Maternal and neonatal outcomes among pregnant women with fibromyalgia: a population-based study of 12 million births

Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center

Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.

Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis?

Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.

Maternal chronic disease and breastfeeding outcomes: a Canadian population-based study

Background: The prevalence of chronic disease in pregnant women has consistently risen over the past two decades. Substantial evidence demonstrates that maternal chronic disease is associated with adverse medical outcomes like preterm birth, but less research has characterized postpartum outcomes such as infant feeding practices. It is recommended that infants be exclusively breastfed from birth to 6 months given the numerous health benefits it provides.Objective: To determine the association between maternal chronic disease and breastfeeding outcomes.Methods: We analyzed cross-sectional self-report data from the 2015/2016 Canadian Community Health Survey, restricted to women who gave birth within 2 years of data collection (n = 2100, rounded). The exposure was professionally diagnosed chronic physical disease (e.g. diabetes, arthritis, heart disease). The outcomes were breastfeeding non-initiation and early cessation of breastfeeding before 6 months. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Estimates were bootstrapped and weighted to represent the national population.Results: Overall, 11.9% (95% CI 9.8-14.1) of women reported chronic disease, and were more likely to be single, be Canadian born, have low education, and be overweight/obese than women without chronic disease. The mean maternal age was approximately 30 years in both groups. Women with chronic disease had similar odds of breastfeeding non-initiation (AOR 0.96, 95% CI 0.54-1.71) and early cessation of any breastfeeding (AOR 1.40, 95% CI 0.82-2.40), but over twice the odds of early cessation of exclusive breastfeeding (AOR 2.48, 95% CI 1.49-4.12) compared to unaffected women.Conclusion: Mothers with chronic disease initiate and continue some form of breastfeeding to six months as often as their unaffected peers. However, they have substantially higher odds of ceasing exclusive breastfeeding before the recommended 6 months. Findings suggest a need to investigate the reasons for this disparity to ensure that appropriate breastfeeding support is available for women with chronic disease and their children.

Managing fibromyalgia syndrome in pregnancy no bridges between USA and EU

The first aim of this article is to analyze the risk/benefit ratio of using psychotropic drugs approved in some countries for treating fibromyalgia syndrome (FMS) during pregnancy. Assessing the effectiveness of non-pharmacological interventions is the second scope of this article, in order to help clinicians to manage FMS in pregnancy in those countries were no drugs are approved for treating the disease. Following the PRISMA guidelines for systematic reviews, a literature search was conducted on PubMed and Google Scholar. Separate literature searches were performed for the three psychotropic drugs approved in the USA for treating FMS, psychotherapy, and transcranial magnetic stimulation (TMS). Perinatal duloxetine exposure is associated with increased risk of gestational and perinatal complications. With regards pregabalin, available information suggests that the drug is not devoid of structural teratogenicity potential. No data are available for milnacipran. Duloxetine and pregabalin should be only given to pregnant women diagnosed with severe forms of FMS after carefully weighing the benefits and risks for the mother-fetus dyad. On the other hand, we have to consider that the proportion of women who discontinue psychotropic drugs during pregnancy is as high as 85.4%. This figure raises further questions about adequate alternative treatment of FMS during the perinatal period. Moreover, neither duloxetine nor milnacipran or pregabalin have been approved by the EMEA for the treatment of FMS. Unfortunately, psychological treatment of FMS in perinatal women are not yet tested and data on TMS are conflicting.

Effect of Sjögren's syndrome on maternal and neonatal outcomes of pregnancy

Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.

Management and outcomes of peptic ulcer disease in pregnancy

PURPOSE

Given the altered physiology of pregnancy, gastroenterologists are often reluctant to perform endoscopic procedures in pregnant women. The purpose of our study was to compare management practices and outcomes among pregnant and nonpregnant women admitted to the hospital for peptic ulcer disease (PUD).

MATERIALS AND METHODS

A retrospective matched cohort study was carried out using the Healthcare Cost and Utilization Project - National Inpatient Sample from 1999 to 2015. A cohort of pregnant women with PUD was generated and compared with an age-matched cohort of nonpregnant women with PUD at a 1:5 ratio. Conditional logistic regression analyses were used to evaluate the adjusted effect of PUD on variables and outcomes of interest, including associated conditions, management and treatment types, and complications.

RESULTS

PUD was diagnosed in 2535 pregnant women and 12,675 age-matched nonpregnant women during the 16-year study period. As compared with nonpregnant women, pregnant women with PUD were less likely to undergo diagnostic or therapeutic esophagogastroduodenoscopies (EGD) for this indication. Outcomes including fever, infection, sepsis, shock, and transfusion were less likely to occur in pregnant women as compared to nonpregnant women. Pregnant women also experienced shorter hospital stays. Pregnant women who underwent EGD were more likely to experience a venous thromboembolism than nonpregnant women.

CONCLUSIONS

Pregnant women with PUD are less likely to undergo interventional diagnostic and therapeutic procedures than nonpregnant women with PUD. The reluctance to intervene in pregnancy does not appear to result in more adverse PUD-associated outcomes.

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans

Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.