Early pregnancy changes in bacterial vaginosis-associated bacteria and preterm delivery.

BACKGROUND: We evaluated the importance of measuring early vaginal levels of eight bacterial vaginosis (BV)-associated bacteria, at two points in pregnancy, and the risk of spontaneous preterm delivery (SPTD) among pregnant women and the subgroup of pregnant women with a history of preterm delivery (PTD). METHODS: This prospective cohort study enrolled women at five urban obstetric practices at Temple University Hospital in Philadelphia PA. Women with singleton pregnancies less than 16 weeks gestation self-collected vaginal swabs at two points in pregnancy, prior to 16 weeks gestation and between 20-24 weeks gestation, to measure the presence and level of eight BV-associated bacteria. Women were followed-up for gestational age at delivery via medical records. RESULTS: Among women reporting a prior PTD, women with higher levels of Leptotrichia/Sneathia species, BVAB1 and Mobiluncus spp., prior to 16 weeks gestation, were significantly more likely to experience a SPTD. In addition, pregnant women with a prior PTD and increasing levels of Leptotrichia/Sneathia species (aOR: 9.1, 95% CI 1.9, 42.9), BVAB1 (aOR: 16.4, 95% CI 4.3, 62.7) or Megasphaera phylotype 1 (aOR: 6.2, 95% CI 1.9, 20.6), through 24 weeks gestation, were significantly more likely to experience an SPTD. Among the overall group of pregnant women, the levels of BV-associated bacteria were not related to SPTD. CONCLUSION: Among the group of women reporting a prior PTD, increasing levels of BVAB1, Leptotrichia/Sneathia species, and Megasphaera phylotype 1, through mid-pregnancy were related to an increased risk of SPTD.

Pregnancy-Associated Onset of Adult-Onset Still's Disease.

Objective This study aims to elucidate the clinical manifestations, diagnostic challenges, and management strategies of adult-onset Still's disease (AOSD) during pregnancy, leveraging a case series overview and a detailed case report from our center. Study Design A comprehensive review of 21 published case reports on AOSD diagnosed during pregnancy was conducted, alongside a detailed case report of a patient diagnosed and managed at our center. This study emphasizes the importance of recognizing AOSD in pregnant patients, outlines the therapeutic challenges encountered, and discusses the potential complications arising from the disease and its treatment. Results The onset of AOSD during pregnancy predominantly occurs in the first or second trimester, with a polycyclic disease course observed in most cases. Management primarily involves corticosteroids and immunosuppressive medications, balancing the disease control with potential pregnancy complications. The case report highlights the complex interplay between AOSD, hemophagocytic lymphohistiocytosis, and pregnancy, illustrating a multidisciplinary approach to management that ensured favorable maternal and fetal outcomes despite the significant challenges. Conclusion AOSD presents unique diagnostic and therapeutic challenges during pregnancy, requiring careful consideration of maternal and fetal health. Early diagnosis, a multidisciplinary approach to care, and judicious use of immunosuppressive therapy are critical for managing AOSD flares and associated complications. Further research is necessary to optimize care for this rare condition in the context of pregnancy.

The role of telemedicine in the management of the pregnancy complicated by diabetes.

The use of technology to deliver health care over a distance has drawn considerable attention and shown dramatic growth over the last decade because of the possibility it has to reduce cost and improve access to modern medical care. Diabetes in pregnancy, which requires tight glycemic control in order to reduce perinatal complications, is a prime telemedicine intervention target. A review of the literature suggests that telemedicine, although not perfect, can potentially play a role in reducing patient visits and could improve quality of life without jeopardizing the outcome.

Insulin resistance: the possible link between gestational diabetes mellitus and hypertensive disorders of pregnancy.

Gestational hypertension, preeclampsia, and diabetes are all associated with increased risks of poor maternal and perinatal outcomes. Pregnant women with gestational diabetes have been shown in population studies to have increased risk of pregnancy-associated hypertension compared with nondiabetic women. Moreover, pregnant patients with hypertension are at increased risk for developing gestational diabetes mellitus. It has been hypothesized that this association could be due, at least in part, to insulin resistance. Although insulin resistance is a physiologic phenomenon in normal pregnancy, in predisposed individuals this could lead to hyperinsulinemia with the development of gestational hypertension, gestational diabetes mellitus, or both.

Childhood Sexual Violence and Consistent, Effective Contraception Use among Young, Sexually Active Urban Women.

Unintended pregnancy (UP) is a significant public health problem. The consistent use of effective contraception is the primary method to prevent UP. We examined the role of childhood sexual and physical violence and current interpersonal violence on the risk of unintended pregnancy among young, urban, sexually active women. In particular, we were interested in examining the role of childhood violence and interpersonal violence while recognizing the psychological correlates of experiencing violence (i.e., high depressive symptoms and low self-esteem) and consistent use of contraception. For this assessment, 315 sexually active women living in Philadelphia PA were recruited from family planning clinics in 2013. A self-administered, computer-assisted interview was used to collect data on method of contraception use in the past month, consistency of use, experiences with violence, levels of depressive symptoms, self-esteem and sexual self-efficacy, substance use and health services utilization. Fifty percent of young sexually active women reported inconsistent or no contraception use in the past month. Inconsistent users were significantly more likely to report at least one prior episode of childhood sexual violence and were significantly less likely to have received a prescription for contraception from a health care provider. Inconsistent contraception users also reported significantly higher levels of depressive symptoms and significantly lower levels of self-esteem. The relation between childhood sexual violence and UP remained unchanged in the multivariate models adjusting for self-esteem or depressive symptoms. These findings highlight the long-term consequences of childhood sexual violence, independent of current depressive symptoms and low self-esteem, on consistent use of contraception.

Alcohol enhances HIV infection of cord blood monocyte-derived macrophages.

Alcohol consumption or alcohol abuse is common among pregnant HIV(+) women and has been identified as a potential behavioral risk factor for the transmission of HIV. In this study, we examined the impact of alcohol on HIV infection of cord blood monocyte-derived macrophages (CBMDM). We demonstrated that alcohol treatment of CBMDM significantly enhanced HIV infection of CBMDM. Investigation of the mechanisms of alcohol action on HIV demonstrated that alcohol inhibited the expression of several HIV restriction factors, including anti-HIV microRNAs, APOBEC3G and APOBEC3H. Additionally, alcohol also suppressed the expression of IFN regulatory factor 7 (IRF-7) and retinoic acid-inducible gene I (RIG-I), an intracellular sensor of viral infection. The suppression of these IFN regulatory factors was associated with reduced expression of type I IFN. These experimental findings suggest that maternal alcohol consumption may facilitate HIV infection, promoting vertical transmission of HIV.

Obstetric outcomes in pregnant women with diabetes versus hypertensive disorders versus both.

OBJECTIVE: To compare obstetrical outcomes in pregnant women with diabetes versus hypertensive disorders versus both. METHODS: One million patients in the New Jersey Database were analyzed. Of which 6.91% had hypertension, 4.79% had diabetes, and 0.91% had both. Information was derived from a perinatal linked data-set provided by the Maternal Child Health Epidemiology (MCH Epi) Program in the New Jersey Department of Health and Senior Services. Linking of electronic birth certificates, hospital discharge records for mother and newborn, and infant death certificates for all infants born in New Jersey between the years 1997 and 2005 created the data-set. RESULTS: Coexistence of hypertension and diabetes increased with advancing maternal age (OR 3.41; CI 3.12-3.72). Among ethnic groups, diabetes was more common in Asians (OR 2.92; CI 2.84-3.00), while hypertension was more common in Blacks (OR 1.49; CI 1.46-1.53). Blacks followed by Asians had a higher risk of being in the combined category. Induction of labor (OR 4.16; CI 3.96-4.38), shoulder dystocia (OR 2.56; CI 2.05-3.19), operative vaginal delivery (OR 3.92; CI 3.29-4.66), cesarean deliveries with no trial of labor (OR 2.54; CI 2.40-2.69) as well as with failed trial of labor (OR 4.09; CI 3.88-4.31) were more common in the combined group. Neonatal outcomes were poor in the combined category, with high rate of preterm deliveries, neonatal intensive care unit (NICU) admissions (OR 2.14; CI 2.01-2.28), neonatal seizures (OR 2.30; CI 1.31-4.04), low 5-min APGAR scores (OR 1.78; CI 1.57-2.01), and longer NICU stay (OR 2.30; CI 2.15-2.47). CONCLUSIONS: Coexistence of hypertension and diabetes was associated with worse obstetric and neonatal outcomes than either alone. This should be emphasized to mothers during prenatal counseling. Further research should focus on interventions to improve morbidity in the combined category.