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Zhu T, Zhan G, Shang Z, Ying Z. Causal relationship between systemic lupus erythematosus and adverse pregnancy outcomes: A two-sample Mendelian randomized study. Heliyon 2024; 10:e35401. [PMID: 39170286 PMCID: PMC11336611 DOI: 10.1016/j.heliyon.2024.e35401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
Background Systemic lupus erythematosus (SLE) is associated with adverse pregnancy outcome (APO). However, the genetic causality of this association remains unclear. In this study, Mendelian randomization (MR) was used to explore the potential causal relationship between SLE and APO risk. Methods We selected 45 single nucleotide polymorphisms (SNPs) associated with SLE from published genome-wide association studies (GWAS). APO's statistics are obtained from the GWAS database. MR estimates were performed using the inverse variance-weighted (IVW) method, the MR-Egger method, and the weighted median (WM) method. Sensitivity analysis was performed using Cochran's Q test, MR-Egger intercept, MR-pleiotropic residual and outlier method, stay-one analysis and funnel plot. Results The results showed a causal relationship between SLE and pre-eclampsia (OR = 1.036, 95 % confidence interval 1.006 to 1.068, P = 0.019), and no significant causal relationship was found between SLE and other adverse pregnancy outcomes, including postpartum hemorrhage, placental abruption, spontaneous abortion, premature rupture of membranes, fetal distress, gestational diabetes mellitus. These findings were robust in several sensitivity analyses. Conclusion This MR study demonstrated the causal effect of SLE on preeclampsia. It provides important clues for identifying and early predicting risk factors for preeclampsia.
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Affiliation(s)
- Tao Zhu
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Gao Zhan
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Zheng Shang
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Zhao Ying
- Department of Gynecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
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Park JS, Chung JH, Kim NS, Jung HS, Seo YH, Gong HY, Ji JY, Park YJ, Jung JY, Chun HR. Emergency cesarean section of a patient with refractory status epilepticus: A case report of challenges during anesthesia. Medicine (Baltimore) 2024; 103:e37988. [PMID: 38701243 PMCID: PMC11062747 DOI: 10.1097/md.0000000000037988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Maternal epilepsy is a critical condition that can significantly affect mothers and fetuses. Notably, the admission of a laboring mother with uncontrolled refractory status epilepticus (RSE) to the operating room presents a challenging scenario for anesthesiologists. THE MAIN SYMPTOMS OF THE PATIENT AND THE IMPORTANT CLINICAL FINDINGS A 30-year-old primigravida was transferred to the operating room for an emergency cesarean section. Cesarean section was performed after a provisional diagnosis of preeclampsia was made. THE MAIN DIAGNOSES, THERAPEUTIC INTERVENTIONS, AND OUTCOMES Cesarean section was performed under general anesthesia. During the postoperative period, the patient exhibited no seizure activity in the brain; however, she experienced mild cognitive dysfunction for up to 6 months postdelivery. The neonate were discharged without any complications. CONCLUSION Inducing anesthesia in pregnant women with ongoing seizure activity are challenging; however, anesthesiologists provide judgment based on the balance between the safety of the mother and fetus and the balance between patient monitoring and the progression of anesthesia. This challenge can be addressed through multidisciplinary collaboration.
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Affiliation(s)
- Jin Soo Park
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Jin Hun Chung
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Hyung Youn Gong
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Jae Yong Ji
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Yu Jun Park
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Jun Yong Jung
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea
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Cipolla S, Catapano P, Messina M, Pezzella P, Giordano GM. Safety of electroconvulsive therapy (ECT) in pregnancy: a systematic review of case reports and case series. Arch Womens Ment Health 2024; 27:157-178. [PMID: 37957411 PMCID: PMC10933171 DOI: 10.1007/s00737-023-01394-1] [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: 07/19/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
Pregnancy and the immediate postpartum period are considered at high risk for women who have already received a previous psychiatric diagnosis and might represent a stressful event favoring the onset of new psychiatric disorders. The electroconvulsive therapy (ECT) is effective for the treatment of severe, treatment-resistant mental disorders, and it could represent a therapeutic choice for psychiatric conditions during pregnancy. The purpose of this systematic review is to evaluate the safety of ECT during pregnancy and to update the state of the art of its use. An extensive literature search on PubMed, APA PsycInfo, and Scopus databases for relevant articles published from inception to September 2023 has been performed. A final number of 45 articles (34 case reports and 11 case series, for a total of 130 pregnant women) were included in the present review. The limited evidence confirmed that ECT is effective in determining a partial remission of symptoms in women suffering from severe mental disorders, especially in the presence of suicidal ideation or psychosis, during all pregnancy epochs. However, ECT is not free from side effects, although the majority of possible complications were of low- or moderate-grade and not life-threatening for the women. Exposure to pharmacological treatment before or during the ECT or to the anesthetic during ECT might have contributed to the onset of these complications. ECT techniques evolved over years, increasing the degree of its safety, and according to our review it appears to be relatively safe and effective during pregnancy in the majority of cases.
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Affiliation(s)
- Salvatore Cipolla
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Pierluigi Catapano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Martin Messina
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy.
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Wilson DA, Mateus J, Ash E, Turan TN, Hunt KJ, Malek AM. The Association of Hypertensive Disorders of Pregnancy with Infant Mortality, Preterm Delivery, and Small for Gestational Age. Healthcare (Basel) 2024; 12:597. [PMID: 38470708 PMCID: PMC10931061 DOI: 10.3390/healthcare12050597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/25/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
Gestational hypertension, preeclampsia, eclampsia, and chronic hypertension (CHTN) are associated with adverse infant outcomes and disproportionately affect minoritized race/ethnicity groups. We evaluated the relationships between hypertensive disorders of pregnancy (HDP) and/or CHTN with infant mortality, preterm delivery (PTD), and small for gestational age (SGA) in a statewide cohort with a diverse racial/ethnic population. All live, singleton deliveries in South Carolina (2004-2016) to mothers aged 12-49 were evaluated for adverse outcomes: infant mortality, PTD (20 to less than <37 weeks) and SGA (<10th birthweight-for-gestational-age percentile). Logistic regression models adjusted for sociodemographic, behavioral, and clinical characteristics. In 666,905 deliveries, mothers had superimposed preeclampsia (HDP + CHTN; 1.0%), HDP alone (8.0%), CHTN alone (1.8%), or no hypertension (89.1%). Infant mortality risk was significantly higher in deliveries to women with superimposed preeclampsia, HDP, and CHTN compared with no hypertension (relative risk [RR] = 1.79, 1.39, and 1.48, respectively). After accounting for differing risk by race/ethnicity, deliveries to women with HDP and/or CHTN were more likely to result in PTD (RRs ranged from 3.14 to 5.25) or SGA (RRs ranged from 1.67 to 3.64). As CHTN, HDP and superimposed preeclampsia confer higher risk of adverse outcomes, prevention efforts should involve encouraging and supporting mothers in mitigating modifiable cardiovascular risk factors.
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Affiliation(s)
- Dulaney A. Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (E.A.); (K.J.H.); (A.M.M.)
| | - Julio Mateus
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, Atrium Health, Charlotte, NC 28204, USA
| | - Emily Ash
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (E.A.); (K.J.H.); (A.M.M.)
| | - Tanya N. Turan
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (E.A.); (K.J.H.); (A.M.M.)
| | - Angela M. Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (E.A.); (K.J.H.); (A.M.M.)
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Swor D, Juneja P, Constantine C, Mann C, Rosenow F, LaRoche S. Management of status epilepticus in pregnancy: a clinician survey. Neurol Res Pract 2024; 6:3. [PMID: 38233889 PMCID: PMC10795404 DOI: 10.1186/s42466-023-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/26/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Status epilepticus in pregnancy (SEP) is rare and life-threatening for both mother and fetus. There are well-established guidelines for the management of women with epilepsy during pregnancy; however, there is little evidence guiding the management of SEP, leading to uncertainty among treating physicians. Therefore, this survey aims to investigate the real-world practices of physicians treating SEP to explore management approaches for improvements in care. METHODS An anonymous, electronic survey was created and distributed to neurointensivists and neurologists between September and December 2021. RESULTS One hundred physicians initiated the survey and 95 completed it in full: 87 (87%, 87/100) identified neurology as their primary specialty, 31 had subspecialty training in neurocritical care, and 48 had subspecialty training in epilepsy and/or clinical neurophysiology. Over half of the survey respondents (67%, 67/100) reported having participated in the management of SEP, with 48.9% (49/98) having done so in the past year. Most survey respondents (73%, 73/100) reported that their management approach to SEP is different than that of non-pregnant patients. Survey respondents were more likely to involve epilepsy consultants when treating SEP (58.5%, 58/99) and the vast majority involved Obstetrics/Maternal Fetal Medicine consultants (90.8%, 89/98). Survey respondents showed a clear preference for levetiracetam (89.7%, 87/97) in the treatment of benzodiazepine refractory status epilepticus followed by lacosamide (61%, 60/98) if an additional second line agent was needed. Valproate and phenobarbital were unlikely to be used. There was less agreement for the management of refractory and super-refractory SEP. CONCLUSIONS Levetiracetam is the most frequently used anti-seizure medication (ASM) for benzodiazepine-refractory SEP. Survey participants tended to manage SEP differently than in non-pregnant patients including greater involvement of interdisciplinary teams as well as avoidance of ASMs associated with known teratogenicity.
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Affiliation(s)
- Dionne Swor
- Department of Neurology, University of Toledo, Toledo, USA.
| | - Pallavi Juneja
- Department of Neurology, Columbia University, New York, USA
| | | | - Catrin Mann
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Suzette LaRoche
- Department of Neurology, University of North Carolina, Chapel Hill, USA
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Lv Y, Hu R, Liang Y, Zhou Y, Lian Y, He T. Effect of daily physical activity on ambulatory blood pressure in pregnant women with chronic hypertension: A prospective cohort study protocol. PLoS One 2024; 19:e0296023. [PMID: 38198464 PMCID: PMC10781089 DOI: 10.1371/journal.pone.0296023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Physical activity, a first-line approach for the treatment of non-gestational hypertension globally, has been shown to benefit most pregnant women in many respects. The benefits and risks of prenatal physical activity in complicated pregnancies, such as preeclampsia and chronic hypertension, require further investigation. It is worth conducting studies to address questions about physical activity during pregnancy in women with chronic hypertension, such as the benefits and risks, frequency, duration, and intensity. This prospective cohort study aims to investigate whether moderate-intensity daily physical activity reduces ambulatory blood pressure in pregnant women with chronic hypertension. METHODS Pregnant women with chronic hypertension at 11+0 to 13+6 gestational weeks will be recruited from the outpatient clinic and divided into moderate- and light-intensity physical activity groups according to the intensity of the 7-day physical activity monitored using the model wGT3X-BT accelerometer. 24-h ambulatory blood pressure monitoring will be performed at enrollment as a baseline and will be repeated in the second and third trimesters. The primary outcome is the difference in the change in 24-h ambulatory systolic blood pressure from the first to the third trimester between the groups. Secondary outcomes include the difference of change in other ambulatory (24-h diastolic, daytime, and nighttime) and office blood pressure variables from the first to the second and third trimesters, the incidence of severe hypertension (≥160/110 mmHg), and changes in the type and dosage of antihypertensive medication. The primary and secondary outcomes related to changes in blood pressure from baseline to the second and third trimesters between the groups will be analyzed using Student's independent t-test or the Mann-Whitney U test. DISCUSSION This cohort study will provide a basis for randomized controlled trials and verify an easily achieved, economical, and non-fetotoxic approach for adjuvant blood pressure management in pregnant women with chronic hypertension. REGISTRY This study is registered with the Chinese Clinical Trials Registry (NO. ChiCTR2200062094). Date Registered: 21/07/2022.
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Affiliation(s)
- Yanxiang Lv
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Rui Hu
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Yan Liang
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Ying Zhou
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Yanan Lian
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
| | - Tongqiang He
- Department of Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s Hospital, Xi’an City, Shaanxi Prov, China
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Boldeanu L, Văduva CC, Caragea DC, Novac MB, Manasia M, Siloși I, Manolea MM, Boldeanu MV, Dijmărescu AL. Association between Serum 8-Iso-Prostaglandin F2α as an Oxidative Stress Marker and Immunological Markers in a Cohort of Preeclampsia Patients. Life (Basel) 2023; 13:2242. [PMID: 38137843 PMCID: PMC10745027 DOI: 10.3390/life13122242] [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: 09/27/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We aimed to analyze the presence and clinical use of serum 8-iso-prostaglandin F2-alpha (8-iso-PGF2α) as an oxidative stress marker and some inflammatory status biomarkers (tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), IL-10, high-sensitivity C-reactive protein (hs-CRP), and pentraxin-3 (PTX3)) for patients with preeclampsia (PE). METHODS Sixty pregnant women, including thirty diagnosed with PE and thirty who were healthy (NP), were included in this study. For the assessment of serum levels of biomarkers, we used the Enzyme-Linked Immunosorbent Assay (ELISA) technique. RESULTS Our preliminary study showed that the expression level of serum 8-iso-PGF2α in the PE group was higher than in the PE after delivery (PE-AD) group (742.00 vs. 324.00 pg/mL, p < 0.0001). Groups of preeclamptic patients (PE + PE-AD) expressed significantly elevated levels for all of the assessed inflammatory mediators as compared to NP. Significant strong positive correlations with 8-iso-PGF2α levels were found for systolic blood pressure (SBP), and TNF-α (Spearman's rho = 0.622, p-value = 0.020 and rho = 0.645, p-value = 0.002, respectively). Our study demonstrates that 8-iso-PGF2α and PTX3 have the greatest diagnostic value for pregnant women with PE. CONCLUSIONS 8-iso-PGF2α and PTX3 can be used as independent predictor factors, along with already-known cytokines, that could represent a prophylactic way to help clinicians identify or predict which pregnant women will develop PE.
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Affiliation(s)
- Lidia Boldeanu
- Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Constantin-Cristian Văduva
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.M.); (A.L.D.)
| | - Daniel Cosmin Caragea
- Department of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Marius Bogdan Novac
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mariana Manasia
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Isabela Siloși
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Maria Magdalena Manolea
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.M.); (A.L.D.)
| | | | - Anda Lorena Dijmărescu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.M.); (A.L.D.)
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Chatzakis C, Eleftheriades M, Demertzidou E, Eleftheriades A, Koletsos N, Lavasidis L, Zikopoulos A, Dinas K, Sotiriadis A. Uterine Arteries Resistance in Pregnant Women with Gestational Diabetes Mellitus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, and Uncomplicated Pregnancies. Biomedicines 2023; 11:3106. [PMID: 38137327 PMCID: PMC10741004 DOI: 10.3390/biomedicines11123106] [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: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The examination of the uterine arteries using Doppler in the first trimester of pregnancy serves as a valuable tool for evaluating the uteroplacental circulation. Diabetes mellitus is associated with altered placental implantation and pregnancy-related pathologies, such as preeclampsia. The aim of this study was to compare the uterine arteries' pulsatility indices (UtA PI) in women with diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), gestational diabetes mellitus (GDM), and uncomplicated pregnancies. METHODS This was a retrospective case-control trial including pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, presenting for first-trimester ultrasound screening in two tertiary university hospitals between 2013 and 2023. The first-trimester UtA pulsatility index (PI), expressed in multiples of medians (MoMs), was compared between the four groups. RESULTS Out of 15,638 pregnant women, 58 women with DM1, 67 women with DM2, 65 women with GDM, and 65 women with uncomplicated pregnancies were included. The mean UtA PI were 1.00 ± 0.26 MoMs, 1.04 ± 0.32 MoMs, 1.02 ± 0.31 MoMs, and 1.08 ± 0.33 MoMs in pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, respectively (p > 0.05). CONCLUSIONS Potential alterations in the implantation of the placenta in pregnant women with diabetes were not displayed in the first-trimester pulsatility indices of the uterine arteries, as there were no changes between the groups.
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Affiliation(s)
- Christos Chatzakis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Makarios Eleftheriades
- Second Department of Obstetrics and Gynecology, Medical School, National and Capodistrian University of Athens, 115 28 Athens, Greece; (M.E.); (A.E.)
| | - Eleftheria Demertzidou
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Anna Eleftheriades
- Second Department of Obstetrics and Gynecology, Medical School, National and Capodistrian University of Athens, 115 28 Athens, Greece; (M.E.); (A.E.)
| | - Nikolaos Koletsos
- Department of Rheumatology, University of Ioannina, 451 10 Ioannina, Greece;
| | - Lazaros Lavasidis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | | | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (C.C.)
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Li D, Zhang M, Xu S, Bian Z, Huang X, Hu G, Li J. A study of adverse maternal-foetal outcomes in nephrotic syndrome combined with preeclampsia. BMC Pregnancy Childbirth 2023; 23:773. [PMID: 37936071 PMCID: PMC10629058 DOI: 10.1186/s12884-023-06073-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Although the majority of pregnancies with preeclampsia are characterised by elevated blood pressure, preeclampsia is often associated with nephrotic syndrome with similar symptoms such as high proteinuria and bilateral lower limb oedema. In this study, we compared the maternal-foetal outcomes of pregnant women with preeclampsia in a population with nephrotic syndrome and explored the factors that contribute to the corresponding outcomes and disease development. METHODS A total of 90 pregnant women were included in this study, of whom 30 had nephrotic syndrome and were diagnosed with preeclampsia during pregnancy, and 60 had nephrotic syndrome alone. Descriptive statistical analyses of baseline data were performed to analyse the effect of combined preeclampsia on maternal and foetal pregnancy outcomes using unadjusted and adjusted logistic regression models. RESULTS In this study, the baseline data of the two study populations demonstrated no differences except for the history of caesarean section and 24-h proteinuria results, which were significantly different (P < 0.05). The risk of preterm birth in the nephrotic syndrome with preeclampsia group was 8.25 (95% CI:3.041-22.084 P < 0.05); for a low birth weight, the risk was 6.00 (95% CI:2.302-15.638 P < 0.05); for foetal distress,the risk was 5.667 (95% CI:2.070-15.514 P < 0.05); and the risk of foetal birth restriction was 7.429 (95% CI: 2.642-20.885 P < 0.05). A risk-based analysis of adverse maternal outcomes yielded a risk of miscarriage of 2.200 (95% CI: 0.584-8.291; P > 0.05). After adjusting the model for each outcome, significant risks of preterm labour, foetal birth restriction, and low birth weight were revealed (P < 0.05). CONCLUSION Combined preeclampsia has a significantly higher risk of adverse pregnancy outcomes for the foetus.Therefore, the prevention and control of eclampsia in pregnant women should be improved to ensure maternal and neonatal health.
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Affiliation(s)
- Dong Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Minyi Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shuxiu Xu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou, Guangdong, China
| | - Ziwei Bian
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiaoli Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Guifang Hu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Jing Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou, Guangdong, China.
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Martellino C, Laganà A, Atanasio G, Lamanna F, Attardo S, Cascino S, De Luca M, Pardeo O, Giacobbe G, Tripepi G, Roberti R, Granata F, Morace C, Russo E, Labate A. The real-world effectiveness of intravenous brivaracetam as a second-line treatment in status epilepticus. Epilepsy Behav 2023; 148:109464. [PMID: 37839249 DOI: 10.1016/j.yebeh.2023.109464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability (effectiveness) of intravenous brivaracetam (BRV) as a second-line treatment. METHODS Twenty-one patients (median age 68 years ± 17.28) were prospectively recruited between June 2019 and December 2022. Patients were treated with BRV (50-200 mg) as a second-line add-on therapy for SE. We evaluated the response of SE to the administration of BRV in terms of SE termination and recurrence of epileptic seizures at 6, 12, and 24 h, also monitoring safety. The first-line therapy was represented by intravenous benzodiazepines (mainly diazepam). RESULTS Almost a quarter of patients had generalized seizures, whereas the vast majority (76.2%) presented focal seizures. In 52.4% of patients, the underlying cause was cerebrovascular. Fourteen (66.7%) patients displayed a good early response in the subsequent 6 h. At 12 and 24 h, 8 (38%) and 11 (52.4%) patients, respectively, did not present seizures. CONCLUSION The present study highlights the potential of BRV when used as an early add-on therapy in SE, further confirming its good safety profile.
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Affiliation(s)
- Chiara Martellino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angelina Laganà
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Giorgia Atanasio
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Fabio Lamanna
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Silvia Attardo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Cascino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Marcella De Luca
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Orazio Pardeo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giuseppa Giacobbe
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Roberta Roberti
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | | | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy.
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11
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Domanski K, Allswede M. The criminalisation of women's healthcare in the post-Dobbs era: an analysis of the anti-abortion trigger law statutes. EUR J CONTRACEP REPR 2023; 28:258-262. [PMID: 37590051 DOI: 10.1080/13625187.2023.2242546] [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: 05/14/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
On 24 June 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organisation held that:'The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.'Since the ruling, thirteen states have enacted 'trigger laws' that restrict access to abortion except in specified circumstances, such as to save the life of the pregnant patient in a medical emergency. These laws not only inappropriately insert the State into the physician-patient relationship, but create an uncertain practice landscape for physicians by placing them at risk of criminal penalties. We illustrate the complexity of medical decision making for pregnant patients using examples from the case report literature, and discuss how leaving the definition of 'medical emergency' up to courts to decide will create a patchwork of restrictive and permissive standards that criminalises physicians and creates a 'political standard of care' that replaces evidence based medical care.
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Affiliation(s)
- Kristina Domanski
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Michael Allswede
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
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12
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Ito M, Kyozuka H, Yamaguchi T, Sugeno M, Murata T, Hiraiwa T, Ito F, Suzuki D, Fukuda T, Yasuda S, Fujimori K, Nomura Y. Association between Gestational Weight Gain and Risk of Hypertensive Disorders of Pregnancy among Women with Obesity: A Multicenter Retrospective Cohort Study in Japan. Nutrients 2023; 15:nu15112428. [PMID: 37299392 DOI: 10.3390/nu15112428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The relationship between weight gain during pregnancy and the onset of hypertensive disorders of pregnancy in women with pre-pregnancy obesity remains unclear. We examined the effects of weight gain during pregnancy on hypertensive disorders of pregnancy among women with pre-pregnancy body mass index (BMI) ≥ 25.0 kg/m2. This multicenter retrospective cohort study included nullipara women who delivered at two units in Japan between 1 January 2013, and 31 December 2020. Singleton primipara (n = 3040) were categorized into two pre-pregnancy BMI groups: 25.0-<30.0, and ≥30.0 kg/m2. Using multiple logistic regression analyses (reported as adjusted odds ratio and 95% confidence interval), gestational weight gain effects on overall hypertensive disorders of pregnancy, gestational hypertension, and pre-eclampsia were determined. Gestational weight gain increased hypertensive disorders of pregnancy (1.09, 1.03-1.16, p < 0.05) and pre-eclampsia risk (1.10, 1.01-1.20, p < 0.05) among the BMI 25.0-<30.0 kg/m2 group and hypertensive disorders of pregnancy risk among the ≥30.0 kg/m2 group (1.07, 1.00-1.05, p < 0.05). Using receiver operating characteristic curve analyses, among the BMI 25.0-<30.0 kg/m2 group, for hypertensive disorders of pregnancy (area under the curve [AUC], 0.63, p < 0.05) and pre-eclampsia (AUC, 0.62; p < 0.05), the weight gain cut-off was 10.5 and 10.6 kg, with sensitivity/specificity of 0.47/0.73 and 0.50/0.73, respectively. For the BMI ≥30.0 kg/m2 group (AUC, 0.63, p < 0.05), the cut-off was 3.5 kg (sensitivity/specificity, 0.75/0.49). The optimal gestational weight gain for reducing hypertensive disorders of pregnancy among women with a pre-pregnancy BMI > 25 kg/m2 may facilitate personalized pre-conception counseling among women with obesity.
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Affiliation(s)
- Momoka Ito
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Tomoko Yamaguchi
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Misa Sugeno
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University, 1, Hikarigaoka, Fukushima City 961-8141, Fukushima, Japan
| | - Tsuyoshi Hiraiwa
- Department of Obstetrics and Gynecology, Iwase General Hospital, 20, Kitamachi, Sukagawa City 962-8503, Fukushima, Japan
| | - Fumihiro Ito
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, 1, Hikarigaoka, Fukushima City 961-8141, Fukushima, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, 1, Hikarigaoka, Fukushima City 961-8141, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, 1, Hikarigaoka, Fukushima City 961-8141, Fukushima, Japan
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, 2-5-20, Nishinouchi, Koriyama City 963-8558, Fukushima, Japan
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13
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Rosenow F, Mann C. Status epilepticus in pregnancy. Epilepsy Behav 2023; 138:109034. [PMID: 36525922 DOI: 10.1016/j.yebeh.2022.109034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Status epilepticus is a frequent neurological emergency associated with a case fatality of about 10-15% depending on age, cause, and other factors, and a high burden for patients, caregivers, and society. In pregnancy, it can occur in two different clinical constellations: (1) In women with a history of epilepsy and (2) as new onset status epilepticus in pregnancy (NOSEP). Both entities are relatively rare but differ in terms of etiology. Here we describe the epidemiology, etiologies, diagnosis, clinical course with the maternal and fetal outcome, and the suggested management strategies for either manifestation. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
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