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1.
BJOG ; 127(3): 355-362, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31505103

RESUMO

OBJECTIVE: To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN: A retrospective study. SETTING: Reference fetal medicine unit. POPULATION: Sixty-two fetuses infected <14 weeks of gestation. METHODS: We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES: For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS: The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS: Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT: Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.


Assuntos
Encéfalo/diagnóstico por imagem , Infecções por Citomegalovirus , Citomegalovirus/isolamento & purificação , Doenças Fetais , Imagem por Ressonância Magnética/métodos , Polimicrogiria , Complicações Infecciosas na Gravidez , Ultrassonografia Pré-Natal/métodos , Aborto Eugênico/estatística & dados numéricos , Adulto , Autopsia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Feminino , Doenças Fetais/etiologia , Doenças Fetais/patologia , França , Humanos , Lactente , Recém-Nascido , Masculino , Polimicrogiria/etiologia , Polimicrogiria/patologia , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Trimestres da Gravidez , Prognóstico
2.
Environ Pollut ; 256: 113055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31744686

RESUMO

Little is known about fine particulate matter (PM2.5) exposure among pregnant women in rural China. This study aims to characterize exposure to PM2.5 among pregnant women in rural China, and investigate potential risk factors of personal exposure to PM2.5. The data were obtained from a birth cohort study that enrolled 606 pregnant women in Xuanwei, a county known for its high rates of lung cancer. The personal exposure to PM2.5 was measured using small portable particulate monitors during each trimester of pregnancy. Participants were interviewed using structured questionnaires that sought information on risk factors of PM2.5 exposure. The daily exposure to PM2.5 among the pregnant women ranged from 19.68 to 97.08 µg/m3 (median = 26.08). Exposure to PM2.5 was higher in winter and autumn than other seasons (p < 0.05); higher during the day than during the night (p < 0.001); and greater during cooking hours than during the rest of the day (p < 0.001). Using a mixed effects model, domestic solid fuel for cooking (ß = 1.75, p < 0.001), winter and autumn (ß = 2.96, p < 0.001), cooking ≥ once per day (ß = 1.58, p < 0.05), heating with coal (ß = 1.69, p < 0.001), secondhand smoke exposure (ß = 1.59, p < 0.001) and township 1(ß = 2.39, p < 0.001) were identified as risk factors for personal exposure to PM2.5 of pregnant women throughout pregnancy. Indirect effects of season and township factors on personal PM2.5 exposure were mediated by heating, cooking and domestic fuel using. In conclusion, PM2.5 levels in Xuanwei exceeded WHO guidelines. Seasonal and township factors and individual behaviors like domestic solid fuel using for cooking, heating with coal and secondhand smoke exposure are associated with higher personal PM2.5 exposure among pregnant women in rural China.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental/métodos , Exposição por Inalação/análise , Exposição Materna , Material Particulado/análise , Adulto , China , Carvão Mineral/análise , Estudos de Coortes , Culinária , Feminino , Calefação , Humanos , Gravidez , Trimestres da Gravidez , População Rural , Estações do Ano , Inquéritos e Questionários , Adulto Jovem
3.
Environ Int ; 133(Pt B): 105254, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31675562

RESUMO

BACKGROUND: Urinary phthalate metabolites and psychosocial stress in pregnancy have each been associated with preterm birth (PTB), but no study has examined the joint impact of these two environmental exposures. We hypothesized that there would be stronger associations between phthalate exposure and PTB in mothers with higher stress in pregnancy compared to mothers with lower stress. METHODS: We addressed this question using data from The Infant Development and the Environment Study (TIDES), a prospective birth cohort conducted at four US sites (N = 783). We examined urinary phthalate metabolite concentrations measured in samples collected from up to three trimesters of pregnancy. Mothers reported their exposure to stressful life events (SLE) in each trimester in a questionnaire administered in the third trimester. PTB was defined as delivery before 37 weeks completed gestation (n = 71, 9.1%). We examined associations between urinary phthalate metabolite concentrations (individual time points and on average) and PTB using logistic regression models adjusted for maternal race, age, pre-pregnancy body mass index, education, specific gravity, and gestational age at sample collection. In addition, we created models stratified by whether or not mothers were exposed to any or no SLE in pregnancy. RESULTS: Summed di-2-ethylhexyl phthalate (ΣDEHP) metabolites measured in urine samples from the third trimester, but not the first trimester, were associated with an increased odds ratio (OR) of PTB (OR = 1.44, 95% confidence interval [CI] = 1.06, 1.95). In models stratified by SLE, associations between third trimester ΣDEHP concentrations and PTB were significant only for women experiencing one or more SLE during pregnancy (OR for ΣDEHP: 2.09, 95% CI: 1.29, 3.37) but not for women with no SLE during pregnancy (OR for ΣDEHP: 1.04, 95% CI: 0.66, 1.63) (p for interaction = 0.07). CONCLUSIONS: We observed an association between urinary ΣDEHP levels and PTB that was modified by whether a mother was exposed to one or more psychosocial stressors during pregnancy. Additional research to understand the joint impacts of chemical and non-chemical exposures, with an emphasis on timing of exposure, is needed in order to advance the state of the science on how the environment influences pregnancy.


Assuntos
Exposição Materna/efeitos adversos , Ácidos Ftálicos/toxicidade , Nascimento Prematuro/epidemiologia , Estresse Psicológico , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Ácidos Ftálicos/urina , Gravidez , Trimestres da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
4.
An Bras Dermatol ; 94(5): 549-552, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777355

RESUMO

BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.


Assuntos
Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Adulto , Doenças Mamárias/sangue , Doenças Mamárias/diagnóstico , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Eczema/sangue , Eczema/diagnóstico , Feminino , Humanos , Imunoglobulina E/sangue , Índia , Contagem de Leucócitos , Neutrófilos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Trimestres da Gravidez , Estudos Prospectivos
5.
Environ Int ; 133(Pt A): 105110, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31610366

RESUMO

BACKGROUND: Ambient air pollution and maternal diabetes may affect common biological pathways underlying adverse neurodevelopmental effects. However, joint effects of maternal diabetes and air pollution on autism spectrum disorder (ASD) have not been studied. OBJECTIVE: We evaluated whether prenatal and early-life air pollution exposure interacts with maternal diabetes status to affect ASD risk. METHODS: This retrospective cohort study included 246,420 singleton children born in Kaiser Permanente Southern California hospitals in 1999-2009. Children were followed from birth until age 5, during which 2471 ASD cases were diagnosed. Ozone (O3), particulate matter < 2.5 µm (PM2.5) and <10 µm in aerodynamic diameter, and nitrogen dioxide measured at regulatory air monitoring stations were interpolated to estimate exposures during preconception and each pregnancy trimester, and first year of life at each child's birth address. Hazard ratios (HRs) for ASD were estimated adjusting for birth year, KPSC service areas, and relevant maternal and child characteristics. For each exposure window, interactions were tested between pollutants and a 4-category maternal diabetes variable (none, GDM ≥ 24 and <24 weeks' gestation, and pre-existing type 2 diabetes). For an exposure window with statistically significant global interaction between pollutant and diabetes (p < 0.05), pollutant-associated HRs were estimated separately for each category of maternal diabetes. RESULTS: There were associations of ASD with preconception, first and third trimesters, and first year of life PM2.5, but not with other pollutants. There were, however, interactions of maternal diabetes with first trimester and first year of life O3. Increased ASD risk was associated with first trimester O3 among mothers with GDM < 24 weeks' gestation [adjusted HR 1.50 per 15.7 ppb O3 (95% CI: 1.08-2.09)]. No O3 associations with ASD were observed in other categories of maternal diabetes. CONCLUSIONS: GDM onset early in pregnancy may increase children's susceptibility to prenatal O3-associated ASD risk. These novel findings merit further investigation.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Transtorno do Espectro Autista/etiologia , Diabetes Gestacional/etiologia , Exposição Materna , Adulto , Poluentes Atmosféricos/análise , California , Pré-Escolar , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Dióxido de Nitrogênio/análise , Ozônio/efeitos adversos , Ozônio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Gravidez , Trimestres da Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31590213

RESUMO

Poor diet quality in pregnancy could impact gestational weight gain (GWG) and consequently fetal growth and development. But today there is limited data available on gestational diet quality. This study investigated the association between diet quality in each pregnancy trimester and GWG in Malaysian women. Diet quality was assessed using the modified Healthy Eating Index for Malaysians (HEI). Total GWG was defined as the difference between measured weight at last prenatal visit and pre-pregnancy weight. About one-fourth of women (23.3%) had excessive total GWG. There were significant differences in the HEI component score across trimesters, except for fruits. Overall, overweight/obese women had lower total HEI score (51.49-55.40) during pregnancy compared to non-overweight/obese women (53.38-56.50). For non-overweight/obese women, higher total HEI scores in the second and third trimesters were significantly associated with lower risk of inadequate GWG (aOR = 0.97, 95% CI = 0.95-0.99, p = 0.01) and higher risk of excessive GWG (aOR = 1.04, 95% CI = 1.01-1.07, p = 0.03), respectively. Overweight/obese women with higher total HEI scores in the second (aOR = 1.04, 95% CI = 1.01-1.07, p = 0.02) and third trimester (aOR = 1.04, 95% CI = 1.01-1.08, p = 0.02) were significantly at higher risk for excessive GWG. Pregnant women had relatively low diet quality throughout pregnancy. Diet quality and GWG association differed according to pre-pregnancy BMI with excessive GWG more likely to be associated with higher total HEI scores in the third trimester.


Assuntos
Índice de Massa Corporal , Dieta , Ganho de Peso na Gestação , Adulto , Feminino , Humanos , Gravidez , Trimestres da Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Fatores de Risco
7.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532100

RESUMO

BACKGROUND: Urine sediment parameters of pregnant women are different from those of non-pregnant women, and it is necessary to establish reference intervals for pregnant women. The aim of this study was to establish reference intervals of white blood cell (WBC), red blood cell (RBC), bacteria (BACT), squamous epithelial cell (EC), small round epithelial cell (SRC), and mucous strands (MUS) for urine sediment test of pregnant women using a UF-1000i analyzer as the detection device. The differences between pregnant women and non-pregnant women in terms of the aforementioned parameters as well as the differences of such parameters in different trimesters of pregnancy were clarified. METHODS: The experimental subjects were divided into two groups: the experiment group (612 healthy pregnant women) and the control group (582 healthy non-pregnant women). Subjects of both groups are women between the age of 22 and 46. The urine specimens were analyzed using the Sysmex UF-1000i analyzer, followed by manual correction. A statistical analysis was performed by SPSS 22.0. Results were considered significant at p < 0.01. RESULTS: The pregnancy reference intervals of WBC, RBC, BACT, EC, SRC, and MUS were 0 ~ 30/µL, 0 ~ 23/µL, 0 ~ 698/µL, 0 ~ 28/µL, 0 ~ 8/µL, and 0 ~ 3/µL, respectively. In the experiment group, the concentrations of WBC, BACT, EC, and SRC were significantly higher than those of the control group (p < 0.01), while the concentrations of RBC and MUS were significantly lower than those of the control group (p < 0.01). The inter-trimester differences in terms of the concentrations of WBC, BACT, EC, and SRC were statistically indistinguishable (p > 0.05). However, the concentration of RBC was significantly lower with the increase of trimester of pregnancy (the comparison between the first trimester with the second trimester: p = 0.000 < 0.01; the comparison between the second trimester and the third trimester: p = 0.004 < 0.01). The WBC, BACT, EC, and SRC had moderate intercorrelations (0.569 ~ 0.681, p < 0.01). CONCLUSIONS: There were significant differences in the aforementioned parameters between the two groups. The intervals of WBC, RBC, BACT, EC, SRC, and MUS for urine sediment analysis of healthy pregnant women using a UF-1000i should be established.


Assuntos
Primeiro Trimestre da Gravidez/urina , Segundo Trimestre da Gravidez/urina , Trimestres da Gravidez/urina , Urinálise/instrumentação , Urinálise/métodos , Adulto , Contagem de Eritrócitos , Feminino , Humanos , Contagem de Leucócitos , Pessoa de Meia-Idade , Gravidez , Valores de Referência , Reprodutibilidade dos Testes , Urina/microbiologia , Adulto Jovem
8.
Pregnancy Hypertens ; 17: 226-232, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487645

RESUMO

OBJECTIVE: We aimed to examine the ELABELA levels at different stages of pregnancy among normotensive controls and women with hypertensive disorders of pregnancy (HDP). STUDY DESIGN: A total of 336 blood samples of 169 women were collected from pre-pregnancy, the first, second, and third trimesters. Women were divided into the following six groups: 1) non-pregnant healthy women; 2) healthy pregnant controls; 3) chronic hypertension; 4) gestational hypertension; 5) preeclampsia; and 6) preeclampsia superimposed on chronic hypertension. ELABELA plasma concentrations were measured by human ELA Elisa Kit (Peninsula Laboratories International, Inc. USA). Kruskal-Wallis test was used to test whether ELABELA level in each type of HDP differed from that in gestational week-matched normotensive controls. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy. RESULTS: In the first trimester, patients with gestational hypertension had higher ELABELA level than gestational week-matched normotensive controls [median (ng/ml): 31.9, (IQR (ng/ml): 16.3, 47.6) vs. 19.7 (13.7, 23.2), p = 0.03]. In the second trimester, the levels were 49.2 (32.2, 69.1) vs 24.0 (13.0, 32.6) (p = 0.002), respectively. The level for gestational hypertensive women in the third trimester did not differ significantly from that of normotensive women [43.8 (30.8, 62.7) vs 25.0 (12.3, 74.0), p = 0.82]. The ELABELA levels were similar between preeclamptic women and normotensive controls throughout pregnancy. CONCLUSIONS: Maternal blood ELABELA levels in the first and second trimesters were elevated in women who developed gestational hypertension late in pregnancy, but the ELABELA level bears no significant relationship with preeclampsia during any stage of pregnancy.


Assuntos
Hormônios Peptídicos/sangue , Pré-Eclâmpsia/diagnóstico , Diagnóstico Pré-Natal , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Pré-Eclâmpsia/sangue , Gravidez , Trimestres da Gravidez
9.
Pregnancy Hypertens ; 17: 241-248, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487647

RESUMO

BACKGROUND: It is still unclear how well aspirin performs in women with different risks and how the timing of aspirin use influences its efficacy. This study was to evaluate the association between timing of aspirin exposure and hypertensive disorders in pregnant women with various risks in a prospective cohort. METHODS: We used data from the Collaborative Perinatal Project, U.S., 1959-1976. Women were grouped into high, moderate and low risks based on medical history. We classified the timing of aspirin exposure into 4 weeks before the last menstrual period, the first, second and third trimesters. RESULTS: A total of 50,579 pregnant women were included in our analysis with 6453, 18,552 and 25,574 women at high, moderate and low risks, respectively. In high-risk women, aspirin use for more than 7 days in the first trimester reduced the risks of preterm and term preeclampsia/eclampsia by 42% (adjusted OR 0.58; 95% CI 0.36-0.94) and 24% (adjusted OR 0.76; 95% CI 0.59-0.97), respectively; in moderate-risk women, aspirin use for more than 7 days during the third trimester reduced the risks of term preeclampsia/eclampsia and gestational hypertension by 37% (adjusted OR 0.63; 95% CI 0.50-0.79) and 27% (adjusted OR 0.73; 95% CI 0.62-0.86), respectively. CONCLUSION: Aspirin use in pregnancy reduces the risks of maternal hypertensive disorders. Early initiation of aspirin in high-risk women was associated with lower incidence of preeclampsia/eclampsia. Meanwhile, the protective effect of aspirin on term preeclampsia/eclampsia and gestational hypertension may continue till late pregnancy.


Assuntos
Aspirina/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/epidemiologia , Adulto , Aspirina/administração & dosagem , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Inibidores da Agregação de Plaquetas/administração & dosagem , Pré-Eclâmpsia/prevenção & controle , Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
10.
R I Med J (2013) ; 102(6): 35-40, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398967

RESUMO

OBJECTIVE: Our objective was to identify patterns of opioid use among pregnant women enrolled in RI Medicaid. METHODS: This study used linked RI Medicaid and RI Birth Certificate data from 01/01/2006 to 12/31/2016. We examined temporal trends of prescription opioid dispensings and identified risk factors associated with opioids use during pregnancy. RESULTS: Among 25,500 RI Medicaid enrolled pregnant women who delivered a live baby from 2008 to 2016, 1,914 (7.5%) received at least one prescription for an opioid medication during pregnancy, 810 (3.2%) were during the first trimester, 633 (2.5%) during the second trimester, and 866 (3.4%) during the third trimester. Of these, 213 (0.8%) women received 3 or more opioids during pregnancy. The prevalence of prescription opioids dispensed in pregnant women increased from 4.9% in 2008 to 9.6% in 2015 (ß±SD: 0.66±0.28, P=0.05). CONCLUSIONS: Prescription opioid use during pregnancy has increased among women enrolled in RI Medicaid.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Gravidez , Adolescente , Adulto , Feminino , Humanos , Hidrocodona/uso terapêutico , Modelos Logísticos , Análise Multivariada , Oxicodona/uso terapêutico , Dor/tratamento farmacológico , Trimestres da Gravidez , Estudos Retrospectivos , Rhode Island , Estados Unidos , Adulto Jovem
11.
Georgian Med News ; (291): 31-36, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31418726

RESUMO

The purpose of the study was to assess the features of the postoperative period according to the parameters of the blood coagulation system in pregnant women who undergone laparoscopic and traditional appendectomy in different gestational terms. The age of pregnant women ranged from 18 to 40 years, the average age was 25.7±0.5 years. The gestational period was from 4-5 to 35-36 weeks. In accordance with the purpose of the work, the patients were divided into two groups. For women of group I (n=75), laparoscopic appendectomy was performed as a surgical treatment, in group II (n=25), appendectomy was performed by a laparotomy. It has been established that activation of the regulatory mechanisms of the blood coagulation system in the treatment of acute appendicitis during pregnancy does not go beyond the limits of physiological parameters both before and after laparoscopic appendectomy. The hemostasis system with traditional appendectomy has more pronounced and persistent signs of hypercoagulation that were aggravated under the conditions of surgical intervention and in the postoperative period there was a very slow tendency for their recovery. Thus, changes in the hemostasis system in the traditional treatment of acute appendicitis during pregnancy compared with laparoscopic evidence of a significant increase in blood coagulation potential. Considering the minimal changes in the hemostasis system during endoscopic surgical intervention, the absence of surgical and obstetric complications, favorable pregnancy outcomes for mother and child, the optimal choice of the treatment is laparoscopic appendectomy in different periods of pregnancy.


Assuntos
Apendicectomia , Apendicite/cirurgia , Idade Gestacional , Laparoscopia , Complicações na Gravidez/cirurgia , Trimestres da Gravidez , Adulto , Feminino , Humanos , Recém-Nascido , Complicações Pós-Operatórias , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
12.
BMC Pregnancy Childbirth ; 19(1): 295, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412799

RESUMO

BACKGROUND: Physical activity (PA) and dietary intake are important modifiable factors associated with health outcomes. However, Chinese pregnant women's PA and dietary intake are only vaguely understood. The aim of this study was to reveal the characteristics of PA and dietary intake of Chinese women in different trimesters as well as the associations between PA and dietary intake. METHODS: This is a cross-sectional observational study. PA, dietary intake, and demographics of 1077 Chinese pregnant women were measured. The Chi-square test, Kruskal-Wallis test, multiple logistic regression, and multiple linear regression were used for data analysis. RESULTS: About 57.1% of the participants met the international guideline for PA. Household activity and occupational activity contributed the most to the total PA, while sports/exercise contributed little. The mean energy intake of the participants was 2008 ± 748.0 kcal. Most participants had normal energy intake, but they obtained excessive energy from fat (mean = 41.7 ± 8.7%). PA was not found to be significantly associated with dietary intake. Further, the participants who were unemployed during pregnancy (OR = 0.72, 95% CI: 0.55-0.95; p < 0.05) or had no exercise habits before pregnancy (OR = 0.62, 95% CI: 0.47-0.80; p < 0.01) were less likely to meet the PA guideline. The participants in the third trimester (OR = 1.43, 95% CI: 1.03-1.99; p < 0.05) were more likely to meet the PA guideline compared to those in the first trimester. The older participants (> 30 years) showed higher dietary intake than the younger (< 25 years) participants (p < 0.01). CONCLUSIONS: The total PA of Chinese women during pregnancy mostly consists of household and occupational activities, but little sports/exercise. Starting exercise before pregnancy may help women achieve adequate PA during pregnancy. Moreover, these women consumed an excessive amount of fat and their diet intake varies by age.


Assuntos
Dieta/estatística & dados numéricos , Ingestão de Alimentos , Exercício , Trimestres da Gravidez , Adulto , Distribuição de Qui-Quadrado , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Gravidez
13.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414751

RESUMO

BACKGROUND: Pregnancy is a natural physiological variation as a result of hormonal and metabolic changes. Worldwide a large proportion of women are expected to die each year as a result of pregnancy complication related to hematological profile alterations. Therefore, this study is aimed at assessing hematological indices of pregnant in comparison with non-pregnant women. METHODS: A comparative cross-sectional study was conducted among pregnant and non-pregnant women at the University of Gondar Hospital, from February to April 2015. A blood sample was collected from 139 pregnant and 139 age-matched non-pregnant women using systematic random sampling technique. Data analysis was made using SPSS version 20. Level of significance was analyzed using independent t-test and Mann-Whitney U test. A p-value ≤ 0.05 was considered statistically significant. RESULTS: In this study, pregnant women had significantly higher WBC count [(7.08 ± 2.07 vs. 5.77 ± 1.85) x 109/L], MCV [(93.16 ± 3.44 vs. 90.74 ± 4.12) fL], MCHC [(30.40 ± 1.19 vs. 29.47 ± 1.46) pg], Neutrophil count [(4.73 ± 1.86 vs. 3.06 ± 1.47) x 109/L], Lymphocyte count [(1.65 ± 0.41 vs. 1.2 ± 0.54) x 109/L], RDW [(49.35 ± 2.9 vs. 46.37 ± 2.73) fL], PDW [(14.02 ± 0.6 vs. 13.12 ± 0.19) fL], and MPV [(10.49 ± 0.95 vs. 10.06 ± 1.18) fL] compared with controls. The RBC count [(4.55 ± 0.38 vs. 5.14 ± 0.53) x 1012/L], Hb [(13.73 ± 0.96 vs. 15.30 ± 1.074) g/dL], Hct [(42.14 ± 2.55 vs. 47.16 ± 3.36)%], and Platelets [(196.07 ± 48.88 vs. 249.36 ± 62.73) x 109/L] were significantly lower among pregnant women compared to the control group, respectively. This study also indicated that there was a significant difference in MCV, MCH, platelet count, absolute lymphocyte count and RDW across the three trimes-ters of pregnancy. CONCLUSIONS: This study found a statistically significant difference in the majority of hematological indices between pregnant and non-pregnant women. Trimesters of pregnancy have an influence on some hematological indices. This study provides baseline data for basic hematological indices changes, and it is vital especially in the antenatal care assessment to avoid pregnancy-related adverse outcomes.


Assuntos
Contagem de Células Sanguíneas/estatística & dados numéricos , Hospitais Universitários , Complicações Hematológicas na Gravidez/sangue , Trimestres da Gravidez/sangue , Encaminhamento e Consulta , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Contagem de Leucócitos/estatística & dados numéricos , Gravidez , Valores de Referência , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 19(1): 308, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443707

RESUMO

BACKGROUND: Preeclampsia is a major cause of maternal, fetal and neonatal morbidity and mortality, particularly in developing countries. Considering the burden of preeclampsia and its associated complications, it is important to understand the underlying risk factors and mechanisms involved in its etiology. There is considerable interest in the potential for dietary long chain polyunsaturated fatty acids (LCPUFA) as a therapeutic intervention to prevent preeclampsia, as they are involved in angiogenesis, oxidative stress, and inflammatory pathways. METHODS: The REVAMP study (Research Exploring Various Aspects and Mechanisms in Preeclampsia) follows a cohort of pregnant women from early pregnancy until delivery to examine longitudinally the associations of maternal LCPUFA with clinical outcome in preeclampsia. A multisite centre for advanced research was established and pregnant women coming to Bharati hospital and Gupte hospital, Pune, India for their first antenatal visit are recruited and followed up at 11-14 weeks, 18-22 weeks, 26-28 weeks, and at delivery. Their personal, obstetric, clinical, and family history are recorded. Anthropometric measures (height, weight), food frequency questionnaire (FFQ), physical activity, socioeconomic status, fetal ultrasonography, and color Doppler measures are recorded at different time points across gestation. Maternal blood at all time points, cord blood, and placenta at delivery are collected, processed and stored at - 80 °C. The children's anthropometry is assessed serially up to the age of 2 years, when their neurodevelopmental scores will be assessed. DISCUSSION: This study will help in early identification of pregnant women who are at risk of developing preeclampsia. The prospective design of the study for the first time will establish the role of LCPUFA in understanding the underlying biochemical and molecular mechanisms involved in preeclampsia and their association with developmental programming in children.


Assuntos
Gorduras Insaturadas na Dieta/administração & dosagem , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/prevenção & controle , Estudos de Casos e Controles , Feminino , Sangue Fetal/metabolismo , Humanos , Índia , Lactente , Recém-Nascido , Estudos Longitudinais , Placenta/metabolismo , Gravidez , Trimestres da Gravidez/sangue , Cuidado Pré-Natal , Estudos Prospectivos , Projetos de Pesquisa , Medição de Risco , Fatores de Risco
15.
J Perinat Med ; 47(7): 704-709, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31421046

RESUMO

Background Spontaneous miscarriages are common pregnancy complications which result in psychological and emotional burden in the affected women. It is therefore necessary to identify biomarkers that can predict pregnancy outcome in women with threatened miscarriages so as to assist in their counselling and management. Methods The study compared levels of maternal serum CA125 in 65 pregnancies with threatened miscarriages (study group) with 65 normal intrauterine pregnancies (control group) between 6 weeks and 19 weeks + 6 days gestation using an enzyme linked immunosorbent assay (ELISA) technique. Results The mean age of the study and control groups were 29.5 ± 0.14 years and 30.1 ± 0.14 years, respectively. The mean serum CA125 in the study group was 30.1 ± 1.1 IU/mL while that of the control group was 22.9 ± 1.2 IU/mL and this was statistically significant (P = 0.0001). The mean serum CA125 level in the women whose pregnancies were aborted (aborters) was 34.8 ± 1.4 IU/mL while the mean value among those whose pregnancies continued till term (non-aborters) was 27.3 ± 1.2 IU/mL. This was statistically significant (P = 0.001). Further analysis using CA125 ≥36.2 IU/mL (mean value of serum CA125 among aborters + 1 standard deviation) as a threshold for intrauterine pregnancies that eventually got aborted showed a sensitivity of 66.7%, specificity of 83.3%, positive predictive value of 55.6%, negative predictive value of 88.9% and the diagnostic effectiveness (accuracy) was 79.4%. Conclusion The measurement of serum CA125 is a useful predictor of pregnancy outcome in threatened miscarriages.


Assuntos
Ameaça de Aborto , Antígeno Ca-125/sangue , Ameaça de Aborto/sangue , Ameaça de Aborto/diagnóstico , Ameaça de Aborto/prevenção & controle , Adulto , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Trimestres da Gravidez , Sensibilidade e Especificidade
16.
J Clin Psychopharmacol ; 39(5): 479-484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31425466

RESUMO

PURPOSE: This review examined the current literature about the potential relationship between the use of antidepressants during pregnancy and neonatal seizures. METHODS: PubMed was searched for English language reports published between January 1, 1996, and October 31, 2018, by using combinations of the following key words: pregnancy, neonatal outcome, neonatal convulsion, neonatal seizure, SSRI, selective serotonin norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant (TCA), antidepressants, sertraline, fluoxetine, paroxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, mirtazapine, duloxetine, bupropion, amitriptyline, imipramine, and clomipramine. FINDINGS: A total of 9 relevant studies that met the review criteria were examined. The prevalence rates of neonatal seizures in the antidepressant groups and control groups were 0.30% to 0.91% and 0.10% to 0.30%, respectively. The use of selective serotonin reuptake inhibitors was associated with up to 5-fold increase in the risk of neonatal seizures. Compared with the controls, higher risks were reported in newborns of pregnant women using any antidepressant or tricyclic antidepressants albeit in a limited number of studies. Exposure to antidepressants in the third trimester of pregnancy appeared to be associated more with neonatal seizures compared with earlier exposure. IMPLICATONS: Although an increased risk of neonatal seizures in newborns antenatally exposed to antidepressants especially selective serotonin reuptake inhibitors may be suggested, the available studies have severe methodological limitations to enable any firm conclusion.


Assuntos
Antidepressivos/administração & dosagem , Complicações na Gravidez/tratamento farmacológico , Convulsões/epidemiologia , Antidepressivos/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Trimestres da Gravidez , Prevalência , Convulsões/etiologia
17.
BMC Womens Health ; 19(1): 97, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299964

RESUMO

BACKGROUND: Despite the increasing use of Assisted Reproductive Technology (ART) and the significant physical and emotional commitments that these treatments and procedures involve, only limited evidence exists regarding the psychological health of women who undergo ART. This study investigated the changes over time in the psychological health of women who have conceived using ART during the first, second, and third trimesters of pregnancy and during the postpartum period in Taiwan. METHODS: A quantitative longitudinal study was conducted at a fertility centre in Taiwan. 158 pregnant women who had conceived using ART completed a web-based questionnaire that included the following instruments: State Anxiety Inventory, Edinburgh Postnatal Depression Scale, Modified Maternal Foetal Attachment Scale, Pregnancy Stress Rating Scale, Maternity Social Support Scale, Intimate Bond Measure, and Parenting Stress Index. The data were collected the first (9-12 weeks), second (19-22 weeks), third (28-31 weeks) trimesters of pregnancy and at 7-10 weeks postpartum. RESULTS: Levels of anxiety and depression, which are both key indicators of psychological health, were highest during the first trimester, with scores of 42.30 ± 11.11 and 8.43 ± 4.44, respectively. After the first trimester, anxiety scores decreased and remained stable through the remainder of pregnancy, with scores of 38.03 ± 10.58 in the second and 38.39 ± 10.36 in the third trimester, but increased at two-months postpartum, attaining a score of 41.18 ± 11.68. Further, depression scores showed a similar pattern, declining to a mean of 7.21 ± 4.23 in the second and 6.99 ± 4.11 in the third trimester and then increasing to 8.39 ± 5.25 at two-months postpartum. Pregnancy stress and social support were found to be the most important predictors of change in psychological health during pregnancy and the postpartum period. CONCLUSION: Psychological health was found to be poorest during the first trimester and at two-months postpartum. Moreover, pregnancy stress and social support were identified as key predictors of change in psychological health. The findings indicate a need for increased sensitivity among healthcare professionals to the psychological vulnerability of women who have conceived using ART as well as a need to introduce tailored interventions to provide appropriate psychological support to these women.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Complicações na Gravidez/psicologia , Trimestres da Gravidez/psicologia , Técnicas de Reprodução Assistida/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Período Pós-Parto/psicologia , Gravidez , Escalas de Graduação Psiquiátrica , Apoio Social , Inquéritos e Questionários , Taiwan , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 19(1): 237, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288789

RESUMO

BACKGROUND: Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Although their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. This study aimed to determine hematological, coagulation and cytokine profiles in hypertensive as compared to normotensive pregnancy and to identify correlations between these profiles. METHODS: This was a hospital-based comparative cross-sectional study conducted from September 2017 to February 2018. There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women admitted to the maternity block of the same hospital. Hematological and cytokine parameters were compared between the hypertensive and the normotensive group. We analyzed the data using Student's independent t-test when the data were normally distributed; and the Mann-Whitney U-test when the data were not normally distributed. Kruskal Wallis with Dunn's multiple comparison tests was run for subgroup analysis and correlation studies were done using Spearman ranking. RESULTS: Hemoglobin levels were slightly but significantly lower, (P < 0.01) in women with HDP compared to normotensive (N) women; the same was true for platelet counts (P < 0.001). The red cell distribution width (RDW) was slightly but significantly higher in HDP than in N. Neutrophil counts and Interleukin 6 (IL-6) levels were significantly (P < 0.001) higher in HDP than in N; and within HDP IL-6 levels increased with increasing severity of HDP. A novel remarkable finding was that eosinophil counts, normal in N, were lower and lower with increasing severity of HDP, to the point that they were nearly absent in women with eclampsia. CONCLUSION: There are significant changes in hematological, cytokine and coagulation parameters in pregnant women with hypertensive disorders compared to normotensive pregnant women. The picture that emerges is that of an inflammatory state associated with hypertensive disorders of pregnancy.


Assuntos
Citocinas/sangue , Hipertensão Induzida pela Gravidez/sangue , Interleucina-6/sangue , Testes para Triagem do Soro Materno/estatística & dados numéricos , Trimestres da Gravidez/sangue , Adulto , Contagem de Células Sanguíneas , Pressão Sanguínea , Estudos Transversais , Eclampsia/sangue , Eosinófilos , Índices de Eritrócitos , Feminino , Hemoglobinas/análise , Humanos , Inflamação , Neutrófilos , Gravidez , Cuidado Pré-Natal , Índice de Gravidade de Doença , Adulto Jovem
19.
BMC Womens Health ; 19(1): 100, 2019 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331317

RESUMO

BACKGROUND: Uterine leiomyomas are often discovered during early pregnancy and in most cases will have no effect on pregnancy outcomes. However, in rare cases uterine leiomyomas may lead to obstetric complications. The aim of the study was to evaluate rate of uterine leiomyoma growth in the 3 trimesters of pregnancy. METHODS: We conducted a retrospective cohort study. Included were women who were diagnosed with uterine leiomyoma during pregnancy and had at least two sonographic measurements in different trimesters. Data regarding leiomyoma growth, recorded by ultrasound examination, during 1st 2nd and 3rd trimesters were collected from electronic patient records. RESULTS: Two-hundred forty-eight uterine leiomyomas were included in the study. Leiomyoma area increased substantially in size between the 1st and 2nd trimesters (54.5% ± 75.9%, p = .007) and to a lesser degree between the 2nd and 3rd trimesters (17.9% ± 59.7%, NS). Evaluation of the change in size throughout the pregnancy - between 1st and 3rd trimesters revealed a significant increase of 95.9% ± 191.3% (p < .001). There was no significant growth of the leiomyomas between the 2nd and 3rd trimesters. CONCLUSIONS: Uterine leiomyomas tend to grow substantially during the 1st trimester of pregnancy. This trend is attenuated later with minimal growth towards the end of gestation.


Assuntos
Leiomioma/patologia , Complicações Neoplásicas na Gravidez/patologia , Trimestres da Gravidez , Neoplasias Uterinas/patologia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Carga Tumoral , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Adulto Jovem
20.
Environ Int ; 131: 105023, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31351385

RESUMO

BACKGROUND: Phthalates are a family of endocrine disruptors with short elimination half-lives in the human body. To date, few epidemiological studies have examined repeated measures of maternal urinary phthalates and the combined effects of prenatal exposure to multiple phthalates on children's neurocognitive development. OBJECTIVES: We aimed to investigate the association between children's neurocognitive development at 2 years of age and prenatal phthalate exposure, as assessed by repeated measurements during pregnancy, and to further examine the effects of co-exposure to multiple phthalates using cumulative risk assessment. METHOD: Within a prenatal cohort in Wuhan, China, we measured five high-molecular-weight (HMW) phthalates and three low-molecular-weight (LMW) phthalate metabolites' concentrations in three urine samples collected in the 1st, 2nd, and 3rd trimester of pregnancy from each mother. We assessed neurocognitive development by Bayley Scales of Infant and Toddler Development (BSID) at 2 years of age (n = 476) to obtain the children's mental development index (MDI) and psychomotor development index (PDI). RESULTS: Higher exposure levels to LMW phthalates compared to HMW phthalates were observed in our population. Ln-transformed averaged concentration of mono-n-butyl phthalate (MnBP), a metabolite of the LMW phthalate di-n-butyl phthalate (DnBP) during pregnancy, was associated with decreased PDI scores in all children (ß = -1.90, 95% CI: -3.43, -0.37). Similarly, the averaged sum concentration of ∑dibutyl phthalate (∑DBP) was associated with decreased PDI scores in all children (ß = -1.89, 95% CI: -3.63, -0.15). A negative trend of association between exposure to HMW phthalates and PDI scores was observed in girls, while a positive association was found in boys. In cumulative risk assessment analyses, we consistently observed that the hazard quotient of DnBP (the parent compound of MnBP) was inversely associated with PDI scores in all children, whereas the hazard quotient of di-2-ethylhexyl phthalate (DEHP), an HMW phthalate, was positively associated with PDI scores in boys only. CONCLUSIONS: This study is the first to use repeated measurement of maternal urinary phthalates in all three trimesters to assess prenatal exposure in relation to children's neurodevelopment. Our study suggested a negative association between prenatal exposure to MnBP and children's psychomotor development, and potentially sex-specific associations between HMW phthalates and neurocognitive development among boys and girls. These findings warrant further confirmation.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Cognição/efeitos dos fármacos , Disruptores Endócrinos/toxicidade , Ácidos Ftálicos/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Adulto , Pré-Escolar , China , Estudos de Coortes , Disruptores Endócrinos/urina , Exposição Ambiental , Feminino , Humanos , Lactente , Masculino , Ácidos Ftálicos/urina , Gravidez , Trimestres da Gravidez , Medição de Risco , Fatores Sexuais
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