1
|
Segal E, Landau D, Hassan L, Israeli A, Gorodischer R. Prenatal Exposure to Acid Suppressor Medications and Development of Ductus Arteriosus in Term Newborns. Am J Perinatol 2024. [PMID: 38537691 DOI: 10.1055/a-2295-6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
OBJECTIVE The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H2RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids-proton pump inhibitors (PPIs) and H2RA. STUDY DESIGN This was a population-based matched case-control study of mothers registered at "Clalit" Health Maintenance Organization (HMO) and their infants born at "Soroka" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H2RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC). RESULTS PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H2RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all p < 0.001). PDA association with exposure window was similar in each trimester (1.5-2%) for both H2RA and PPI. CONCLUSION PDA incidence in term infants in our population was greater than previously reported. PPI and H2RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias. KEY POINTS · Term newborns with PDA have different characteristics than newborns without PDA.. · Prenatal exposure to PPIs or H2RA is associated with greater risk of PDA in term newborns.. · The possible effect mechanism of PPIs on the ductus is unclear and understudied..
Collapse
Affiliation(s)
- Ella Segal
- Joyce and Irving Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Hassan
- Joyce and Irving Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adir Israeli
- Joyce and Irving Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
2
|
Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus 2024; 16:e55544. [PMID: 38576690 PMCID: PMC10993087 DOI: 10.7759/cureus.55544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Pregnancy affects many organ systems and causes significant physiological changes that are mainly caused by changes in hormone levels. This review explores the complex interactions between pregnancy-related hormonal changes and renal function, providing insights into the practical applications of these relationships. Extensive literature searches were conducted, combining data from several sources to produce thorough knowledge. Essential discoveries include changes in renal hemodynamics, calcium/phosphorus level variations, thyroid gland hypertrophy, changed function, and cardiovascular adaptations. The review also addresses how sex hormones affect immunological responses, emphasizing their importance for conditions like multiple sclerosis. Additionally impacted is the gastrointestinal tract, which results in symptoms like nausea and heartburn. Comprehending these physiological changes is essential for proficient therapeutic handling, guaranteeing the best possible health for both the mother and the fetus. The study emphasizes the importance of specialized medical treatment during pregnancy and calls for more investigation to clarify the intricacies of these physiological changes.
Collapse
Affiliation(s)
- Sohan B Jee
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe) Wardha, Wardha, IND
| | - Anupama Sawal
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Sawangi (Meghe) Wardha, Wardha, IND
| |
Collapse
|
3
|
Valdovinos Díaz MA, Amieva-Balmori M, Carmona-Sánchez R, Coss-Adame E, Gómez-Escudero O, González-Martínez M, Huerta-Iga F, Morel-Cerda E, Remes-Troche JM, Tamayo-de la Cuesta JL, Torres-Villalobos G, Valdovinos-García LR, Vázquez-Elizondo G, Villar-Chávez AS, Arenas-Martínez JA. Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:121-143. [PMID: 38580493 DOI: 10.1016/j.rgmxen.2023.12.002] [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: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.
Collapse
Affiliation(s)
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Práctica privada, San Luis Potosí, Mexico
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia y Motilidad Gastrointestinal, Endoneurogastro, Hospital Ángeles Puebla, Puebla, Mexico
| | - M González-Martínez
- Departamento de Endoscopia, Hospital de Especialidades del CMN Siglo XXI IMSS, Mexico City, Mexico
| | - F Huerta-Iga
- Servicio de Gastroenterología, Hospital Ángeles Torreón, Torreón, Mexico
| | - E Morel-Cerda
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - J L Tamayo-de la Cuesta
- Servicio de Gastroenterología y Endoscopia Gastrointestinal, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - G Torres-Villalobos
- Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - G Vázquez-Elizondo
- Servicio de Gastroenterología, Centro de Enfermedades Digestivas ONCARE, Monterrey, Mexico
| | - A S Villar-Chávez
- Servicio de Gastroenterología, Hospital Ángeles Acoxpa, Mexico City, Mexico
| | - J A Arenas-Martínez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
4
|
Liu BD, Udemba SC, Saleh S, Hill H, Song G, Fass R. Raloxifene increases the risk of gastroesophageal reflux disease, Barrett's esophagus, and esophageal stricture in postmenopausal women with osteoporosis. Neurogastroenterol Motil 2023; 35:e14689. [PMID: 37807850 DOI: 10.1111/nmo.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Estrogen-based therapies may increase the risk of gastroesophageal reflux (GERD) and its complications. We aimed to determine the effect of raloxifene on the development of GERD, Barrett's esophagus, and esophageal stricture in postmenopausal women with osteoporosis. METHODS This was a population-based, propensity-matched cohort study using the TriNetX platform. Patients 50 years and older with a diagnosis of "menopause" and "osteoporosis" were included in this study. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for new GERD, esophageal stricture and Barrett's esophagus after raloxifene exposure. The control cohort consisted of patients who did not start any hormonal replacement therapy. We conducted a multivariable logistic regression analysis to evaluate the effect of confounding variables and also addressed common confounding medications with 1:1 propensity score-matching. Internal validity was confirmed by comparing to negative controls (lisinopril, atorvastatin) and positive controls (metformin, ibuprofen, aspirin). RESULTS Five thousand four hundred and seventy two postmenopausal women with osteoporosis were on raloxifene of which 1908 (34.86%) developed GERD, compared to 296,067 postmenopausal who were not on raloxifene of which 90,643 (30.62%) developed GERD (OR 1.2; 95% CI 1.10-1.31, p < 0.0001). This persisted after adjusting for common medications known to affect GERD. Raloxifene was identified as a risk factor for GERD in a multivariate analysis, controlling for factors including age, obesity, smoking, and alcohol use (OR 1.51, 95% Wald CI 1.47-1.53). Raloxifene was associated with esophageal stricture (OR 1.60; 95% Wald CI 1.51-1.69) and Barrett's esophagus (OR 1.50; 95% Wald CI 1.37-1.63) in multivariate analysis. These associations persisted using sensitivity analyses. CONCLUSION Raloxifene increases the risk of GERD, esophageal stricture and Barrett's esophagus in postmenopausal women with osteoporosis. Further studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Benjamin D Liu
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon C Udemba
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sherif Saleh
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hannah Hill
- Population Health and Equity Research Institute, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
5
|
Quach DT, Luu MN, Nguyen PV, Vo UPP, Vo CHM. Dietary and lifestyle factors associated with troublesome gastroesophageal reflux symptoms in Vietnamese adults. Front Nutr 2023; 10:1280511. [PMID: 38024385 PMCID: PMC10663327 DOI: 10.3389/fnut.2023.1280511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Dietary and lifestyle habits related to troublesome gastroesophageal reflux symptoms (tGERS) differ significantly across populations. There have yet to be studies on the Vietnamese population. Aims To identify dietary and lifestyle habits associated with tGERS in Vietnamese adults. Methods A cross-sectional survey was conducted among Vietnamese adults aged 18 years and older from March 2023 to May 2023. Participants were recruited online through a widely read national newspaper and Facebook, one of Vietnam's most popular social media platforms. The survey questionnaire comprised 27 questions covering participants' basic demographic information, dietary and lifestyle habits, the presence and characteristics of tGERS, and inquiries about specific dietary and lifestyle patterns, foods, and beverages associated with tGERS. Results A total of 4,400 valid responses were collected, including 2050 participants without tGERS and 2,350 participants with tGERS. Multivariate analysis showed several factors associated with tGERS, including eating beyond fullness (OR 1.383, CI95% 1.127-1.698), tight clothing (OR 1.627, CI95% 1.256-2.107), stress (OR 1.566, CI95% 1.363-1.800), and insomnia (OR 1.321, CI95% 1.129-1.546). Among habits associated with tGERS, eating beyond fullness was the most frequently reported (64.6%). Interestingly, although a short meal-to-bed time and staying up late after midnight were not risk factors for tGERS, they were two common factors associated with tGERS in symptomatic participants, particularly those with nocturnal reflux symptoms. For food triggers, the three most common ones were greasy foods (71.9%), sour/spicy soups (64.7%), and citrus fruits (36.0%). In terms of beverages, carbonated soft drinks were at the top of triggering tGERS (40.3%), and beer and orange juice were the second and third most common triggers, accounting for 35.7 and 30.6%, respectively. Conclusion We reported the dietary and lifestyle habits associated with tGERS in Vietnamese adults for the first time. These findings will serve as a basis for future studies on the primary prevention and nondrug management of tGERS in Vietnam.
Collapse
Affiliation(s)
- Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Mai Ngoc Luu
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Phong Van Nguyen
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Uyen Pham-Phuong Vo
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Cong Hong-Minh Vo
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
6
|
Madej J, Atanassova T, McGuire S, Cohen B, Weidner M, Zhang Y, Horton DB. Acid-suppressive medication and incidence of chronic childhood immune-mediated diseases: A scoping review. Pediatr Allergy Immunol 2023; 34:e14042. [PMID: 38010007 PMCID: PMC10683867 DOI: 10.1111/pai.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Use of acid-suppressive medications (ASMs), for example, proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), has been rising along with the incidence of pediatric immune-mediated diseases (IMDs). We conducted a scoping review to characterize the literature about prenatal or pediatric exposure to ASMs in relation to incident pediatric IMDs. METHODS Electronic searches were conducted to identify studies from 2001 to 2023 on (a) prenatal or pediatric exposure to PPIs and/or H2RAs and (b) the risk of developing chronic IMDs during childhood. Eligible studies after title/abstract and full-text screening underwent data abstraction. RESULTS Of 26 eligible studies, 11 focused on prenatal ASM exposure and 16 on pediatric exposure. Asthma was the most commonly investigated outcome (16 studies), followed by other allergic diseases (8), eosinophilic esophagitis (3), inflammatory bowel disease (2), and other autoimmune diseases (2). Positive associations between ASM exposure and pediatric IMD outcomes emerged in all but two recent studies, which reported null or negative associations with allergic diseases. The strength of associations was similar across exposure times (prenatal/pediatric), medications (PPIs/H2RAs), and outcomes. Dose-response relationships were often present (7/11 studies). Reported effects by trimester and age of exposure varied. Commonly reported limitations were residual confounding, exposure misclassification, and outcome misclassification. CONCLUSION In summary, prenatal or pediatric exposure to PPIs and/or H2RAs has frequently, but not exclusively, been associated with the development of asthma, other allergic diseases, and chronic gastrointestinal IMDs. However, concerns remain about confounding and other sources of bias. Prescribers and families should be aware of these possible risks of ASMs.
Collapse
Affiliation(s)
- Joanna Madej
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Tania Atanassova
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Sarah McGuire
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Barry Cohen
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Melissa Weidner
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Yingtng Zhang
- Robert Wood Johnson Library of Health Sciences, New Brunswick, New Jersey, USA
| | - Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| |
Collapse
|
7
|
Le YLT, Luu MN, Mai LH, Hoang AT, Nguyen TT, Quach DT. Prevalence and characteristics of gastroesophageal reflux disease in pregnant women. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:341-346. [PMID: 35810101 DOI: 10.1016/j.rgmxen.2022.06.012] [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: 08/06/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND AIMS The prevalence of gastroesophageal reflux disease (GERD) has been reported to be increasing in recent years. However, there have been few reports on the prevalence of GERD during pregnancy in the Asian population. The aim of our study was to evaluate the prevalence and characteristics of GERD in Vietnamese pregnant women. MATERIALS AND METHODS This cross-sectional study was conducted at the antenatal clinic of the Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam. Four hundred females, at various stages of pregnancy, were enrolled. GERD was diagnosed if there was troublesome heartburn and/or acid regurgitation, at least once a week, during the current pregnancy. RESULTS The overall prevalence of GERD in pregnancy was 38.5% (154/400). The prevalence of GERD in the third trimester was significantly higher than that in the second trimester (46.8% vs. 30.7%, P=0.008) and tended to be higher than its prevalence in the first trimester (46.8% vs. 35.4%, P=0.051). In the pregnant women with GERD, the frequency of regurgitation was significantly higher than that of heartburn (92.9% vs. 30.5%, P<0.001). Those typical symptoms were more prevalent in the daytime, compared with nighttime. CONCLUSION Our study showed that GERD was prevalent during pregnancy in Vietnam. In the pregnant women with GERD, regurgitation was much more common than heartburn, and those typical reflux symptoms occurred more frequently in the daytime, compared with nighttime.
Collapse
Affiliation(s)
- Y-L T Le
- Departamento de Medicina Interna, Facultad de Medicina y Farmacia, Universidad de Tay-Nguyen, Buon Ma Thuot, Viet Nam
| | - M N Luu
- Departamento de Medicina Interna, Universidad de Medicina y Farmacia, Ciudad de Ho Chi Minh, Ho Chi Minh, Viet Nam; Departamento de Gastroenterología, Hospital de Nhan Dan Gia Dinh, Ho Chi Minh, Viet Nam
| | - L H Mai
- Departamento de Obstetricia, Hospital de Nhan Dan Gia Dinh, Ho Chi Minh, Viet Nam
| | - A T Hoang
- Departamento de Obstetricia, Hospital de Nhan Dan Gia Dinh, Ho Chi Minh, Viet Nam
| | - T T Nguyen
- Departamento de Obstetricia, Hospital de Nhan Dan Gia Dinh, Ho Chi Minh, Viet Nam
| | - D T Quach
- Departamento de Medicina Interna, Universidad de Medicina y Farmacia, Ciudad de Ho Chi Minh, Ho Chi Minh, Viet Nam; Departamento de Gastroenterología, Hospital de Nhan Dan Gia Dinh, Ho Chi Minh, Viet Nam.
| |
Collapse
|
8
|
S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:862-933. [PMID: 37494073 DOI: 10.1055/a-2060-1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
|
9
|
Tomei KL, Hodges TR, Ragsdale E, Katz T, Greenfield M, Sweet JA. Best practices for the pregnant neurosurgical resident: balancing safety and education. J Neurosurg 2023; 138:1758-1765. [PMID: 36683192 DOI: 10.3171/2022.9.jns221727] [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: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022]
Abstract
Establishment of a diverse neurosurgical workforce includes increasing the recruitment of women in neurosurgery. The impact of pregnancy on the training and career trajectory of female neurosurgeons poses a barrier to recruitment and retention of women in neurosurgery. A recent Women in Neurosurgery survey evaluated female neurosurgeons' perception and experience regarding childbearing of female neurosurgeons and identified several recommendations regarding family leave policies. Additionally, pregnancy may carry higher risk in surgical fields, yet little guidance exists to aid both the pregnant resident and her training program in optimizing the safety of the training environment with specific considerations to risks inherent in neurosurgical training. This review of current literature aims to address best practices that can be adopted by pregnant neurosurgery residents and their training programs to improve the well-being of these residents while considering the impact on their education and the educational environment for their colleagues.
Collapse
Affiliation(s)
- Krystal L Tomei
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 2Division of Pediatric Neurological Surgery, Rainbow Babies & Children's Hospital, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
| | - Tiffany R Hodges
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
| | - Ellie Ragsdale
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Tyler Katz
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Marjorie Greenfield
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Jennifer A Sweet
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
| |
Collapse
|
10
|
Chrisnata V, Sugiarto A, Erniody E, Sethiono A. Sudden life-threatening laryngeal edema in pregnancy: a case report. J Med Case Rep 2023; 17:180. [PMID: 37076895 PMCID: PMC10116716 DOI: 10.1186/s13256-023-03880-7] [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: 12/28/2022] [Accepted: 03/07/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Severe laryngeal edema during pregnancy is uncommon but can be encountered, particularly in patients with preeclampsia accompanied by other comorbidities. Careful consideration must be given to balance the urgency of securing the airway with the safety of the fetus and the patient's long-term health consequences. CASE PRESENTATION A 37-year-old Indonesian woman was brought to the emergency department at 36 weeks gestation due to severe dyspnea. Her condition worsened a few hours later during intensive care unit admission, with tachypnea, decreased oxygen saturation, and inability to communicate, necessitating intubation. Due to the edematous larynx, we could only use 6.0-sized endotracheal tube. The use of a small-sized endotracheal tube was expected to be short-lived, so she was considered for tracheostomy. Nevertheless, we decided to perform a cesarean section first after lung maturation because it would be safer for the fetus, and laryngeal edema usually improves after delivery. Cesarean section was performed under spinal anesthesia for the safety of the fetus, and 48 hours after delivery, she underwent a leakage test with a positive result, so extubation was performed. Stridor was no longer audible, breathing pattern was within normal limits, and vital signs were stable. The patient and her baby both recovered well with no long-term health consequences. CONCLUSION This case demonstrates that unexpected life-threatening laryngeal edema can occur during pregnancy, in which upper respiratory tract infections may trigger it. The decision between conservative and aggressive immediate airway management should be made with careful consideration of securing the patient's airway, the safety of the fetus, and the patient's long-term health consequences.
Collapse
Affiliation(s)
- Vincent Chrisnata
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia.
- Department of Anesthesiology and Intensive Care, Husada Hospital, Jakarta, Indonesia.
| | - Adhrie Sugiarto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Erniody Erniody
- Department of Anesthesiology and Intensive Care, Husada Hospital, Jakarta, Indonesia
| | - Aldy Sethiono
- Department of Anesthesiology and Intensive Care, Husada Hospital, Jakarta, Indonesia
| |
Collapse
|
11
|
Saleh S, Liu BD, Trujillo S, Thomas C, Fass R. The effect of combined oral contraceptives and Nexplanon on gastroesophageal reflux disease in premenopausal women: A nationwide database analysis. Neurogastroenterol Motil 2023; 35:e14542. [PMID: 36740824 DOI: 10.1111/nmo.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pregnancy, combined oral contraceptives (COC), and hormone replacement therapy have been reported to increase the risk of gastroesophageal reflux disease (GERD). To date, no study has evaluated the effect of Nexplanon, a commonly used progesterone-based contraceptive, on GERD. We aimed to determine the effect of Nexplanon and COC on GERD. METHODS We performed a population-based analysis using the IBM Explorys national database (1999-2021). The study group included premenopausal women, defined as women less than 50 years of age while excluding the diagnosis of menopause. The effect of Nexplanon and COC on GERD (at least 30 days after Nexplanon/COC was initiated) was assessed by comparing it to premenopausal women who were not on contraceptives. Foregut surgery, esophageal dysmotility disorders, hiatal hernia, and delayed gastric emptying were excluded. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. A multivariate logistic regression analysis was conducted. KEY RESULTS A total of 23,299,470 patients were identified as being premenopausal, of which 47,260 were on Nexplanon and 5480 on COCs. As compared to premenopausal women with GERD on no contraceptives (n = 565,880), 690 patients developed GERD at least 30 days after being on Nexplanon (OR = 0.55, 95% CI [0.51-0.59], p < 0.001) and 280 developed GERD after COC (1.93, [1.71-2.18], p < 0.001). A multivariate analysis accounting for Caucasian race, obesity, smoking, alcohol use, and NSAIDs revealed that COC is an independent risk factor for GERD (1.16, [1.12-1.20], p < 0.001), and Nexplanon was protective against GERD (0.90, [0.89-0.92], p < 0.001). Hydralazine was used as a control medication for data reliability. A total of 8420 patients developed GERD after initiating hydralazine, which was not statistically nor clinically significant (OR = 1.02, 95% CI [0.99-1.04], p = 0.08) when compared to those not on contraceptives. CONCLUSIONS & INFERENCES Combined oral contraceptives is an independent risk factor for GERD, while Nexplanon has a limited protective effect. Further studies are needed to confirm the different effects on GERD of these two contraceptives.
Collapse
Affiliation(s)
- Sherif Saleh
- Department of Internal Medicine, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin D Liu
- Department of Internal Medicine, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Sophie Trujillo
- Department of Internal Medicine, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronnie Fass
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
12
|
Choi A, Noh Y, Jeong HE, Choi EY, Man KKC, Han JY, Kim HS, Yon DK, Shin JY. Association Between Proton Pump Inhibitor Use During Early Pregnancy and Risk of Congenital Malformations. JAMA Netw Open 2023; 6:e2250366. [PMID: 36626173 PMCID: PMC9856708 DOI: 10.1001/jamanetworkopen.2022.50366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Proton pump inhibitors (PPIs) are increasingly used during pregnancy; however, several observational studies have raised concerns about an increased risk of specific types of congenital malformations. OBJECTIVE To examine the association between PPI exposure during early pregnancy and the risk of congenital malformations. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the National Health Insurance Service-National Health Information Database of South Korea (2010-2020); sibling-controlled analyses were conducted to account for familial factors. A total of 2 696 216 pregnancies in women aged 19 to 44 years between June 1, 2011, and December 31, 2019, and their live-born infants were identified. Pregnant women who were exposed to known teratogens or who delivered infants with chromosomal abnormalities or genetic syndromes were excluded. Data on participant race and ethnicity were not collected because the National Health Information Database does not report this information. EXPOSURES Proton pump inhibitor use during the first trimester. MAIN OUTCOMES AND MEASURES Primary outcomes were major congenital malformations, congenital heart defects, cleft palate, hydrocephalus, and hypospadias. The subtypes of major congenital malformations and congenital heart defects were evaluated as exploratory outcomes. Propensity score fine stratification was used to control for potential confounders, and a weighted generalized linear model was used to estimate relative risks with 95% CIs. RESULTS Of 2 696 216 pregnancies (mean [SD] maternal age, 32.1 [4.2] years), 40 540 (1.5%; mean [SD] age, 32.4 [4.6] years) were exposed to PPIs during the first trimester. The absolute risk of major congenital malformations was 396.7 per 10 000 infants in PPI-exposed pregnancies and 323.4 per 10 000 infants in unexposed pregnancies. The propensity score-adjusted relative risks were 1.07 (95% CI, 1.02-1.13) for major congenital malformations, 1.09 (95% CI, 1.01-1.17) for congenital heart defects, 1.02 (95% CI, 0.72-1.43) for cleft palate, 0.94 (95% CI, 0.54-1.63) for hydrocephalus, and 0.77 (95% CI, 0.51-1.17) for hypospadias. In the sibling-controlled analyses, no associations were observed between PPI use and primary outcomes, including major congenital malformations (odds ratio, 1.05; 95% CI, 0.91-1.22) and congenital heart defects (odds ratio, 1.07; 95% CI, 0.88-1.30). A range of sensitivity analyses revealed results that were similar to the main findings. CONCLUSIONS AND RELEVANCE In this cohort study, the use of PPIs during early pregnancy was not associated with a substantial increase in the risk of congenital malformations, although small increased risks were observed for major congenital malformations and congenital heart defects; findings from sibling-controlled analyses revealed that PPIs were unlikely to be major teratogens. These findings may help guide clinicians and patients in decision-making about PPI use in the first trimester.
Collapse
Affiliation(s)
- Ahhyung Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Eun-Young Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Jung Yeol Han
- Korean Mothersafe Counselling Center, Department of Obstetrics and Gynecology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
13
|
Dunbar K, Yadlapati R, Konda V. Heartburn, Nausea, and Vomiting During Pregnancy. Am J Gastroenterol 2022; 117:10-15. [PMID: 36194028 PMCID: PMC10782592 DOI: 10.14309/ajg.0000000000001958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Kerry Dunbar
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Vani Konda
- Baylor Scott and White Center for Esophageal Diseases, Department of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
| |
Collapse
|
14
|
Altuwaijri M. Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review. Medicine (Baltimore) 2022; 101:e30487. [PMID: 36107559 PMCID: PMC9439837 DOI: 10.1097/md.0000000000030487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.
Collapse
Affiliation(s)
- Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Mansour Altuwaijri, Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia (e-mail: )
| |
Collapse
|
15
|
Le YL, Luu M, Mai L, Hoang A, Nguyen T, Quach D. Prevalencia y características de la enfermedad por reflujo gastroesofágico en mujeres embarazadas. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022. [DOI: 10.1016/j.rgmx.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
|
16
|
Ali RAR, Hassan J, Egan LJ. Review of recent evidence on the management of heartburn in pregnant and breastfeeding women. BMC Gastroenterol 2022; 22:219. [PMID: 35508989 PMCID: PMC9066781 DOI: 10.1186/s12876-022-02287-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is one the most common medical complaints in pregnant women. Some women continue to experience GERD symptoms after delivery. Effective management of GERD symptoms is important to improve productivity and quality of life. Management of heartburn in pregnant and breastfeeding women involves lifestyle modifications, dietary modifications, non-pharmaceutical remedies and pharmaceutical drugs. For most patients, lifestyle/dietary modifications are helpful in reducing GERD symptoms. For patients who require a more intense intervention, various types of pharmaceutical drugs are available. However, the suitability of each treatment for use during pregnancy and lactation must be taken into consideration. This article explores the reported efficacy and safety of these treatment options in pregnant and breastfeeding women. Recommended treatment algorithm in pregnant and breastfeeding women have been developed.
Collapse
Affiliation(s)
- Raja Affendi Raja Ali
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. .,GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
| | - Jamiyah Hassan
- Faculty of Medicine and Hospital, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Laurence J Egan
- Department of Clinical Pharmacology, Galway University Hospital, The National University of Ireland, Galway, Ireland
| |
Collapse
|
17
|
Martinez MN, Sinko B, Wu F, Flanagan T, Borbás E, Tsakalozou E, Giacomini KM. A Critical Overview of the Biological Effects of Excipients (Part I): Impact on Gastrointestinal Absorption. AAPS J 2022; 24:60. [DOI: 10.1208/s12248-022-00711-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/16/2022] [Indexed: 02/07/2023] Open
|
18
|
Artificial intelligence in obstetrics. Obstet Gynecol Sci 2021; 65:113-124. [PMID: 34905872 PMCID: PMC8942755 DOI: 10.5468/ogs.21234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
This study reviews recent advances on the application of artificial intelligence for the early diagnosis of various maternal-fetal conditions such as preterm birth and abnormal fetal growth. It is found in this study that various machine learning methods have been successfully employed for different kinds of data capture with regard to early diagnosis of maternal-fetal conditions. With the more popular use of artificial intelligence, ethical issues should also be considered accordingly.
Collapse
|
19
|
Lee KS, Kim ES, Kim DY, Song IS, Ahn KH. Association of Gastroesophageal Reflux Disease with Preterm Birth: Machine Learning Analysis. J Korean Med Sci 2021; 36:e282. [PMID: 34751010 PMCID: PMC8575763 DOI: 10.3346/jkms.2021.36.e282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study used machine learning and population data for testing the associations of preterm birth with gastroesophageal reflux disease (GERD) and periodontitis. METHODS Retrospective cohort data came from Korea National Health Insurance Service claims data for all women who aged 25-40 years and gave births for the first time as singleton pregnancy during 2015-2017 (405,586 women). The dependent variable was preterm birth during 2015-2017 and the independent variables were GERD (coded as no vs. yes) for each of the years 2002-2014, periodontitis (coded as no vs. yes) for each of the years 2002-2014, age (year) in 2014, socioeconomic status in 2014 measured by an insurance fee, and region (city) (coded as no vs. yes) in 2014. Random forest variable importance was adopted for finding main predictors of preterm birth and testing its associations with GERD and periodontitis. RESULTS Based on random forest variable importance, main predictors of preterm birth during 2015-2017 were socioeconomic status in 2014, age in 2014, GERD for the years 2012, 2014, 2010, 2013, 2007 and 2009, region (city) in 2014 and GERD for the year 2006. The importance rankings of periodontitis were relatively low. CONCLUSION Preterm birth has a stronger association with GERD than with periodontitis. For the prevention of preterm birth, preventive measures for GERD would be essential together with the improvement of socioeconomic status for pregnant women. Especially, it would be vital to promote active counseling for general GERD symptoms (neglected by pregnant women).
Collapse
Affiliation(s)
- Kwang-Sig Lee
- AI Center, Korea University Anam Hospital, Seoul, Korea
| | - Eun Sun Kim
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
| | - Do-Young Kim
- AI Center, Korea University Anam Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, Korea
| | - In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul, Korea.
| |
Collapse
|
20
|
Ruiz de León San Juan A, Pérez de la Serna Bueno J, Sevilla Mantilla MC, Esteban López-Jamar JM, Sánchez Pernaute A. Gastro-esophageal reflux disease: limits of medical treatment and surgical indications. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:356-363. [PMID: 33393330 DOI: 10.17235/reed.2020.7648/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Proton-pump inhibitors (PPI) have long been considered as the ideal treatment for gastroesophageal reflux disease (GERD), and their limitations and side effects have revealed a need for new therapeutic approaches. At present, the therapeutic gains achieved are relatively small or limited to groups of patients with specific characteristics. This article updates the contributions, indications, and limitations of pharmacological, endoscopic, and surgical treatment.
Collapse
|
21
|
Bokern MP, Robijn AL, Jensen ME, Barker D, Callaway L, Clifton V, Wark P, Giles W, Mattes J, Peek M, Attia J, Seeho S, Abbott A, Gibson PG, Murphy VE. Factors Associated with Asthma Exacerbations During Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4343-4352.e4. [DOI: 10.1016/j.jaip.2021.07.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
|
22
|
Short Meal-to-Bed Time Is a Predominant Risk Factor of Gastroesophageal Reflux Disease in Pregnancy. J Clin Gastroenterol 2021; 55:316-320. [PMID: 32694265 DOI: 10.1097/mcg.0000000000001399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/20/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Short meal-to-bed time (MTBT) has been reported to relate to gastroesophageal reflux disease (GERD), but evidence is lacking in pregnant women. We aimed to assess the characteristics of GERD and the association between MTBT and GERD during pregnancy. PATIENTS AND METHODS A cross-sectional study was carried out on 400 pregnant women aged 18 years and older visiting the antenatal clinic of Gia-Dinh People's Hospital, Vietnam. GERD was defined as having troublesome heartburn and/or regurgitation at least once a week. Reflux-related insomnia was defined as having difficulties in initiating or maintaining sleep through the night. MTBT was defined as "short" if it was ≤2 hours in more than two thirds of days in a week. RESULTS There were 154 (38.5%) patients with GERD and 20 (13.0%) patients with reflux-related insomnia. In multivariate analysis, there were 3 factors significantly associated with GERD: third trimester [odds ratio (OR)=1.66; 95% confidence interval (CI): 1.03-2.69], previous history of typical reflux symptoms (OR=9.05; 95% CI: 5.29-15.50), and short MTBT (OR=12.73; 95% CI: 2.92-55.45). The frequency of reflux symptoms progressively increased across subgroups of patients with no short MTBT, either daytime or nighttime short MTBT, and with both daytime and nighttime short MTBT. Nighttime MTBT was also a significant risk factor for reflux-related insomnia (OR=4.60; 95% CI: 1.64-12.92). CONCLUSIONS We reported for the first time that short MTBT was a predominant risk factor of GERD in pregnancy. This dieting habit was significantly associated with reflux symptom frequency and reflux-related insomnia.
Collapse
|
23
|
Application of Artificial Intelligence in Early Diagnosis of Spontaneous Preterm Labor and Birth. Diagnostics (Basel) 2020; 10:diagnostics10090733. [PMID: 32971981 PMCID: PMC7555184 DOI: 10.3390/diagnostics10090733] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
This study reviews the current status and future prospective of knowledge on the use of artificial intelligence for the prediction of spontaneous preterm labor and birth (“preterm birth” hereafter). The summary of review suggests that different machine learning approaches would be optimal for different types of data regarding the prediction of preterm birth: the artificial neural network, logistic regression and/or the random forest for numeric data; the support vector machine for electrohysterogram data; the recurrent neural network for text data; and the convolutional neural network for image data. The ranges of performance measures were 0.79–0.94 for accuracy, 0.22–0.97 for sensitivity, 0.86–1.00 for specificity, and 0.54–0.83 for the area under the receiver operating characteristic curve. The following maternal variables were reported to be major determinants of preterm birth: delivery and pregestational body mass index, age, parity, predelivery systolic and diastolic blood pressure, twins, below high school graduation, infant sex, prior preterm birth, progesterone medication history, upper gastrointestinal tract symptom, gastroesophageal reflux disease, Helicobacter pylori, urban region, calcium channel blocker medication history, gestational diabetes mellitus, prior cone biopsy, cervical length, myomas and adenomyosis, insurance, marriage, religion, systemic lupus erythematosus, hydroxychloroquine sulfate, and increased cerebrospinal fluid and reduced cortical folding due to impaired brain growth.
Collapse
|
24
|
Slater K, Rollo ME, Szewczyk Z, Ashton L, Schumacher T, Collins C. Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations? Nutrients 2020; 12:nu12082438. [PMID: 32823663 PMCID: PMC7468772 DOI: 10.3390/nu12082438] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
The maternal diet influences the long-term health status of both mother and offspring. The current study aimed to compare dietary intakes of pregnant women compared to food and nutrient recommendations in the Australian Guide to Healthy Eating (AGHE) and Nutrient Reference Values (NRVs). Usual dietary intake was assessed in a sample of women in their 3rd trimester of pregnancy attending antenatal outpatient clinics at John Hunter Hospital, Newcastle, New South Wales (NSW). Dietary intake was measured using the Australian Eating Survey, a validated, semi-quantitative 120-item food frequency questionnaire. Daily food group servings and nutrient intakes were compared to AGHE and NRV targets. Of 534 women participating, none met the AGHE recommendations for all food groups. Highest adherence was for fruit serves (38%), and lowest for breads and cereals (0.6%). Only four women met the pregnancy NRVs for folate, iron, calcium, zinc and fibre from food alone. Current dietary intakes of Australian women during pregnancy do not align with national nutrition guidelines. This highlights the importance of routine vitamin and mineral supplementation during pregnancy, as intakes from diet alone may commonly be inadequate. Future revisions of dietary guidelines and pregnancy nutrition recommendations should consider current dietary patterns. Pregnant women currently need more support to optimise food and nutrient intakes.
Collapse
Affiliation(s)
- Kaylee Slater
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (M.E.R.); (Z.S.); (L.A.)
| | - Megan E. Rollo
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (M.E.R.); (Z.S.); (L.A.)
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Zoe Szewczyk
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (M.E.R.); (Z.S.); (L.A.)
- Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Lee Ashton
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (M.E.R.); (Z.S.); (L.A.)
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Tracy Schumacher
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- Department of Rural Health, The University of Newcastle, Tamworth, NSW 2340, Australia
- Priority Research Centre for Health Behaviours, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (M.E.R.); (Z.S.); (L.A.)
- Correspondence: ; Tel.: +61-2-49215646
| |
Collapse
|
25
|
Kazma JM, van den Anker J, Allegaert K, Dallmann A, Ahmadzia HK. Anatomical and physiological alterations of pregnancy. J Pharmacokinet Pharmacodyn 2020; 47:271-285. [PMID: 32026239 PMCID: PMC7416543 DOI: 10.1007/s10928-020-09677-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023]
Abstract
The extensive metabolic demands of pregnancy require specific physiological and anatomical changes. These changes affect almost all organ systems, including the cardiovascular, respiratory, renal, gastrointestinal, and hematologic system. The placenta adds another layer of complexity. These changes make it challenging for clinicians to understand presenting signs and symptoms, or to interpret laboratory and radiological tests. Furthermore, these physiological alterations can affect the pharmacokinetics and pharmacodynamics of drugs. Drug safety in lactation is only supported by limited evidence. In addition, the teratogenic effects of medications are often extrapolated from animals, which further adds uncertainties. Unfortunately, pregnant women are only rarely included in clinical drug trials, while doses, regimens, and side effects are often extrapolated from studies conducted in non-pregnant populations. In this comprehensive review, we present the changes occurring in each system with its effects on the pharmacokinetic variables. Understanding these physiological changes throughout normal pregnancy helps clinicians to optimize the health of pregnant women and their fetuses. Furthermore, the information on pregnancy-related physiology is also critical to guide study design in this vulnerable 'orphan' population, and provides a framework to explore pregnancy-related pathophysiology such as pre-eclampsia.
Collapse
Affiliation(s)
- Jamil M Kazma
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Karel Allegaert
- Department of Development and Regeneration, and Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - André Dallmann
- Clinical Pharmacometrics, Research & Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| |
Collapse
|
26
|
Voice Changes During Pregnancy Trimesters in Iranian Pregnant Women. J Voice 2020; 34:358-363. [DOI: 10.1016/j.jvoice.2018.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022]
|
27
|
Lee KS, Song IS, Kim ES, Ahn KH. Determinants of Spontaneous Preterm Labor and Birth Including Gastroesophageal Reflux Disease and Periodontitis. J Korean Med Sci 2020; 35:e105. [PMID: 32281316 PMCID: PMC7152528 DOI: 10.3346/jkms.2020.35.e105] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/17/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Periodontitis is reported to be associated with preterm birth (spontaneous preterm labor and birth). Gastroesophageal reflux disease (GERD) is common during pregnancy and is expected to be related to periodontitis. However, little research has been done on the association among preterm birth, GERD and periodontitis. This study uses popular machine learning methods for analyzing preterm birth, GERD and periodontitis. METHODS Data came from Anam Hospital in Seoul, Korea, with 731 obstetric patients during January 5, 1995 - August 28, 2018. Six machine learning methods were applied and compared for the prediction of preterm birth. Variable importance, the effect of a variable on model performance, was used for identifying major determinants of preterm birth. RESULTS In terms of accuracy, the random forest (0.8681) was similar with logistic regression (0.8736). Based on variable importance from the random forest, major determinants of preterm birth are delivery and pregestational body mass indexes (BMI) (0.1426 and 0.1215), age (0.1211), parity (0.0868), predelivery systolic and diastolic blood pressure (0.0809 and 0.0763), twin (0.0476), education (0.0332) as well as infant sex (0.0331), prior preterm birth (0.0290), progesterone medication history (0.0279), upper gastrointestinal tract symptom (0.0274), GERD (0.0242), Helicobacter pylori (0.0151), region (0.0139), calcium-channel-blocker medication history (0.0135) and gestational diabetes mellitus (0.0130). Periodontitis ranked 22nd (0.0084). CONCLUSION GERD is more important than periodontitis for predicting and preventing preterm birth. For preventing preterm birth, preventive measures for hypertension, GERD and diabetes mellitus would be needed alongside the promotion of effective BMI management and appropriate progesterone and calcium-channel-blocker medications.
Collapse
Affiliation(s)
- Kwang Sig Lee
- AI Center, Korea University Anam Hospital, Seoul, Korea
| | - In Seok Song
- Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Eun Seon Kim
- Department of Gastroenterology, Korea University Anam Hospital, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics & Gynecology, Korea University Anam Hospital, Seoul, Korea.
| |
Collapse
|
28
|
Thélin CS, Richter JE. Review article: the management of heartburn during pregnancy and lactation. Aliment Pharmacol Ther 2020; 51:421-434. [PMID: 31950535 DOI: 10.1111/apt.15611] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/15/2019] [Accepted: 11/24/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Gestational reflux is common, affecting up to 80% of pregnant women. Most symptoms will abate during lactation. During both of these periods, interventions used to relieve symptoms focus on a "step-up" methodology with progressive intensification of treatment. This begins with lifestyle modifications. AIM To provide guidance in the treatment of reflux in pregnancy and lactation, as well as briefly summarising the pathogenesis, clinical presentation and diagnostic workup. METHODS A comprehensive search, using online databases PubMed and MEDLINE, along with relevant manuscripts published in English between 1966 and 2019 was used. All abstracts were screened, potentially relevant articles were researched, and bibliographies were reviewed. RESULTS Only a small percentage of relevant drugs are contraindicated for use in pregnancy or while breastfeeding. However, not all drug agents have been extensively evaluated in pregnant women or during the breastfeeding period. Antacids, alginates, and sucralfate are the first-line therapeutic agents. If symptoms persist, any of the H2 RAs can be used except for nizatidine (due to foetal teratogenicity or harm in animal studies). PPIs are reserved for women with intractable symptoms or complicated GERD; all are FDA category B drugs, except for omeprazole, which is a category C drug. CONCLUSIONS The management of heartburn during pregnancy and lactation begins with lifestyle modifications. In situations where disease severity increases, medical providers must discuss risks and benefits of these medicines with the patient in detail.
Collapse
Affiliation(s)
- Camille S Thélin
- Division of Digestive Diseases & Nutrition, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Joel E Richter
- Joy Culverhouse Center for Swallowing Disorders, Division of Digestive Diseases & Nutrition, Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
29
|
Yousaf M, Nirwan JS, Smith AM, Timmins P, Conway BR, Ghori MU. Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review. J Appl Polym Sci 2019. [DOI: 10.1002/app.48012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Maria Yousaf
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| | - Jorabar Singh Nirwan
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| | - Alan M. Smith
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| | - Peter Timmins
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied ScienceUniversity of Huddersfield Huddersfield HD1 3DH United Kingdom
| |
Collapse
|
30
|
Chatila AT, Nguyen MTT, Krill T, Roark R, Bilal M, Reep G. Natural history, pathophysiology and evaluation of gastroesophageal reflux disease. Dis Mon 2019; 66:100848. [PMID: 30803725 DOI: 10.1016/j.disamonth.2019.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common diseases encountered by both internists and gastroenterologists. GERD can cause a wide variety of symptoms ranging from heartburn and regurgitation to more atypical symptoms such as cough, chest pain, and hoarseness. The diagnosis is often times made on the basis of history and clinical symptomatology. The prevalence of GERD is currently estimated to be 8-33% with the incidence of disease only expected to increase over time. Although most cases of GERD can be diagnosed based on symptoms and clinical presentation, the diagnosis of GERD can be challenging when symptoms are atypical. In this review, we provide a comprehensive summary of the epidemiology, pathophysiology, evaluation and diagnosis of gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Minh Thu T Nguyen
- The University of Texas Medical Branch School of Medicine, Galveston, TX, United States
| | - Timothy Krill
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Russell Roark
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, United States.
| | - Gabriel Reep
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, United States
| |
Collapse
|
31
|
Kastrinidis N, Kleinjung T. [Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy]. PRAXIS 2019; 108:329-334. [PMID: 30940040 DOI: 10.1024/1661-8157/a003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy Abstract. In this overview the clinical pictures of ear, nose and throat diseases and their symptoms, which occur frequently but also particularly during pregnancy, are presented. In addition, the respective therapy options in this partially vulnerable phase of mother and child are discussed. The primary principle is 'as much as necessary, but as little as possible'. Even if the complaints often disappear with the birth of the child, there may be considerable suffering of the pregnant woman and therapy may be necessary. Moreover, an adequate therapy should be applied with all ENT diseases, even for those not specifically associated with pregnancy.
Collapse
Affiliation(s)
- Nikos Kastrinidis
- 1 Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich
| | - Tobias Kleinjung
- 1 Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie, Universitätsspital Zürich
| |
Collapse
|
32
|
Kim O, Jang HJ, Kim S, Lee HY, Cho E, Lee JE, Jung H, Kim J. Gastroesophageal reflux disease and its related factors among women of reproductive age: Korea Nurses' Health Study. BMC Public Health 2018; 18:1133. [PMID: 30241473 PMCID: PMC6150961 DOI: 10.1186/s12889-018-6031-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 09/10/2018] [Indexed: 12/19/2022] Open
Abstract
Background Recently, the number of patients diagnosed with gastroesophageal reflux disease (GERD) has increased in Korea. Risk factors of GERD include age, sex, medication use, lack of physical exercise, increased psychological stress, low or high body mass index (BMI), unhealthy eating habits, increased alcohol consumption, and cigarette smoking. However, few studies examined the major factors affecting GERD in women of childbearing age. Therefore, this study assessed the risk factors of GERD among 20,613 female nurses of reproductive age using data from the Korea Nurses’ Health Study. Methods Participants were recruited from July 2013 to November 2014. They provided their history of GERD 1 year prior to data collection, along with information on their demographic characteristics, health-related behaviors, diet, medical history, and physical and psychological factors. Of the total sample, 1184 individuals with GERD diagnosed in the year prior to the study were identified. Propensity score matching was used for analysis. Results Cigarette smoking, increased alcohol consumption, low or high BMI, depression, and increased psychosocial stress were associated with the prevalence of GERD among Korean young women. Multivariate ordinal logistic regression analysis revealed significant positive relationships between GERD and being a former smoker; having a low (< 18.5 kg/m2) or high BMI (> 23 kg/m2); and having mild, moderate, moderately severe, and severe depression. Conclusions Smoking, BMI, and depression were associated with GERD. To reduce this risk among female nurses, intervention strategies are required to help nurses maintain a normal weight and manage their depression.
Collapse
Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea.,Ewha Research Institute of Nursing Science, Seoul, Republic of Korea
| | - Hee Jung Jang
- Division of Nursing, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 24252, Republic of Korea. .,Research Institute of Nursing Science, Hallym University, Chuncheon, Republic of Korea.
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hea-Young Lee
- Department of Nursing, Doowon Technical University, Anseong, Republic of Korea
| | - Eunyoung Cho
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Heeja Jung
- College of Nursing, Konyang University, Daejeon, Republic of Korea
| | - Jiyoung Kim
- Department of Nursing, Dong-eui University, Busan, Republic of Korea
| |
Collapse
|
33
|
Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol 2018; 31:385-394. [PMID: 29991883 PMCID: PMC6033757 DOI: 10.20524/aog.2018.0264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/26/2018] [Indexed: 12/15/2022] Open
Abstract
Pregnancy is characterized by numerous physiological changes that may lead to a diversity of symptoms and frequently to gastrointestinal complaints, such as heartburn, nausea and vomiting, or constipation. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the mother may be harmful for the fetus. In addition, certain diseases, such as acute fatty liver of pregnancy, only develop during pregnancy and may require urgent procedures, such as fetus delivery. Even though they are not present in our day-to-day practice, knowledge of pregnancy-related diseases is fundamental and collaboration between gastroenterologists and obstetricians is often necessary. Herein, we review pregnancy-related diseases and systematize the most appropriate treatment choices according to the recent literature and guidelines, so that the article can serve as a guide to the gastroenterologist regarding the medical approach to pregnancy-related gastrointestinal and liver diseases and their therapeutic management.
Collapse
Affiliation(s)
- Catarina Frias Gomes
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
| | - Mónica Sousa
- Medicine Department, Internal Medicina Division (Mónica Sousa);), Hospital Beatriz Ângelo, Loures, Portugal
| | - Inês Lourenço
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Diana Martins
- Surgical Department, Gynaecology and Obstetrics Division (Inês Lourenço, Diana Martins), Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Surgical Department, Gastroenterology Division (Catarina Frias Gomes, Joana Torres), Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
34
|
Li T, Qiao H, Yue P, Cai M, He X. Embryo-fetal toxicity assessment of vonoprazan in rats and rabbits. J Appl Toxicol 2018; 38:987-995. [DOI: 10.1002/jat.3607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/30/2017] [Accepted: 01/17/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Tianyi Li
- School of Pharmaceutical Sciences; Nanjing Tech University; Nanjing 211816 China
| | - Hongqun Qiao
- School of Pharmaceutical Sciences; Nanjing Tech University; Nanjing 211816 China
| | - Peng Yue
- JiangSu Center for Safety Evaluation of Drugs; Nanjing 211816 China
| | - Ming Cai
- JiangSu Center for Safety Evaluation of Drugs; Nanjing 211816 China
| | - Xuejun He
- School of Pharmaceutical Sciences; Nanjing Tech University; Nanjing 211816 China
| |
Collapse
|
35
|
Brew BK, Almqvist C. Acid Suppressant Use in Pregnancy and Asthma in Offspring: Should We Be Worried? Pediatrics 2018; 141:peds.2017-3741. [PMID: 29326338 DOI: 10.1542/peds.2017-3741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; and.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
36
|
Abstract
OBJECTIVES To review the evidence-based management of nausea and vomiting of pregnancy and hyperemesis gravidarum. EVIDENCE MEDLINE and Cochrane database searches were performed using the medical subject headings of treatment, nausea, vomiting, pregnancy, and hyperemesis gravidarum. The quality of evidence reported in these guidelines has been described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on Preventative Health Care. BENEFITS Nausea and vomiting of pregnancy has a profound effect on women's health and quality of life during pregnancy as well as a financial impact on the health care system, and its early recognition and management is recommended. COST: Costs, including hospitalizations, additional office visits, and time lost from work, may be reduced if nausea and vomiting in pregnancy is treated early. RECOMMENDATIONS
Collapse
|
37
|
Primary Care Evaluation and Management of Gastroenterologic Issues in Women. Obstet Gynecol Clin North Am 2017; 43:347-66. [PMID: 27212096 DOI: 10.1016/j.ogc.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gastrointestinal disorders often present to the primary care setting where initial preventive, diagnostic, and treatment strategies are implemented. This article reviews the presentation and diagnosis of common gastrointestinal disorders, including colorectal cancer, irritable bowel syndrome, peptic ulcer disease, gallbladder disorders, inflammatory bowel disease, gastroesophageal reflux, and Barrett's esophagus. We focus on the evaluation and management of these diseases in women.
Collapse
|
38
|
Campbell K, Rowe H, Azzam H, Lane CA. Prise en charge des nausées et vomissements de la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1138-1149. [DOI: 10.1016/j.jogc.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Alaraudanjoki V, Laitala ML, Tjäderhane L, Pesonen P, Lussi A, Ronkainen J, Anttonen V. Influence of Intrinsic Factors on Erosive Tooth Wear in a Large-Scale Epidemiological Study. Caries Res 2016; 50:508-516. [DOI: 10.1159/000448292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 07/03/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To assess the influence of self-reported intrinsic factors [gastroesophageal reflux disease (GERD), long-term alcoholism, long-term heavy use of alcohol and multiple pregnancies] on erosive tooth wear in a middle-aged cohort sample. Materials and Methods: Of the total Northern Finland Birth Cohort (NFBC 1966), a convenience sample (n = 3,181) was invited for an oral health examination in 2012-2013, of which 1,962 participated, comprising the final study group. Erosive tooth wear was assessed by sextants using the Basic Erosive Wear Examination Index (BEWE, 0-18). Clinical data were supplemented by questionnaires conducted in 1997/1998 and 2012/2013. The participants were divided into severe (BEWE sum ≥9) and no-to-moderate (BEWE sum 0-8) erosive wear groups, and the logistic regression model was applied. Results: Selected intrinsic factors were quite rare in this cohort sample and explained only 5.9% of the difference in the prevalence and severity of erosive wear. Daily symptoms of GERD [odds ratio (OR) 3.8, confidence interval (CI) 1.2-12.0] and hyposalivation (OR 3.8, CI 1.2-11.8) were the strongest risk indicators for severe erosive wear. Additionally, variables associated with an elevated risk for severe erosive wear were diagnosed alcoholism at any point (OR 2.5, CI 0.7-9.7) and self-reported heavy use of alcohol in both questionnaires (OR 2.0, CI 0.6-6.2). Even low-dose long-term consumption of alcohol was associated with erosive wear. Conclusions: In this cohort sample, intrinsic factors such as GERD or alcoholism alone are relatively uncommon causes of erosive tooth wear. The role of long-term use of alcohol in the erosion process may be bigger than presumed.
Collapse
|
40
|
Body C, Christie JA. Gastrointestinal Diseases in Pregnancy: Nausea, Vomiting, Hyperemesis Gravidarum, Gastroesophageal Reflux Disease, Constipation, and Diarrhea. Gastroenterol Clin North Am 2016; 45:267-83. [PMID: 27261898 DOI: 10.1016/j.gtc.2016.02.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many disorders of the gastrointestinal tract are common in pregnancy. Elevated levels of progesterone may lead to alterations in gastrointestinal motility which could contribute to nausea, vomiting, and/or GERD. Pregnancy-induced diarrhea may be due to elevated levels prostaglandins. This article reviews the normal physiologic and structural changes associated with pregnancy that could contribute to many of the common gastrointestinal complaints in pregnant patients. Additionally, the appropriate clinical and laboratory evaluations, other pathologic conditions that should be included in the differential, as well as the nonpharmacologic and pharmacologic therapies for each of these conditions is discussed.
Collapse
Affiliation(s)
- Cameron Body
- Department of Internal Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Suite 1264, Atlanta, GA 30322, USA
| | - Jennifer A Christie
- Department of Internal Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Suite 1264, Atlanta, GA 30322, USA.
| |
Collapse
|
41
|
Turan I, Kitapcioglu G, Tavmergen Goker E, Sahin G, Bor S. In vitro fertilization-induced pregnancies predispose to gastroesophageal reflux disease. United European Gastroenterol J 2016; 4:221-8. [PMID: 27087950 DOI: 10.1177/2050640615597836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/05/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Women conceiving following in vitro fertilization (IVF) likely have a variety of risk factors that predispose them to gastroesophageal reflux disease (GERD) in the future. OBJECTIVE We aimed to investigate whether pregnancy through IVF may predispose to subsequent GERD compared with pregnancies without IVF. We also evaluate whether twin IVF pregnancies lead to additional risk for having GERD compared with singleton IVF pregnancies. METHODS A validated reflux questionnaire was administered to 156 women with singleton (n = 102) or twin (n = 54) IVF birth (IVF group) and 111 women with a naturally conceived singleton birth (control group). All women included in the study were primiparas who had given birth at least 1 year prior to data collection. The diagnosis of GERD was based on the occurrence of typical symptoms (heartburn, regurgitation, or both) at least once a week. RESULTS The prevalence of GERD was 13.5% and 4.5% in IVF and control groups (p = 0.015); in the IVF group, this was slightly higher, but not statistically significant, in women with twin compared with singleton pregnancies (14.8% vs. 12.7%, p = 0.749). Logistic regression analysis showed that IVF was strongly associated with subsequent GERD (OR, 3.30; 95% CI 1.20-9.04; p = 0.02). CONCLUSION The risk of developing GERD at least 1 year after delivery increased following IVF. Long-term follow-up studies are required to determine whether therapy during pregnancy can prevent this risk.
Collapse
Affiliation(s)
- Ilker Turan
- Section of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | - Gul Kitapcioglu
- Department of Biostatistics, Ege University School of Medicine, Izmir, Turkey
| | - Ege Tavmergen Goker
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey; Family Planning and Infertility Treatment and Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Gulnaz Sahin
- Family Planning and Infertility Treatment and Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Serhat Bor
- Section of Gastroenterology, Ege University School of Medicine, Izmir, Turkey
| | | |
Collapse
|
42
|
Devine RE, Sheikh A, Nwaru BI. Acid-suppressive medications during pregnancy and risk of asthma and allergy in the offspring: protocol for a systematic review. NPJ Prim Care Respir Med 2016; 26:16001. [PMID: 26934831 PMCID: PMC4776038 DOI: 10.1038/npjpcrm.2016.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/23/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rebecca E Devine
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Bright I Nwaru
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,School of Health Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
43
|
Cea Soriano L, Hernández-Díaz S, Johansson S, Nagy P, García-Rodríguez LA. Exposure to acid-suppressing drugs during pregnancy and the risk of asthma in childhood: an observational cohort study. Aliment Pharmacol Ther 2016; 43:427-37. [PMID: 26612701 DOI: 10.1111/apt.13486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/21/2015] [Accepted: 11/04/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some research has suggested a potential link between prenatal exposure to proton pump inhibitors (PPIs) or H2 -receptor antagonists (H2 RAs) and the development of childhood asthma. AIM To quantify the relative risk of asthma in children who experienced pre-natal exposure to PPIs and/or H2 RAs, adjusting for potential confounders. METHODS In this observational cohort study (NCT01787435), women aged 18-45 years with completed pregnancies between January 1996 and December 2010 were identified from The Health Improvement Network in the United Kingdom, and were linked to infants. Hazard ratios (HRs) were estimated using Cox proportional hazard models. RESULTS Our analysis identified 2371 prenatally exposed and 7745 unexposed infants. The incidence of asthma (per 1000 person-years) was 19.52 in the unexposed cohort, 23.88 in the PPI cohort and 32.16 in the H2 RA cohort. After adjusting for maternal healthcare utilisation during the year before pregnancy, the HR for asthma in infants whose mothers received prescriptions at any time during pregnancy was 1.12 (95% confidence interval: 0.88-1.44) for PPIs and 1.43 (1.20-1.70) for H2 RAs, when compared with unexposed infants. With further adjustment for maternal comorbidities and other medications, the HR for asthma was 1.03 (0.76-1.40) for PPIs and 1.32 (1.05-1.64) for H2 RAs. CONCLUSIONS Our analysis showed no association between prenatal exposure to PPIs and asthma in childhood after adjusting for confounders. The association found for H2 RAs may be explained largely by underlying environmental or genetic factors, as suggested by reductions in hazard ratio estimates following adjustment for maternal comorbidities.
Collapse
Affiliation(s)
- L Cea Soriano
- Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
| | - S Hernández-Díaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - S Johansson
- AstraZeneca Gothenburg, Global Medicines Development, Mölndal, Sweden
| | - P Nagy
- AstraZeneca Gothenburg, Global Medicines Development, Mölndal, Sweden
| | | |
Collapse
|
44
|
Saltürk Z, Kumral TL, Bekiten G, Atar Y, Ataç E, Aydoğdu İ, Yıldırım G, Kılıç A, Uyar Y. Objective and Subjective Aspects of Voice in Pregnancy. J Voice 2015; 30:70-3. [PMID: 25913751 DOI: 10.1016/j.jvoice.2015.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to evaluate vocal changes in pregnancy according to trimesters both objectively and subjectively. METHODS Fifty pregnant women and 15 nonpregnant women were included in the study. Eighteen of the 50 pregnant women were in the first trimester, 17 in the second trimester, and 15 in the third trimester of their pregnancies. The fundamental frequency (F0), jitter, shimmer, noise-to-harmonics ratio (NHR), and minimum and maximum pitch were determined during acoustic voice analysis. Laryngologic examination was evaluated via reflux finding score (RFS). Voice Handicap Index 10 (VHI-10) was used for subjective analysis. RESULTS Maximum phonation time (MPT), VHI-10, and RFS were the parameters that differed significantly. MPT was significantly shorter in the third trimester. Acoustic analysis revealed that F0, jitter, shimmer, NHR, and minimum and maximum pitch values were not significantly different in any groups. RFS was higher in the first and third trimesters than the second trimester and control groups. VHI-10 scores were significantly higher in the third trimester. CONCLUSIONS Our results showed that MPT is decreased during the third trimester, although acoustic parameters did not differ. VHI-10 results deteriorated in the third trimester significantly.
Collapse
Affiliation(s)
- Ziya Saltürk
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey.
| | - Tolgar Lütfi Kumral
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Güler Bekiten
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Enes Ataç
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - İmran Aydoğdu
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Güven Yıldırım
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Aydın Kılıç
- Gynecology and Obstetrics Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Uyar
- Ear Nose and Throat Clinic, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
45
|
Chaves RCDM, Navarro-Rodriguez T. Respiratory physiotherapy in gastroesophageal reflux disease: A review article. World J Respirol 2015; 5:28-33. [DOI: 10.5320/wjr.v5.i1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/05/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a frequent disorder which is expensive to diagnose and treat. Initiating therapy with empiric trial of proton-pump inhibitor is a well established strategy; however, symptoms of GERD do often persist regardless of effective medication. Nowadays, increasing interest concerning the efficacy and safety of chronic acid suppression with proton-pump inhibitors (PPIs), prompts a consideration for GERD treatment strategies related to the basic physiology of the lower esophageal sphincter, including modulation of its tone and ending of spontaneous transient lower esophageal sphincter relaxation, which contributes to reflux. Together, the lower esophageal sphincter and the crural diaphragm represent the major antireflux barrier, protecting the esophagus from reflux of gastric content. In order to prevent the need for enduring PPIs therapy or surgical procedures, substitute therapeutics approaches are being researched. Recently, studies have focused on the response of the respiratory muscles to inspiratory muscle training. As a result, inspiratory muscle training has emerged as a potential alternative for treatment of gastroesophageal reflux. The present report reviews the physiologic factors contributing to GERD, and presents the newly developed therapies that can be applied either alone or in association with available efficient GERD therapy.
Collapse
|
46
|
Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts. J Perinat Neonatal Nurs 2015; 29:23-31. [PMID: 25633397 DOI: 10.1097/jpn.0000000000000078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.
Collapse
|
47
|
Abstract
Pregnancy is associated with a variety of physiological changes that can alter the pharmacokinetics and pharmacodynamics of several drugs. However, limited data exists on the pharmacokinetics and pharmacodynamics of the majority of the medications used in pregnancy. In this article, we first describe basic concepts (drug absorption, bioavailability, distribution, metabolism, elimination, and transport) in pharmacokinetics. Then, we discuss several physiological changes that occur during pregnancy that theoretically affect absorption, distribution, metabolism, and elimination. Further, we provide a brief review of the literature on the clinical pharmacokinetic studies performed in pregnant women in recent years. In general, pregnancy increases the clearance of several drugs and correspondingly decreases drug exposure during pregnancy. Based on current drug exposure measurements during pregnancy, alterations in the dose or dosing regimen of certain drugs are essential during pregnancy. More pharmacological studies in pregnant women are needed to optimize drug therapy in pregnancy.
Collapse
Affiliation(s)
- Yang Zhao
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, 718 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261
| | - Mary F. Hebert
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA,Department of Obstetrics and Gynecology, School of Medicine University of Washington, Seattle, WA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, 718 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261; Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Thomas Starzl Transplantation Institute, Pittsburgh, PA; McGovern Institute for Regenerative Medicine, Pittsburgh, PA; Magee Womens Research Institute, Pittsburgh, PA.
| |
Collapse
|
48
|
Maternal Use of Proton Pump Inhibitors During Early Pregnancy and the Prevalence of Hypospadias in Male Offspring. Am J Ther 2014; 21:254-9. [DOI: 10.1097/mjt.0b013e3182456a8f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Tsen LC, Kodali BS. Can general anesthesia for cesarean delivery be completely avoided? An anesthetic perspective. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
50
|
Wang X, Rytting E, Abdelrahman DR, Nanovskaya TN, Hankins GD, Ahmed MS. Quantitative determination of famotidine in human maternal plasma, umbilical cord plasma and urine using high-performance liquid chromatography-mass spectrometry. Biomed Chromatogr 2013; 27:866-73. [PMID: 23401067 PMCID: PMC3872971 DOI: 10.1002/bmc.2873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 11/08/2022]
Abstract
Liquid chromatography with electrospray ionization mass spectrometry for the quantitative determination of famotidine in human urine, maternal and umbilical cord plasma was developed and validated. The plasma samples were alkalized with ammonium hydroxide and extracted twice with ethyl acetate. The extraction recovery of famotidine in maternal and umbilical cord plasma ranged from 53 to 64% and 72 to 79%, respectively. Urine samples were directly diluted with the initial mobile phase then injected into the HPLC system. Chromatographic separation of famotidine was achieved by using a Phenomenex Synergi™ Hydro-RP™ column with a gradient elution of acetonitrile and 10 mm ammonium acetate aqueous solution (pH 8.3, adjusted with ammonium hydroxide). Mass spectrometric detection of famotidine was set in the positive mode and used a selected ion monitoring method. Carbon-13-labeled famotidine was used as internal standard. The calibration curves were linear (r(2) > 0.99) in the concentration ranges of 0.631-252 ng/mL for umbilical and maternal plasma samples and 0.075-30.0 µg/mL for urine samples. The relative deviation of method was <14% for intra- and inter-day assays, and the accuracy ranged between 93 and 110%. The matrix effect of famotidine in human urine, maternal and umbilical cord plasma was less than 17%.
Collapse
Affiliation(s)
- Xiaoming Wang
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| | - Erik Rytting
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| | - Doaa R. Abdelrahman
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| | - Tatiana N. Nanovskaya
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| | - Gary D.V. Hankins
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| | - Mahmoud S. Ahmed
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, 301 University Blvd., Galveston, TX 77555-0587, USA
| |
Collapse
|