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1.
Sci Total Environ ; 855: 158830, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36150594

RESUMO

PURPOSE: This meta-analysis aimed to clarify the relationship between particulate matter (PM) and autism spectrum disorder (ASD) in detail. METHODS: A systematic literature search was performed using eight databases before April 9, 2022. The estimated effects were combined separately according to the PM type. Subgroup analyses were conducted in terms of the study design type, study location, exposure window, birth year, and sex. RESULTS: PM2.5 was associated with an increased risk of ASD, while PM10 was not. PMc, PM1, and diesel particulate matter (DPM) were also associated with an increased risk of ASD. Specifically, a 10 µg/m3 increase in PM2.5 was associated with a 1.337-fold increased risk of ASD in children, and a 10 µg/m3 increase in PMc and PM1 may increase the risk of ASD by 1.062 and 3.643 times, respectively. PM2.5 exposure may increase the risk of ASD in boys. Exposure to PMc might increase the risk of ASD in children born after the year 2000. The combined results of different PM differed between studies with continuous and non-continuous data for different study design type, study location, and birth year. The sensitive window for PM2.5 exposure to increase the risk of ASD may be from the first, second, and third trimesters to the first year of the postnatal period. Exposure to PMc during pregnancy was significantly associated with ASD. CONCLUSION: Exposure to PM2.5 may increase the risk of ASD in boys. Exposure to PM2.5 during the first, second, and third trimesters and postnatally increased the risk of ASD.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Transtorno do Espectro Autista , Humanos , Criança , Masculino , Gravidez , Feminino , Material Particulado/análise , Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/epidemiologia , Bases de Dados Factuais , Terceiro Trimestre da Gravidez , Projetos de Pesquisa , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Exposição Ambiental
2.
Int J Lab Hematol ; 44(6): 1060-1067, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36380467

RESUMO

INTRODUCTION: Mild anaemia often occurs in the third trimester of pregnancy. Particularly in the Hb range between 101-110 g/L it is difficult to determine whether the decreased haemoglobin concentration is physiological or pathological and whether supplementation is required. The aim of this study was to gain insight into the added value of measuring the percentages of microcytic RBCs (%MicroR) and hypochromic RBCs (%Hypo-He) for monitoring effects of iron supplementation in case of suspected iron-deficient erythropoiesis (IDE) in the third trimester of pregnancy. METHODS: After assessing haematological parameters and zinc protoporphyrin/heme ratio as marker for IDE, subjects were classified into a group with symptoms of IDE (n = 39) or without IDE (n = 106). The subjects with IDE (n = 39) were treated with iron supplementation. After 4 weeks effects of treatment were evaluated. RESULTS: In the group of pregnant women with IDE results of %MicroR and %Hypo-He were increased (p = <.001), compared to the group without haematological symptoms of IDE, whereas RET-He, RBC-He and delta-He were decreased (p = <.001). A significant positive correlation to increased values of %MicroR (r = .75, p = <.001) and %Hypo-He (r = .77, p = <.001) with ZPP was established. However, in the ZPP interval 75-100 µmol/mol heme a slight overlap was demonstrated between subjects with and without symptoms of IDE. After iron supplementation, %Hypo-He decreased (p = .002) while %MicroR remained stable. RET-He, delta-He and RDW-SD increased (p = <.001). CONCLUSION: The added value of %MicroR and %Hypo-He as a single marker for IDE is poor. However, combined interpretation of %MicroR, %Hypo-He, Ret-He and delta-He has added value in monitoring erythropoiesis during pregnancy.


Assuntos
Anemia Ferropriva , Ferro , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Hemoglobinas/análise , Eritrócitos/química , Suplementos Nutricionais , Anemia Ferropriva/diagnóstico
3.
BMC Cardiovasc Disord ; 22(1): 495, 2022 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-36404327

RESUMO

INTRODUCTION: Congenital heart disease (CHD) is one of the most prevalent birth defects in the world. The pathogenesis of CHD is complex and unclear. With the development of metabolomics technology, variations in metabolites may provide new clues about the causes of CHD and may serve as a biomarker during pregnancy. METHODS: Sixty-five amniotic fluid samples (28 cases and 37 controls) during the second and third trimesters were utilized in this study. The metabolomics of CHD and normal fetuses were analyzed by untargeted metabolomics technology. Differential comparison and randomForest were used to screen metabolic biomarkers. RESULTS: A total of 2472 metabolites were detected, and they were distributed differentially between the cases and controls. Setting the selection criteria of fold change (FC) ≥ 2, P value < 0.01 and variable importance for the projection (VIP) ≥ 1.5, we screened 118 differential metabolites. Within the prediction model by random forest, PE(MonoMe(11,5)/MonoMe(13,5)), N-feruloylserotonin and 2,6-di-tert-butylbenzoquinone showed good prediction effects. Differential metabolites were mainly concentrated in aldosterone synthesis and secretion, drug metabolism, nicotinate and nicotinamide metabolism pathways, which may be related to the occurrence and development of CHD. CONCLUSION: This study provides a new database of CHD metabolic biomarkers and mechanistic research. These results need to be further verified in larger samples.


Assuntos
Líquido Amniótico , Cardiopatias Congênitas , Humanos , Feminino , Gravidez , Metabolômica/métodos , Biomarcadores , Cardiopatias Congênitas/diagnóstico , Terceiro Trimestre da Gravidez
4.
BMC Pregnancy Childbirth ; 22(1): 848, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397016

RESUMO

BACKGROUND: Maternal prenatal infections have been linked to children's neurodevelopment and cognitive outcomes. It remains unclear, however, whether infections occurring during specific vulnerable gestational periods can affect children's cognitive outcomes. The study aimed to examine maternal infections in each trimester of pregnancy and associations with children's developmental and intelligence quotients. The ALSPAC birth cohort was used to investigate associations between maternal infections in pregnancy and child cognitive outcomes. METHODS: Infection data from mothers and cognition data from children were included with the final study sample size comprising 7,410 mother-child participants. Regression analysis was used to examine links between maternal infections occurring at each trimester of pregnancy and children's cognition at 18 months, 4 years, and 8 years. RESULTS: Infections in the third trimester were significantly associated with decreased verbal IQ at age 4 (p < .05, adjusted R2 = 0.004); decreased verbal IQ (p < .01, adjusted R2 = 0.001), performance IQ (p < .01, adjusted R2 = 0.0008), and total IQ at age 8 (p < .01, adjusted R2 = 0.001). CONCLUSION: Results suggest that maternal infections in the third trimester could have a latent effect on cognitive development, only emerging when cognitive load increases over time, though magnitude of effect appears to be small. Performance IQ may be more vulnerable to trimester-specific exposure to maternal infection as compared to verbal IQ. Future research could include examining potential mediating mechanisms on childhood cognition, such as possible moderating effects of early childhood environmental factors, and if effects persist in future cognitive outcomes.


Assuntos
Cognição , Mães , Gravidez , Feminino , Humanos , Pré-Escolar , Criança , Testes de Inteligência , Terceiro Trimestre da Gravidez
5.
Georgian Med News ; (328-329): 100-107, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36318851

RESUMO

Currently, in relation to the effect of this pandemic on pregnancy, there are more questions than certainties about the real impact of COVID-19 on pregnant women. Studies are updated and often contradict each other. There is no evidence to suggest that pregnant women with COVID-19 have higher morbidity than affected non-pregnant women. We aimed to know whether maternal morbidities were more frequent in pregnant woman with COVID-19 compared to non-infected pregnant women. A retrospective case control study was conducted during a period of 6 months. Medical records were reviewed. A 120 files of COVID-19 infected women from Mosul city, and 95 files of non-infected pregnant women were reviewed and analyzed. We found that Infection with COVID-19 had a significant effect on pregnancy outcome, infected women were more likely to have higher incidence rates of adverse perinatal outcomes in both mothers and the newborns. Also, higher odds of complications associated with severe disease form Findings of our study came in line with previous studies in other countries, however, more medical care and support should be provided to pregnant women infected with COVID-19, particularly severe cases. Further studies with larger sample size are still needed for good understanding of the effect of virus on pregnancy outcomes.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Recém-Nascido , Feminino , Gravidez , Humanos , Terceiro Trimestre da Gravidez , Estudos de Casos e Controles , Estudos Retrospectivos , Resultado da Gravidez
6.
Sci Rep ; 12(1): 18474, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36323816

RESUMO

Epidemiological studies have reported the association between extreme temperatures and adverse reproductive effects. However, the susceptible period of exposure during pregnancy remains unclear. This study aimed to assess the impact of extreme temperature on the stillbirth rate. We performed a time-series analysis to explore the associations between temperature and stillbirth with a distributed lag nonlinear model. A total of 22,769 stillbirths in Taiwan between 2009 and 2018 were enrolled. The mean stillbirth rate was 11.3 ± 1.4 per 1000 births. The relative risk of stillbirth due to exposure to extreme heat temperature (> 29 °C) was 1.18 (95% CI 1.11, 1.25). Pregnant women in the third trimester were most susceptible to the effects of extreme cold and heat temperatures. At lag of 0-3 months, the cumulative relative risk (CRR) of stillbirth for exposure to extreme heat temperature (29.8 °C, 97.5th percentile of temperature) relative to the optimal temperature (21 °C) was 2.49 (95% CI: 1.24, 5.03), and the CRR of stillbirth for exposure to extreme low temperature (16.5 °C, 1st percentile) was 1.29 (95% CI: 0.93, 1.80). The stillbirth rate in Taiwan is on the rise. Our findings inform public health interventions to manage the health impacts of climate change.


Assuntos
Calor Extremo , Natimorto , Feminino , Humanos , Gravidez , Temperatura , Natimorto/epidemiologia , Terceiro Trimestre da Gravidez , Calor Extremo/efeitos adversos , Temperatura Baixa , Temperatura Alta
7.
BMC Pregnancy Childbirth ; 22(1): 811, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333677

RESUMO

BACKGROUND: Woman's weight changes during pregnancy and postpartum contribute to obesity and health outcomes later in life. This study aimed to identify and characterize weight change trajectories from pregnancy to one year postpartum among adult women. METHODS: We used data from an ongoing cohort of healthy adult women (n = 819) with singleton pregnancies from 2007 - 2011. Sociodemographic data, pre-pregnancy body weight, and sedentary and breastfeeding practices were collected using questionaries applied by trained professionals. We applied a group-based trajectory modeling to distinguish weight change measured in the second and third trimesters of pregnancy and at one month, six, and 12 months postpartum. Multinomial regression models were run to characterize each trajectory. RESULTS: We identified six weight change trajectories with the main difference in the patterns followed after one month of delivery. One in three women (36.7%) was classified in some of the three postpartum weight gain trajectories and regained weight from the second trimester of the first year postpartum. Women who followed some of these trajectories were more likely to have higher age, obesity before pregnancy, < 10 years of schooling, and partner, compared with women (10.7%, n = 87) in a postpartum sustained-fast-lost-weight trajectory (p < 0.05). CONCLUSIONS: Women with obesity before pregnancy have higher odds of regaining gestational weight after delivery without reaching their pre-pregnancy weight. The first six months postpartum are crucial to establishing obesity prevention strategies. Further research is needed to evaluate the effect of the interventions that prevent substantial weight gain through reproductive years in high-risk women.


Assuntos
Trajetória do Peso do Corpo , Gravidez , Adulto , Feminino , Humanos , Criança , Período Pós-Parto , Aumento de Peso , Obesidade , Terceiro Trimestre da Gravidez , Índice de Massa Corporal
8.
Tomography ; 8(5): 2609-2617, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36287817

RESUMO

(1) Purpose: To evaluate the anatomy and perfusion of choroidal substructures in third-trimester pregnant women using optical coherence tomography (OCT) and OCT angiography (OCTA) imaging. (2) Methods: In this cross-sectional study, women in their third trimester of uncomplicated pregnancy and non-pregnant age-matched women were recruited. Participants underwent enhanced depth imaging (EDI) OCT and OCTA. Subfoveal choroidal thickness (SFCT), as well as choroidal sublayer perfusion, were compared between groups. (3) Results: In total, 26 eyes of 26 pregnant and 26 eyes of 26 non-pregnant women were included. The median age in both groups was 29 years. The median SFCT was 332 (211-469) µm in the pregnant group and 371.5 (224-466) µm in the non-pregnant cohort (p = 0.018). The median choriocapillaris perfusion (CCP) was significantly lower in the pregnant group (46% vs. 48%, p = 0.039). Moreover, Haller's layer perfusion correlated significantly with mean arterial pressure in non-pregnant women (CC = 0.430, p = 0.028) but not in pregnant ones (CC = 0.054, p = 0.792). (4) Conclusions: SFCT was found to be thinner and CCP was lower in third-trimester pregnant women. Hormonal changes during pregnancy and consecutive impacts on autoregulation of small choroidal vessels might play an important role. Therefore, altered choroidal measurements during third-trimester pregnancy should be carefully evaluated as, to some extent, it could be a normal physiological change.


Assuntos
Corioide , Tomografia de Coerência Óptica , Gravidez , Feminino , Humanos , Adulto , Terceiro Trimestre da Gravidez , Estudos Transversais , Corioide/anatomia & histologia , Corioide/irrigação sanguínea , Tomografia de Coerência Óptica/métodos , Angiografia
9.
Nutrients ; 14(19)2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36235594

RESUMO

Several studies have investigated the association between selenium levels and gestational diabetes mellitus (GDM); however, their results are not conclusive. This systematic review and meta-analysis aimed to update and draw conclusions regarding the evidence from published studies that investigated selenium levels in relation to GDM. PubMed, Google Scholar, Cochrane Library and ScienceDirect were searched for studies related to selenium and GDM, published from the inception of each database through to July 2022. The meta-analysis was conducted by measuring the standardized mean difference (SMD) between the selenium levels of women with GDM and those pregnant without GDM (control group). Stratified meta-analysis, meta-regression analysis and reporting bias were applied. The "meta" package in the open-access software R was used to analyze all of the data. A total of 12 studies, including 940 pregnant women with GDM and 1749 controls met this study's inclusion criteria. The selenium levels were significantly lower in women with GDM compared with the control group (SMD = -0.66; 95% confidence interval (CI): (-1.04, -0.28); p ≤ 0.001). Due to significant heterogeneity (I2 = 94%, Cochrane Q = 186.7; p ≤ 0.0001), the random-effects model was followed. The stratified meta-analysis showed that the selenium levels were lower in the cases compared with the normal controls in the third trimester (SMD = -1.85 (-3.03, -0.66); p ≤ 0.01). The same trend was observed in the studies published before the year 2014 (SMD = -0.99 (-1.70, -0.28); p ≤0.01) and those published in or after 2014 (SMD = -0.45 (-0.90, 0.00); p = 0.05). None of the investigated covariates in the meta-regression analysis (each study's geographic location, trimester of selenium quantification, World Bank economic classification, method of selenium determination, study design, study quality score, publication year and study's sample size) were significantly associated with the selenium SMD. The current evidence indicates that selenium levels are lower among women with GDM in comparison to those without GDM; however, after the correction of the reporting bias, the result was no longer significant. Further studies with more prospective designs are needed to confirm this evidence and explain the function of selenium in GDM throughout pregnancy.


Assuntos
Diabetes Gestacional , Selênio , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Trimestres da Gravidez
10.
Nutrients ; 14(19)2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36235743

RESUMO

BACKGROUND: Systematic iron supplementation may be harmful in pregnant women with non-depleted iron. Our objectives were to estimate the prevalence of anemia at the third trimester of pregnancy (T3) and to identify the parameters at the first trimester (T1), which best predict anemia at T3. METHODS: This prospective cohort study in France included pregnant women at T1 without non-iron deficiency anemia. Clinical and social characteristics, health-related quality of life, blood count, and a frozen blood sample were collected at T1 and/or T3. Secondly, a matched nested case-control study was built for women with anemia at T3 but not at T1. Multivariate analyses and ROC curves were used to identify the best predictive parameter(s) of anemia at T3. RESULTS: The prevalence of anemia at T3 in the cohort (629 women) was 21.9% (95% CI 18.7-25.2%). In the matched nested case-control study (256 women), hemoglobin (Hb), serum ferritin (SF) and the SF/soluble transferrin receptor ratio at T1 were predictive of anemia at T3 (p < 0.001); however, clinical and social characteristics, as serum hepcidin were not. In multivariate analyses, Hb at T1 was the best predictive biomarker of anemia at T3 with a cut-off value of 120 g/L (specificity 87.5%). CONCLUSIONS: The prevalence of anemia at the end of pregnancy remained high in a High-Income Country. Clinical, social, and biochemical parameters did not seem useful to predict anemia at T3 and could not guide iron supplementation. We suggest systematically performing a simple blood count in the first trimester of pregnancy and offering oral iron supplementation for women with Hb < 120 g/L.


Assuntos
Anemia Ferropriva , Anemia , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Biomarcadores , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Ferritinas , Hemoglobinas/metabolismo , Hepcidinas , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Qualidade de Vida , Receptores da Transferrina
11.
BMJ Open ; 12(10): e065825, 2022 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-36288838

RESUMO

PURPOSE: The Swedish Maternal Microbiome (SweMaMi) project was initiated to better understand the dynamics of the microbiome in pregnancy, with longitudinal microbiome sampling, shotgun metagenomics, extensive questionnaires and health registry linkage. PARTICIPANTS: Pregnant women were recruited before the 20th gestational week during 2017-2021 in Sweden. In total, 5439 pregnancies (5193 unique women) were included. For 3973 pregnancies (73%), samples were provided at baseline, and for 3141 (58%) at all three timepoints (second and third trimester and postpartum). In total, 38 591 maternal microbiome samples (vaginal, faecal and saliva) and 3109 infant faecal samples were collected. Questionnaires were used to collect information on general, reproductive and mental health, diet and lifestyle, complemented by linkage to the nationwide health registries, also used to follow up the health of the offspring (up to age 10). FINDINGS TO DATE: The cohort is fairly representative for the total Swedish pregnant population (data from 2019), with 41% first-time mothers. Women with university level education, born in Sweden, with normal body mass index, not using tobacco-products and aged 30-34 years were slightly over-represented. FUTURE PLANS: The sample and data collection were finalised in November 2021. The next steps are the characterisation of the microbial DNA and linkage to the health and demographic information from the questionnaires and registries. The role of the microbiome on maternal and neonatal outcomes and early-childhood diseases will be explored (including preterm birth, miscarriage) and the role and interaction of other risk factors and confounders (including endometriosis, polycystic ovarian syndrome, diet, drug use). This is currently among the largest pregnancy cohorts in the world with longitudinal design and detailed and standardised microbiome sampling enabling follow-up of both mothers and children. The findings are expected to contribute greatly to the field of reproductive health focusing on pregnancy and neonatal outcomes.


Assuntos
Microbiota , Nascimento Prematuro , Lactente , Gravidez , Recém-Nascido , Feminino , Humanos , Criança , Suécia/epidemiologia , Terceiro Trimestre da Gravidez , Estudos de Coortes
12.
Sci Rep ; 12(1): 17506, 2022 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261471

RESUMO

This study aimed to evaluate the changes in quadriceps femoris muscle thickness during the pregnancy and postpartum periods and to elucidate the effect of bed rest for threatened preterm labor on muscle thickness. In 26 women with normal pregnancy, quadriceps femoris thickness was measured at 11-13, 26, 30, and 35 weeks' gestation, and at 3-5 days and 1 month postpartum using ultrasonography. In 15 pregnant women treated with bed rest for threatened premature labor, quadriceps femoris thickness was measured at 30 and 35 weeks' gestation and postpartum. In women with normal pregnancy, quadriceps femoris thickness increased, peaking at 35 weeks' gestation, followed by a postpartum decrease. In women on bed rest, quadriceps femoris thickness showed no significant change during the pregnancy and postpartum periods, and the muscle was significantly thinner at 35 weeks' gestation than that in women with normal pregnancy. In conclusion, a significant increase in quadriceps femoris muscle thickness during normal pregnancy was found using ultrasonography. Meanwhile, in pregnant women on bed rest treatment, the quadriceps femoris was significantly thinner in the late third trimester than that in normal pregnant women. Prolonged bed rest can affect normal changes in the quadriceps femoris muscle thickness during the pregnancy and postpartum periods.


Assuntos
Repouso em Cama , Trabalho de Parto Prematuro , Recém-Nascido , Humanos , Feminino , Gravidez , Músculo Quadríceps/diagnóstico por imagem , Trabalho de Parto Prematuro/diagnóstico por imagem , Idade Gestacional , Terceiro Trimestre da Gravidez
13.
Artigo em Inglês | MEDLINE | ID: mdl-36231278

RESUMO

PURPOSE: The objective of this study was to determine whether decreases in or consistently low preconception to pregnancy self-rated health (SRH) were associated with perinatal depressive and anxiety symptoms among Latinas. METHODS: This is a secondary data analysis of 153 perinatal Latinas. Three groups were created to capture SRH from preconception to pregnancy: a decline in ratings, consistently low, and good+ (i.e., good, very good, or excellent). SRH was measured using two questions about their perceived physical health before and during pregnancy. Depressive symptoms and anxiety symptoms were assessed in the third trimester and six weeks postpartum using the Edinburgh Postnatal Depression Scale and State-Trait Anxiety Inventory, respectively. Life stressors were assessed in pregnancy using a modified version of the Life Experiences Survey. Linear regressions tested the associations. RESULTS: Women with consistently low (i.e., fair or poor) SRH reported significantly more prenatal depressive symptoms than women who reported consistently good+ SRH. Women who reported a decline in SRH to fair or poor reported more prenatal anxiety symptoms but decreased postpartum anxiety symptoms than women who reported consistently good+ ratings. Life stressors were positively associated with prenatal depressive and anxiety symptoms. CONCLUSIONS: Healthcare practitioners should assess changes in SRH ratings to identify risks for prenatal depressive and anxiety symptoms among Latinas, who have elevated rates of depressive and anxiety symptoms compared to non-Hispanic White women. Policymakers should provide healthcare providers with mental health resources to support at-risk Latinas during the prenatal period.


Assuntos
Ansiedade , Hispânico ou Latino , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Período Pós-Parto , Gravidez , Terceiro Trimestre da Gravidez , Escalas de Graduação Psiquiátrica
14.
BMC Pregnancy Childbirth ; 22(1): 790, 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36289479

RESUMO

OBJECTIVE: To review and analyze the efficacy and safety of mifepristone combined with ethacridine lactate for induction of stillbirth in the third trimester. METHODS: All patients with stillbirth in late pregnancy (≥ 28 weeks) in a university-affiliated maternity center from October 2016 to September 2021 were included in this study. After exclusion, patients were divided into ethacridine lactate and non-ethacridine lactate groups according to induction methods. Logistic regression was conducted to identify the risks of complications. RESULTS: We identified 122 patients that experienced stillbirth (5' Apgar score = 0) in third-trimester from the 5-year total deliveries in the hospital, among whom 39 stillbirths that resulted from termination of pregnancy for severe fetal anomalies and 1 stillbirth that was in twin pregnancy were excluded. Thus, 82 cases with stillbirths (dead before induction) were included in the analyses. In the 82 cases, 49 (59.76%) accepted intra-amniotic ethacridine lactate induction with 47 (95.92%, 47/49) successfully induced. No statistical difference was observed in induction failure rate between ethacridine dosage groups of < 75mg and ≥ 75mg (0/25, vs. 2/24, respectively; P > 0.05). The ethacridine lactate induction group showed no increased risks in complications (6.12%, 3/49), compared with non-ethacridine lactate group (12.12%, 4/33) (P = 0.35, OR, 0.47, 95%CI, 0.10 to 2.27). CONCLUSION: Mifepristone combined with ethacridine lactate is a safe and low-risk induction method for patients with stillbirth in the third trimester.


Assuntos
Aborto Induzido , Mifepristona , Humanos , Feminino , Gravidez , Mifepristona/efeitos adversos , Etacridina/efeitos adversos , Terceiro Trimestre da Gravidez , Natimorto/epidemiologia , Aborto Induzido/métodos , Segundo Trimestre da Gravidez , China/epidemiologia , Lactatos
15.
J Matern Fetal Neonatal Med ; 35(25): 10168-10172, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36100267

RESUMO

OBJECTIVE: To evaluate maternal and neonatal outcomes of low-risk singleton pregnancies, without underlying maternal medical conditions or genetic and fetal anomalies associated with fetal growth restriction, that were diagnosed with fetal growth restriction (FGR) (EFW < 10th %) in the mid-second trimester (between 17 and 22 weeks and 6 days' gestation). METHODS: A retrospective cohort study of all women who underwent a routine fetal anatomy ultrasound between 17 and 22 weeks and 6 days' gestation at a community-based academic hospital was performed to identify subjects with an EFW <10th%. Pregnancies with inadequate dating, multiple gestations, preexisting maternal vascular disease (chronic hypertension and pregestational diabetes), lethal fetal anomalies, and abnormal prenatal genetic screening were excluded. Descriptive statistics were computed to describe the study population. Subjects were stratified into two groups, estimated fetal weight (EFW) <5th% and EFW 5th-9th%. The primary outcome was a small for gestational age neonate (SGA) at delivery. Secondary outcomes included a composite adverse neonatal outcome, perinatal death, hypertensive disorders of pregnancy, medically indicated delivery, and mode of delivery. A comparison of the two groups, EFW <5th% and EFW 5th-9th %, was performed. Continuous variables were compared utilizing Wilcoxon Rank Sum tests and categorical variables were compared using Fisher's exact test or Chi-squared tests, and a dichotomous composite variable for adverse neonatal outcomes was also calculated. RESULTS: In total, 3,868 unique patient records were screened. Thirty-two patient records (0.8% of the total screened records) were eligible for inclusion. The primary outcome, SGA at delivery, occurred in 13/32 (41%) of the subjects. The secondary outcomes of the composite neonatal morbidity occurred in 9/32 (28%), hypertensive disorders of pregnancy in 10/32 (31%), and medically indicated delivery at <28 weeks gestation in 7/32 (22%) of the subjects. When comparing EFW <5th% and EFW 5th-9th%, EFW <5th% had a larger percentage of SGA newborns (66% vs. 25%, p = .02, OR = 8.0 95% CI 1.5-42.5). EFW <5th% was also significantly associated with a greater composite adverse neonatal outcome when compared to EFW 5th-9th% (54% vs. 10%, p = .015). The subgroup with an EFW <5th% also had higher rates of adverse outcomes including preeclampsia (42% vs. 10%, p = .073), abnormal umbilical artery Doppler studies (50% vs. 15%, p = .049), and medically indicated delivery <28 weeks (42% vs. 10%, p = .07). CONCLUSIONS: Early onset FGR is a associated with high rates of SGA at delivery, as well as several adverse maternal and neonatal outcomes which include hypertensive disorders of pregnancy, a greater composite neonatal morbidity, perinatal death, and medically indicated preterm delivery. EFW <5th% was associated with worse outcomes when compared to those with an EFW 5th%-9th%.


Assuntos
Hipertensão Induzida pela Gravidez , Morte Perinatal , Gravidez , Recém-Nascido , Humanos , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/epidemiologia , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Terceiro Trimestre da Gravidez , Peso Fetal , Recém-Nascido Pequeno para a Idade Gestacional , Ultrassonografia Pré-Natal , Idade Gestacional
16.
Br J Anaesth ; 129(5): 726-733, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36096944

RESUMO

BACKGROUND: Acid-base status in full-term pregnant women is characterised by hypocapnic alkalosis. Whether this respiratory alkalosis is primary or consequent to changes in CSF electrolytes is not clear. METHODS: We enrolled third-trimester pregnant women (pregnant group) and healthy, non-pregnant women of childbearing age (controls) undergoing spinal anaesthesia for Caesarean delivery and elective surgery, respectively. Electrolytes, strong ion difference (SID), partial pressure of carbon dioxide ( [Formula: see text] ), and pH were measured in simultaneously collected CSF and arterial blood samples. RESULTS: All pregnant women (20) were hypocapnic, whilst only four (30%) of the controls (13) had an arterial [Formula: see text] <4.7 kPa (P<0.001). The incidence of hypocapnic alkalosis was higher in the pregnant group (65% vs 8%; P=0.001). The CSF-to-plasma Pco2 difference was significantly higher in pregnant women (1.5 [0.3] vs 1.0 [0.4] kPa; P<0.001), mainly because of a decrease in arterial Pco2 (3.9 [0.3] vs 4.9 [0.5] kPa; P<0.001). Similarly, the CSF-to-plasma difference in SID was less negative in pregnant women (-7.8 [1.4] vs -11.4 [2.3] mM; P<0.001), mainly because of a decreased arterial SID (31.5 [1.2] vs 36.1 [1.9] mM; P<0.001). The major determinant of the reduced plasma SID of pregnant women was a relative increase in plasma chloride compared with sodium. CONCLUSIONS: Primary hypocapnic alkalosis characterises third-trimester pregnant women leading to chronic acid-base adaptations of CSF and plasma. The compensatory SID reduction, mainly sustained by an increase in chloride concentration, is more pronounced in plasma than in CSF, as the decrease in Pco2 is more marked in this compartment. CLINICAL TRIAL REGISTRATION: NCT03496311.


Assuntos
Alcalose , Morte Súbita do Lactente , Gravidez , Feminino , Humanos , Dióxido de Carbono , Cloretos , Terceiro Trimestre da Gravidez , Concentração de Íons de Hidrogênio , Equilíbrio Ácido-Base , Eletrólitos , Sódio , Bicarbonatos
17.
Health Psychol ; 41(12): 894-903, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36154104

RESUMO

OBJECTIVES: Anxiety is prevalent in pregnancy and predicts risk of adverse birth outcomes. Many instruments measure anxiety in pregnancy, some of which assess pregnancy anxiety defined as maternal concerns about a current pregnancy (e.g., baby, childbirth). The present study examined covariance among four anxiety or distress measures at two times in pregnancy and tested joint and individual effects on gestational length. We hypothesized that the common variance of the measures in each trimester would predict earlier delivery. METHOD: Research staff interviewed 196 women in first and third trimester utilizing a clinical screener of anxiety severity/impairment, two instruments measuring pregnancy anxiety, and one on prenatal distress. Birth outcomes and medical risk factors were obtained from medical records after birth. Structural equation modeling fit latent factors for each trimester from the four measures. Subsequent models tested whether the latent factors predicted gestational length, and unique effects of each measure. RESULTS: The third-trimester pregnancy anxiety latent factor predicted shorter gestational length adjusting for mother's age, education, parity, and obstetric risk. Scores on a four-item pregnancy-specific anxiety measure (PSAS) in third trimester added uniquely to prediction of gestational length. In first trimester, scores on the clinical screener (OASIS) uniquely predicted shorter gestational length whereas the latent factor did not. CONCLUSION: These results support existing evidence indicating that pregnancy anxiety is a reliable risk factor for earlier birth. Findings point to possible screening for clinically significant anxiety symptoms in the first trimester, and pregnancy-specific anxiety thereafter to advance efforts to prevent earlier delivery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Ansiedade , Complicações na Gravidez , Gravidez , Lactente , Feminino , Humanos , Ansiedade/diagnóstico , Ansiedade/psicologia , Terceiro Trimestre da Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/psicologia , Primeiro Trimestre da Gravidez , Transtornos de Ansiedade
18.
Obstet Gynecol Surv ; 77(9): 547-557, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36136077

RESUMO

Importance: A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies. Objectives: The aim of this study was to review the literature to clarify what classifies a placenta as "thickened" and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy. Evidence Acquisition: Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes. Results: There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a "thickened placenta" vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality. Conclusions: The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered. Relevance: A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.


Assuntos
Doenças Fetais , Placenta , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta/diagnóstico por imagem , Gravidez , Resultado da Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Diagnóstico Pré-Natal
19.
Womens Health (Lond) ; 18: 17455057221117967, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36124367

RESUMO

OBJECTIVE: Current exercise guidelines recommend women to exercise throughout pregnancy, and the benefits are well documented. Still, there is an increasing decline of exercise levels during pregnancy and a high percentage of them are sedentary. It is well established that individual attitudes and perception of barriers may influence the ability to engage in sufficient amount of exercise. This has, however, not been examined in an Italian pregnant population. Hence, the aims of the present study were to increase knowledge of facilitators and barriers to regular exercise in Italian pregnant women and to report their social support in regard to maternal exercise. METHODS: Healthy, pregnant women (n = 513) were allocated from Fatebenefratelli San Giovanni Calibita, a public hospital in Rome, and four antenatal clinics in Rome and Modena. The participants completed a validated self-administrated questionnaire, the Physical Activity Pregnancy Questionnaire, in gestational week 36. In line with current American College of Obstetricians and Gynecologists guidelines (2020), participants were categorized as "regular exercisers" (⩾150 min/week) and "not regular exercisers" (< 150 min/week). RESULTS: Only 4.6% of the women engaged in regular physical activity/exercise in the third trimester. "Insufficient time" (54%) were the only barrier negatively associated with exercise. The facilitators "relaxation/recreation" (18%), "prevention of health complaints" (15%), "enjoyment" (10%), and "prevention of gestational weight gain" (4%) were associated with achieving the recommendations of exercise. This study found no association between achieving the recommendations and childhood exercise/having social modeling, or exercising network/milieu (p = 0.294 and p = 0.123). Nevertheless, exercising together with others was a significant predictor for regular maternal exercise (p < 0.001). Most women did not receive any advice on exercise during pregnancy from their doctor or midwife (60.0 %). Yet, those who received such advice were significantly more likely to exercise regularly compared to those who did not (75.0% vs 38.2%; p < 0.001). CONCLUSION: Italian pregnant women mainly reported internal facilitators for their willingness to participate in regular maternal exercise, while barriers were primarily related to inconveniences (such as insufficient time and difficulty combining with work/studies). The study addresses the positive association between achieving the recommended amount of exercise and social support in terms of exercising with others and getting advice from health professions. Because women respect their doctor and have regular prenatal checkups, this health care setting can play a pivotal role in the initiation and maintenance of exercise behavior during pregnancy.


Assuntos
Exercício Físico , Gestantes , Criança , Estudos Transversais , Feminino , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Inquéritos e Questionários
20.
Ultrasound Obstet Gynecol ; 60(5): 612-619, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36056735

RESUMO

OBJECTIVES: To develop further a competing-risks model for the prediction of a small-for-gestational-age (SGA) neonate by including sonographically estimated fetal weight (EFW) and biomarkers of impaired placentation at 36 weeks' gestation, and to compare the performance of the new model with that of the traditional EFW < 10th percentile cut-off. METHODS: This was a prospective observational study in 29 035 women with a singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. A competing-risks model for the prediction of a SGA neonate was used. The parameters included in the prior-history model were provided in previous studies. An interaction continuous model was used for the EFW likelihood. A folded plane regression model was fitted to describe likelihoods of biomarkers of impaired placentation. Stratification plans were also developed. The new model was evaluated and compared with EFW percentile cut-offs. RESULTS: The performance of the model was better for predicting SGA neonates delivered closer to the point of assessment. The prediction provided by maternal factors alone was improved significantly by the addition of EFW, uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF) but not by mean arterial pressure or soluble fms-like tyrosine kinase-1. At a 10% false-positive rate, maternal factors and EFW predicted 77.6% and 65.8% of SGA neonates < 10th percentile delivered before 38 and 42 weeks, respectively. The respective figures for SGA < 3rd percentile were 85.5% and 74.2%. Addition of UtA-PI and PlGF resulted in marginal improvement in prediction of SGA < 3rd percentile requiring imminent delivery. A competing-risks approach that combines maternal factors and EFW performed better when compared with fixed EFW percentile cut-offs at predicting a SGA neonate, especially with increasing time interval between assessment and delivery. The new model was well-calibrated. CONCLUSIONS: A competing-risks model provides effective risk stratification for a SGA neonate at 35 + 0 to 36 + 6 weeks' gestation and is superior to EFW percentile cut-offs. The use of biomarkers of impaired placentation in addition to maternal factors and fetal biometry results in small improvement of the predictive performance for a neonate with severe SGA. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Peso Fetal , Ultrassonografia Pré-Natal , Gravidez , Recém-Nascido , Feminino , Humanos , Lactente , Fator de Crescimento Placentário , Terceiro Trimestre da Gravidez , Ultrassonografia Pré-Natal/métodos , Valor Preditivo dos Testes , Idade Gestacional , Retardo do Crescimento Fetal , Biomarcadores
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