Maternal/Perinatal Outcome in Women with Sickle Cell Disease: A Comparison of Two Time Periods.

OBJECTIVE: To compare pregnancy outcomes in women with sickle cell disease from recent deliveries with a similar group delivered earlier. METHODS: During a 12-year period (2005-2016), data from pregnant women with hemoglobin SS or SC were collected from three university medical centers and compared with earlier studies (1979-2003) involving similar patients. The primary endpoints were maternal complications during pregnancy and newborn outcomes. RESULTS: There were 278 patients in the control group (1979-2003) compared with 150 patients in the study group (2005-2016). Women in the study group were older (P < 0.0001) and of less parity (P =0.0001), and complications of preterm delivery, preeclampsia, and having a transfusion were similar between the two groups (P = 0.45, 0.95, and 0.49, respectively). Pain crises were more common in the study group (P = 0.02) as was cesarean section (P < 0.0001), but there was a reduction in pulmonary complications (P = 0.0002). Maternal mortality was uncommon (control group [N=4] vs study group [N=3], P = 0.40). Newborn statistics revealed a similar gestational age at delivery (37 weeks), and the incidence of intrauterine growth restriction, as well as 5-minute Apgar score <7 did not differ by group (P = 0. 91, 0.85, and 0.16, respectively). Infants in the study group were heavier on average by approximately 220 g (P = 0.02), whereas the neonatal death rate was low (control group [N=1], study group [N=2] P = 0.60). CONCLUSIONS: Recent pregnancy outcome statistics in women with sickle cell disease have not changed through the years. Innovative strategies to improve maternal and newborn outcomes among such patients are needed.

Selective Serotonin Reuptake Inhibitor Pharmacokinetics During Pregnancy: Clinical and Research Implications.

Pregnancy and associated physiologic changes affect the pharmacokinetics of many medications, including selective serotonin reuptake inhibitors-the first-line pharmacologic interventions for depressive and anxiety disorders. During pregnancy, SSRIs exhibit extensive pharmacokinetic variability that may influence their tolerability and efficacy. Specifically, compared to non-pregnant women, the activity of cytochrome P450 (CYP) enzymes that metabolize SSRIs drastically changes (e.g., decreased CYP2C19 activity and increased CYP2D6 activity). This perspective examines the impact of pharmacokinetic genes-related to CYP activity on SSRI pharmacokinetics during pregnancy. Through a simulation-based approach, plasma concentrations for SSRIs metabolized primarily by CYP2C19 (e.g., escitalopram) and CYP2D6 (e.g., fluoxetine) are examined and the implications for dosing and future research are discussed.

Maternal and perinatal outcomes of indicated inductions of labor.

PURPOSE: The purpose of this study was to evaluate the labor characteristics and maternal/perinatal consequences following indicated induction of labor. METHODS: This retrospective study examined all of the indicated inductions over 24 months and at two institutions evaluated mode of delivery (vaginal versus cesarean) as well as a comprehensive list of labor characteristics and maternal/perinatal outcomes. RESULTS: There were 1577 indicated inductions with 1097/1577 (69.6%) delivering vaginally. Women with a cesarean delivery had lower parity (p < (0).0001) and Bishop's score (p < (0).0001), and higher body mass indices (p = 0.022). Indication for induction due to preeclampsia increased the risk of a cesarean delivery (p = 0.008). Chorioamnionitis, post-partum complications and NICU admissions were greater in the women delivered by cesarean section. CONCLUSIONS: Indicated inductions which result in cesarean delivery were more likely in women with higher body mass indexes, lower parity, and Bishops scores, as well as preeclampsia.