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Georgescu T. The role of maternal hormones in regulating autonomic functions during pregnancy. J Neuroendocrinol 2023; 35:e13348. [PMID: 37936545 DOI: 10.1111/jne.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 11/09/2023]
Abstract
Offspring development relies on numerous physiological changes that occur in a mother's body, with hormones driving many of these adaptations. Amongst these, the physiological functions controlled by the autonomic nervous system are required for the mother to survive and are adjusted to meet the demands of the growing foetus and to ensure a successful birth. The hormones oestrogen, progesterone, and lactogenic hormones rise significantly during pregnancy, suggesting they may also play a role in regulating the maternal adaptations linked to autonomic nervous system functions, including respiratory, cardiovascular, and thermoregulatory functions. Indeed, expression of pregnancy hormone receptors spans multiple brain regions known to regulate these physiological functions. This review examines how respiratory, cardiovascular, and thermoregulatory functions are controlled by these pregnancy hormones by focusing on their action on central nervous system circuits. Inadequate adaptations in these systems during pregnancy can give rise to several pregnancy complications, highlighting the importance in understanding the mechanistic underpinnings of these changes and potentially identifying ways to treat pregnancy-associated afflictions using hormones.
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Affiliation(s)
- T Georgescu
- Centre for Neuroendocrinology and Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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Choi EY, Kim ES, Kim JY, Song MK, Kim SH, Noh CI. Pregnancy outcomes in patients with structural heart disease: a single center experience. Cardiovasc Diagn Ther 2021; 11:81-90. [PMID: 33708480 DOI: 10.21037/cdt-20-786] [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: 11/06/2022]
Abstract
Background In women, pregnancy is a period of relatively drastic hemodynamic change in a short period of time. Most pregnant women adapt well to these gradual hemodynamic changes. However, in women with congenital heart disease or other structural heart disease, adaptation to theses sudden hemodynamic changes is difficult, and heart failure or arrhythmia can get aggravated. This study shares our experiences on the outcomes of pregnancy in patients with structural heart disease. Methods From January 2007 to December 2016, we reviewed the medical records of all pregnant women with structural heart disease who received obstetric care at the Sejong General Hospital. Results During the study period, 103 pregnancies were observed in 79 women with structural heart disease. Of the 103 pregnancies, 55 were primiparous and 48 were multiparous. Echocardiography performed before pregnancy revealed that 52 patients had moderate to severe valvular regurgitation and 38 patients had moderate to severe valvular stenosis; 22 patients had mechanical valves and 5 patients had pulmonary hypertension. Overall, there were 9 maternal cardiac events, 7 obstetric events and 19 neonatal events. Pulmonary embolic events occurred only in 1 case; 77 deliveries were made, and 26 pregnancies did not last. Among 77 deliveries, 55 patients delivered by cesarean section (C/S) (71.43%). C/S in 16 of 55 patients was performed due to the maternal hemodynamic risk. Conclusions Overall complications associated with pregnancy in women with structural heart disease were very high at 28.16%. However, it is hoped that maternal and neonatal outcomes will be improved through careful observation and preparedness for anticipated complications.
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Affiliation(s)
- Eun-Young Choi
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea.,Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Eun Sun Kim
- Department of Pediatrics, College of Medicine, Kangwon National University, Gangwon-do, Korea
| | - Jung-Yoon Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Min-Kyung Song
- Department of Obstetrics and Gynecology, Sejong General Hospital, Gyeonggi-do, Korea
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
| | - Chung Il Noh
- Department of Pediatrics, Sejong General Hospital, Gyeonggi-do, Korea
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3
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Cottrell J, Calhoun J, Szczepanski J, Corvera J, Creswell LL, Kogon B, Hasaniya N, Copeland H. Aortic root valve‐sparing repair and dissections in Marfans syndrome during pregnancy: A case series. J Card Surg 2020; 35:1439-1443. [DOI: 10.1111/jocs.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jesse Cottrell
- Department of Obstetrics and Gynecology Marshall University Huntington West Virginia
| | - John Calhoun
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Jamie Szczepanski
- Department of Obstetrics and Gynecology University of Mississippi Medical Center Jackson Mississippi
| | - Joel Corvera
- Department of Surgery Indiana University Health Indianapolis Indiana
| | - Lawrence L. Creswell
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Brian Kogon
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
| | - Nahidh Hasaniya
- Dignity Health Medical Group Inland Empire San Bernardino California
| | - Hannah Copeland
- Department of Surgery University of Mississippi Medical Center Jackson Mississippi
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Heland S, de Chellis A, Rieder W, Sleeman M, Johns J, Lancefield T, Robinson A, Fung A, Walker S. Good at heart: Developing a tertiary perinatal cardiac service; the first eight years of experience. Aust N Z J Obstet Gynaecol 2020; 60:760-765. [PMID: 32323865 DOI: 10.1111/ajo.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal cardiac disease is the most common cause of indirect maternal death, and women with pre-existing cardiac disease have complex medical, obstetric and anaesthetic requirements. Our hospital commenced a multidisciplinary perinatal cardiac service in 2009 to optimise outcomes in women with cardiac disease. AIM To assess the maternal and perinatal outcomes of women referred to the clinic to evaluate clinical practice and inform future service provision. MATERIALS AND METHODS This is a single-centre retrospective study of women referred to the perinatal cardiac service between 2009-2016. Data collected included: demographic details; cardiac diagnosis; pregnancy outcomes, including anaesthetic and delivery complications, and admission to intensive care unit (ICU)/high dependency unit (HDU). RESULTS One hundred and fifty-two women were referred for care in 165 pregnancies. Congenital heart disease was the most common indication for referral (35%), followed by maternal cardiac arrhythmia (26%) and valvular disease (18%). The perinatal mortality rate was 2%, median gestational age at delivery was 38 weeks 4 days, fetal growth restriction (customised birthweight <10th centile) was 9% although 25 (17%) pregnancies resulted in preterm birth, 36% of which were spontaneous and 64% were iatrogenic. Maternal outcomes were favourable and there were no maternal deaths. However, 51% of women required a caesarean section, and 23% who achieved a live birth required ICU/HDU admission. CONCLUSION This study confirmed that women with cardiac disease are at increased risk of preterm birth, and high acuity in the peripartum period but otherwise good maternal and perinatal outcomes. An integrated multidisciplinary perinatal cardiac service can optimise perinatal outcomes in these women.
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Affiliation(s)
- Sarah Heland
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Adam de Chellis
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Wawrzyniec Rieder
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Matthew Sleeman
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Jennifer Johns
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Terase Lancefield
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Robinson
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Alison Fung
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Susan Walker
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Foeller ME, Foeller TM, Druzin M. Maternal Congenital Heart Disease in Pregnancy. Obstet Gynecol Clin North Am 2018; 45:267-280. [PMID: 29747730 DOI: 10.1016/j.ogc.2018.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital heart disease comprises most maternal cardiac diseases in pregnancy and is an important cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Pregnancy is often considered a high-risk state for individuals with structural heart disease as a consequence of a limited ability to adapt to the major hemodynamic changes associated with pregnancy. Preconception counseling and evaluation are of utmost importance, as pregnancy is contraindicated in certain cardiac conditions. Pregnancy can be safely accomplished in most individuals with careful risk assessment before conception and multidisciplinary care throughout pregnancy and the postpartum period.
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Affiliation(s)
- Megan E Foeller
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA.
| | - Timothy M Foeller
- Internal Medicine, Stanford Health Care-ValleyCare, 5555 West Positas Boulevard, 1 West Hospitalist Room 1, Pleasanton, CA 94588, USA
| | - Maurice Druzin
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA
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Kanoh M, Inai K, Shinohara T, Shimada E, Shimizu M, Tomimatsu H, Ogawa M, Nakanishi T. Influence of pregnancy on cardiac function and hemodynamics in women with Ebstein's anomaly. Acta Obstet Gynecol Scand 2018; 97:1025-1031. [DOI: 10.1111/aogs.13373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Miki Kanoh
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Kei Inai
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Mikiko Shimizu
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Hirofumi Tomimatsu
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
| | - Masaki Ogawa
- Department of Obstetrics and Gynecology; Tokyo Women's Medical University; Tokyo Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology; Division of Adult Congenital Heart Disease Pathophysiology and Life-long Care; Tokyo Women's Medical University; Tokyo Japan
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Kanoh M, Inai K, Shinohara T, Shimada E, Shimizu M, Tomimatsu H, Ogawa M, Nakanishi T. Pregnancy and delivery outcomes from patients with repaired anomalous origin of the left coronary artery from the pulmonary artery. J Obstet Gynaecol Res 2018; 44:899-906. [PMID: 29400413 DOI: 10.1111/jog.13606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/31/2017] [Indexed: 12/01/2022]
Abstract
AIM We investigated the clinical courses before and during pregnancy and after delivery in patients with repaired anomalous origin of the left coronary artery from the pulmonary artery to determine the impact of the hemodynamic changes and cardiac function on the selection of the appropriate mode of delivery. METHODS Six patients who underwent coronary artery reimplantation delivered 10 infants. We scrutinized the patients' hemodynamic changes on echocardiographs and the plasma brain natriuretic peptide levels before and during pregnancy and after delivery, the perinatal outcomes and maternal and fetal events. RESULTS All patients were asymptomatic and categorized as having New York Heart Association functional class I before pregnancy. In 8 of 10 pregnancies, vaginal deliveries were performed; two elective cesarean sections were performed because of symptomatic heart failure. The hemodynamic parameters were stable throughout pregnancy and postdelivery, and no maternal or fetal events occurred in the patients who underwent vaginal deliveries. One cesarean section patient developed significant heart failure during the late second and third trimesters, which was accompanied by hemodynamic changes, including increased brain natriuretic peptide levels, left ventricular diastolic dysfunction and worsening arrhythmias, and thrombosis and post-partum hemorrhage occurred postdelivery. The baby had intrauterine growth retardation and small for gestational age. None of the babies had congenital anomalies. CONCLUSION Pregnancy was safe in most of the asymptomatic patients long after anomalous origin of the left coronary artery from the pulmonary artery was repaired. Symptomatic heart failure might occur during pregnancy in patients with persisting myocardial damage. Pregnancy and delivery should be carefully managed.
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Affiliation(s)
- Miki Kanoh
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Tokuko Shinohara
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Mikiko Shimizu
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirofumi Tomimatsu
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaki Ogawa
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Division of Adult Congenital Heart Disease Pathophysiology and Life-Long Care, Tokyo Women's Medical University, Tokyo, Japan
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Anticoagulation for Thromboembolic Risk Reduction in Adults With Congenital Heart Disease. Can J Cardiol 2017; 33:1597-1603. [DOI: 10.1016/j.cjca.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/29/2017] [Accepted: 08/08/2017] [Indexed: 01/29/2023] Open
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Kratzert WB, Boyd EK, Schwarzenberger JC. Management of the Critically Ill Adult With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2017; 32:1682-1700. [PMID: 29500124 DOI: 10.1053/j.jvca.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 02/01/2023]
Abstract
Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age. Comorbidities affect all organ systems, including cognitive function, pulmonary and cardiovascular systems, liver, and kidneys. Critical care management requires an in-depth understanding of underlying anatomy and pathophysiology in order to apply contemporary concepts of adult ICU care to this population and optimize patient outcomes. In this review, the main CHD lesions and their common surgical management approaches are described, and the sequelae of CHD physiology are discussed. In addition, the effects of chronic comorbidities on the management of critically ill adults are explored, and the adjustments of current ICU management modalities and pharmacology to optimize care are discussed.
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Affiliation(s)
- Wolf B Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA.
| | - Eva K Boyd
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
| | - Johanna C Schwarzenberger
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Los Angeles, CA
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Ntiloudi D, Zegkos T, Bazmpani MA, Parcharidou D, Panagiotidis T, Hadjimiltiades S, Karvounis H, Giannakoulas G. Pregnancy outcome in women with congenital heart disease: A single-center experience. Hellenic J Cardiol 2017; 59:155-159. [PMID: 28873334 DOI: 10.1016/j.hjc.2017.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Pregnancies in patients with adult congenital heart disease (ACHD) are often complicated. We aimed to highlight the nature and the rate of these complications in a single-center patient population. METHODS We retrospectively studied all the pregnancies of women who presented on an outpatient basis, and all pregnancies were reviewed for maternal and fetal outcomes. RESULTS Of 117 pregnancies from 52 ACHD patients (age at pregnancy 28.3 ± 6.6 years), 10 were therapeutically aborted. A proportion of 41.1% of the remaining 107 pregnancies were complicated either with cardiac (3.7%), obstetric (15.0%), or fetal/neonatal (11.2%) adverse events or with spontaneous abortion (17.8%). Hospitalization during pregnancy was required in 10 patients. Elective cesarean sections were initially planned for 31% of the 87 pregnancies, which were finally completed, while 8% required an emergency cesarean section, mostly for obstetric reasons. NYHA class deterioration after pregnancy was detected in 9.3% of our cohort. Modified WHO class III/IV, prior medication use, and higher body mass index (BMI) were related to cardiac complications during pregnancy or NYHA deterioration. CONCLUSION Pregnancies in ACHD patients are at high risk for complications. Advanced modified WHO class, prior medication use, and high BMI were related to adverse cardiac events.
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Affiliation(s)
- Despina Ntiloudi
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Zegkos
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
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Duan R, Xu X, Wang X, Yu H, You Y, Liu X, Xing A, Zhou R, Xi M. Pregnancy outcome in women with Eisenmenger's syndrome: a case series from west China. BMC Pregnancy Childbirth 2016; 16:356. [PMID: 27852228 PMCID: PMC5112756 DOI: 10.1186/s12884-016-1153-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Eisenmenger's syndrome (ES) consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. The cardiovascular changes that occur during the pregnancy contribute to the high maternal morbidity and mortality in patients with ES. This study is to assess maternal and fetal outcomes in patients with ES. METHODS This study is a retrospective analysis of 11 pregnancies in women with ES who delivered at a tertiary care center in west China between 2010 and 2014. Cases were divided into group I (maternal survival) and group II (maternal death). Clinical data were noted and analyzed. RESULTS All ES patients presented with severe pulmonary arterial hypertension (PAH). Four maternal deaths were recorded (maternal mortality of 36%). Only one pregnancy continued to term. Ventricular septal defect diameter in group II was larger than that in group I (2.93 ± 0.76 cm vs. 1.90 ± 0.54 cm, p < 0.05). Arterial oxygen saturation and pre-delivery arterial oxygen tension during oxygen inhalation were significantly lower in group II (p < 0.05). Pulmonary arterial blood pressure (PABP) in both groups were high while ejection fractions (EF) were significantly lower in group II (p < 0.05). The incidence of pre-delivery heart failure in group II was substantially higher than in survivors (100 vs.14.3%, p < 0.05). Fetal complications were exceptionally high: preterm delivery (88%), small for gestational age (83%), fetal mortality (27%) and neonatal mortality (25%). CONCLUSIONS In west China,the perinatal outcome of pregnant women with ES is poor, especially when complicated with high pulmonary arterial hypertension (PAH). Pregnancy remains strongly contraindicated in ES. Effective contraception is essential, and the option of terminating pregnancy in the first trimester should be presented to pregnant women with ES.
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Affiliation(s)
- Ruiqi Duan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Xiumei Xu
- ICU of Gynecology & Obstetrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Yong You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Aiyun Xing
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
| | - Mingrong Xi
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China
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Abstract
PURPOSE OF REVIEW Adolescents and young adults with special health care needs (SHCN) are uniquely vulnerable to health risk behaviors including smoking, alcohol and illicit drug use, and sexual risk-taking. Their likelihood of experiencing adverse health outcomes because of these behaviors may be beyond that experienced by their healthier peer group. Pediatric providers are responsible for appropriately counseling these patients about healthy lifestyles. This review provides some background regarding these health risks among adolescents and young adults with SHCN with particular focus on three populations: childhood cancer survivors, congenital heart disease patients, and those with intellectual disability. RECENT FINDINGS Young adults and adolescents with chronic medical conditions are as likely - and perhaps more likely - to engage in health risk behaviors. However, these behaviors are not fully addressed by primary care providers. SUMMARY Pediatric providers are encouraged to ask adolescents and young adults with SHCN about their understanding of, and engagement in, health risk behaviors. A multidisciplinary approach to encourage a healthy lifestyle within this population may have significant health benefits.
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