after adjusting for maternal age, chronic hypertension, nulliparity, and neonatal sex (P<.001). In twin pregnancies, fetal growth was similar between pregnancies with and without gestational diabetes mellitus (P=.105 and P=.483 for unadjusted and adjusted models, respectively). The findings were similar to the association of gestational diabetes mellitus with the risk of large for gestational fetuses and the growth of each biometric index. When stratified by type of gestational diabetes mellitus treatment, twin pregnancies with gestational diabetes mellitus was associated with accelerated fetal growth only in the subgroup of women with medically treated gestational diabetes mellitus (P<.001), which represented 12% (n=21) of the twin pregnancy group with gestational diabetes mellitus. CONCLUSION: In contrast to singleton pregnancies, twin pregnancies with gestational diabetes mellitus is less likely to be associated with accelerated fetal growth. This finding has raised the question of whether the diagnostic criteria for gestational diabetes mellitus and the blood glucose targets in women diagnosed with gestational diabetes mellitus should be individualized for twin pregnancies.


Assuntos
Diabetes Gestacional/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Macrossomia Fetal/epidemiologia , Peso Fetal , Idade Gestacional , Gravidez de Gêmeos , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Retrospectivos
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