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Tang J, Zhao H, Zhou YH. Screening for viral hepatitis carriage. Best Pract Res Clin Obstet Gynaecol 2024:102523. [PMID: 38908915 DOI: 10.1016/j.bpobgyn.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024]
Abstract
Viral hepatitis during pregnancy is common globally. In this review, we focus on the antenatal screen for hepatitis A, B, C and E, the prevention of mother-to-child transmission (MTCT) of hepatitis B and C, and the management of hepatitis A, B, C and E during pregnancy. Neonatal timely administration of hepatitis B immunoglobulin and hepatitis B vaccine is the cornerstone for preventing MTCT of hepatitis B virus (HBV), and perinatal antiviral prophylaxis with tenofovir disoproxil fumarate in mothers with positive HBeAg or HBV DNA >2 × 105 IU/ml also plays important roles in further reducing MTCT. Avoidance of risk practices in managing labor and delivery process of women with HCV infection may be useful to reduce MTCT of HCV. Early recognition of severe hepatic injury or liver failure associated with hepatitis viruses by regular liver function tests is critical to prevent maternal mortality associated with hepatitis.
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Affiliation(s)
- Jie Tang
- Department of Obstetrics and Gynecology, Wujin Hospital Affiliated with Jiangsu University, Jiangsu, China; Department of Obstetrics and Gynecology, The Wujin Clinical College of Xuzhou Medical University, Jiangsu, China
| | - Hong Zhao
- Department of Infectious Diseases, Nanjing Second Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi-Hua Zhou
- Departments of Laboratory Medicine and Infectious Diseases and Obstetrics & Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
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2
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Creisher PS, Klein SL. Pathogenesis of viral infections during pregnancy. Clin Microbiol Rev 2024; 37:e0007323. [PMID: 38421182 PMCID: PMC11237665 DOI: 10.1128/cmr.00073-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
SUMMARYViral infections during pregnancy are associated with significant adverse perinatal and fetal outcomes. Pregnancy is a unique immunologic and physiologic state, which can influence control of virus replication, severity of disease, and vertical transmission. The placenta is the organ of the maternal-fetal interface and provides defense against microbial infection while supporting the semi-allogeneic fetus via tolerogenic immune responses. Some viruses, such as cytomegalovirus, Zika virus, and rubella virus, can breach these defenses, directly infecting the fetus and having long-lasting consequences. Even without direct placental infection, other viruses, including respiratory viruses like influenza viruses and severe acute respiratory syndrome coronavirus 2, still cause placental damage and inflammation. Concentrations of progesterone and estrogens rise during pregnancy and contribute to immunological adaptations, placentation, and placental development and play a pivotal role in creating a tolerogenic environment at the maternal-fetal interface. Animal models, including mice, nonhuman primates, rabbits, and guinea pigs, are instrumental for mechanistic insights into the pathogenesis of viral infections during pregnancy and identification of targetable treatments to improve health outcomes of pregnant individuals and offspring.
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Affiliation(s)
- Patrick S Creisher
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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3
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Usuda D, Kaneoka Y, Ono R, Kato M, Sugawara Y, Shimizu R, Inami T, Nakajima E, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Current perspectives of viral hepatitis. World J Gastroenterol 2024; 30:2402-2417. [PMID: 38764770 PMCID: PMC11099385 DOI: 10.3748/wjg.v30.i18.2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/11/2024] Open
Abstract
Viral hepatitis represents a major danger to public health, and is a globally leading cause of death. The five liver-specific viruses: Hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus, and hepatitis E virus, each have their own unique epidemiology, structural biology, transmission, endemic patterns, risk of liver complications, and response to antiviral therapies. There remain few options for treatment, in spite of the increasing prevalence of viral-hepatitis-caused liver disease. Furthermore, chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality, even though effective treatments are available that could reduce or prevent most patients' complications. In 2016, the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030, along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis. Today, treatment is sufficiently able to prevent the disease from reaching advanced phases. However, future therapies must be extremely safe, and should ideally limit the period of treatment necessary. A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis. This review aims to summarize the current state of knowledge on each type of viral hepatitis, together with major innovations.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuki Kaneoka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Rikuo Ono
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Masashi Kato
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuto Sugawara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Runa Shimizu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Tomotari Inami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Eri Nakajima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo 113-8421, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima 177-8521, Tokyo, Japan
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Cannovo N, Bianchini E, Gironacci L, Garbati E, Di Prospero F, Cingolani M, Scendoni R, Fedeli P. Sexually Transmitted Infections in Adolescents and Young Adults: A Cross Section of Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:501. [PMID: 38673412 PMCID: PMC11050350 DOI: 10.3390/ijerph21040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Sexually transmitted infections (STIs) can be caused by a number of microorganisms that vary greatly in size, life cycle, clinical manifestations, and sensitivity to available treatments. Transmission of STIs can occur during unprotected (or condomless) sexual contact and through the exchange of body fluids during any type of activity. The prevalence of sexually transmitted diseases remains high in the world, despite diagnostic and therapeutic improvements for these infectious diseases that rapidly eliminate the contagiousness of patients. Our study determines the prevalence of STI pathogens in adolescents and young adults in the population of the Province of Macerata (Italy). We will analyze data in correspondence to age and gender, and we will compare our results to international studies. MATERIALS AND METHOD We analyzed STI test results from the entire database of a Provincial Health Authority for the period 2021-2022. The samples came from the following age groups: 0-12, 13-18, 19-25, and 26-35 from 2021 to 2022. The results came from vaginal and cervical swabs (for females); urethral, rectal, and pharyngeal swabs (for males and females); and seminal fluid (for males) for the following infections: HPV, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasmas, Gardnerella, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum. The results also came from blood tests for HIV, hepatitis C, hepatitis B, and Treponema pallidum (TPHA, VDRL). In addition, we examined results from urine tests for chlamydia, Neisseria gonorrhoeae, trichomonas, and Treponema pallidum. CONCLUSIONS The literature for other countries reports the need for comprehensive, culturally and developmentally sensitive care to address sexuality-related issues in adolescents and young adults, a need that also applies to Italy. These data will be of great importance in adopting evidence-based STI control programs in Marche Region. This study could, indeed, represent a landmark for public health officials and professionals, with the aim of promoting adolescents' access to sexual health services to receive useful information, strengthening preventive measures in younger age groups, and designing sexual education programs.
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Affiliation(s)
- Nunzia Cannovo
- Legal Medicine Unit, Local Health Authority (AST) 3, 62032 Camerino, Italy;
| | - Elena Bianchini
- Clinical Governance and Risk Unit, Macerata Hospital, Local Health Authority (AST) 3, 62100 Macerata, Italy;
| | - Luciana Gironacci
- Analysis Laboratory Unit, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy;
| | - Elisabetta Garbati
- Gynecology and Obstetrics Unit, Civitanova Marche Hospital, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy; (E.G.); (F.D.P.)
| | - Filiberto Di Prospero
- Gynecology and Obstetrics Unit, Civitanova Marche Hospital, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy; (E.G.); (F.D.P.)
| | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy;
| | - Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy;
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
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Mularoni A, Cona A, Ribeiro Dias L, Bulati M, Busà R, Castelbuono S, Lo Porto D, Pietrosi G, Liotta R, Conaldi PG, Grossi PA, Luppi M. Cytokine storm and severe hepatitis in pregnancy due to herpes simplex virus 2. Infection 2024; 52:259-263. [PMID: 37759073 PMCID: PMC10811078 DOI: 10.1007/s15010-023-02092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023]
Abstract
CASE PRESENTATION A pregnant woman developed hepatitis due to a herpes simplex virus 2 primary infection with a severe systemic inflammatory response. Treatment with acyclovir and human immunoglobulin was given and both mother and baby survived. PURPOSE We provide the first description of the inflammatory response associated with herpetic hepatitis in pregnancy.
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Affiliation(s)
- Alessandra Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via Tricomi 5, 90127, Palermo, Italy
| | - Andrea Cona
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via Tricomi 5, 90127, Palermo, Italy.
| | - Lùcia Ribeiro Dias
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via Tricomi 5, 90127, Palermo, Italy
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Matteo Bulati
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Rosalia Busà
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Salvatore Castelbuono
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Davide Lo Porto
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via Tricomi 5, 90127, Palermo, Italy
| | - Giada Pietrosi
- Department for the Treatment and Study of Abdominal Disease and Abdominal Transplantation, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Rosa Liotta
- Pathology Unit, Department of Diagnostic and Therapeutic Services, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Pier Giulio Conaldi
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, 41124, Modena, Italy
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Cao G, Liu J, Liu M. Associations of hepatitis B and C in women aged 15-49 years with neonatal preterm birth in 66 high-income countries, 1990-2019. Int J Gynaecol Obstet 2024; 164:115-123. [PMID: 37358002 DOI: 10.1002/ijgo.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/04/2023] [Accepted: 05/28/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To assess the associations between hepatitis B and C in women aged 15-49 years and neonatal preterm birth in high-income countries (HICs). METHODS This ecological study collected hepatitis B and C prevalence data in women aged 15-49 years and age-standardized incidence rates (ASIRs) of neonatal preterm birth in HICs in 1990-2019 from the Global Burden of Disease study. Estimated annual percentage changes (EAPCs) in hepatitis B and C prevalence and ASIRs of neonatal preterm birth were calculated to quantify their temporal trends. Pearson correlation tests and generalized additive mixed models were used to estimate the associations between hepatitis B and C prevalence and ASIR of neonatal preterm birth. RESULTS Among women aged 15-49 years in HICs, hepatitis B prevalence increased only in the Northern Mariana Islands (EAPC, 0.16 [95% confidence interval (CI), 0.05-0.27]) and the United Kingdom (EAPC, 0.08 [95% CI, 0.04-0.12]) and hepatitis C prevalence increased in more than 20% of HICs in 1990-2019, with the largest increase in Belgium (EAPC, 1.00 [95% CI, 0.65-1.35]). Nearly 80% of HICs showed an increasing trend in ASIR of neonatal preterm birth in 1990-2019, with the largest increase in Greece (EAPC, 3.91 [95% CI, 3.65-4.18]). A positive association between hepatitis C prevalence in women aged 15-49 years and ASIR of neonatal preterm birth was observed in Pearson correlation tests and generalized additive mixed models (P ≤ 0.01). CONCLUSION ASIR of neonatal preterm birth was associated with hepatitis C prevalence in women aged 15-49 years in HICs. Universal screening for hepatitis C virus is recommended at least once for women of reproductive age and during each pregnancy.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission, Beijing, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Fiorillo L, Minervini G, Laino L, Peditto M, Cicciù M, Cervino G. Hepatitis-virus-positive patients management in dental office. Minerva Dent Oral Sci 2023; 72:312-318. [PMID: 37255308 DOI: 10.23736/s2724-6329.23.04803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Hepatitis is a condition characterized by inflammation of the liver, which can be caused by several viruses including hepatitis A, B, C, D and E. This condition can affect the oral health of patients and increase the risk of complications during dental management. The clinical management of hepatitis patients in the dental setting requires a comprehensive and individualized approach to ensure safety and optimal treatment outcomes. This article aims to provide a comprehensive overview of the current literature on the dental management of patients with different forms of hepatitis. METHODS The article focuses on the specific challenges associated with dental treatments in hepatitis patients, including increased risk of infection and bleeding. Additionally, the article provides recommendations for dental practitioners, including infection control measures, communication with medical providers, and the use of prophylactic antibiotics. RESULTS The authors show that the dental management of patients with hepatitis requires a thorough understanding of the specific challenges associated with this condition, as well as the implementation of appropriate preventive measures to ensure the safety and well-being of these patients. CONCLUSIONS Further research is needed to better understand the impact of hepatitis on oral health and the most effective approaches to managing dental treatments in this patient population.
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Affiliation(s)
- Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy -
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy -
- Department of Prosthodontics, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, India -
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Matteo Peditto
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
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Abstract
PURPOSE The purpose of this document is to describe the specific types of viral hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection. TARGET POPULATION Pregnant or postpartum women and individuals who screen positive for viral hepatitis infection. The onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on hepatitis B virus and hepatitis C virus screening in pregnancy; prepregnancy, antepartum, intrapartum, and postpartum management for patients with hepatitis B virus infection or hepatitis C virus infection; management of accidental and occupational exposure to hepatitis B virus or hepatitis C virus in pregnant health care workers; and hepatitis A virus and hepatitis B virus vaccination in pregnancy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
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Grünebaum A, Bornstein E, McLeod-Sordjan R, Lewis T, Wasden S, Combs A, Katz A, Klein R, Warman A, Black A, Chervenak FA. The impact of birth settings on pregnancy outcomes in the United States. Am J Obstet Gynecol 2023; 228:S965-S976. [PMID: 37164501 DOI: 10.1016/j.ajog.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 05/12/2023]
Abstract
In the United States, 98.3% of patients give birth in hospitals, 1.1% give birth at home, and 0.5% give birth in freestanding birth centers. This review investigated the impact of birth settings on birth outcomes in the United States. Presently, there are insufficient data to evaluate levels of maternal mortality and severe morbidity according to place of birth. Out-of-hospital births are associated with fewer interventions such as episiotomies, epidural anesthesia, operative deliveries, and cesarean deliveries. When compared with hospital births, there are increased rates of avoidable adverse perinatal outcomes in out-of-hospital births in the United States, both for those with and without risk factors. In one recent study, the neonatal mortality rates were significantly elevated for all planned home births: 13.66 per 10,000 live births (242/177,156; odds ratio, 4.19; 95% confidence interval, 3.62-4.84; P<.0001) vs 3.27 per 10,000 live births for in-hospital Certified Nurse-Midwife-attended births (745/2,280,044; odds ratio, 1). These differences increased further when patients were stratified by recognized risk factors such as breech presentation, multiple gestations, nulliparity, advanced maternal age, and postterm pregnancy. Causes of the increased perinatal morbidity and mortality include deliveries of patients with increased risks, absence of standardized criteria to exclude high-risk deliveries, and that most midwives attending out-of-hospital births in the United States do not meet the gold standard for midwifery regulation, the International Confederation of Midwives' Global Standards for Midwifery Education. As part of the informed consent process, pregnant patients interested in out-of-hospital births should be informed of its increased perinatal risks. Hospital births should be supported for all patients, especially those with increased risks.
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Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Tricia Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Shane Wasden
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Risa Klein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Alex Black
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
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An Overview of Antiviral Treatments in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:183-203. [PMID: 36822703 DOI: 10.1016/j.ogc.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Viral infections pose unique threats to pregnant persons and their infants. As the frequency of epidemics caused by novel pathogens increases, understanding pregnancy-specific considerations for antiviral treatments is critical for obstetric and nonobstetric providers alike. The use of pharmacologic therapeutics in pregnancy, which include antivirals, pathogen-specific antibodies, and vaccines, is limited due to the lack of purposeful, methodologic, pharmacometrics analyses in this special population. Our current understanding regarding dosing, safety, and efficacy stems from our knowledge of potential maternal or neonatal risks, observational data, and rarely clinical trials. In this review, we provide an overview on the use of antivirals during pregnancy.
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Abrams EJ, Penazzato M. Disrupting the status quo to achieve early inclusion of pregnant women in studies of new agents for prevention and treatment of HIV infection. J Int AIDS Soc 2022; 25 Suppl 2:e25927. [PMID: 35851572 PMCID: PMC9294859 DOI: 10.1002/jia2.25927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Martina Penazzato
- Global Programme on HIV, Hepatitis and Sexually Transmitted infections, World Health Organization, Geneva, Switzerland
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Behnke C, Nissim O, Simerlein W, Beeker K, Tarleton JL, Lazenby GB. Quality improvement to evaluate and provide treatment for chronic hepatitis C postpartum. J Am Pharm Assoc (2003) 2021; 62:864-869. [PMID: 34975005 DOI: 10.1016/j.japh.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infections are increasing among reproductive age individuals. Direct acting antivirals (DAAs) can cure HCV, but the use of DAAs is not currently recommended during pregnancy and breastfeeding. Individuals with HCV commonly have inadequate prenatal and postnatal care. OBJECTIVES The purpose of our study was to demonstrate the success of a quality improvement program to increase evaluation during pregnancy and ensuring access to DAA treatment medication during the postpartum period for individuals with chronic HCV to achieve cure 12 weeks after completing therapy. The primary outcome was documented HCV cure rate compared among individuals who received immediate treatment with DAA after delivery or after weaning or a traditional approach of referral to an infectious diseases specialist or hepatologist. The secondary outcome was the proportion of infants exposed to HCV evaluated. METHODS An interdisciplinary team developed a program to increase evaluation and HCV treatment for postpartum individuals. Individuals who received prenatal care from March 2017 to May 2021 were eligible. Individuals with chronic HCV had a laboratory evaluation before delivery, and appropriate DAAs were selected for postpartum treatment. The health system specialty pharmacy dispensed DAA prescriptions immediately after delivery to those who were not breastfeeding. Individuals who did breastfeed had the option to begin treatment after weaning. Cure was defined as a sustained viral response or undetectable HCV RNA collected 12 weeks after completing DAA treatment. RESULTS We demonstrate the success of an interdisciplinary team to ensure access to therapy for the treatment of postpartum chronic HCV. Only 3 infants (25%) with mothers referred were evaluated at our institution compared with 44% of infants (n = 10) whose mothers were treated after delivery. CONCLUSION An interdisciplinary team for HCV treatment improves access to treatment therapy with DAAs leading to the cure of chronic HCV after delivery.
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Liu HY, Guo J, Zeng C, Cao Y, Ran R, Wu T, Yang G, Zhao D, Yang P, Yu X, Zhang W, Liu SM, Zhang Y. Transient Early Fine Motor Abnormalities in Infants Born to COVID-19 Mothers Are Associated With Placental Hypoxia and Ischemia. Front Pediatr 2021; 9:793561. [PMID: 35071136 PMCID: PMC8772397 DOI: 10.3389/fped.2021.793561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Long-term effects of Coronavirus Disease 2019 (COVID-19) on infants born to infected mothers are not clear. Fine motor skills are crucial for the development of infant emotional regulation, learning ability and social skills. Methods: Clinical information of 100 infants born to 98 mothers (COVID-19 n = 31, non-COVID-19 n = 67) were collected. Infants were follow-up up to 9 months post-partum. The placental tissues were examined for SARS-CoV-2 infection, pathological changes, cytokines, and mtDNA content. Results: Decreased placental oxygen and nutrient transport capacity were found in infected pregnant women. Increased IL-2, IL-6, TNF-α, and IFN-γ were detected in trophoblast cells and maternal blood of COVID-19 placentas. Elevated early fine motor abnormal-ities and increased serum TNI (troponin I) levels at delivery were observed in infants born to mothers with COVID-19. Increased abnormal mitochondria and elevated mtDNA content were found in the placentas from infected mothers. The placental mtDNA content of three infants with abnormal DDST were increased by 4, 7, and 10%, respectively, compared to the mean of the COVID-19 group. The Maternal Vascular Malperfusion (MVM), elevated cytokines and increased placental mtDNA content in mothers with COVID-19 might be associated with transient early fine motor abnormalities in infants. These abnormalities are only temporary, and they could be corrected by daily training. Conclusions: Babies born to COVID-19 mothers with mild symptoms appeared to have little or no excess long-term risks of abnormal physical and neurobehavioral development as compared with the infants delivered by non-COVID-19 mothers.
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Affiliation(s)
- Huan-Yu Liu
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
| | - Juanjuan Guo
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
| | - Chang Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yuming Cao
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
| | - Ruoxi Ran
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Department of Clinical Laboratory, Center for Gene Diagnosis, and Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tiancheng Wu
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
| | - Guifang Yang
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dongchi Zhao
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pu Yang
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuechen Yu
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute of Precision Medicine, Jining Medical University, Jining, China
| | - Song-Mei Liu
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China.,Department of Clinical Laboratory, Center for Gene Diagnosis, and Program of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuanzhen Zhang
- Department of Gynaecology and Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, China
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