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Feldstein O, Dekalo A, Mor L, Levin M, Schreiber L, Paz YG, Israeli E, Barda G, Weiner E. Placental Histopathological Lesions and Adverse Neonatal Outcomes in Patients with Inflammatory Bowel Diseases- A retrospective Cohort Study. Reprod Sci 2024; 31:2836-2842. [PMID: 38664358 DOI: 10.1007/s43032-024-01571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
Inflammatory bowel diseases (IBD) are significantly associated with adverse pregnancy and neonatal outcomes, though the pathomechanism is yet unknown. To investigate the relationship between IBD and adverse pregnancy outcomes by comparing neonatal outcomes and placental histopathology in two matched groups of patients with and without IBD. In this retrospective study, data of all patients who gave birth between 2008-2021 and were diagnosed with IBD were reviewed and compared to a control group matching two control cases for every IBD case. Neonatal outcomes and placental pathology were compared between the groups. Compared to the control group (n=76), the placentas of patients with IBD (n=36) were characterized by significantly lower placental weight (p < 0.001), and higher rates of maternal vascular malperfusion lesions (MVM, p < 0.001) and maternal and fetal inflammatory response lesions (p < 0.001). Neonates of patients with IBD were more frequently small for gestational age (SGA) (p=0.01), with increased rates of need for phototherapy (p = 0.03), respiratory morbidity and NICU admission (p < 0.001 for both outcomes). Multivariate logistic regression analyses adjusting for possible confounders (including maternal age, gestational age, chronic hypertension, smoking, and thrombophilia) confirmed the independent association between IBD and composite MVM lesions (aOR 4.31, p < 0.001), maternal inflammatory responses (aOR 40.22, p < 0.001) and SGA infants (aOR 4.31, p = 0.013). IBD is associated with increased rates of placental histopathological lesions and adverse pregnancy outcomes, including SGA infants. These novel findings imply the role of placental malperfusion and inflammatory processes in pregnancy complications of IBD patients, which should be followed accordingly. Approval of local ethics committee # WOMC-0219-20.
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Affiliation(s)
- Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Ann Dekalo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Liat Mor
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.
| | - Meital Levin
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Ganor Paz
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Israeli
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, The Edith Wolfson Medical Center, Holon, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Getahun D, Sacks DA, Shi J, Xie F, Khadka N, Chiu VY, Mensah NA, Avila CC, Yeh M, Kawatkar AA, Ruma MS, Joyce D, Fassett MJ. Management, Utilization, and Outcomes of Preterm Labor in an Integrated Health Care System. Am J Perinatol 2024. [PMID: 38714204 DOI: 10.1055/s-0044-1786545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs. STUDY DESIGN We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009-December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and/or TVUS results and perinatal outcomes. RESULTS Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only. CONCLUSION This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS. KEY POINTS · Patients with positive fFN tests had higher odds of sPTB, RDS, and NICU admission.. · Inverse relationship between sPTB and CL among those with positive fFN tests was observed.. · Health care costs for mothers and neonates were lowest for those with fFN testing only..
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Affiliation(s)
- Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - David A Sacks
- Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jiaxiao Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Fagen Xie
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Nehaa Khadka
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Vicki Y Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Nana A Mensah
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Chantal C Avila
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Meiyu Yeh
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Aniket A Kawatkar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael S Ruma
- Perinatal Associates of New Mexico, Maternal-Fetal Medicine, Albuquerque, New Mexico
- Hologic Inc., Diagnostics, San Diego, California
| | - Derek Joyce
- Hologic Inc., Diagnostics, San Diego, California
| | - Michael J Fassett
- Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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3
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Costa RV, Simões C, Correia L, Pinto L. Inflammatory Bowel Disease and Pregnancy: Is It a Marker for Adverse Outcomes? REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:915-924. [PMID: 36446558 PMCID: PMC9708404 DOI: 10.1055/s-0042-1756149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess obstetric/puerperal/neonatal outcomes in an inflammatory bowel disease (IBD) population and to analyze disease characteristics that may be associated to adverse outcomes. METHODS Retrospective descriptive analysis including 47 pregnant women with IBD (28 with Crohn's disease - CD and 19 with ulcerative colitis - UC) who delivered between March 2012 and July 2018 in a tertiary hospital. We reviewed clinical records to extract demographic information, previous medical history, disease subtype, activity, severity, treatment, and obstetric, puerperal, and neonatal outcome measures. RESULTS Obstetric and neonatal complications (composite outcomes) occurred in 55.3% and 14.6% of the IBD population, respectively, and were more frequent in UC patients. Preterm birth (PTB), preeclampsia, anemia, low birth weight (LBW), and neonatal death were also more frequent in UC patients. The rate of postpartum hemorrhage (PPH) was 14.9%, and it was higher in CD patients. Women with active IBD had more obstetric/neonatal adverse outcomes (fetal growth restriction and LBW in particular) and cesarean sections. Patients with medicated IBD had less obstetric/neonatal complications (PTB and LBW in specific) and cesarean sections but more PPH. CONCLUSION Women with IBD may have an increased risk of obstetric/puerperal/neonatal adverse outcomes. Ulcerative colitis patients had more obstetric and neonatal complications, whereas PPH was more frequent if CD patients. Other disease characteristics were considered, which allowed a better understanding of their possible influence. Although more research is needed, this work reinforces the importance of adequate surveillance to allow prompt recognition and treatment of complications.
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Affiliation(s)
- Rita Vicente Costa
- Gynecology and Obstetris Service, Hospital Distrital de Santarém, Santarém, Portugal,Address for correspondence Rita Vicente Costa, MSc Av. Bernardo Santareno, Santarém 2005-177Portugal
| | - Carolina Simões
- Gastroenterology Service, Hospital de Santa Maria, Lisboa, Portugal
| | - Luís Correia
- Gastroenterology Service, Hospital de Santa Maria, Lisboa, Portugal
| | - Luísa Pinto
- Gynecology and Obstetrics Service, Hospital de Santa Maria, Lisboa, Portugal
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A national study of pregnancy-related maternal and fetal outcomes in women with inflammatory bowel disease. Int J Colorectal Dis 2022; 37:1535-1543. [PMID: 35612619 DOI: 10.1007/s00384-022-04185-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease (IBD) among women is highest during their reproductive years and current estimates suggest that the rate of conception is low in female IBD patients. The aim of our study was to assess the burden of adverse maternal and perinatal outcomes among female IBD patients. METHODS Using the national inpatient sample database from 2016 to 2018, we recruited all female patients above the age of 15 years admitted with a primary diagnosis of pregnancy and a secondary diagnosis of IBD. We adjusted our results for hospital and patient level variables including age, race, socioeconomic status, hypertension, diabetes mellitus, obesity, smoking, hyperlipidemia, alcohol use, and malnutrition. Multivariable regression analysis was used for analysis. RESULTS Pregnant women with IBD had greater odds of gestational diabetes (adjusted odds ratio [AOR] 1.55, 95% confidence interval [CI] 1.04-2.3, p 0.02), hypertensive complications (AOR 1.35, 95% CI 1.06-1.72, p 0.01), and pre-term delivery (AOR, 1.41 95% CI 1.13-1.76, p 0.003). Pregnancies with co-existent IBD were associated with fetal growth restriction (AOR 1.27, 95% CI 1-1.63, p 0.04) and fetal death (AOR 3.21, 95% CI 1.72-6.00, p < 0.01). Odds of experiencing postpartum hemorrhage or large for gestational age infant were comparable to general population. Crohn's disease was independently associated with increased odds of worse maternal and fetal outcome. IBD patients had increased mean length of stay by 0.14 days and increased mean hospital charges of $2741. CONCLUSIONS Women with IBD had greater likelihood of poor maternal and fetal outcomes and increased hospital resource utilization.
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Association of Preterm Birth with Inflammatory Bowel Disease and Salivary Gland Disease: Machine Learning Analysis Using National Health Insurance Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053056. [PMID: 35270746 PMCID: PMC8910052 DOI: 10.3390/ijerph19053056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
This study employs machine learning and population data for testing the associations of preterm birth with inflammatory bowel disease (IBD), salivary gland disease, socioeconomic status and medication history, including proton pump inhibitors. The source of population-based retrospective cohort data was the Korea National Health Insurance Service claims data for all women aged 25–40 years and who experience their first childbirths as singleton pregnancy during 2015 to 2017 (402,092 women). These participants were divided into the Ulcerative Colitis (UC) Group (1782 women), the Crohn Group (1954 women) and the Non-IBD Group (398,219 women). For each group, the dependent variable was preterm birth during 2015–2017, and 51 independent variables were included. Random forest variable importance was employed for investigating the main factors of preterm birth and testing its associations with salivary gland disease, socioeconomic status and medication history for each group. The proportion of preterm birth was higher for the UC Group and the Non-IBD Group than for the Crohn Group: 7.86%, 7.17% vs. 6.76%. Based on random forest variable importance, salivary gland disease was a top 10 determinant for the prediction of preterm birth for the UC Group, but this was not the case for the Crohn Group or the Non-IBD Group. The top 5 variables of preterm birth for the UC Group during 2015–2017 were socioeconomic status (8.58), age (8.00), proton pump inhibitors (2.35), progesterone (2.13) and salivary gland disease in 2014 (1.72). In conclusion, preterm birth has strong associations with ulcerative colitis, salivary gland disease, socioeconomic status and medication history including proton pump inhibitors.
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Rajagopal S, Gupta A, Parveen R, Shukla N, Bhattacharya S, Naravula J, Kumar S A, Mathur P, Simlot A, Mehta S, Bihari C, Mehta S, Mishra AK, Nair BG, Medicherla KM, Reddy GB, Sreenivasulu N, Kishor PK, Suravajhala P. Vitamin K in human health and metabolism: A nutri-genomics review. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hoffmann P, Krueger J, Bashlekova T, Rupp C, Baumann L, Gauss A. Pregnancy with inflammatory bowel disease: Outcomes for mothers and their children at a European tertiary care center. J Obstet Gynaecol Res 2021; 48:621-633. [PMID: 34935257 DOI: 10.1111/jog.15136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
AIM The study aimed at investigating pregnancy complications, birth outcomes, and postnatal child development in pregnancies of women with inflammatory bowel diseases (IBDs). METHODS This is an uncontrolled retrospective single-center study between 2014 and 2019. It is a mixed-method cross-sectional study using data from (1) electronic patient records and (2) questionnaires and copies of mothers' and children's health booklets. Disease activity and IBD medications were analyzed and related to pregnancy complications, birth outcomes, and postnatal child development using mixed models for statistical analyses. RESULTS Fifty live births from 46 patients were included. Disease activity anytime during pregnancy occurred in 56%. Biologics were applied in ca. 25% of pregnancies, mostly only through the second trimester. Pregnancies of mothers with active disease were slightly shorter than those of mothers with inactive disease (37.4 weeks vs. 38.9 weeks). Adverse pregnancy outcomes were reported in 28% of the live births, including small for gestational age in 6%, low birth weight in 18%, and preterm birth in 20%. Postnatal developmental abnormalities and health problems were reported in 26.8% of the children. Mixed model analyses failed to reveal significant associations between IBD activity and IBD medications during pregnancy and pregnancy complications, perinatal birth outcomes, and postnatal child development. CONCLUSION Despite a tendency of shorter pregnancies in patients with active IBD and lower birth weight and birth size in patients with IBD-related therapy during pregnancy, disease activity and medications did not significantly influence pregnancy, birth, and developmental outcomes.
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Affiliation(s)
- Peter Hoffmann
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Krueger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Teodora Bashlekova
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Rupp
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Baumann
- Department of Medical Biometry, University Hospital Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
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Kaler MK, Malina M, Kok K, Khan R. Inflammatory bowel disease in pregnancy: Developing a multidisciplinary care pathway in East London. Obstet Med 2021; 14:235-241. [PMID: 34880937 DOI: 10.1177/1753495x211009747] [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: 10/12/2020] [Revised: 02/28/2021] [Accepted: 03/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Evaluate the management of pregnant women with inflammatory bowel disease. Method We collected data from maternity records for women with IBD who gave birth at The Royal London Hospital between January 2018 and February 2019. Results Twenty-three pregnancies were identified where 8/23 (35%) women had a peri-conception flare and 7/23 (30%) had a flare during pregnancy. Two women received pre-conception counselling. The obstetric medicine team reviewed a patient on average three times and the gastroenterologists twice, during pregnancy. Nine women (39%) gave birth pre-term. Mean birthweight was lower in the group with active disease at conception compared with those in remission (2173 g vs. 2807 g, p = 0.03). Conclusions Women with IBD should all receive pre-conception counselling to reduce the risk of pregnancy complications. By developing a multidisciplinary care pathway for pregnant women with IBD (which includes a joint obstetric/gastroenterology clinic), this will ensure care is standardised throughout the pregnancy and puerperium.
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Freundlich A, Gozal E, Grisaru-Granovsky S, Grass A, Bar-Gil Shitrit A, Ioscovich A. Peripartum anesthetic management of patients with inflammatory bowel disease, a retrospective case-control study. Taiwan J Obstet Gynecol 2021; 60:70-77. [PMID: 33495012 DOI: 10.1016/j.tjog.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Inflammatory bowel diseases (IBD) are a group of pathologies associated with an increased rate of abortions, premature deliveries, cesarean sections and other morbidity during the peripartum period. The objective of this retrospective study was to investigate the anesthetic management for delivery of women with IBD. MATERIAL AND METHODS The records of patients with IBD, who delivered at our Center, were obtained for data which included anesthetic and obstetric management as well as neonatal outcome. Five subgroups were defined based on mode of delivery, presence or absence of epidural in normal vaginal delivery (NVD) and urgency of cesarean section, each of which was compared with control groups of healthy parturients in the same period. Additionally, the rate of cesarean sections and the use of epidural analgesia for NVD were compared with the general obstetric population of our center in the same period. RESULTS 107 patients with IBD who delivered at our center were studied. The rates of cesarean sections and emergency cesarean sections were significantly higher compared to the general population. However, the rate of instrumental delivery and of epidural analgesia use for NVD were similar. Among those who underwent cesarean sections, no significant differences were found in anesthesia type, surgery duration, number of complications, type of monitoring or postoperative management compared to the control group. CONCLUSION Peripartum anesthetic management of patients with IBD does not differ significantly from that of parturients without it. Anesthesiologists can plan their anesthesia in a similar way as they do in healthy parturients.
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Affiliation(s)
- Andres Freundlich
- Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Eytan Gozal
- Medical School, Hebrew University of Jerusalem, Israel
| | | | - Ariel Grass
- Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Israel
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Roy-McMahon C, Rekawek P, Anne Bigelow C, Raymond S, Overbey JR, Dubinsky MC, Teresa Mella M. Accuracy of third trimester ultrasound in predicting neonatal birthweight in patients with inflammatory bowel disease. Eur J Obstet Gynecol Reprod Biol 2021; 264:336-339. [PMID: 34375822 DOI: 10.1016/j.ejogrb.2021.07.054] [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: 04/13/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the accuracy of third trimester ultrasound in predicting birthweight in patients with inflammatory bowel disease (IBD) using the gestation-adjusted projection (GAP) method. STUDY DESIGN Retrospective cohort study including pregnant patients with IBD who had third trimester ultrasounds and delivered at a single institution from 2012 to 2017. Controls included pregnant patients without IBD seen during the study period with third trimester ultrasounds. Correlation plots of GAP birthweight and actual birthweight (AB) were created for IBD-positive cases, IBD-negative controls, and IBD-positive cases with and without prior abdominal surgery. GAP predicted birthweight error was calculated for cases and controls. Univariable linear regression models estimated the association between predicted birthweight and AB. Multivariable linear regression models estimated the association between GAP birthweight and AB adjusting for age, BMI, race, and IBD status. RESULTS 320 patients were included (172 cases and 148 controls). Cases were more likely to be older (p < 0.001), white (p < 0.001), and have a lower BMI (p = 0.001). Correlation plots of GAP birthweight and AB showed linear correlations in cases (Spearman ρ = 0.81), controls (ρ = 0.74), cases with (p = 0.78) and without prior surgery (ρ = 0.83). GAP birthweight was significantly associated with AB in controls and cases in univariable linear regression models (β = 0.85, standard error = 0.04, p < 0.001; β = 0.90, standard error = 0.06, p < 0.001, respectively). No significant difference was found between the parameter estimates of the two models (p = 0.47). GAP birthweight remained significantly associated with AB in a multivariable linear regression model (β = 0.86, standard error = 0.03, p < 0.001). There were no significant differences between GAP predicted birthweight error between controls and cases (APE 11% vs 10% respectively, p = 0.56) and between cases without and with prior surgery (APE 10% vs 11%, p = 0.7). CONCLUSION The accuracy of fetal biometry in the third trimester for predicting actual birthweight was equivalent between patients with and without IBD and those with prior abdominal surgery.
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Affiliation(s)
- Christine Roy-McMahon
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia Rekawek
- Department of Obstetrics and Gynecology, NYU Langone Health, NYU Langone Long Island Hospital, NYU Long Island School of Medicine, Mineola, NY, USA.
| | | | - Samantha Raymond
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica R Overbey
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla C Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Teresa Mella
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Garshol BF, Aamodt G, Madsen C, Vatn MH, Bengtson MB. The effect of nitrogen dioxide on low birth weight in women with inflammatory bowel disease: a Norwegian pregnancy cohort study (MoBa). Scand J Gastroenterol 2020; 55:272-278. [PMID: 32064969 DOI: 10.1080/00365521.2020.1726446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Adverse birth outcomes are more frequent among mothers with inflammatory bowel diseases (IBDs) than non-IBD mothers. In recent studies, air pollution, such as high concentrations of nitrogen dioxide (NO2), is reckoned as a risk factor for preterm birth in the general population. In this study, we investigated whether IBD mothers are at higher risk of preterm birth when exposed to NO2 compared to non-IBD mothers.Methods: We used information from the Norwegian Mother, Father and Child Cohort Study (MoBa). The pregnancy cohort was linked to the Norwegian Medical Birth Registry and air-pollution exposure data available from a subset of the study cohort. The relevant outcome in this study was preterm birth. A total of 16,170 non-IBD and 92 IBD mothers were included in the study.Results: The mean exposure of NO2 during the pregnancy was similar for IBD and non-IBD mothers, 13.7 (6.9) μg/m3 and 13.6 (4.2) μg/m3, respectively.IBD mothers with higher exposure of NO2 in the second and third trimester were at significant risk of preterm birth compared to non-IBD mothers [OR = 1.28 (CI 95%: 1.04-1.59) and OR = 1.23 (95% CI: 1.06-1.43), respectively]. The mean NO2 exposure was significantly higher in IBD mothers with preterm birth than in IBD mothers who delivered at term, at 19.58 (1.57) μg/m3 and 12.89 (6.37) μg/m3, respectively.Conclusions: NO2 exposure influenced the risk of preterm birth in IBD mothers. Higher risk of preterm birth in IBD was associated with higher exposure of NO2, suggesting vulnerability of preterm birth in IBD when exposed to NO2.
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Affiliation(s)
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Sciences, Ås, Norway
| | - Christian Madsen
- Department of Health & Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Morten Harald Vatn
- EpiGen Institute, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - May-Bente Bengtson
- EpiGen Institute, Akershus University Hospital, University of Oslo, Oslo, Norway.,Medical Department, Vestfold Hospital Trust, Tønsberg, Norway
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12
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Tsuda S, Sameshima A, Sekine M, Kawaguchi H, Fujita D, Makino S, Morinobu A, Murakawa Y, Matsui K, Sugiyama T, Watanabe M, Suzuki Y, Nagahori M, Murashima A, Atsumi T, Oku K, Mitsuda N, Takei S, Miyamae T, Takahashi N, Nakajima K, Saito S. Pre-conception status, obstetric outcome and use of medications during pregnancy of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) in Japan: Multi-center retrospective descriptive study. Mod Rheumatol 2019; 30:852-861. [DOI: 10.1080/14397595.2019.1661592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sayaka Tsuda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Azusa Sameshima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences University of Toyama, Toyama, Japan
| | - Haruna Kawaguchi
- Department of Maternal Fetal Medicine, Osaka Women’s and Children’s Hospita, Osaka, Japan
| | - Daisuke Fujita
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Akio Morinobu
- Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yohko Murakawa
- Department of Rheumatology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kiyoshi Matsui
- Department of Internal Medicine, Division of Rheumatology, Hyogo College of Medicine, Hyogo, Japan
| | - Takao Sugiyama
- Department of Rheumatology, National Hospital Organization Shimoshizu National Hospital, Yotuskaido City, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Sakura Medical Center, Toho University, Chiba, Japan
| | - Masakazu Nagahori
- Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women’s and Children’s Hospita, Osaka, Japan
| | - Syuji Takei
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatric and Neonatal Intensive Care, The University of Tokyo Hospital, Tokyo, Japan
| | - Ken Nakajima
- Department of Pharmacy, National hospital organization Sagamihara National Hospital, Kanagawa, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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Williams A, Grantz K, Seeni I, Robledo C, Li S, Ouidir M, Nobles C, Mendola P. Obstetric and neonatal complications among women with autoimmune disease. J Autoimmun 2019; 103:102287. [PMID: 31147159 PMCID: PMC6708459 DOI: 10.1016/j.jaut.2019.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of autoimmune diseases on pregnancy remains understudied on a population level. Examination of obstetric and neonatal outcomes among women with autoimmune disease and their infants can provide important insights for clinical management. METHODS Autoimmune diseases and outcomes were identified using medical records. Cesarean delivery, preterm birth, preeclampsia, small for gestational age (SGA), neonatal intensive care (NICU) admission, neonatal respiratory distress syndrome (RDS), and perinatal mortality risk was assessed. Poisson regression with robust standard errors estimated relative risks (RR) and 95% confidence intervals (95% CI) with adjustment for maternal characteristics and other chronic conditions. RESULTS Women with T1DM were at increased risk for nearly all outcomes including RDS (RR: 3.62; 95% CI: 2.84, 4.62), perinatal mortality (RR: 2.35; 95% CI: 1.12, 4.91), cesarean delivery (RR: 2.16; 95% CI: 2.02, 2.32) and preterm birth (RR: 3.52; 95% CI: 3.17, 3.91). Women with SLE also had higher risk for preterm delivery (RR: 2.90; 95% CI: 2.42, 3.48) and RDS (RR:2.99; 95% CI: 1.99, 4.51) as did women with Crohn's (cesarean delivery RR:1.31, 95% CI: 1.08, 1.60; preterm delivery RR: 1.84, 95% CI: 1.37, 2.49. RA increased risk for SGA (RR:1.66; 95% CI: 1.08, 2.55). CONCLUSION(S) Despite the heterogeneity in autoimmune diseases, we observed elevated preterm birth risk for most women with autoimmune disease. SLE and T1DM appeared to confer increased risk for a wide range of adverse outcomes.
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Affiliation(s)
- Andrew Williams
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Katherine Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Indulaxmi Seeni
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Candace Robledo
- Department of Population Health and Biostatistics, University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Shanshan Li
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, USA
| | - Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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14
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Robertson RC, Manges AR, Finlay BB, Prendergast AJ. The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol 2018; 27:131-147. [PMID: 30529020 DOI: 10.1016/j.tim.2018.09.008] [Citation(s) in RCA: 411] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/04/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
The assembly of microbial communities within the gastrointestinal tract during early life plays a critical role in immune, endocrine, metabolic, and other host developmental pathways. Environmental insults during this period, such as food insecurity and infections, can disrupt this optimal microbial succession, which may contribute to lifelong and intergenerational deficits in growth and development. Here, we review the human microbiome in the first 1000 days - referring to the period from conception to 2 years of age - and using a developmental model, we examine the role of early microbial succession in growth and development. We propose that an 'undernourished' microbiome is intergenerational, thereby perpetuating growth impairments into successive generations. We also identify and discuss the intertwining host-microbe-environment interactions occurring prenatally and during early infancy, which may impair the trajectories of healthy growth and development, and explore their potential as novel microbial targets for intervention.
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Affiliation(s)
- Ruairi C Robertson
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, UK.
| | - Amee R Manges
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - B Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J Prendergast
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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15
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Targeted drugs in spondyloarthritis during pregnancy and lactation. Pharmacol Res 2018; 136:21-28. [PMID: 30125669 DOI: 10.1016/j.phrs.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
Spondyloarthritis (SpA) are a heterogeneous group of chronic inflammatory joint diseases that includes several clinical subgroups. SpA can affect women in the reproductive stage so pregnancy can influence the course of the disease and SpA can affect the maternal-fetal outcome. The treatment of SpA has changed dramatically in recent years and the use of targeted drugs is part of therapeutic armamentarium. The use of targeted drugs during pregnancy is controversial because the information available on safety during this period is still limited. Several cytokines have an important role in the normal development of pregnancy or other cytokines may play a role in certain maternal-fetal complications. Potentially targeted drugs can affect the function of these cytokines during pregnancy. The aim of this study is to review the interrelationship between SpA during pregnancy and lactation, the role of some cytokines during normal pregnancy and the development of maternal-fetal complications as well as to review recent information on targeted drugs during pregnancy and breastfeeding in these patients in order to maximize their use in these critical periods of life.
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16
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Huusko JM, Karjalainen MK, Graham BE, Zhang G, Farrow EG, Miller NA, Jacobsson B, Eidem HR, Murray JC, Bedell B, Breheny P, Brown NW, Bødker FL, Litterman NK, Jiang PP, Russell L, Hinds DA, Hu Y, Rokas A, Teramo K, Christensen K, Williams SM, Rämet M, Kingsmore SF, Ryckman KK, Hallman M, Muglia LJ. Whole exome sequencing reveals HSPA1L as a genetic risk factor for spontaneous preterm birth. PLoS Genet 2018; 14:e1007394. [PMID: 30001343 PMCID: PMC6042692 DOI: 10.1371/journal.pgen.1007394] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Preterm birth is a leading cause of morbidity and mortality in infants. Genetic and environmental factors play a role in the susceptibility to preterm birth, but despite many investigations, the genetic basis for preterm birth remain largely unknown. Our objective was to identify rare, possibly damaging, nucleotide variants in mothers from families with recurrent spontaneous preterm births (SPTB). DNA samples from 17 Finnish mothers who delivered at least one infant preterm were subjected to whole exome sequencing. All mothers were of northern Finnish origin and were from seven multiplex families. Additional replication samples of European origin consisted of 93 Danish sister pairs (and two sister triads), all with a history of a preterm delivery. Rare exonic variants (frequency <1%) were analyzed to identify genes and pathways likely to affect SPTB susceptibility. We identified rare, possibly damaging, variants in genes that were common to multiple affected individuals. The glucocorticoid receptor signaling pathway was the most significant (p<1.7e-8) with genes containing these variants in a subgroup of ten Finnish mothers, each having had 2-4 SPTBs. This pathway was replicated among the Danish sister pairs. A gene in this pathway, heat shock protein family A (Hsp70) member 1 like (HSPA1L), contains two likely damaging missense alleles that were found in four different Finnish families. One of the variants (rs34620296) had a higher frequency in cases compared to controls (0.0025 vs. 0.0010, p = 0.002) in a large preterm birth genome-wide association study (GWAS) consisting of mothers of general European ancestry. Sister pairs in replication samples also shared rare, likely damaging HSPA1L variants. Furthermore, in silico analysis predicted an additional phosphorylation site generated by rs34620296 that could potentially affect chaperone activity or HSPA1L protein stability. Finally, in vitro functional experiment showed a link between HSPA1L activity and decidualization. In conclusion, rare, likely damaging, variants in HSPA1L were observed in multiple families with recurrent SPTB.
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Affiliation(s)
- Johanna M. Huusko
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, Ohio, United States of America
| | - Minna K. Karjalainen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Britney E. Graham
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Ge Zhang
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, Ohio, United States of America
| | - Emily G. Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - Neil A. Miller
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, United States of America
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Area of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Haley R. Eidem
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jeffrey C. Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Bruce Bedell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States of America
| | - Patrick Breheny
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, United States of America
| | - Noah W. Brown
- Department of Epidemiology, College of Public Health and Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Frans L. Bødker
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Pan-Pan Jiang
- 23andMe, Inc. Mountain View, California, United States of America
| | - Laura Russell
- 23andMe, Inc. Mountain View, California, United States of America
| | - David A. Hinds
- 23andMe, Inc. Mountain View, California, United States of America
| | - Youna Hu
- 23andMe, Inc. Mountain View, California, United States of America
| | | | - Antonis Rokas
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Kari Teramo
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaare Christensen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Scott M. Williams
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Mika Rämet
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Stephen F. Kingsmore
- Rady Children’s Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California, United States of America
| | - Kelli K. Ryckman
- Department of Epidemiology, College of Public Health and Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Louis J. Muglia
- Division of Human Genetics, Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, Ohio, United States of America
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17
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Fujioka K, Fukushima S, Nishida K, Iijima K, Morioka I. Intraventricular Hemorrhage Due to Coagulopathy After Vitamin K Administration in a Preterm Infant With Maternal Crohn Disease. JAPANESE CLINICAL MEDICINE 2017; 8:1179670717746333. [PMID: 29344001 PMCID: PMC5764135 DOI: 10.1177/1179670717746333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022]
Abstract
Intraventricular hemorrhage (IVH) is a devastating morbidity in preterm infants and can result in poor neurodevelopmental outcomes. Intraventricular hemorrhage usually occurs within 72 hours after birth; post-acute-phase IVH (>1 week after birth) is uncommon. Development of the hemostatic system in fetuses and neonates is an age-dependent evolving process, and the neonatal hemostatic system is characterized by low levels of vitamin K-dependent factors, with further reduction caused by prematurity. Importantly, a severe coagulation deficiency can be a major contributing factor of IVH. Active maternal Crohn disease (CD) during pregnancy causes malnutrition via enteral malabsorption; this may include vitamin K deficiency, resulting in fetal vitamin K deficiency. We herein describe a preterm infant who was born to a mother with CD and developed post-acute-phase IVH due to coagulopathy despite vitamin K administration.
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Affiliation(s)
- Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kosuke Nishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Modi BP, Teves ME, Pearson LN, Parikh HI, Haymond‐Thornburg H, Tucker JL, Chaemsaithong P, Gomez‐Lopez N, York TP, Romero R, Strauss JF. Mutations in fetal genes involved in innate immunity and host defense against microbes increase risk of preterm premature rupture of membranes (PPROM). Mol Genet Genomic Med 2017; 5:720-729. [PMID: 29178652 PMCID: PMC5702565 DOI: 10.1002/mgg3.330] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Twin studies have revealed a significant contribution of the fetal genome to risk of preterm birth. Preterm premature rupture of membranes (PPROM) is the leading identifiable cause of preterm delivery. Infection and inflammation of the fetal membranes is commonly found associated with PPROM. METHODS We carried out whole exome sequencing (WES) of genomic DNA from neonates born of African-American mothers whose pregnancies were complicated by PPROM (76) or were normal term pregnancies (N = 43) to identify mutations in 35 candidate genes involved in innate immunity and host defenses against microbes. Targeted genotyping of mutations in the candidates discovered by WES was conducted on an additional 188 PPROM cases and 175 controls. RESULTS We identified rare heterozygous nonsense and frameshift mutations in several of the candidate genes, including CARD6, CARD8, DEFB1, FUT2, MBL2, NLP10, NLRP12, and NOD2. We discovered that some mutations (CARD6, DEFB1, FUT2, MBL2, NLRP10, NOD2) were present only in PPROM cases. CONCLUSIONS We conclude that rare damaging mutations in innate immunity and host defense genes, the majority being heterozygous, are more frequent in neonates born of pregnancies complicated by PPROM. These findings suggest that the risk of preterm birth in African-Americans may be conferred by mutations in multiple genes encoding proteins involved in dampening the innate immune response or protecting the host against microbial infection and microbial products.
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Affiliation(s)
- Bhavi P. Modi
- Department of Human and Molecular GeneticsVirginia Commonwealth UniversityRichmondVirginia
| | - Maria E. Teves
- Department of Obstetrics and GynecologyVirginia Commonwealth UniversityRichmondVirginia
| | - Laurel N. Pearson
- Department of AnthropologyPennsylvania State UniversityUniversity ParkPennsylvania
| | - Hardik I. Parikh
- Department of Microbiology and ImmunologyVirginia Commonwealth UniversityRichmondVirginia
| | | | - John L. Tucker
- Department of Obstetrics and GynecologyVirginia Commonwealth UniversityRichmondVirginia
| | - Piya Chaemsaithong
- Perinatology Research BranchEunice Kennedy Shriver National Institute for Child Health and Human DevelopmentNIHDetroitMichigan
| | - Nardhy Gomez‐Lopez
- Perinatology Research BranchEunice Kennedy Shriver National Institute for Child Health and Human DevelopmentNIHDetroitMichigan
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichigan
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMichigan
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMichigan
| | - Timothy P. York
- Department of Human and Molecular GeneticsVirginia Commonwealth UniversityRichmondVirginia
- Department of Obstetrics and GynecologyVirginia Commonwealth UniversityRichmondVirginia
| | - Roberto Romero
- Perinatology Research BranchEunice Kennedy Shriver National Institute for Child Health and Human DevelopmentNIHDetroitMichigan
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMichigan
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMichigan
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMichigan
| | - Jerome F. Strauss
- Department of Human and Molecular GeneticsVirginia Commonwealth UniversityRichmondVirginia
- Department of Obstetrics and GynecologyVirginia Commonwealth UniversityRichmondVirginia
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Abstract
Many factors influence the sexual health of people with Crohn's disease, but active disease and depression play key roles. The fertility rate in nonoperated patients with inflammatory bowel disease with quiescent disease is similar to that in the general population. Crohn's disease can increase the risk for adverse pregnancy outcomes, but being in remission on a stable, steroid-free medication regimen for at least 3 months before conception and adhering to the treatment throughout pregnancy can improve outcomes. Infants with intrauterine exposure to anti-tumor necrosis factor medications should avoid live vaccines for the first 9 months or until drug concentrations are undetectable.
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Affiliation(s)
- Jill K J Gaidos
- GI/Hepatology Service, McGuire VA Medical Center, Virginia Commonwealth University, 111-N, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA
| | - Sunanda V Kane
- Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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20
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Abstract
OPINION STATEMENT Inflammatory bowel disease is frequently diagnosed before or during key childbearing years. One of the most important factors for a healthy pregnancy is having quiescent disease prior to conception and maintaining disease remission for the duration of the pregnancy. In order to achieve that, most women will need to continue their inflammatory bowel disease (IBD) treatment during pregnancy. One of the main concerns these women have is whether these medications will have adverse effects on their growing fetus. Aminosalicylates, antibiotics, and steroids are all relatively low risk for use during pregnancy and breastfeeding. Recent studies also support the safety of continuing immunomodulators and anti-tumor necrosis factor agents during pregnancy and with breastfeeding. There seems to be an increased risk for infection, however, with use of combination therapy including both a biologic agent and an immunomodulator. Less evidence is available on the use of anti-integrins in pregnancy; however, the current data suggest they may be safe as well. Conversations about a patient's desire for pregnancy should occur between the patient and provider on a regular basis prior to conception and particularly with any change in disease activity or change in the treatment regimen. This chapter will review the current evidence on the safety of IBD medications during pregnancy and lactation so that providers can more easily discuss the importance of medication adherence for disease remission with their patients who are contemplating conception.
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21
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Enfermedad de Crohn: hemorragia fatal en paciente con 19.3 semanas de gestación. Reporte de un caso y revisión de la literatura mundial. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Andersen ABT, Ehrenstein V, Erichsen R, Frøslev T, Sørensen HT. Maternal inflammatory bowel disease and hypospadias in male offspring: a population-based study in Denmark. BMJ Open Gastroenterol 2016; 3:e000121. [PMID: 27933203 PMCID: PMC5128952 DOI: 10.1136/bmjgast-2016-000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/10/2016] [Accepted: 10/21/2016] [Indexed: 01/01/2023] Open
Abstract
Background The occurrence of inflammatory bowel disease (IBD) and hypospadias has been concurrently increasing, possibly through shared environmental risk factors such as endocrine disrupting compounds. Also, maternal IBD may disturb the normal development of the fetal reproductive tract. However, whether maternal IBD increases the risk of hypospadias in male offspring is unknown. We compared hypospadias risk in sons of mothers with and without IBD. Methods We used Danish nationwide population-based registries to conduct a longitudinal prevalence study including all live-born boys from 1979 through 2009. We computed HRs, as estimates of prevalence ratios (PRs), with 95% CIs for hypospadias, using Cox proportional hazards regression, while adjusting for measured confounding. Results Among 966 038 live-born boys, 4688 (0.5%) had a mother with a history of IBD diagnosis before the relevant childbirth. Among the boys with maternal IBD, 36 (0.8%) were diagnosed with hypospadias any time after birth, whereas 6112 (0.6%) sons of mothers without IBD diagnosis had hypospadias (adjusted PR: 1.20, (95% CI 0.86 to 1.67). Adjusted PRs for maternal Crohn's disease and ulcerative colitis were 1.38 (95% CI 0.83 to 2.29) and 1.10 (95% CI 0.71 to 1.68), respectively. Analyses defining hypospadias diagnosis recorded <6 months postpartum showed similar results. Conclusions We found no convincing evidence of an association between maternal IBD and hypospadias.
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Affiliation(s)
| | - Vera Ehrenstein
- Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus N , Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus N , Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus N , Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus N , Denmark
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23
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A free terminal ileal perforation from active crohn disease in pregnancy: a diagnostic challenge. Int Surg 2016; 100:450-4. [PMID: 25785326 DOI: 10.9738/intsurg-d-14-00070.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The surgical management of the complications of Crohn disease is often challenging. These difficulties are compounded in pregnancy by competing interests of the mother and the baby. In this report, we describe the presentation and surgical management of a patient in her second trimester with active Crohn disease who required emergent surgical intervention. She had presented with the uncommon complication of a free perforation in the presence of active untreated disease.
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The Effects of Active IBD During Pregnancy in the Era of Novel IBD Therapies. Am J Gastroenterol 2016; 111:1305-12. [PMID: 27349339 DOI: 10.1038/ajg.2016.254] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 04/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Previous data on inflammatory bowel disease (IBD) relapse during pregnancy mainly originate from retrospective studies. The aim of this study was therefore (i) to evaluate the effect of active disease at conception and IBD disease type on disease relapse during pregnancy and (ii) to study the effects of disease relapse during pregnancy on birth outcomes in a prospective cohort with adequate representation of current treatments. METHODS From 2008 to 2014, IBD women were recruited from an ongoing prospective clinical cohort. All patients with confirmed IBD diagnosis with a pregnancy wish or pregnancy were prospectively followed-up until pregnancy and delivery. Disease relapse was measured at each visit. Birth outcomes were recorded from the obstetrician. RESULTS A total of 298 pregnancies were observed in 229 IBD patients (157 Crohn's disease (CD), 66 ulcerative colitis (UC), and 6 IBD unclassified), resulting in 226 live births. Active disease at conception was strongly associated with disease relapse during pregnancy (aOR=7.66, 95% confidence interval (CI): 3.77-15.54). UC patients experienced relapse during pregnancy more often than CD patients, independent of maternal age, smoking, periconceptional disease activity, previous IBD surgery, and the use of immunosuppressives or anti-tumor necrosis factor (TNF) (aOR=3.71, 95% CI:1.86-7.40). Disease relapse was not associated with adverse birth outcomes such as spontaneous abortion, low-birth weight, or preterm birth. CONCLUSIONS This study confirms that active disease around conception increases the risk of disease relapse during pregnancy. In addition, UC patients relapse more often during pregnancy than CD patients. Birth outcomes were excellent, reflecting the stringent follow-up and treatment of this group of patients.
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Gaidos JKJ, Kane SV. Overcoming challenges of treating inflammatory bowel disease in pregnancy. Expert Rev Clin Immunol 2016; 12:871-8. [PMID: 26981845 DOI: 10.1586/1744666x.2016.1166958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inflammatory bowel disease (IBD) is frequently diagnosed before or during the peak reproductive years. Overall management of inflammatory bowel disease is becoming more complex given the nuances involved with multiple mechanisms of action of the current treatment and need for therapeutic monitoring for safety and efficacy; another layer of complexity is added in the setting of a pregnancy. In this review, we have identified several key challenges that health care providers face when caring for patients with IBD during pregnancy. The goal of this review is to provide the most up-to-date evidence and provide our expert recommendations so that providers can more comfortably address patients' questions about pregnancy in IBD and the associated risks as well as optimize their care to ensure the best outcomes possible.
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Affiliation(s)
- Jill K J Gaidos
- a McGuire VA Medical Center , Virginia Commonwealth University , Richmond , VA , USA
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Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, Leontiadis GI, Tse F, Mahadevan U, van der Woude CJ. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology 2016; 150:734-757.e1. [PMID: 26688268 DOI: 10.1053/j.gastro.2015.12.003] [Citation(s) in RCA: 317] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. METHODS A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS Consensus was reached on 29 of the 30 recommendations considered. Preconception counseling and access to specialist care are paramount in optimizing disease management. In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Discontinuation of anti-TNF therapy or switching from combination therapy to monotherapy may be considered in very select low-risk patients. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. Endoscopy or urgent surgery should not be delayed during pregnancy if indicated. Decisions regarding cesarean delivery should be based on obstetric considerations and not the diagnosis of IBD alone, with the exception of women with active perianal Crohn's disease. With the exception of methotrexate, the use of medications for IBD should not influence the decision to breast-feed and vice versa. Live vaccinations are not recommended within the first 6 months of life in the offspring of women who were on anti-TNF therapy during pregnancy. CONCLUSIONS Optimal management of IBD before and during pregnancy is essential to achieving favorable maternal and neonatal outcomes.
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Affiliation(s)
- Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Cynthia H Seow
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Huang
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Yvette Leung
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Frances Tse
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Uma Mahadevan
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Shand AW, Chen JS, Selby W, Solomon M, Roberts CL. Inflammatory bowel disease in pregnancy: a population-based study of prevalence and pregnancy outcomes. BJOG 2016; 123:1862-70. [DOI: 10.1111/1471-0528.13946] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 02/06/2023]
Affiliation(s)
- AW Shand
- Clinical and Population Perinatal Health Research; Kolling Institute; University of Sydney; Sydney NSW Australia
- Department of Maternal Fetal Medicine; Royal Hospital for Women; Randwick NSW Australia
| | - JS Chen
- Clinical and Population Perinatal Health Research; Kolling Institute; University of Sydney; Sydney NSW Australia
| | - W Selby
- AW Morrow Gastroenterology and Liver Centre; Royal Prince Alfred Hospital; Camperdown NSW Australia
- Faculty of Medicine; Central Clinical School; University of Sydney; Sydney NSW Australia
| | - M Solomon
- SOuRCe (Surgical Outcomes Research Centre); The Institute of Academic Surgery; Royal Prince Alfred Hospital; University of Sydney; Camperdown Sydney NSW Australia
| | - CL Roberts
- Clinical and Population Perinatal Health Research; Kolling Institute; University of Sydney; Sydney NSW Australia
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Abstract
Immunomodulators and biologic medications, alone or in combination, form the core therapeutic strategy for managing moderate-to-severe inflammatory bowel disease (IBD). IBD incidence peaks during the prime reproductive years, raising concerns about the impact of disease and its treatment on fertility, maternal and fetal health during pregnancy, breastfeeding safety, and childhood development. Although IBD increases risk of pregnancy complications independent of disease activity, adverse pregnancy outcomes are more common when disease is active. To mitigate fetal risk, women should conceive while disease is quiescent. Aside from methotrexate, immunomodulators and biologics may be used during pregnancy to achieve and maintain disease control. Based on available safety data, there is no increased risk of congenital anomalies among infants exposed to these medications. Active thiopurine metabolites and most monoclonal antibodies cross the placenta and are detectable in neonates. They are detectable in breast milk in minute levels as well. The impact of this exposure on neonatal outcomes is discussed. Adjusted dosing schedules during gestation may reduce fetal drug exposure, though the maternal risks of such manipulation require careful consideration. Ongoing prospective studies will further inform risk assessment, including for newer medications such as the anti-integrin agents.
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Jakobsson GL, Stephansson O, Askling J, Jacobsson LTH. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study. Ann Rheum Dis 2015; 75:1838-42. [PMID: 26698845 DOI: 10.1136/annrheumdis-2015-207992] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 11/24/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Unlike other chronic inflammatory diseases, little is known about how ankylosing spondylitis (AS) affects outcomes of pregnancy and birth characteristics. METHODS In a nationwide population-based case-control study, 388 deliveries among women with AS (identified in the Swedish National Patient Register and Medical Birth Register) and deliveries among matched controls (n=1082) from the general population were included. Information regarding pregnancies after AS diagnosis, birth outcomes and possible confounders were retrieved from the national Swedish registers. ORs with 95% CIs were calculated with generalised estimating equations. RESULTS Emergency and elective Caesarean section (CS) were performed in 16.5% and 9.8% of deliveries among women with AS compared with 6.5% and 6.9%, respectively, in population controls, resulting in OR of 3.00 (95% CI 2.01 to 4.46) and 1.66 (95% CI 1.09 to 2.54), respectively. Offspring of women with AS were more often preterm (9.0% vs 4.9%) and small-for-gestational-age (SGA) (3.1% vs 1.5%), resulting in an OR of 1.92 (95% CI 1.17 to 3.15) and 2.12 (95% CI 1.00 to 4.50), respectively. Adjustment for smoking habits, age, educational level, parity and exclusion of women with comorbidities resulted in similar or only slightly lower point estimates of risk. Cases with a more extensive antirheumatic therapy exposures tended to have a higher risk for elective CS and being SGA. CONCLUSIONS Women with AS had a higher prevalence for several adverse birth outcomes, with results suggesting an influence by both disease severity and comorbidities.
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Affiliation(s)
- Gustav L Jakobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Olof Stephansson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Khan N, Asim H, Lichtenstein GR. Safety of anti-TNF therapy in inflammatory bowel disease during pregnancy. Expert Opin Drug Saf 2015; 13:1699-708. [PMID: 25406728 DOI: 10.1517/14740338.2014.973399] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The highest incidence of inflammatory bowel disease (IBD) is seen between the second and fourth decades of life, which is the most fertile age for women. Increased disease activity has been shown to effect female fertility and pregnancy outcomes, stressing the need for drugs that can safely induce and maintain clinical remission without harming either the mother or fetus. AREAS COVERED Anti-TNF-α agents have been shown to be effective in both inducing and maintaining remission among IBD patients. This review highlights the results of previous studies conducted on pregnant women who were exposed to anti-TNF-α agents during the course of their pregnancy. The drugs reviewed include infliximab (IFX), adalimumab (ADA), certolizumab pegol (CZP) and golimumab (GMB). Of > 200 articles reviewed, 105 were included in the manuscript based on relevance. The keywords used were anti-TNF, infliximab, adalimumab, certolizumab, golimumab, biologics, pregnancy and inflammatory bowel disease. EXPERT OPINION Anti-TNF agents have been studied extensively during pregnancy from the early case reports to the more recent prospective Pregnancy in IBD and Neonatal Outcomes study. A comprehensive review of the literature has shown that biologics can be safely used during pregnancy. In view of this safety data, it is recommended to maintain therapy during pregnancy.
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Affiliation(s)
- Nabeel Khan
- University of Pennsylvania Perelman School of Medicine, Department of Gastroenterology , Philadelphia, PA , USA
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Gawron LM, Goldberger AR, Gawron AJ, Hammond C, Keefer L. Disease-related pregnancy concerns and reproductive planning in women with inflammatory bowel diseases. ACTA ACUST UNITED AC 2015; 41:272-7. [PMID: 25902816 DOI: 10.1136/jfprhc-2014-101000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 03/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women with inflammatory bowel diseases (IBD) endorse disease-related pregnancy concerns that influence parity. Improvements in IBD management have potentially altered reproductive planning. Additionally, the proportion of American women who choose not to have children is increasing. AIM To explore the effect of disease-related pregnancy concerns on parity and reproductive planning in a subset of women with IBD. DESIGN AND SETTING Cross-sectional qualitative phone survey in an academic gastroenterology practice. METHODS Questions included demographics, medical and reproductive history, future pregnancy plans, and if IBD affected pregnancy decision-making. Qualitative data were coded and frequencies and proportions calculated. RESULTS The 129 female participants (31% response rate) were predominately white (85%), had at least some college education (97%) and a mean age of 34.3 years [standard deviation 6.2]. Some 60% had Crohn's disease and 30% had undergone IBD-related surgery. Half were nulliparae, 53% reported IBD-related pregnancy concerns and 57% desired future pregnancy. Women who desired a future pregnancy and had IBD-related concerns had higher parity than those without concerns (p=0.02). Women desiring a future pregnancy and those with Crohn's disease had increased IBD-related concerns. Only four (3.1%) women identified IBD-related concerns that led to a smaller family size than desired. CONCLUSIONS IBD-related concerns appear to be less likely to affect a woman's planned family size than previously reported. Concern about adverse pregnancy outcomes is more common in women with Crohn's disease and those desiring future pregnancy, suggesting a need for targeted counselling to moderate risk perception.
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Affiliation(s)
- Lori M Gawron
- Assistant Professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Adina R Goldberger
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew J Gawron
- Assistant Professor, Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
| | - Cassing Hammond
- Associate Professor, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie Keefer
- Associate Professor, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Growth modeling of the maternal cytokine milieu throughout normal pregnancy: macrophage-derived chemokine decreases as inflammation/counterregulation increases. J Immunol Res 2015; 2015:952571. [PMID: 25866828 PMCID: PMC4381731 DOI: 10.1155/2015/952571] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/24/2015] [Indexed: 02/02/2023] Open
Abstract
Several recent studies have shown differences in the maternal immune milieu at different phases of pregnancy, but most studies have been cross-sectional or of relatively few time points. Levels of 42 cytokines were determined using a multiplex bead-based assay on archived serum from a cohort of pregnant women (N = 16) at median of 18 time points tested, from the first trimester through to parturition, per woman. Unconditional growth modeling was then used to determine time-dependent changes in levels of these cytokines. Macrophage-derived chemokine (MDC, aka CCL22) decreases as pregnancy progresses. IL-1β, IL-6, IL-8, IL-12p70, IL-13, IL-15, IP-10, and FLT3-ligand increase as a function of gestational weeks, and IFNα2, IL-1ra, IL-3, IL-9, IL-12p40, and soluble CD40 ligand increase as a function of trimester. As pregnancy normally progresses, a maternal shift away from a type 2-biased immune response and toward an inflammatory/counterregulatory response is observed.
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Khan N, Asim H, Lichtenstein GR. Safety of anti-TNF therapy in inflammatory bowel disease during pregnancy. Expert Opin Drug Saf 2014. [DOI: 10.1517/14740338.2015.973399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Stone RH, Hong J, Jeong H. Pharmacokinetics of monoclonal antibodies used for inflammatory bowel diseases in pregnant women. ACTA ACUST UNITED AC 2014; 4. [PMID: 26539323 DOI: 10.4172/2161-0495.1000209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Inflammatory bowel disease (IBD) is a condition of chronic immune response and inflammation of the gastrointestinal tract. Most women with IBD are affected during their reproductive years, and untreated IBD can have detrimental maternal and fetal outcomes. In recent years, many biological therapies including anti-TNF agents (infliximab, adalimumab, and certolizumab) have been developed for the treatment of IBD. An increasing number of IBD patients are treated with these agents during pregnancy. Sporadic reports suggest an absence of negative pregnancy outcomes related to use of anti-TNF agents in women with IBD. However, it is unclear if the physiological changes occurring in pregnancy alter mAb dose requirements for optimal maternal disease management and minimal fetal exposure to therapeutic antibodies. Based on current understanding of the pharmacokinetic profiles for anti-TNF agents in nonpregnant subjects, it appears very likely that physiological changes accompanying pregnancy can alter pharmacokinetics of anti-TNF agents. This review focuses on how such physiological changes may impact disposition of anti-TNF agents during pregnancy. Further improvement in pregnancy outcomes may be achieved in women with IBD by better understanding of pregnancy-mediated changes in the pharmacokinetics of anti-TNF agents.
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Affiliation(s)
- Rebecca H Stone
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - James Hong
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Hyunyoung Jeong
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA ; Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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