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Muacevic A, Adler JR, Mujalda A, Mujalda J, Yadav S, Kundal RK. The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre. Cureus 2023; 15:e34318. [PMID: 36865957 PMCID: PMC9971241 DOI: 10.7759/cureus.34318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. OBJECTIVES The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. MATERIAL AND METHODS The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. RESULTS Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications were sickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. CONCLUSION In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCD vigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.
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Patel J, Reyes JA, Berezowski I, Tran QK, Frasure SE, Pourmand A. Hypertensive emergency versus preeclampsia in a patient with sickle cell disease: a case report. World J Emerg Med 2023; 14:329-331. [PMID: 37425075 PMCID: PMC10323508 DOI: 10.5847/wjem.j.1920-8642.2023.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Jigar Patel
- Division of Hospital Medicine, Department of Medicine, the George Washington University, Washington DC 20037, USA
| | - Juan A Reyes
- Division of Hospital Medicine, Department of Medicine, the George Washington University, Washington DC 20037, USA
| | - Ivan Berezowski
- Division of Hospital Medicine, Department of Medicine, the George Washington University, Washington DC 20037, USA
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore 21201-1544, USA
- Program in Trauma, the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore 21201, USA
| | - Sarah E Frasure
- Department of Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
| | - Ali Pourmand
- Department of Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA
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Brown HK, McKnight A, Aker A. Association between pre-pregnancy multimorbidity and adverse maternal outcomes: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221096584. [PMID: 35586034 PMCID: PMC9106308 DOI: 10.1177/26335565221096584] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective We reviewed the literature on the association between pre-pregnancy multimorbidity (co-occurrence of two or more chronic conditions) and adverse maternal outcomes in pregnancy and postpartum. Data sources Medline, EMBASE, and CINAHL were searched from inception to September, 2021. Study selection Observational studies were eligible if they reported on the association between ≥ 2 co-occurring chronic conditions diagnosed before conception and any adverse maternal outcome in pregnancy or within 365 days of childbirth, had a comparison group, were peer-reviewed, and were written in English. Data extraction and synthesis Two reviewers used standardized instruments to extract data and rate study quality and the certainty of evidence. A narrative synthesis was performed. Results Of 6,381 studies retrieved, seven met our criteria. There were two prospective cohort studies, two retrospective cohort studies, and 3 cross-sectional studies, conducted in the United States (n=6) and Canada (n=1), and ranging in size from n=3,110 to n=57,326,681. Studies showed a dose-response relation between the number of co-occurring chronic conditions and risk of adverse maternal outcomes, including severe maternal morbidity or mortality, hypertensive disorders of pregnancy, and acute health care use in the perinatal period. Study quality was rated as strong (n=1), moderate (n=4), or weak (n=2), and the certainty of evidence was very low to moderate. Conclusion Given the increasing prevalence of chronic disease risk factors such as advanced maternal age and obesity, more research is needed to understand the impact of pre-pregnancy multimorbidity on maternal health so that appropriate preconception and perinatal supports can be developed.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Anthony McKnight
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amira Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Li F, Qin J, Zhang S, Chen L. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis. Pregnancy Hypertens 2021; 24:13-21. [PMID: 33626437 DOI: 10.1016/j.preghy.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.
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Affiliation(s)
- Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China.
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Moodley M, Moodley J, Naicker T. Neutrophil extracellular traps: The synergy source in the placentae of HIV infected women with pre-eclampsia. Pregnancy Hypertens 2020; 20:69-74. [PMID: 32193148 DOI: 10.1016/j.preghy.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To immuno-localize histone H2A expression as a marker of neutrophil extracellular traps (NETs) in the placenta; and to quantify and compare the percentage H2A immune-expression as a marker of NETs in the placental intervillous space according to: pregnancy type, HIV status and across the study population. STUDY DESIGN The participants to the study were a pregnant South African population group of African ancestry (n = 60) stratified as normotensive (N) (n = 30) or pre-eclamptic (PE) (n = 30) and further subdivided as HIV infected (HIV+) (n = 15) or HIV naïve (HIV-) (n = 15). Following informed consent placental tissue samples were obtained at the time of delivery. Immunohistochemistry using the anti-histone 2A (H2A) antibody as a biomarker of NETs, and morphometric image analysis was used to immuno-localize and quantify placental H2A immuno-expression respectively in the placental inter-villous space. Statistical analysis was performed using Graph Pad Prism software (Version 5). MAIN OUTCOME MEASURES To determine if HIV neutralizes the elevated NETs in PE. RESULTS NETs were localized within the inter-villous space surrounding the exchange villi and conducting villi of placental tissue. Based on HIV status, a significant elevation in H2A immuno-expression was observed in the HIV+ compared to the HIV- group (p = 0.0008) and in the pre-eclampsia HIV- compared to the normotensive HIV- group (p = 0.0008). However, a significant decline in H2A immuno-expression was observed in the PEHIV+ group compared to the NHIV+ group (p = 0.0072). CONCLUSIONS Both PE and HIV elevate placental NETs; however, they synergistically downregulate NETs expression. Further investigations are required to interrogate the signaling pathways involved to establish potential NET-targeted therapeutic actions.
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Affiliation(s)
- Merantha Moodley
- Discipline of Optics and Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, University of KwaZulu-Natal, South Africa
| | - Thajasvarie Naicker
- Discipline of Optics and Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Smith-Whitley K. Complications in pregnant women with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:359-366. [PMID: 31808864 PMCID: PMC6913482 DOI: 10.1182/hematology.2019000039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Pregnancy in women with sickle cell disease (SCD) is associated with increased maternal and fetal morbidity and mortality. Outcomes vary widely owing to methodological limitations of clinical studies, but overall, hypertensive disorders of pregnancy, venothromboembolism, poor fetal growth, and maternal and perinatal mortality are increased globally. Few therapeutic interventions have been explored other than prophylactic and selective transfusion therapy. Unfortunately, existing data are limited, and it remains unclear whether prophylactic use of chronic transfusions will improve pregnancy outcomes. Management of pregnant women with SCD is best accomplished with a multidisciplinary team that includes a sickle cell expert and an obstetrician familiar with high-risk pregnancies. Women with SCD should have individualized care plans that outline management of acute pain and guidelines for transfusion therapy. Neonates require close monitoring for neonatal abstinence syndrome and hemolytic disease of the newborn. Ideally all young women with SCD will have a "reproductive life plan" developed as a component of preconception counseling and health promotion. Research leading to improved pregnancy management focused on diminishing adverse maternal and neonatal outcomes is overdue. International collaborations should be considered to improve subject recruitment and foster timely completion of clinical trials. Additional therapeutic interventions outside of transfusion therapy should be explored.
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Affiliation(s)
- Kim Smith-Whitley
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Nourollahpour Shiadeh M, Riahi SM, Khani S, Alizadeh S, Hosseinzadeh R, Hasanpour AH, Shahbazi M, Ebrahimpour S, Javanian M, Fakhri Y, Vasigala V, Rostami A. Human Immunodeficiency Virus and risk of pre-eclampsia and eclampsia in pregnant women: A meta-analysis on cohort studies. Pregnancy Hypertens 2019; 17:269-275. [PMID: 31487651 DOI: 10.1016/j.preghy.2019.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022]
Abstract
Maternal HIV infection is related to several perinatal adverse outcomes. This study is aimed at establishing whether maternal HIV infection is associated with the development of pre-eclampsia (PE) and eclampsia. We comprehensively searched MEDLINE/PubMed, Web of Science, SCOPUS and Embase databases for relevant studies published up to 20 November 2018, without time and language restrictions. We have limited our literature searches to observational studies in humans. We applied a random-effects model to calculate the relative risks (RR) and 95% confidence intervals (CI) for the meta-analyses. We also systematically reviewed eligible studies to determine the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors, which are effective in increased risk of PE or eclampsia. We identified a total of 11,186 publications, out of which 22 eligible studies (11 prospective and 11 retrospective cohort studies) comprising 90,514 HIV-positive and 66,085,278 HIV-negative pregnant women were included in meta-analysis. Results of the meta-analyses suggested that maternal HIV infection is not significantly associated with the development of PE (RR, 1.04; 95%CI, 0.89-1.21) and eclampsia (RR, 1.05; 95%CI, 0.63-1.75). Six studies were included to understand the effects of HIV infection on imbalance of angiogenic and anti-angiogenic factors. All six studies demonstrated that HIV infection had no significant effect on expression levels of these factors in pre-eclamptic and normotensive pregnant women. Our study showed that maternal HIV infection was not significantly associated with increased or reduced risks of pre-eclampsia and eclampsia. More well-designed studies with large sample size and well defined outcomes are recommended to confirm or refute the present findings.
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Affiliation(s)
| | - Seyed Mohammad Riahi
- Cardiovascular Diseases Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran.
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Solmaz Alizadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Amir Hossein Hasanpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Shahbazi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadollah Fakhri
- Department of Environmental Health Engineering, Student Research Committee, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran; Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Baptista LC, Figueira CO, Souza BB, Fertrin KY, Antolini A, Costa FF, de Melo MB, Costa ML. Different morphological and gene expression profile in placentas of the same sickle cell anemia patient in pregnancies of opposite outcomes. Exp Biol Med (Maywood) 2019; 244:395-403. [PMID: 30818999 DOI: 10.1177/1535370219834305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPACT STATEMENT Environmentally induced changes in placental morphological and molecular phenotypes may provide relevant insight towards pathophysiology of diseases. The rare opportunity to evaluate the same patient, with sickle cell anemia (SCA), in two different pregnancies, of opposite outcomes (one early onset severe preeclampsia (PE) and the other mostly non-complicated) can prove such concept. In addition, the comparison to other conditions of known placental and vascular/inflammatory involvement strengthens such findings. Our results suggest that the clinical association between SCA and PE can be supported by common pathophysiological mechanisms, but that pathways involving response to copper and triglyceride metabolism may be important drivers of the pathophysiology of PE. Future studies using in a larger number of samples should confirm these findings and explore pathways involved in the pathophysiology of PE and its relationship with SCA.
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Affiliation(s)
- Letícia C Baptista
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Camilla O Figueira
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
| | - Bruno B Souza
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil
| | - Kleber Y Fertrin
- 3 Division of Hematology, University of Washington, Seattle, WA 98195-7230, USA
| | - Arthur Antolini
- 4 Department of Pathology, University of Campinas - UNICAMP, Campinas, SP 13083-887, Brazil
| | - Fernando F Costa
- 5 Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, SP 13083-878
| | - Mônica B de Melo
- 1 Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas - UNICAMP, Campinas, SP 13083-875, Brazil.,*Shared first and last authorship
| | - Maria Laura Costa
- 2 Department of Obstetrics and Gynecology, University of Campinas - UNICAMP, Campinas, SP 13083-880, Brazil.,*Shared first and last authorship
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