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Groden CM, Raed M, Helft P, Allen JD. End of life care in a level IV outborn neonatal intensive care unit. J Perinatol 2024; 44:1022-1028. [PMID: 38480788 DOI: 10.1038/s41372-024-01930-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU). STUDY DESIGN Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years. RESULTS A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance. CONCLUSION We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
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Affiliation(s)
| | - Mona Raed
- Division of Palliative Care, Community Health Network, Indianapolis, IN, USA
| | - Paul Helft
- Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jayme D Allen
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Haem T, Benson B, Dernoncourt A, Gondry J, Schmidt J, Foulon A. Vascular Ehlers-Danlos syndrome and pregnancy: A systematic review. BJOG 2024. [PMID: 38926786 DOI: 10.1111/1471-0528.17893] [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: 02/12/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Vascular Ehlers-Danlos syndrome (vEDS) is a hereditary connective tissue disorder associated with an elevated risk of vascular, uterine and digestive complications. Managing pregnancy in this context can be a challenge. OBJECTIVES To systematically review the literature data on the complications in pregnancy associated with vEDS. SEARCH STRATEGY We searched the Pubmed Medline and Embase databases for articles using the following terms "vascular Ehlers-Danlos syndrome" or "vEDS" AND "pregnancy". SELECTION CRITERIA Women with vEDS. DATA COLLECTION AND ANALYSIS We searched the PubMed® MEDLINE® database for publications evaluating obstetric outcomes in women with vEDS. MAIN RESULTS A total of 121 publications were screened, with six (accounting for 412 pregnancies) included in our review. Of the women included in this sample, 30% were infertile. The miscarriage rate was 13.8% (57/412) and 8.8% of the live births were premature. Obstetric anal sphincter injuries occurred in 11.3% (23/203) of the deliveries. The maternal mortality rate per pregnancy was 5.7%. CONCLUSIONS Women with vEDS present an elevated risk of uterine rupture, vascular events, digestive events and death during pregnancy. Women appear to be most at risk during the peripartum period; to avoid expulsive efforts, a caesarean section should be scheduled at 37 weeks of gestation.
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Affiliation(s)
- Théo Haem
- Department of Gynaecology and Obstetrics, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
| | - Betty Benson
- Department of Gynaecology and Obstetrics, Centre Hospitalier, Beauvais, France
| | - Amandine Dernoncourt
- Department of Internal Medicine and Réseau d'Epidémiologie Clinique International Francophone (RECIF), Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
- Faculty of Medicine, Université Picardie Jules Verne, Amiens, France
| | - Jean Gondry
- Department of Gynaecology and Obstetrics, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
- Faculty of Medicine, Université Picardie Jules Verne, Amiens, France
| | - Jean Schmidt
- Department of Internal Medicine and Réseau d'Epidémiologie Clinique International Francophone (RECIF), Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
- Faculty of Medicine, Université Picardie Jules Verne, Amiens, France
| | - Arthur Foulon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Universitaire Amiens Picardie, Amiens, France
- Faculty of Medicine, Université Picardie Jules Verne, Amiens, France
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Cordier AG, Zerbib E, Favier A, Dabi Y, Daraï E. Value of Non-Coding RNA Expression in Biofluids to Identify Patients at Low Risk of Pathologies Associated with Pregnancy. Diagnostics (Basel) 2024; 14:729. [PMID: 38611642 PMCID: PMC11011513 DOI: 10.3390/diagnostics14070729] [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: 01/28/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Pregnancy-related complications (PRC) impact maternal and fetal morbidity and mortality and place a huge burden on healthcare systems. Thus, effective diagnostic screening strategies are crucial. Currently, national and international guidelines define patients at low risk of PRC exclusively based on their history, thus excluding the possibility of identifying patients with de novo risk (patients without a history of disease), which represents most women. In this setting, previous studies have underlined the potential contribution of non-coding RNAs (ncRNAs) to detect patients at risk of PRC. However, placenta biopsies or cord blood samples are required, which are not simple procedures. Our review explores the potential of ncRNAs in biofluids (fluids that are excreted, secreted, or developed because of a physiological or pathological process) as biomarkers for identifying patients with low-risk pregnancies. Beyond the regulatory roles of ncRNAs in placental development and vascular remodeling, we investigated their specific expressions in biofluids to determine favorable pregnancy outcomes as well as the most frequent pathologies of pregnant women. We report distinct ncRNA panels associated with PRC based on omics technologies and subsequently define patients at low risk. We present a comprehensive analysis of ncRNA expression in biofluids, including those using next-generation sequencing, shedding light on their predictive value in clinical practice. In conclusion, this paper underscores the emerging significance of ncRNAs in biofluids as promising biomarkers for risk stratification in PRC. The investigation of ncRNA expression patterns and their potential clinical applications is of diagnostic, prognostic, and theragnostic value and paves the way for innovative approaches to improve prenatal care and maternal and fetal outcomes.
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Affiliation(s)
| | - Elie Zerbib
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France; (A.-G.C.); (Y.D.)
| | | | | | - Emile Daraï
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France; (A.-G.C.); (Y.D.)
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Glachant S, Salle B, Langlois-Jacques C, Labrune E, Renault L, Roy P, Benchaib M, Fraison E. [Predictive factors of spontaneous pregnancies among women with diminished ovarian reserve patients treated with DHEA]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:400-407. [PMID: 37331511 DOI: 10.1016/j.gofs.2023.06.001] [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: 02/23/2023] [Revised: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Diminished ovarian reserve remains a challenge in the reproductive medicine field. Treatment options for these patients are limited and there is no consensus to make any recommendations. Regarding adjuvant supplements, DHEA could play a role in follicular recruitment and, therefore, may increase spontaneous pregnancy rate. MATERIALS AND METHODS This study was a monocentric historical and observational cohort study carried out in the reproductive medicine department at the University Hospital, Femme-Mère-Enfant in Lyon. All women presenting with a diminished ovarian reserve treated with 75mg/day of DHEA were consecutively included. The main objective was to evaluate the spontaneous pregnancy rate. The secondary objectives were to identify predictive factors for pregnancy and the evaluation of treatment side effects. RESULTS Four hundred and thirty-nine women were included. In all, 277 were analyzed, 59 had a spontaneous pregnancy (21.3%). The probability of being pregnant was respectively 13.2% (IC95 9-17.2%), 21.3% (IC95 15.1-27%) and 38.8% (IC95 29.3-48.4%) at 6, 12 and 24 months. Only 20.6% of patients complained of side effects. CONCLUSION DHEA may improve spontaneous pregnancies in women with diminished ovarian reserve without any stimulation.
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Affiliation(s)
- S Glachant
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Laennec, université Claude-Bernard, 7, rue Guillaume-Paradin, Lyon, France
| | - B Salle
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Lyon Sud, université Claude-Bernard, 165, chemin du Petit-Revoyet, Oullins, France; Inserm unité 1208, 18, avenue Doyen-Lépine, Bron, France
| | - C Langlois-Jacques
- Service de biostatistique et bioinformatique, hospices civils de Lyon, 69003 Lyon, France; CNRS, UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, 69100 Villeurbanne, France
| | - E Labrune
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Laennec, université Claude-Bernard, 7, rue Guillaume-Paradin, Lyon, France; Inserm unité 1208, 18, avenue Doyen-Lépine, Bron, France
| | - L Renault
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Laennec, université Claude-Bernard, 7, rue Guillaume-Paradin, Lyon, France; Inserm unité 1208, 18, avenue Doyen-Lépine, Bron, France
| | - P Roy
- Service de biostatistique et bioinformatique, hospices civils de Lyon, 69003 Lyon, France; CNRS, UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, 69100 Villeurbanne, France
| | - M Benchaib
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Laennec, université Claude-Bernard, 7, rue Guillaume-Paradin, Lyon, France; Inserm unité 1208, 18, avenue Doyen-Lépine, Bron, France
| | - E Fraison
- Service de médecine de la reproduction, hospices civils de Lyon, hôpital Mère-Enfant, 59, boulevard Pinel, Bron, France; Faculté de médecine Laennec, université Claude-Bernard, 7, rue Guillaume-Paradin, Lyon, France.
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Toutain T, Philip CA, Bollon L, Cros M, Fraissenon A, Dupont C, Gaucher L, Haesebaert J, Nohuz E, Cortet M. Surgical management of a loss of pregnancy in the first trimester: Patient experience and influencing factors, a prospective observational study. J Gynecol Obstet Hum Reprod 2023; 52:102602. [PMID: 37187317 DOI: 10.1016/j.jogoh.2023.102602] [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: 08/08/2022] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Describe the "patient experience" regarding care provided during the surgical management of a loss of pregnancy in the first trimester and identify the factors influencing this experience. MATERIAL AND METHODS It is an observational prospective study conducted in two type III, academic, maternity wards in Lyon, France, carrying out 8,500 deliveries per year. Adult female patients, having undergone a suction curettage for a loss of pregnancy in the first trimester from 24 December 2020 to 13 June 2021 were inculded. The "patient experience" was assessed using the 15 questions of the Picker Patient Experience (PPE-15) questionnaire, and research was conducted on factors influencing the patient experience. The main outcome was the percentage of patients reporting a problem in response to at least one of the PPE-15 questions. RESULTS 58 out of 79 patients (73% CI [62-83]) reported at least one problem with their care. The largest proportion of problems was raised in question about "Opportunity for family/loved ones to talk to the doctor" (76% CI [61-87]). The lowest proportion of problems was raised in question about "Treated with respect and dignity" (8% CI [3-16]). No factors influencing the patient experience were identified. DISCUSSION Almost three out of four patients reported a problem in the experience as a patient. The main areas of improvement reported by patients were the participation of their family/relatives and the emotional support provided by the healthcare team. TWEETABLE ABSTRACT Better communication with patient families and emotional support could improve patient experience during the surgical management of a loss of pregnancy in the first trimester.
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Affiliation(s)
- T Toutain
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France
| | - C-A Philip
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France
| | - L Bollon
- Faculty of Maieutic, Lyon, France
| | - M Cros
- Faculty of Maieutic, Lyon, France
| | - A Fraissenon
- Mother and Child Radiology Department, North University Hospital, Saint Etienne 42000, France; Paediatric Imaging Department, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - C Dupont
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; AURORE Perinatal Network, Lyon 69004, France
| | - L Gaucher
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Midwifery Department, Geneva, Switzerland; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - J Haesebaert
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - E Nohuz
- Department of Obstetrics and Gynaecology, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - M Cortet
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France.
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Barbe C, Ouy J, Boiteux-Chabrier M, Bouazzi L, Pham BN, Carrau-Truillet S, Hurtaud A. Exploring the impact of prior spontaneous miscarriage on stress among pregnant women during the first trimester: an observational study. BJGP Open 2023; 7:BJGPO.2022.0100. [PMID: 36517185 DOI: 10.3399/bjgpo.2022.0100] [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: 07/03/2022] [Revised: 10/08/2022] [Accepted: 11/10/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Spontaneous miscarriage (SM) is the most common complication of pregnancy. Its psychological repercussions are widely documented but few studies have investigated its effect on women's experience of a subsequent pregnancy. AIM To evaluate the impact of prior SM on the level of stress experienced by pregnant women during the first trimester of pregnancy. DESIGN AND SETTING Cross-sectional, observational study, which was conducted between June and October 2021 in France. METHOD A self-report questionnaire was distributed to women in the first trimester of pregnancy. Stress was assessed using the Antenatal Perceived Stress Inventory to yield an overall score and a score for three dimensions ('medical and obstetric risks or fetal health'; 'psychosocial changes during pregnancy'; and the 'prospect of childbirth'). Women with a history of prior SM and those without were compared. RESULTS In total, 93 women were included; 63 without and 30 with a history of prior SM. Prior SM was not associated with the overall score. The score for the dimension 'medical and obstetric risks or fetal health' was significantly higher in women with prior SM (3.00±0.86 versus 2.34±0.80; β = 0.61 [95% confidence interval {CI} = 0.25 to 0.96]; P = 0.001). Prior SM was significantly associated with the items 'the baby's health' (P = 0.048) and 'the echography' (P = 0.002). CONCLUSION This study shows a significant impact of prior SM on the level of stress of pregnant women during the first trimester, particularly relating to the medical and obstetric risks or fetal health, underlining the need for appropriate psychological support to be provided to women who experience SM.
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Affiliation(s)
- Coralie Barbe
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, Reims, France
- Laboratoire C2S (Cognition, Santé, Société), Université de Reims Champagne Ardenne, Reims, France
| | - Justine Ouy
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | - Marie Boiteux-Chabrier
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | - Leïla Bouazzi
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, Reims, France
| | - Bach-Nga Pham
- Comité Universitaire de Ressources pour la Recherche en Santé, Université de Reims Champagne-Ardenne UFR Médecine, Reims, France
| | - Sandra Carrau-Truillet
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | - Aline Hurtaud
- Département de Médecine Générale, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
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Guillet S, Loustau V, Boutin E, Zarour A, Comont T, Souchaud-Debouverie O, Costedoat Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Viallard JF, Morin AS, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Lambotte O, Girault S, Lioger B, Audia S, Sacre K, Lega JC, Langlois V, Benachi A, Orvain C, Devidas A, Humbert S, Gambier N, Ruivard M, Zarrouk V, Ebbo M, Willems L, Segaux L, Mahevas M, Haddad B, Michel M, Canoui-Poitrine F, Godeau B. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood 2023; 141:11-21. [PMID: 36054922 PMCID: PMC10644036 DOI: 10.1182/blood.2022017277] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/18/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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MESH Headings
- Infant, Newborn
- Female
- Humans
- Pregnancy
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/complications
- Cohort Studies
- Prospective Studies
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Thrombocytopenia, Neonatal Alloimmune/therapy
- Retrospective Studies
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Affiliation(s)
- Stéphanie Guillet
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Valentine Loustau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
- Service de Médecine Interne, Centre Hospitalier Alpes Léman, Contamine sur Arve, France
| | - Emmanuelle Boutin
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Anissa Zarour
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Thibault Comont
- Service de Médecine Interne et d’Immunopathologie–IUCT-Oncopole, CHU de Toulouse, Toulouse, France
| | | | - Nathalie Costedoat Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
- Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, AP-HP, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | | | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Stéphane Cheze
- Institut d’Hématologie de Basse-Normandie, Centre Hospitalier de Caen Normandie, Caen, France
| | | | - Anne-Sophie Morin
- Service de Médecine Interne, Hôpital Jean Verdier, AP-HP, Bondy, France
| | - Gaetan Sauvetre
- Service de Médecine Interne, Hôpital Charles Nicolle, Université de Rouen, Rouen, France
| | - Manuel Cliquennois
- Service d'Onco-hématologie Adulte, Hôpital Saint-Vincent de Paul, GH de l'institut Catholique de Lille, Lille, France
| | - Bruno Royer
- Service d’Immuno-hématologie, Hôpital Saint Louis, Paris, France
- Service d’Hématologie clinique, CHU d’Amiens, Amiens, France
| | - Agathe Masseau
- Service de Médecine Interne, CHU de Nantes, Nantes, France
| | - Louis Terriou
- Service de Médecine Interne et d’Immunologie Clinique, CHU Lille, Université de Lille, Lille, France
| | - Claire Fieschi
- Service d’Immunologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Olivier Lambotte
- Service de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, Université Paris Sacly, Le Kremlin-Bicêtre, France
| | - Stéphane Girault
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France
| | | | - Sylvain Audia
- Service de Médecine Interne et d’Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes, Hôpital François Mitterrand, CHU Dijon-Bourgogne, Dijon, France
| | - Karim Sacre
- Service de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France et Université de Paris, Centre de Recherche sur l’Inflammation, INSERM UMR1149, CNRS ERL8252, Laboratoire d’Excellence Inflamex, Paris, France
| | - Jean Christophe Lega
- Service de Médecine Interne et Médecine Vasculaire, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Université de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS-UMR 5588, Université Lyon 1, Lyon, France
| | - Vincent Langlois
- Service de Médecine Interne, Hôpital Jacques Monod, Le Havre, France
| | - Alexandra Benachi
- Service d’Obstétrique et Gynécologie, Hôpital Antoine-Béclère, AP-HP, Université Paris-Saclay, Clamart, France
| | - Corentin Orvain
- Service d’Hématologie, Hôpital d’Anger, INSERM, CRCINA, Université d’Angers, Angers, France
| | - Alain Devidas
- Service d’Hématologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Nicolas Gambier
- Service de Médecine Interne, CH Général Delafontaine, St Denis, France
| | - Marc Ruivard
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France
| | - Mikael Ebbo
- Service de Médecine Interne, Hôpital de la Conception, AP-HP, Université Aix-Marseille, Marseille, France
| | - Lise Willems
- Service d’Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Lauriane Segaux
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Matthieu Mahevas
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Bassam Haddad
- Centre Hospitalier Inter-Communal de Créteil, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Equipe Immunorégulation et Biothérapie (I-BIOT), Université Paris Est Créteil, Univ Paris Est Créteil, INSERM U955, Institut Mondor De Recherche Biomédicale (IMRB), Créteil, France
| | - Marc Michel
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
| | - Florence Canoui-Poitrine
- Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Service de Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre national de référence des cytopénies auto-immunes de l’adulte, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Université Paris Est Créteil, Créteil, France
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8
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Kleinplatz PJ, Weindling P. Women's experiences of infertility after the Holocaust. Soc Sci Med 2022; 309:115250. [PMID: 36007428 DOI: 10.1016/j.socscimed.2022.115250] [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: 06/10/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Nuremburg trial evidence demonstrated that Nazis sought methods of mass sterilization of Jewish women. Immediately upon arrival at the concentration camps, over 98% of women stopped menstruating. There has been minimal investigation as to the cause(s) of amenorrhea, beyond malnutrition and trauma. The major objectives of this article are to 1) provide an alternate hypothesis to explain women's amenorrhea, i.e., surreptitious administration of exogenous hormones to women; 2) detail survivors' reproductive histories so as to demonstrate long-term sequellae, especially pregnancy losses; 3) provide women's subjective narratives of the short- and long-term experience of reproductive losses; 4) link women's amenorrhea, subsequent primary and secondary infertility and the evidence for the hypothesized causal mechanism, i.e., the administration of sex steroids which might have led to both immediate and long-term reproductive impacts. We conducted telephone interviews from 2018 to 2021 with Holocaust survivors internationally in 4 languages. We collected 93 testimonies from female Holocaust survivors (average age 92.5) or offspring who could provide complete reproductive histories for survivors. The interviews focused on reproductive histories, including amenorrhea beginning in 1942-45, subsequent attempts to conceive, numbers of pregnancies, miscarriages and stillbirths. Ninety-eight percent of women interviewed were unable to conceive or carry to term their desired number of children. Of 197 confirmed pregnancies, at least 48 (24.4%) ended in miscarriages, 13 (6.6%) in stillbirths and 136 (69.0%) in live births. The true number of pregnancy losses is likely much higher. Only 15/93 (16.1%) of women were able to carry more than two babies to term, despite most wanting more children desperately. Amenorrhea among Jewish women arriving at concentration camps was too uniform and sudden to be effected only by trauma and/or malnutrition. Survivors' narratives and historical evidence suggest the role of exogenous hormones, administered without women's knowledge to induce amenorrhea as well as subsequent primary and secondary infertility.
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Affiliation(s)
- Peggy J Kleinplatz
- Department of Family Medicine and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Paul Weindling
- Headington Campus, Tonge Block, T512, Oxford Brookes University, Oxford, OX3 0BP, UK
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Association between Obstetric Complications and Intravitreal Anti-Vascular Endothelial Growth Factor Agents or Intravitreal Corticosteroids. J Pers Med 2022; 12:jpm12091374. [PMID: 36143159 PMCID: PMC9501719 DOI: 10.3390/jpm12091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
This nationwide population-based cohort study aimed to describe the use of intravitreal injections (IVTs) of anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids in pregnant women in France and to report on the incidence of obstetric and neonatal complications. All pregnant women in France who received any anti-VEGF or corticosteroid IVT during pregnancy or in the month preceding pregnancy from 1 January 2009 to 31 December 2018 were identified in the national medico-administrative databases. Between 2009 and 2018, there were 5,672,921 IVTs performed in France. Among these IVTs, 228 anti-VEGF or corticosteroid IVTs were administered to 139 women during their pregnancy or in the month preceding their pregnancy. Spontaneous abortion or the medical termination of pregnancy occurred in 10 women (16.1%) who received anti-VEGF agents and in one (3.1%) of the women who received corticosteroids (p = 0.09). This is the first national cohort study of pregnant women treated with anti-VEGF or corticosteroid IVTs. We found a high incidence of obstetric complications in pregnant women treated with anti-VEGF or corticosteroid IVTs but could not demonstrate a statistically significant association between the intravitreal agents and these complications. These agents should continue to be used with great caution in pregnant women.
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Kalla A, Loucif L, Yahia M. Miscarriage Risk Factors for Pregnant Women: A Cohort Study in Eastern Algeria’s Population. J Obstet Gynaecol India 2022; 72:109-120. [PMID: 35928069 PMCID: PMC9343518 DOI: 10.1007/s13224-021-01564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
Background Miscarriage is defined as an adverse and unexpected termination of pregnancy; it is the most frequent pregnancy complication. Here, we aimed to identify the factors predisposing to miscarriage in pregnant women in Eastern Algeria and the effect of the combination of several factors, including maternal Body Mass Index (BMI), maternal age, concomitant pathologies, and nutrients, and to predict the occurrence of miscarriage. Methods A total of 786 pregnant women from Eastern Algeria were interviewed between 2011 and 2015. Association between miscarriage exposure and identified risk factors was assessed using a Generalized Linear Model (GLM), ANOVA test, Multiple Correspondence Analysis (MCA), and Hierarchical Clustering Analysis (HCA). Throughout this study, we sought to find answers, discuss this association, and predict the occurrence of miscarriage. Results We developed a predictive model for miscarriage, and we found that miscarriage was significantly higher for pregnant women aged over 35 years (1.75; 95% CI: 0.75-4.37; p = 0.208), with a high BMI (> 25 kg/m2), (1.88; 95% CI:1.28-2.78; p = 0.001). We have highlighted that miscarriage is strongly associated with hypertension (1.67; 95% CI: 1.16-2.39; p = 0.006), diet rich in meat (0.60; 95% CI: 0.33-1.04; p = 0.075), and moderate in fish (2.32; 95% CI: 1.18-4.58; p = 0.015). Conclusion Our study proved that knowing these risk factors helps to establish predictive models and strategies to prevent tragic pregnancy outcomes and highlights the link between miscarriage and several risk factors; and thus, will allow protecting mother and fetus health.
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11
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Late fetal demise, a risk factor for post-traumatic stress disorder. Sci Rep 2022; 12:12364. [PMID: 35859001 PMCID: PMC9300686 DOI: 10.1038/s41598-022-16683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one's arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.
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12
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Yevgi R, Bilge N, Simsek F, Eren A, Cimilli Senocak GN. Vitamin D levels and C-reactive protein/albumin ratio in pregnant women with cerebral venous sinus thrombosis. J Thromb Thrombolysis 2021; 53:532-539. [PMID: 34342785 DOI: 10.1007/s11239-021-02541-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.
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Affiliation(s)
- Recep Yevgi
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
| | - Nuray Bilge
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Fatma Simsek
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Alper Eren
- Department of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Bloomfield J, Pénager C, Mandelbrot L. Shirodkar cerclage: Obstetrical and neonatal outcomes in a single-center cohort of 55 cases. J Gynecol Obstet Hum Reprod 2021; 50:102152. [PMID: 33887533 DOI: 10.1016/j.jogoh.2021.102152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cervical insufficiency is thought to be responsible for 10% of preterm deliveries. Shirodkar cerclage is among the available techniques ranging from McDonald's to definitive procedures, however the indications for the prevention of preterm births and mid-trimester miscarriages are still poorly delineated. OBJECTIVE To describe the characteristics, obstetrical and neonatal outcomes of pregnancies with Shirodkar cerclage procedures. METHOD We performed a descriptive retrospective single-center study, including all patients who had a Shirodkar cerclage between January 1, 2008 and December 31, 2020. The main outcomes measured were delivery at or beyond 24 and 32 weeks of gestations (WG). RESULTS 55 Shirodkar cerclages were performed over the period studied. 7.3% of patients had a uterine malformation, 9% had a history of cervical conization. 74.5% had history of one or more mid-trimester miscarriages. 63.6% had a history of a failed emergency or prophylactic cerclage. The median gestational age (GA) at cerclage placement was 14 WG. There were 4 deliveries before 24 WG, 8 before 32 WG and 16 before 37 WG. Overall neonatal survival was 48/53 (90.6%). The median GA at delivery was 38 weeks (IQR 35-39), with 70.3% of vaginal deliveries. CONCLUSION Shirodkar cerclage was successful in more than 90% of patients, despite their obstetric history. Shirodkar cerclage may be indicated in the event of prior cerclage failure using the McDonald technique or in order to allow for correct stitch placement in very short cervixes. Its advantage over definitive cerclage is to allow for vaginal delivery.
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Affiliation(s)
- Joy Bloomfield
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris and Colombes, France
| | - Cécile Pénager
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris and Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris and Colombes, France; Inserm UMR1137 IAME, Paris, France.
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14
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Boyer A, Lobbedez T, Ouethrani M, Thuillier Lecouf A, Bouvier N, Châtelet V, Hurault de Ligny B. Paternity in male kidney transplant recipients: a French national survey, the PATeRNAL study. BMC Nephrol 2020; 21:483. [PMID: 33198659 PMCID: PMC7667842 DOI: 10.1186/s12882-020-02115-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background There is concern about the impact of immunosuppressive agents taken by male kidney transplant (KT) recipients on the risk of foetal malformations. The aim of our survey was to estimate the paternity rate and the outcomes of pregnancies fathered by kidney transplanted males. Methods This survey analysed 1332 male KT recipients older than 18 years, followed in 13 centres in France. A self-reported questionnaire was used to collect data on the patients, treatments at the time of conception and the pregnancy outcomes. Results The study included data on 349 children from 404 pregnancies fathered by 232 male KT recipients. The paternity rate was 17% (95% CI [15–20]). There were 37 (9%, 95% CI [7–12]) spontaneous abortions, 12 (3%, 95% CI [2–5]) therapeutic abortions, 2 (0.5%, 95% CI [0.1–1]) still births, and 13 (4%, 95% CI [2–6]) malformations reported. Compared to the general population, there was no difference in the proportion of congenital malformations nor unwanted outcomes whether the father was exposed or not to immunosuppressive agents. Conclusions This survey does not provide any warning signal that pregnancies fathered by male patients exposed to immunosuppressive agents, notably the debated MMF/MPA, have more complications than pregnancies in the general population. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12882-020-02115-x.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France. .,U1086 INSERME - ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, 14076, Caen, Cedex 5, France.
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France.,U1086 INSERME - ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, 14076, Caen, Cedex 5, France.,Unicaen, UFR de Médecine, Normandie Université, 2 rue des Rochambelles, 14032, Caen, Cedex, France
| | - Mohamed Ouethrani
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France
| | - Angélique Thuillier Lecouf
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France
| | - Nicolas Bouvier
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France.,Unicaen, UFR de Médecine, Normandie Université, 2 rue des Rochambelles, 14032, Caen, Cedex, France
| | - Valérie Châtelet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France.,U1086 INSERME - ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, 14076, Caen, Cedex 5, France.,Unicaen, UFR de Médecine, Normandie Université, 2 rue des Rochambelles, 14032, Caen, Cedex, France
| | - Bruno Hurault de Ligny
- Centre Universitaire des Maladies Rénales, CHU de Caen, Avenue de la côte de Nacre, 14033, Caen, Cedex 9, France.,Unicaen, UFR de Médecine, Normandie Université, 2 rue des Rochambelles, 14032, Caen, Cedex, France
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Vaccines based on replication incompetent Ad26 viral vectors: Standardized template with key considerations for a risk/benefit assessment. Vaccine 2020; 39:3081-3101. [PMID: 33676782 PMCID: PMC7532807 DOI: 10.1016/j.vaccine.2020.09.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
Replication-incompetent adenoviral vectors have been under investigation as a platform to carry a variety of transgenes, and express them as a basis for vaccine development. A replication-incompetent adenoviral vector based on human adenovirus type 26 (Ad26) has been evaluated in several clinical trials. The Brighton Collaboration Viral Vector Vaccines Safety Working Group (V3SWG) was formed to evaluate the safety and features of recombinant viral vector vaccines. This paper reviews features of the Ad26 vectors, including tabulation of safety and risk assessment characteristics of Ad26-based vaccines. In the Ad26 vector, deletion of E1 gene rendering the vector replication incompetent is combined with additional genetic engineering for vaccine manufacturability and transgene expression optimization. These vaccines can be manufactured in mammalian cell lines at scale providing an effective, flexible system for high-yield manufacturing. Ad26 vector vaccines have favorable thermostability profiles, compatible with vaccine supply chains. Safety data are compiled in the Ad26 vaccine safety database version 4.0, with unblinded data from 23 ongoing and completed clinical studies for 3912 participants in five different Ad26-based vaccine programs. Overall, Ad26-based vaccines have been well tolerated, with no significant safety issues identified. Evaluation of Ad26-based vaccines is continuing, with >114,000 participants vaccinated as of 4th September 2020. Extensive evaluation of immunogenicity in humans shows strong, durable humoral and cellular immune responses. Clinical trials have not revealed impact of pre-existing immunity to Ad26 on vaccine immunogenicity, even in the presence of Ad26 neutralizing antibody titers or Ad26-targeting T cell responses at baseline. The first Ad26-based vaccine, against Ebola virus, received marketing authorization from EC on 1st July 2020, as part of the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen. New developments based on Ad26 vectors are underway, including a COVID-19 vaccine, which is currently in phase 3 of clinical evaluation.
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Diguisto C, Dochez V. [Consequences of Active Cigarette Smoking in Pregnancy - CNGOF-SFT Expert Report and Guidelines on the management of smoking during pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:559-566. [PMID: 32360705 DOI: 10.1016/j.gofs.2020.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To synthesize knowledge on the consequences of active smoking in pregnancy. METHODS The MedLine database, the Cochrane Library and French and foreign guidelines from 1999 to 2019 have been consulted. RESULTS Active maternal smoking is associated with an increased risk of first trimester complications such as early miscarriage and ectopic pregnancy with a dose-effect relationship between smoking and those risks. Active cigarette smoking during pregnancy is associated with an increased risk of certain type of birth defects, placenta abruptio, placenta previa, stillbirth and cesarean delivery. Active maternal smoking is associated with a reduced risk of pre-eclampsia. Children born to mothers who smoke are more at risk of premature birth and low birth weight with a dose-effect relationship for those two risks. CONCLUSION Apart from preeclampsia which is reduced in case of active maternal smoking, perinatal morbidity is increased among women who smoke during their pregnancy.
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Affiliation(s)
- C Diguisto
- Service de gynécologie obstétrique, maternité Olympe de Gouges, université François-Rabelais, centre hospitalier universitaire de Tours, 37100 Tours, France.
| | - V Dochez
- Service de gynécologie obstétrique, centre hospitalier universitaire de Nantes, 44093 Nantes cedex 1, France
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Birindwa EK, Sindayirwanya JB, Harerimana S. [Prognosis of pregnant women with vaginal bleeding during the first trimester: about 239 cases at the Kamenge University Hospital in Bujumbura]. Pan Afr Med J 2020; 35:111. [PMID: 32637009 PMCID: PMC7320776 DOI: 10.11604/pamj.2020.35.111.20413] [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] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/03/2020] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study is to evaluate the post-discharge prognosis of pregnant women with vaginal bleeding during the first trimester, admitted to the Emergency Maternity at the Kamenge University Hospital (CHUK), according to patients age, amount of bleeding and ultrasound results. We conducted a retrospective descriptive and analytical study of 239 medical records of patients hospitalized over a period of six years from January 2012 to December 2017. In this study, the prognosis of pregnant women with first-trimester metrorrhagia hospitalized at the CHUK was bad; the majority of them (65.7%) had miscarriage. Amount of bleeding, maternal age below 20 years, or well above or equal to 35 years, were significant risk factors but much more ultrasound detection of trophoblastic detachment. It would be interesting to perform a prospective study to detect the causes of these metrorrhagias and to determine late pregnancy complications.
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Affiliation(s)
- Etienne Kajibwami Birindwa
- Université Catholique de Bukavu, Bugabo 02, Avenue de la Mission, Commune de Kadutu Bukavu, République Démocratique du Congo
- Université du Burundi, Avenue de l'Unesco numéro 2, BP 1550 Bujumbura, Burundi
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Demortiere S, Rico A, Maarouf A, Boutiere C, Pelletier J, Audoin B. Maintenance of natalizumab during the first trimester of pregnancy in active multiple sclerosis. Mult Scler 2020; 27:712-718. [PMID: 32202216 DOI: 10.1177/1352458520912637] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Planning pregnancy in patients with active multiple sclerosis (MS) is highly challenging because treatment withdrawn may be associated with dramatic disease reactivation. OBJECTIVE To compare two strategies for women with active MS who were planning pregnancy: stopping natalizumab (1) at the end of the first trimester and (2) at conception. METHODS Standardized strategy for women with active MS was initiated in our department. Maintenance of natalizumab until the end of first trimester was recommended ("secured first trimester" (SFT)). When patients refused, they were advised to continue until conception ("secured conception" (SC)). Predictors of disease activity during pregnancy were assessed. RESULTS Forty-six pregnancies were prospectively followed (30 with SFT and 16 with SC). One congenital anomaly occurred in the SC group. The proportions of patients with relapse and disability progression during pregnancy were lower in the SFT than in the SC group (3.6% vs 38.5%, p < 0.005 and 3.6% vs 30.8%, p < 0.05, respectively). Predictors of relapse and disability progression during pregnancy were the time when natalizumab was stopped (conception vs end of first trimester) and the number of relapses during the year before natalizumab. CONCLUSION Maintaining natalizumab during the first trimester may reduce the risk of disease reactivation during pregnancy in patients with active MS.
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Affiliation(s)
- Sarah Demortiere
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Audrey Rico
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Adil Maarouf
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Clémence Boutiere
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Jean Pelletier
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Bertrand Audoin
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
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The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis. PLoS One 2019; 14:e0221709. [PMID: 31532766 PMCID: PMC6750576 DOI: 10.1371/journal.pone.0221709] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023] Open
Abstract
Background Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments. Method To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children. Results The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint. Conclusions Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.
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Sokal A, Elefant E, Leturcq T, Beghin D, Mariette X, Seror R. Pregnancy and newborn outcomes after exposure to bisphosphonates: a case-control study. Osteoporos Int 2019; 30:221-229. [PMID: 30171300 DOI: 10.1007/s00198-018-4672-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/13/2018] [Indexed: 01/13/2023]
Abstract
UNLABELLED We analyzed women and newborn outcome after maternal exposure to BPs. BPs have no teratogenic effect on the 36 analyzed pregnancies compared to unexposed controls matched on women underlying diseases (either systemic disease, either "bone" disease) but some outcome differed: neonatal complications rate in systemic diseases and live birth rate in bone diseases). INTRODUCTION The effect of bisphosphonates (BPs) during pregnancy remains unclear. We aimed to study pregnancy outcomes in women exposed to BPs during pregnancy. METHODS Data for cases and controls were from the French Reference Centre of Teratogenic Agents. Cases were women who received BPs in the 6 weeks before or during a pregnancy and had systemic or bone diseases. We included two respectively matched control groups: women with systemic diseases not exposed to BPs and healthy women not exposed to BPs or any teratogenic agent. Four controls were assigned to each case. RESULTS Thirty-six women were exposed to BPs including 5 just before pregnancy and 30 during the first trimester; 23 had systemic diseases (systemic lupus erythematosus, n = 5; rheumatoid arthritis, n = 5; other, n = 13) and 13 had bone diseases. Rate of observed congenital malformations did not differ in women with a systemic or a bone disease compared to their respective controls (respectively 2/23 [8.7%] vs 2/92 [2.2%], p = 0.178 and 0/13 [0%] vs 0/52 [0%], p = 1.00). Among women with systemic diseases, non-specific neonatal complications were more frequent for cases (4/16 [25.0%] vs 4/64 [6.3%], p = 0.027). Among women with bone disorders, the live birth rate was lower for cases than healthy controls (8/10 [80%] vs 50/50 [100%], p = 0.025). CONCLUSION We found no major teratogenic effects of BPs, but rates of neonatal complications were increased for women with systemic diseases, as were spontaneous abortions for women with bone diseases likely linked to the severity of the underlying diseases and concomitant medications.
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Affiliation(s)
- A Sokal
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Department of Rheumatology, Hôpital Bicêtre Université Paris-Sud, INSERM U1184, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - E Elefant
- Centre de Référence sur les Agents Tératogènes (CRAT), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Est Parisien - Pôle Périnatalité - Hôpital Armand Trousseau, 26, av Dr Netter, 75571, Paris cedex 12, France
| | - T Leturcq
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Department of Rheumatology, Hôpital Bicêtre Université Paris-Sud, INSERM U1184, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - D Beghin
- Centre de Référence sur les Agents Tératogènes (CRAT), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Est Parisien - Pôle Périnatalité - Hôpital Armand Trousseau, 26, av Dr Netter, 75571, Paris cedex 12, France
| | - X Mariette
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Department of Rheumatology, Hôpital Bicêtre Université Paris-Sud, INSERM U1184, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - R Seror
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud, Department of Rheumatology, Hôpital Bicêtre Université Paris-Sud, INSERM U1184, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
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Hu L, Du J, Lv H, Zhao J, Chen M, Wang Y, Wu F, Liu F, Chen X, Zhang J, Ma H, Jin G, Shen H, Chen L, Ling X, Hu Z. Influencing factors of pregnancy loss and survival probability of clinical pregnancies conceived through assisted reproductive technology. Reprod Biol Endocrinol 2018; 16:74. [PMID: 30086781 PMCID: PMC6081896 DOI: 10.1186/s12958-018-0390-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pregnancies following assisted reproductive technology (ART) may have elevated potential risk of pregnancy loss (PL) when compared to natural conception. However, rare studies comprehensively analyzed the IVF/ICSI cycle-dependent factors for loss of clinical pregnancy. Therefore, we aimed to determine the ART subgroup-specific risks of PL throughout pregnancy and explore different risk factors for early miscarriage and late miscarriage among pregnancies conceived through ART. METHODS A retrospective cohort study was launched in two infertility treatment centers in Nanjing and Changzhou including 5485 IVF/ICSI embryo transfer cycles with known outcomes after clinical pregnancy by the end of 2015. Cox proportional hazards regression analysis was performed to estimate the hazard ratios and their 95% confidence intervals. The associations between survival time during pregnancy and demographics and clinical characteristics of clinical pregnancies were estimated using the Kaplan-Meier method and the Log-rank test. RESULTS The overall PL rate in current ART population was 12.5%. Among the 685 pregnancy loss cycles, a total of 460 ended as early miscarriage, 191 as late miscarriage. We found couples in ART pregnancies demonstrated a significantly increased risk of PL as maternal age (HR = 1.31, Ptrend < 0.001) grows. Pregnancies received controlled ovarian hyperstimulation (COH) protocol like GnRH antagonist protocol (HR = 3.49, P < 0.001) and minimal stimulation protocol (HR = 1.83, P < 0.001) had higher risk of PL than GnRH-a long protocol. Notably, in contrast to fresh cycle, women who received frozen cycle embryo had a significant increased risk of early miscarriage (P < 0.001), while frozen cycle was linked with lower risk of late miscarriage (P = 0.045). In addition, four factors (maternal age, COH protocol, cycle type and serum hCG level 14 days after transfer) had independent impact on miscarriage mainly before 12 weeks of gestational age. CONCLUSIONS With these findings in this study, clinicians may make it better to evaluate a patient's risk of PL based on the maternal age at the time of treatment, COH protocol, cycle type and serum hCG level 14 days after transfer and the gestational week of the fetus, and we hope that it contributes to future study on its etiology and guide the clinical prevention and treatment.
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Affiliation(s)
- Lingmin Hu
- Department of Reproduction, the Affiliated Changzhou Maternity and Child Health Care, Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Jiangbo Du
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hong Lv
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Jing Zhao
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health, Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Mengxi Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health, Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Yifeng Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Fang Wu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Feng Liu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaojiao Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health, Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Junqiang Zhang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health, Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Guangfu Jin
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Li Chen
- Department of Reproduction, the Affiliated Changzhou Maternity and Child Health Care, Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu, China.
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
| | - Xiufeng Ling
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
- Department of Reproduction, the Affiliated Nanjing Maternity and Child Health, Hospital of Nanjing Medical University, Nanjing, 210004, China.
| | - Zhibin Hu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, 211166, China.
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Thellier E, Levaillant JM, Pourcelot AG, Houllier M, Fernandez H, Capmas P. Are 3D ultrasound and office hysteroscopy useful for the assessment of uterine cavity after late foetal loss? J Gynecol Obstet Hum Reprod 2018; 47:183-186. [DOI: 10.1016/j.jogoh.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 01/01/2023]
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Barthes C, Mezan De Malartic C, Baumann C, Rousseaux H, Morel O. [Echographic diagnosis of missed early miscarriage: Assessment of image quality]. ACTA ACUST UNITED AC 2018; 46:86-92. [PMID: 29352716 DOI: 10.1016/j.gofs.2017.12.002] [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: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Ultrasound examination plays a central role in case of suspected non-viable pregnancy. A wrong diagnosis might have major consequence in terms of inadequate care, especially in cases of false positive non-viable pregnancy diagnosis. Ultrasound criterions are today well defined. Our objective was to evaluate the feasibility and reproducibility of a novel image-quoting method of first-trimester non-viable pregnancy. METHODS Thirty images of non-viable pregnancy were twice evaluated with blinded proofreading. Two quotations were evaluated: the first for the images of gestational sacs without embryo (gestational sac score), the second for the images with embryo (embryo score). RESULTS The ICC (interclass correlation coefficient) was>0.75 for inter- and intra-observer reproducibility both for the quotations of the gestational sac and for the embryo with a low variability. Reproducibility of quoting crown rump length measurements <5mm was low at first proofreading but after adjustment of the quoting modalities, ICC was also>0.75. CONCLUSION The inter- and intra-observer reproducibility of our quoting methods is high with a low variability. They might be a useful tool in current practice in the future.
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Affiliation(s)
- C Barthes
- Maternité du CHRU Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy, France.
| | - C Mezan De Malartic
- Maternité du CHRU Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - C Baumann
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - H Rousseaux
- Plateforme d'aide à la recherche clinique, CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - O Morel
- Maternité du CHRU Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Université de Lorraine, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy, France
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Cardinale C, Berbis J, Chau C, Bernard F, Arnoux D, Fratacci MF, Boubli L, Bretelle F. Two miscarriages, consecutive or non-consecutive, does it change something? J Gynecol Obstet Hum Reprod 2017; 46:721-725. [PMID: 28993281 DOI: 10.1016/j.jogoh.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the rate of anomalies in the etiological evaluation of patients presenting recurrent early miscarriages (RM) according to miscarriage chronology (number of miscarriages, history of live birth and succession of RM). METHODS Retrospective single centre study including RM, defined as at least 2 miscarriages at less than 14 weeks of gestation (WG) between the 1st January 2012 and the 31st December 2015. Clinical data and etiological evaluation include blood glucose levels, screening for antiphospholipid syndrome (APS), endocrine assessment, vitamin levels, pelvic imaging, karyotyping of both partners, chronic endometritis and thrombophilia screening. RESULTS Two hundred and eighty-eight patients were included over this period, 118 (41%) patients had no history of live birth. Two hundred and twenty-three (77%) patients had consecutive RM and 65 (22%) patients had non-consecutive RM. For consecutive RM, 62,8% had thrombophilic disorders versus 69,8% for non-consecutive RM (P>0,05); 44,7% had endocrine disorders or vitamin deficiencies versus 39,7%; 34,6% of patients with consecutive RM had uterine anomalies versus 45,5% respectively. No difference was found depending on the recurrence of RM or the history of live birth (P>0.05) apart from the age of the patient. Fifty-nine (17.4%) patients had uterine anomalies. There are 24 chronic endometritis on 31 biospsies performed. Seventy-eight (27%) patients were offered treatment. Ninety-four (90%) patients showed good therapy compliance. Eighty-one (78%) patients became pregnant. CONCLUSION An etiological evaluation provides, for over half of the cases, an etiology or the identification of risk factors responsible for RM, as well as in some cases offering an adapted, efficient, therapeutic approach. This evaluation should be offered regardless of the obstetric history of the patient.
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Affiliation(s)
- C Cardinale
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France.
| | - J Berbis
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Public health department, AMU, Aix-Marseille université, 13385 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - C Chau
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - F Bernard
- Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - D Arnoux
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - M-F Fratacci
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Public health department, AMU, Aix-Marseille université, 13385 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France
| | - L Boubli
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - F Bretelle
- Service de gynécologie-obstétrique, gynepole, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Unité de recherche sur les maladies infectieuses tropicales et emergentes, CNRS UMR 7278, Inserm U1095, Aix-Marseille université, 13385 Marseille, France.
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Poli D, Cenci C, Testa S, Paoletti O, Silvestri E, Antonucci E. Obstetrical history of women with cerebral vein thrombosis: outcome of the pregnancies before and after the thrombotic event. Intern Emerg Med 2017; 12:941-945. [PMID: 28589438 DOI: 10.1007/s11739-017-1682-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Cerebral vein thrombosis (CVT) is a rare disease usually affecting young people, especially women, with a high prevalence of thrombophilic defects. It is known that thrombophilia is associated with pregnancy complications; therefore, a high rate of complications could be expected in women with the previous CVT who become pregnant. This study examined the whole obstetric history of women who suffered from CVT to evaluate the incidence of pregnancy complications during their entire lifespan. We prospectively followed consecutive patients with CVT, limiting the analysis to females and their obstetrical history. We studied 123 pregnancies in 99 consecutive women who had a CVT; 71 women had 91 pregnancies before the CVT; 19 women had 23 pregnancies after the CVT; and nine women had a CVT related to pregnancy. All women with CVT before pregnancy were treated with LMWH at prophylactic dosage during pregnancy. No recurrent CVT, venous thromboembolic events, or death was recorded during the observed pregnancies. Ten miscarriages were recorded (rate 8.1%), with a rate similar to that expected in the general population. We confirm the favorable outcome of pregnancies in women who suffered from CVT during their entire lifespan, whether they have occurred before and after or in relation to CVT.
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Affiliation(s)
- Daniela Poli
- Oncology Department, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, 50134, Florence, Italy.
| | - Caterina Cenci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Centre, A O Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Oriana Paoletti
- Haemostasis and Thrombosis Centre, A O Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Verdière S, Guinhouya BC, Salerno D, Deruelle P. [Should physical activity be contraindicated during pregnancy in relation to its potentially related risks?]. ACTA ACUST UNITED AC 2017; 45:104-111. [PMID: 28368790 DOI: 10.1016/j.gofs.2016.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/19/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This paper aimed at providing a critical analysis of data on the risks associated with physical activity of women during their pregnancy. METHODS Cochrane Library, Google Scholar, PubMed (Medline) and Web of Sciences were searched using a combination of MeSH terms associated to "Physical activity", "Pregnancy" and "Adverse events" or "Risks". Only review papers published from inception of these databases to November 2016 were used in the present analysis. RESULTS The electronic search yield a total of 104 citations. After a critical analysis of abstracts and/or full-texts, only a systematic review and cohort study on injuries related to physical activity during pregnancy appeared relevant for the current study. Data reveals a very small proportion (<1 %) of adverse events in direct link with the physical activity behavior of pregnant women. Furthermore, there would be less than one serious adverse event per 5000hours of physical activity. The only serious adverse event attributable to physical activity during pregnancy was uterine contractions. The threat of preterm labor and miscarriage risk cannot be primarily attributed to the participation of pregnant women in a physical activity, even vigorous. Moreover, no adverse effects of maternal physical activity on neonatal outcomes were found. CONCLUSION Physical activity-related risks during pregnancy appear to be infrequent and of minor severity. Though further studies are required to better understand the risk/benefit balance of physical activity during pregnancy, current data do not support the contraindication of this behavior in pregnant women.
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Affiliation(s)
- S Verdière
- Pôle mère enfant gynécologie, centre hospitalier de Seclin, 59113 Seclin, France
| | - B C Guinhouya
- Université de Lille, EA 2694, santé publique : épidémiologie et qualité des soins & UFR ingénierie et management de la santé, 59000 Lille, France.
| | - D Salerno
- Université de Lille, laboratoire MERCUR - LSRC & UFR ingénierie et management de la santé, 59000 Lille, France
| | - P Deruelle
- Pôle femme mère nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France; Université de Lille, EA 4489, environnement périnatal et croissance & faculté de médecine, 59000 Lille, France
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Caimari F, Valassi E, Garbayo P, Steffensen C, Santos A, Corcoy R, Webb SM. Cushing's syndrome and pregnancy outcomes: a systematic review of published cases. Endocrine 2017; 55:555-563. [PMID: 27704478 DOI: 10.1007/s12020-016-1117-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022]
Abstract
Pregnancy in Cushing's syndrome (CS) is extremely rare due to the influence of hypercortisolism on the reproductive axis. Purpose of this study is to investigate whether the etiology of CS in pregnancy determines a different impact on the fetal/newborn and maternal outcomes. We performed a systematic review of cases published in the literature from January 1952 to April 2015 including the words "Cushing AND pregnancy". We included 168 manuscripts containing 220 patients and 263 pregnancies with active CS during pregnancy and with a history of CS but treated and cured hypercortisolism at the time of gestation. Adrenal adenoma was the main cause of active CS during pregnancy (44.1 %). Women with active CS had more gestational diabetes mellitus (36.9 vs. 2.3 %, p = 0.003), gestational hypertension (40.5 vs. 2.3 %, p < 0.001) and preeclampsia (26.3 vs. 2.3 %, p = 0.001) than those with cured disease. The proportion of fetal loss in active CS was higher than in cured CS (23.6 vs. 8.5 %, p = 0.021), as well as global fetal morbidity (33.3 vs. 4.9 %, p < 0.001). The predictors of fetal loss in active CS were etiology of hypercortisolism [Odds Ratio -OR-for pregnancy-induced CS 4.7 (95 % Confidence Interval-CI 1.16-18.96), p = 0.03], publication period [OR for "1975-1994" 0.10 (95 % CI 0.03-0.40), p = 0.001] and treatment during gestation (p = 0.037, [OR medical treatment 0.25 (95 % CI 0.06-1.02), p = 0.052], [OR surgical treatment 0.34 (95 % CI 0.11-1.06), p = 0.063]). The period of diagnosis of CS (before, during or after pregnancy) was the only predictor of overall fetal morbimortality [OR for diagnosis during pregnancy 4.66 (95 % CI 1.37-15.83), p = 0.014]. Patients with active CS, especially in pregnancy-induced CS, experienced more problems in pregnancy and had the worst fetal prognosis in comparison to other causes. Diagnosis of CS during pregnancy was also associated with worse overall fetal morbimortality. Both medical treatment and surgery during pregnancy appeared to be protective in avoiding fetal loss.
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Affiliation(s)
- Francisca Caimari
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - Alicia Santos
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rosa Corcoy
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain
| | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, Instituto de Salud Carlos III, Madrid, Spain.
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Feng B, Dai A, Chen L, Qiu L, Fu Y, Sun W. NADPH oxidase-produced superoxide mediated a 50-Hz magnetic field-induced epidermal growth factor receptor clustering. Int J Radiat Biol 2016; 92:596-602. [PMID: 27442448 DOI: 10.1080/09553002.2016.1206227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE A 50-Hz magnetic field (MF) was found to induce epidermal growth factor receptor (EGFR) clustering in our previous study. The aim of this work was to investigate the molecular mechanisms that mediated MF-induced EGFR clustering. MATERIALS AND METHODS Human amniotic epithelial (FL) cells were exposed to a 50-Hz MF. Total reactive oxygen species (ROS), cytoplasmic and mitochondrial superoxide production were detected by DCFH-DA, DHE and MitoSOX, respectively. EGFR clustering was analyzed using confocal microscopy after indirect immunofluorescence staining. RESULTS Results showed that exposing FL cells to MF at intensity higher than 0.2 mT for 15 min enhanced total ROS production. Additionally, enhanced total ROS and cytoplasmic superoxide production were observed after exposing cells to MF at 0.4 mT for 5, 15, or 30 min, while mitochondrial superoxide production for 15 or 30 min. Pretreatment with Nox inhibitor, DPI, effectively inhibited MF-induced cytoplasmic superoxide production and subsequent EGFR clustering while mitochondrial superoxide production was not affected. CONCLUSIONS Nox-produced superoxide mediated a 50-Hz magnetic field-induced EGFR clustering.
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Affiliation(s)
- Baihuan Feng
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China
| | - Ahui Dai
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China ;,c Healthcare Department , the First Affiliated Hospital, Zhejiang University , Hangzhou , China
| | - Liangjing Chen
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China
| | - Liping Qiu
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China
| | - Yiti Fu
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China
| | - Wenjun Sun
- a Bioelectromagnetics Key Laboratory , Zhejiang University School of Medicine , Hangzhou , China ;,b Institute of Environmental Medicine, Zhejiang University School of Medicine , Hangzhou , China
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Pregnancy loss: French clinical practice guidelines. Eur J Obstet Gynecol Reprod Biol 2016; 201:18-26. [DOI: 10.1016/j.ejogrb.2016.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 12/28/2022]
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Hodes AR, Tichnell C, Te Riele ASJM, Murray B, Groeneweg JA, Sawant AC, Russell SD, van Spaendonck-Zwarts KY, van den Berg MP, Wilde AA, Tandri H, Judge DP, Hauer RNW, Calkins H, van Tintelen JP, James CA. Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy. Heart 2015; 102:303-12. [PMID: 26719359 PMCID: PMC4752646 DOI: 10.1136/heartjnl-2015-308624] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/26/2015] [Indexed: 12/17/2022] Open
Abstract
Objectives To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Methods From a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1–4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised. Obstetric outcomes were ascertained. Incidence of VA and HF were compared with rates in the non-pregnant state. Long-term disease course was compared with 117 childbearing-aged female patients with ARVD/C who had not experienced pregnancy with ARVD/C. Results Treatment during pregnancy (n=39) included β blockers (n=16), antiarrhythmics (n=6), diuretics (n=3) and implantable cardioverter defibrillators (ICDs) (n=28). In five pregnancies (13%), a single VA occurred, including two ICD-terminated events. Arrhythmias occurred disproportionately in probands without VA history (p=0.045). HF, managed on an outpatient basis, developed in two pregnancies (5%) in women with pre-existing overt biventricular or isolated right ventricular disease. All infants were live-born without major obstetric complications. Caesarean sections (n=11, 28%) had obstetric indications, except one (HF). β Blocker therapy was associated with lower birth weight (3.1±0.48 kg vs 3.7±0.57 kg; p=0.002). During follow-up children remained healthy (median 3.4 years), and mothers were without cardiac mortality or transplant. Neither VA nor HF incidence was significantly increased during pregnancy. ARVD/C course (mean 6.5±5.6 years) did not differ based on pregnancy history. Conclusions While most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF.
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Affiliation(s)
- Anke R Hodes
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anneline S J M Te Riele
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Judith A Groeneweg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Abhishek C Sawant
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Maarten P van den Berg
- Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard N W Hauer
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - J Peter van Tintelen
- Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands Department of Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Shaaban OM, Abbas AM, Abdel Hafiz HA, Abdelrahman AS, Rashwan M, Othman ER. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study. Facts Views Vis Obgyn 2015; 7:213-221. [PMID: 27729966 PMCID: PMC5058410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pregnancy during lactation is common in Egypt and is often unplanned. Overlap between pregnancy and lactation could be associated with an increased risk for the pregnant mother, her fetus as well as her nursing child. AIM OF THE STUDY The current study aims to compare the maternal and perinatal outcome of pregnancies occurred during lactation with those occurred after weaning in women with substandard nutrition. MATERIALS AND METHODS A prospective-cohort study was carried out in six Maternal and Child Health Centers in Assiut-Egypt. Estimated sample size was 540 women divided equally into two groups; the first included women who got pregnant during breastfeeding (PDBF), while the second included women who got pregnant after weaning (PAW). Tools were consisted of structured interview questionnaire including personal history, obstetrical data, breastfeeding, family planning histories and dietary intake during pregnancy. Pregnant women had been followed up to delivery to assess different maternal and fetal outcomes. RESULTS Miscarriage rate was not statistically significant between both groups (2.2% in PDBF and 0.4% in PAW, p = 0.284). Women in PDBF group had higher prevalence of maternal anemia (54.1% versus 30.7%), intrauterine growth restriction (16.7% versus 4.8%), cesarean delivery (43.7% versus 31.5%), prolonged labor (13.3% versus 11.1%) and low birth weight infants (15.7% versus 8.8%) compared to women in PAW group. CONCLUSION Pregnancy during breastfeeding is associated with an increase in the overall complications of pregnancy as compared to PAW. Although it does not increase the miscarriage rate, it increases the prevalence of maternal anemia, delayed fetal growth, prolonged labor, cesarean section delivery and the prevalence of low birth weight infants.
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Affiliation(s)
- O M Shaaban
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt
| | - A M Abbas
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt
| | - H A Abdel Hafiz
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut Governorate, Egypt
| | - A S Abdelrahman
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut Governorate, Egypt
| | - M Rashwan
- Department of food science and technology, Faculty of Agriculture, Assiut University, Assiut Governorate, Egypt
| | - E R Othman
- Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut Governorate, Egypt
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Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF. Miscarriage and Stillbirth in Women with Rheumatoid Arthritis. J Rheumatol 2015; 42:1570-2. [DOI: 10.3899/jrheum.141553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 01/01/2023]
Abstract
Objective.To examine the risk of pregnancy loss in women with rheumatoid arthritis (RA).Methods.Cumulative numbers of early miscarriages (before gestational Week 12), late miscarriages (weeks 12–22), and stillbirths reported to the Medical Birth Registry of Norway in the period 1999–2009.Results.There were 1578 women with RA and 411,130 reference women included in the study. Relative risks of early and late miscarriage in women with RA versus references were 1.2 (95% CI 1.1–1.3) and 1.4 (95% CI 1.1–1.7), respectively. There was no difference in stillbirth.Conclusion.The risk of miscarriage was slightly higher among women with RA than in references.
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Gallot V, Nedellec S, Capmas P, Legendre G, Lejeune-Saada V, Subtil D, Nizard J, Levêque J, Deffieux X, Hervé B, Vialard F. Fausses couches précoces « à répétition » : bilan et prise en charge. ACTA ACUST UNITED AC 2014; 43:812-41. [DOI: 10.1016/j.jgyn.2014.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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