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Boyd R, McMullen H, Beqaj H, Kalfa D. Environmental Exposures and Congenital Heart Disease. Pediatrics 2022; 149:183839. [PMID: 34972224 DOI: 10.1542/peds.2021-052151] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/16/2022] Open
Abstract
Congenital heart disease (CHD) is the most common congenital abnormality worldwide, affecting 8 to 12 infants per 1000 births globally and causing >40% of prenatal deaths. However, its causes remain mainly unknown, with only up to 15% of CHD cases having a determined genetic cause. Exploring the complex relationship between genetics and environmental exposures is key in understanding the multifactorial nature of the development of CHD. Multiple population-level association studies have been conducted on maternal environmental exposures and their association with CHD, including evaluating the effect of maternal disease, medication exposure, environmental pollution, and tobacco and alcohol use on the incidence of CHD. However, these studies have been done in a siloed manner, with few examining the interplay between multiple environmental exposures. Here, we broadly and qualitatively review the current literature on maternal and paternal prenatal exposures and their association with CHD. We propose using the framework of the emerging field of the exposome, the environmental complement to the genome, to review all internal and external prenatal environmental exposures and identify potentiating or alleviating synergy between exposures. Finally, we propose mechanistic pathways through which susceptibility to development of CHD may be induced via the totality of prenatal environmental exposures, including the interplay between placental and cardiac development and the internal vasculature and placental morphology in early stages of pregnancy.
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Adane F, Afework M, Seyoum G, Gebrie A. Prevalence and associated factors of birth defects among newborns in sub-Saharan African countries: a systematic review and meta-analysis. Pan Afr Med J 2020; 36:19. [PMID: 32774596 PMCID: PMC7388615 DOI: 10.11604/pamj.2020.36.19.19411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/20/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Birth defects are the most serious causes of infant mortality and disability in sub-Saharan African countries with variable magnitude. Hence, this study was aimed to determine the pooled prevalence of birth defects and its associated risk factors among newborn infants in sub-Saharan African countries. Methods A total of 43 eligible studies were identified through literature search from Medline (PubMed), EMBASE, HINARI, Google scholar, Science Direct, Cochrane Library and other sources. Extracted data were analyzed using STATA 15.0 statistical software. A random effect meta-analysis model was used. Results Twenty-five studies in 9 countries showed that the pooled prevalence of birth defects was 20.40 per 1,000 births (95% CI: 17.04, 23.77). In the sub-group analysis, the highest prevalence was observed in southern Africa region with a prevalence of 43 per 1000 (95% CI: 14.89, 71.10). The most prevalent types of birth defects were musculo-skeletal system defects with a pooled prevalence of 3.90 per 1000 (95% CI: 3.11, 4.70) while the least was Down syndrome 0.62 per 1000 (95% CI: 0.40, 0.84). Lack of folic acid supplementation (95% CI: 1.95, 7.88), presence of chronic disease (95% CI: 2.00, 6.07) and intake of drugs (95% CI: 3.88, 14.66) during pregnancy were significantly associated with the birth defects. Conclusion The prevalence of birth defects is relatively high with high degree of regional variabilities. The most common types of birth defects were musculoskeletal defects. Lack of folic acid supplementation, presence of chronic disease and intake of drugs during pregnancy were significantly associated with birth defects.
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Affiliation(s)
- Fentahun Adane
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Seyoum
- Department of Anatomy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Nzelu D, Dumitrascu-Biris D, Kay P, Nicolaides KH, Kametas NA. Severe hypertension, preeclampsia and small for gestational age in women with chronic hypertension diagnosed before and during pregnancy. Pregnancy Hypertens 2018; 14:200-204. [PMID: 30527112 DOI: 10.1016/j.preghy.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/27/2018] [Accepted: 10/13/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare rates of severe hypertension (SH), preeclampsia (PE) birth of small for gestational age (SGA) neonates between women with chronic hypertension (CH) diagnosed during the first trimester of pregnancy and those with pre-pregnancy CH. STUDY DESIGN Prospective cohort study of women with CH and singleton pregnancies referred to an Antenatal Hypertension Clinic at 8-14 weeks' gestation. At presentation the patients were subdivided into four groups based on blood pressure (BP) control. Group 1 included women without a preceding history of CH presenting with BP of ≥140/90 mmHg (n = 86). Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90 mmHg without antihypertensive medication (n = 200), in group 3 the BP was <140/90 mmHg with antihypertensive medication (n = 231) and in group 4 the BP was ≥140/90 mmHg despite antihypertensive medication (n = 173). MAIN OUTCOME MEASURES PE, SH (BP ≥ 160/110 mmHg), SGA (birthweight < 10th percentile). RESULTS In group 1, the rate of SH (15.1%), was similar to that in group 2 (10.5%) and group 3 (23.8%) but significantly lower than in group 4 (52.6%). In group 1, the rate of PE (12.8%) and SGA <10th centile (18.6%) were similar to those in group 2 (16.5% and 21.0%) and significantly lower than in group 3 (26.0 and 30.7%) and group 4 (26.6% and 31.8). CONCLUSION In women diagnosed with CH in the first trimester of pregnancy, the rates of SH, PE and SGA are similar to those with pre-pregnancy CH who present with BP below 140/90 without the need for antihypertensive medication.
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Affiliation(s)
- Diane Nzelu
- Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Dan Dumitrascu-Biris
- Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Polly Kay
- Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Nikos A Kametas
- Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK; Harris Birthright Research Centre for Fetal Medicine, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
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Nzelu D, Dumitrascu-Biris D, Nicolaides KH, Kametas NA. Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia, and small for gestational age. Am J Obstet Gynecol 2018; 218:337.e1-337.e7. [PMID: 29305253 DOI: 10.1016/j.ajog.2017.12.235] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/09/2017] [Accepted: 12/21/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND There is extensive evidence that prepregnancy chronic hypertension is associated with a high risk of development of severe hypertension and preeclampsia and birth of small-for-gestational-age neonates. However, previous studies have not reported whether antihypertensive use, blood pressure control, or normalization of blood pressure during early pregnancy influences the rates of these pregnancy complications. OBJECTIVE The purpose of this study was to stratify women with prepregnancy chronic hypertension according to the use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first trimester of pregnancy and to examine the rates of severe hypertension, preeclampsia, and birth of small-for-gestational-age neonates according to such stratification. STUDY DESIGN We conducted a prospective study of 586 women with prepregnancy chronic hypertension, in the absence of renal or liver disease, that was booked at a dedicated clinic for the management of hypertension in pregnancy. The patients had singleton pregnancies and were subdivided according to findings in their first visit: group 1 (n=199), blood pressure <140/90 mm Hg without antihypertensive medication; group 2 (n=220), blood pressure <140/90 mm Hg with antihypertensive medication; and group 3 (n=167), systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, despite antihypertensive medication. In the subsequent management of these pregnancies, our policy was to maintain the blood pressure at 130-140/80-90 mm Hg with the use of antihypertensive medication; antihypertensive drugs were stopped if the blood pressure was persistently <130/80 mm Hg. The outcome measures were severe hypertension (systolic blood pressure ≥160 mm Hg and/or diastolic blood pressure ≥110 mm Hg), preterm and term preeclampsia (in addition to hypertension at least 1 of renal involvement, liver impairment, neurologic complications, or thrombocytopenia), and birth of small-for-gestational-age neonates (birthweight <5th percentile for gestational age). The incidence of these complications was compared in the 3 strata. RESULTS The median gestational age at presentation was 10.0 weeks (interquartile range, 9.1-11.0 weeks). In groups 2 and 3, compared with group 1, there was a significantly higher body mass index, incidence of black racial origin, and history of preeclampsia in a previous pregnancy. There was a significant increase from group 1 to group 3 in the incidence of severe hypertension (10.6%, 22.2%, and 52.1%), preterm preeclampsia with onset at <37 weeks of gestation (7.0%, 15.9%, and 20.4%), and small for gestational age (13.1%, 17.7%, and 21.1%), but not term preeclampsia with onset at ≥37 weeks of gestation (9.5%, 9.1%, and 6.6%). CONCLUSIONS In women with prepregnancy chronic hypertension, the rates of development of severe hypertension, preterm preeclampsia, and small for gestational age are related to the use of antihypertensive medications and the level of blood pressure control at the first hospital visit during the first trimester of pregnancy.
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Affiliation(s)
- Diane Nzelu
- Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Dan Dumitrascu-Biris
- Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Kypros H Nicolaides
- Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Nikos A Kametas
- Antenatal Hypertension Clinic, Fetal Medicine Research Institute, King's College Hospital, London, UK.
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Risk of Miscarriage in Women Receiving Antidepressants in Early Pregnancy, Correcting for Induced Abortions. Epidemiology 2018; 27:538-46. [PMID: 27031036 DOI: 10.1097/ede.0000000000000484] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Earlier studies on the association between antidepressant use and miscarriage have obtained conflicting results after accounting for the role of depression, and none have taken into account the high risk of induced abortions in women using antidepressants. METHODS We identified 41,964 pregnant women delivering between 1998 and 2002 using Quebec's health administration databases. We compared women prescribed antidepressants in the first trimester and with a recorded diagnosis of depression before pregnancy to (1) women with neither antidepressant use nor a depression diagnosis before or during pregnancy; (2) women with a depression diagnosis before pregnancy, but no antidepressants prescribed in the first trimester; and (3) women prescribed hypothyroid medication in the first trimester, but not antidepressants. We used log binomial regression to assess the adjusted relative risk of miscarriage, corrected for induced abortion risk. RESULTS The miscarriage risk uncorrected for induced abortions was 16%, 10%, and 9% for depressed women exposed to antidepressants; unexposed depressed women; and unexposed, nondepressed women, respectively. These decreased to 11%, 8%, and 7% after correction for induced abortions. In multivariable analysis, the corrected risk of miscarriage relative to unexposed, nondepressed women was 1.3 (1.1-1.5) for antidepressant-exposed women and 1.1 (1.0-1.2) for unexposed depressed women. The miscarriage relative risk for antidepressant users compared with unexposed depressed women was thus 1.2 (1.0-1.4). CONCLUSIONS Antidepressant use in the first trimester is associated with an increased risk of miscarriage when compared with either nondepressed or depressed unexposed women, even after accounting for induced abortions.
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Davies MJ, Rumbold AR, Marino JL, Willson K, Giles LC, Whitrow MJ, Scheil W, Moran LJ, Thompson JG, Lane M, Moore VM. Maternal factors and the risk of birth defects after IVF and ICSI: a whole of population cohort study. BJOG 2016; 124:1537-1544. [DOI: 10.1111/1471-0528.14365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- MJ Davies
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - AR Rumbold
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - JL Marino
- Department of Obstetrics and Gynaecology Royal Women's Hospital The University of Melbourne Parkville Vic. Australia
| | - K Willson
- School of Public Health The University of Adelaide Adelaide SA Australia
| | - LC Giles
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
- School of Public Health The University of Adelaide Adelaide SA Australia
| | - MJ Whitrow
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
- School of Public Health The University of Adelaide Adelaide SA Australia
| | - W Scheil
- Pregnancy Outcome Unit SA Health Government of South Australia Adelaide SA Australia
| | - LJ Moran
- School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
| | - JG Thompson
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - M Lane
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
| | - VM Moore
- Robinson Research Institute The University of Adelaide Adelaide SA Australia
- School of Public Health The University of Adelaide Adelaide SA Australia
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Tarín JJ, García-Pérez MA, Cano A. Obstetric and offspring risks of women's morbid conditions linked to prior anticancer treatments. Reprod Biol Endocrinol 2016; 14:37. [PMID: 27386839 PMCID: PMC4936115 DOI: 10.1186/s12958-016-0169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/16/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Literature shows the effects of type of cancer and/or anticancer treatment on live birth percentages and/or pregnancy and neonatal complications in female cancer survivors. However, studies analyzing the obstetric and offspring risks of the morbid conditions associated with previous anti-cancer treatments are missing. The present review aims to uncover these risks. METHODS A literature search based on publications up to March 2016 identified by PubMed and references cited in relevant articles. RESULTS The morbid conditions associated with prior anticancer treatments including chemotherapy, radiotherapy, surgery, and/or hematopoietic stem-cell transplant may induce not only obstetric and neonatal complications but also long-term effects on offspring. Whereas some risks are predominantly evidenced in untreated women others are observed in both treated and untreated women. These risks may be superimposed on those induced by the current women's trend in Western societies to postpone maternity. CONCLUSIONS Medical professionals should be aware and inform female cancer survivors wishing to have a child not only of the short- and long-term risks to themselves and their prospective offspring of previous anticancer treatments, fertility-preservation technologies, and pregnancy itself, but also of those risks linked to the morbid conditions induced by prior anticancer treatments. Once female cancer survivors wishing to have a child have been properly informed about the risks of reproduction, they will be best placed to make decisions of whether or not to have a biological or donor-conceived child. In addition, when medical professionals be aware of these risks, they will be also best placed to provide appropriate treatments before/during pregnancy in order to prevent or alleviate the impact of these morbid conditions on maternal and offspring health.
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Affiliation(s)
- Juan J. Tarín
- Department of Cellular Biology, Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100 Spain
| | - Miguel A. García-Pérez
- Department of Genetics, Faculty of Biological Sciences, University of Valencia, Burjassot, Valencia, 46100 Spain
- Research Unit-INCLIVA, Hospital Clínico de Valencia, Valencia, 46010 Spain
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, Valencia, 46010 Spain
- Service of Obstetrics and Gynecology, University Clinic Hospital, Valencia, 46010 Spain
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Ramakrishnan A, Lee LJ, Mitchell LE, Agopian AJ. Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis. Pediatr Cardiol 2015; 36:1442-51. [PMID: 25951814 PMCID: PMC4573362 DOI: 10.1007/s00246-015-1182-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
Maternal hypertension is common during pregnancy, and multiple studies have reported on an association between maternal hypertension and congenital heart defects (CHDs) in offspring; however, there is variability in the quality of these studies. A systematic review and meta-analysis was conducted on the associations between untreated and treated maternal hypertension and the risk of CHDs, evaluating CHDs overall as well as specific CHD subtypes. A systematic search of peer-reviewed articles published before August 2013 identified 16 studies evaluating the associations between untreated and treated maternal hypertension and CHDs. Summary relative risk (RR) estimates were calculated using fixed-effects models and random-effects models. Significant associations were observed between maternal hypertension and overall CHDs, for both treated [RR 2.0; 95 % confidence interval (CI) 1.5, 2.7] and untreated (RR 1.4; 95 % CI 1.2, 1.7) hypertension, as well as for overall hypertension regardless of treatment status (RR 1.8; 95 % CI 1.5, 2.2). The magnitude of effect was similar for the majority of CHD subtypes evaluated. The effects were also similar among women with hypertension who used one of multiple specific hypertension medications. There was no evidence of publication bias, and our results were robust to several factors considered in sensitivity analyses (e.g., source of exposure data, adjustment for potential confounders, and study design). Maternal hypertension was associated with CHDs. By understanding the specific mechanisms involved, appropriate strategies may be developed to reduce this risk, in order to prevent CHDs.
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Affiliation(s)
- Anushuya Ramakrishnan
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX, USA
| | - Laura J. Lee
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX, USA
| | - Laura E. Mitchell
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX, USA
| | - A. J. Agopian
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, 1200 Herman Pressler, Houston, TX, USA
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Benzon S, Zekić Tomaš S, Benzon Z, Vulić M, Kuzmić Prusac I. Involvement of T lymphocytes in the placentae with villitis of unknown etiology from pregnancies complicated with preeclampsia. J Matern Fetal Neonatal Med 2015; 29:1055-60. [PMID: 25812675 DOI: 10.3109/14767058.2015.1032239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the study was to compare immunohistochemical expression of different T type lymphocytes in foci of villitis of placentae with villitis of unknown etiology (VUE) without and with preeclampsia (PE). METHODS Fifty-four placentae were collected from women who had VUE with (N = 27) and without (N = 27) PE. Immunohistochemistry for types of T lymphocytes was performed on formalin fixed and paraffin-embedded sections by use of the CD3, CD4, FOXP3, CD25, CD8 and CD68 antibodies. All data analyses were done by R Development Core Team. RESULTS There was higher immunohistochemical CD4 positive T lymphocyte count and CD4 positive/CD8 positive ratio in placentae with VUE complicated with PE compared to control group. CONCLUSION The higher immunohistochemical CD4 positive T lymphocyte count and CD4 positive/CD8 positive ratio in placentae with VUE complicated with PE could point to their role in ethiopathogenesis of PE.
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Affiliation(s)
- Sandra Benzon
- a Department of Gynecology and Obstetrics , University Hospital Split, School of Medicine, University of Split , Split , Croatia .,b School of Medicine, University of Split , Split , Croatia , and
| | - Sandra Zekić Tomaš
- b School of Medicine, University of Split , Split , Croatia , and.,c Institute for Pathology, University Hospital Split , Split , Croatia
| | - Zdeslav Benzon
- a Department of Gynecology and Obstetrics , University Hospital Split, School of Medicine, University of Split , Split , Croatia .,b School of Medicine, University of Split , Split , Croatia , and
| | - Marko Vulić
- a Department of Gynecology and Obstetrics , University Hospital Split, School of Medicine, University of Split , Split , Croatia .,b School of Medicine, University of Split , Split , Croatia , and
| | - Ivana Kuzmić Prusac
- b School of Medicine, University of Split , Split , Croatia , and.,c Institute for Pathology, University Hospital Split , Split , Croatia
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Kishimba RS, Mpembeni R, Mghamba J. Factors associated with major structural birth defects among newborns delivered at Muhimbili National Hospital and Municipal Hospitals in Dar Es Salaam, Tanzania 2011 - 2012. Pan Afr Med J 2015; 20:153. [PMID: 26525082 PMCID: PMC4613840 DOI: 10.11604/pamj.2015.20.153.4492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 02/03/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Ninety-four percent of all birth defects and 95% of deaths due to the birth defects occur in low and middle income countries, Tanzania among them. In Tanzania there are currently limited birth defects prevention strategies in place due to limited information on factors associated with the occurrence of birth defects. Methods We conducted a case control study that included newborns born from October, 2011 through February, 2012 at 4 participating hospitals. A case was defined as any newborn of a Dar es salaam resident with a neural tube defect, orofacial clefts, limb reduction defects or musculo-skeletal defects (SBD) born during the study period. A control was defined as the next three newborns (delivered after the case) without birth defects. Univariate, bivariate and multivariate analysis were done using Epi Info version 3.5.1. Results A total of 400 newborns participated in the study, 100 cases and 300 controls. Factors associated with higher odds of a SBD included maternal fever (adjusted odds ratio (AOR) = 1.99; 95% confidence interval (CI): 1.14-3.52), maternal hypertension (AOR = 3.99; 95% CI: 1.67-9.54), and low birth weight (AOR = 3.48; 95% CI: 1.77-6.85). Antimalarial use during pregnancy was protective (AOR = 0.48; 95% CI: 0.28-0.84). Folic acid supplementation was protective only in bivariate analysis (OR = 0.56; 95% CI: 0.32-0.96). Conclusion Maternal fever, hypertension, and low birth weight are associated with higher odds of SBD. Antimalarial use during pregnancy was associated with lower odds of SBD. Early screening of pregnant mothers for hypertension and other causes of low birth weight may reduce SBD in Dar Es Salaam.
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Affiliation(s)
- Rogath Saika Kishimba
- Field Epidemiology and Laboratory Training Programme (FELTP), Tanzania ; Ministry of Health and Social Welfare, Tanzania
| | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania
| | - Janneth Mghamba
- Field Epidemiology and Laboratory Training Programme (FELTP), Tanzania ; Ministry of Health and Social Welfare, Tanzania
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Csáky-Szunyogh M, Vereczkey A, Gerencsér B, Czeizel AE. Maternal hypertension with nifedipine treatment associated with a higher risk for right-sided obstructive defects of the heart: a population-based case-control study. HEART ASIA 2014; 6:3-7. [PMID: 27326152 DOI: 10.1136/heartasia-2013-010331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 12/25/2013] [Accepted: 01/06/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To establish possible aetiological factors contributing to congenital heart defects (CHD) overall and separately for different types of CHD, as causes are unknown for the vast majority of patients. DESIGN To estimate a possible association with maternal diseases and related drug treatments as exposures in the mothers of cases with right-sided obstructive defects of the heart (RSODH). SETTING A large population-based Hungarian Case-Control Surveillance of Congenital Abnormalities data set. PATIENTS Newborn infants with four types of RSODH based on autopsy or surgical records. INTERVENTIONS Comparison of 200 live-born cases with RSODH including 72 (36.0%) with pulmonary valve stenosis, 13 (6.5%) with tricuspid atresia/stenosis, 7 (3.5%) with Ebstein's anomaly and 108 (54.0%) with pulmonary atresia, with 304 matched controls and 38 151 population controls without any defects. MAIN OUTCOME MEASURES Risk of any RSODH and risk of each type of RSODH. RESULTS High blood pressure, particularly chronic hypertension with nifedipine treatment, was associated with a risk for RSODH (OR 7.03, 95% CI 3.13 to 13.84). High doses of folic acid reduced the birth prevalence of pulmonary atresia (OR 0.29, 95% CI 0.16 to 0.53). CONCLUSIONS The multifactorial threshold model provides the best explanation for the origins of RSODH. Genetic predisposition may be triggered by maternal hypertension with nifedipine treatment, while the risk for pulmonary atresia is reduced by high doses of folic acid in early pregnancy.
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Affiliation(s)
- Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormality Registry , National Institute for Health Development , Budapest , Hungary
| | - Attila Vereczkey
- Versys Clinics, Human Reproduction Institute , Budapest , Hungary
| | - Balázs Gerencsér
- Alfréd Rényi Institute of Mathematics, Hungarian Academy of Science , Budapest , Hungary
| | - Andrew E Czeizel
- Foundation for the Community Control of Hereditary Diseases , Budapest , Hungary
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McAteer JP, Hecht A, De Roos AJ, Goldin AB. Maternal medical and behavioral risk factors for congenital diaphragmatic hernia. J Pediatr Surg 2014; 49:34-8; discussion 38. [PMID: 24439577 DOI: 10.1016/j.jpedsurg.2013.09.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Maternal factors contributing to the etiology of congenital diaphragmatic hernia (CDH) remain unclear. We hypothesized that specific maternal medical conditions (pregestational diabetes, hypertension), and behaviors (alcohol, tobacco) would be associated with CDH. METHODS We conducted a population-based case-control study using Washington State birth certificates linked to hospital discharge records (1987-2009). We identified all infants with CDH (n=492). Controls were randomly selected among non-CDH infants. Maternal data were extracted from the birth record. Logistic regression was used to adjust for covariates. RESULTS Cases and controls were generally similar regarding demographics, although CDH infants were more likely to be male than controls (58.5% vs. 52.5%). Isolated and complex (multiple-anomaly) CDH had similar characteristics. Each of the exposures of interest was more common among case mothers than among control mothers. In univariate analysis, alcohol use, hypertension, and pregestational diabetes were each significantly associated with the outcome. After multivariate adjustment, only alcohol use (OR=3.65, p=0.01) and pregestational diabetes (OR=12.53, p=0.003) maintained significance. Results were similar for both isolated and complex CDH. CONCLUSIONS Maternal pregestational diabetes and alcohol use are significantly associated with occurrence of CDH in infants. These are important modifiable risk factors to consider with regard to efforts seeking to impact the incidence of CDH.
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Affiliation(s)
- Jarod P McAteer
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105; Department of Surgery University of Washington School of Medicine, Seattle, WA 98105.
| | - Avram Hecht
- Department of Otolaryngology University of California San Diego, San Diego, CA 92103
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health Drexel University School of Public Health, Philadelphia, PA 19102
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105; Department of Surgery University of Washington School of Medicine, Seattle, WA 98105
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Vigil-De Gracia P, Dominguez L, Solis A. Management of chronic hypertension during pregnancy with furosemide, amlodipine or aspirin: a pilot clinical trial. J Matern Fetal Neonatal Med 2013; 27:1291-4. [PMID: 24102416 DOI: 10.3109/14767058.2013.852180] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the maternal and neonatal efficacy and safety with furosemide, amlodipine or aspirin in women with mild/moderate chronic hypertension during pregnancy. METHODS A pilot clinical trial was performed in a tertiary teaching hospital in Panama. Pregnant patients with mild/moderate chronic hypertension at ≤20 weeks of gestation were invited to take part in the study. Mild/moderate chronic hypertension was defined as a pregnancy with systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-109 mmHg. Women in the furosemide group received 20 mg of furosemide oral each day, those in the amlodipine group received 5 mg of amlodipine oral each day and those in the aspirin group received 75 mg of orally-administered acetylsalicylic acid each day. RESULTS We enrolled 63 patients during the study period, 21 women were randomised to each group (aspirin, amlodipine and furosemide). We found no difference in maternal complications, pre-term births, mean birth weight or in the proportion of small for gestational age infants among treatment groups. Severe hypertension and aggregate pre-eclampsia were similar among treatment groups. CONCLUSION This pilot trial demonstrates that both furosemide and amlodipine might have the same effect during pregnancy. However, a large clinical trial is necessary to prove this.
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Affiliation(s)
- Paulino Vigil-De Gracia
- Department of Obstetrics and Gynecology, Critical Care and Maternal Fetal Unit, Caja de Seguro Social , Panama City , Panama
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Patel SS, Burns TL. Nongenetic risk factors and congenital heart defects. Pediatr Cardiol 2013; 34:1535-55. [PMID: 23963188 DOI: 10.1007/s00246-013-0775-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 11/25/2022]
Abstract
Advances have been made in identifying genetic etiologies of congenital heart defects. Through this knowledge, preventive strategies have been designed and instituted, and prospective parents are counseled regarding their risk of having an affected child. Great strides have been made in genetic variant identification, and genetic susceptibility to environmental exposures has been hypothesized as an etiology for congenital heart defects. Unfortunately, similar advances in understanding have not been made regarding strategies to prevent nongenetic risk factors. Less information is available regarding the potential adverse effect of modifiable risk factors on the fetal heart. This review summarizes the available literature on these modifiable exposures that may alter the risk for congenital heart disease. Information regarding paternal characteristics and conditions, maternal therapeutic drug exposures, parental nontherapeutic drug exposures, and parental environmental exposures are presented. Factors are presented in terms of risk for congenital heart defects as a group. These factors also are broken down by specific defect type. Although additional investigations are needed in this area, many of the discussed risk factors present an opportunity for prevention of potential disease.
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Affiliation(s)
- Sonali S Patel
- Department of Pediatrics, Division of Pediatric Cardiology, Carver College of Medicine, University of Iowa, Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Norum J, Heyd A, Hjelseth B, Svee T, Mürer FA, Erlandsen R, Vonen B. Quality of obstetric care in the sparsely populated sub-arctic area of Norway 2009-2011. BMC Pregnancy Childbirth 2013; 13:175. [PMID: 24034451 PMCID: PMC3847544 DOI: 10.1186/1471-2393-13-175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 09/11/2013] [Indexed: 12/02/2022] Open
Abstract
Background It is challenging to obtain high quality obstetric care in a sparsely populated area. In the subarctic region of Norway, significant distances, weather conditions and seasonable darkness have called for a decentralized care model. We aimed to explore the quality of this care. Methods A retrospective study employing data (2009–11) from the Medical Birth Registry of Norway was initiated. Northern Norwegian and Norwegian figures were compared. Midwife administered maternity units, departments at local and regional specialist hospitals were compared. National registry data on post-caesarean wound infection (2009–2010) was added. Quality of care was measured as rate of multiple pregnancies, caesarean section, post-caesarean wound infection, Apgar score <7, birth weight <2.5 kilos, perineal rupture, stillbirth, eclampsia, pregnancy induced diabetes and vacuum or forceps assisted delivery. There were 15,586 births in 15 delivery units. Results Multiple pregnancies were less common in northern Norway (1.3 vs. 1.7%) (P = 0.02). Less use of vacuum (6.6% vs. 8.3%) (P = 0.01) and forceps (0.9% vs 1.7%) (P < 0.01) assisted delivery was observed. There was no difference with regard to pregnancy induced diabetes, caesarean section, stillbirth, Apgar score < 7 and eclampsia. A significant difference in birth weight < 2.5 kilos (4.7% vs. 5.0%) (P < 0.04) and perineal rupture grade 3 and 4 (1.5% vs. 2.3%) (P < 0.02) were revealed. The post-caesarean wound infection rate was higher (10.5% vs. 7.4%) (P < 0.01). Conclusion Northern Norway had an obstetric care of good quality. Birth weight, multiple pregnancies and post-caesarean wound infection rates should be further elucidated.
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Affiliation(s)
- Jan Norum
- Northern Norway Regional Health Authority trust, Bodø, N-8038, Norway.
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Orbach H, Matok I, Gorodischer R, Sheiner E, Daniel S, Wiznitzer A, Koren G, Levy A. Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes. Am J Obstet Gynecol 2013; 208:301.e1-6. [PMID: 23159698 DOI: 10.1016/j.ajog.2012.11.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/01/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite high rates of hypertension in pregnancy, the effects of hypertension have not been separated appropriately from the effects of the medications that are used. We evaluated the safety of exposure to antihypertensive medications during pregnancy, while accounting for disease effects. STUDY DESIGN A population-based retrospective cohort study was performed that compared all pregnancies of women with hypertension who were either exposed or unexposed to antihypertensive medications. A computerized database of the medications that were dispensed to pregnant women from 1998-2008 was linked with computerized databases that contained maternal and infant hospitalization records from the district hospital during the same period. RESULTS During the study period, 100,029 deliveries occurred; of those, 1964 pregnant women experienced chronic hypertension, and 620 neonates (0.6%) were exposed to at least 1 antihypertensive medication (methyldopa or atenolol) during pregnancy. A higher rate of intrauterine growth restriction (7.2% vs 2.1%, respectively; adjusted odds ratio [OR], 4.37; 95% confidence interval [CI], 3.00-6.36; P < .001), small for gestational age (3% vs 1.7%, respectively; adjusted OR, 2.23; 95% CI, 1.27-3.92; P = .005), and preterm deliveries (<37 weeks, 22.9% vs 8.0%, respectively; adjusted OR, 3.69; 95% CI, 2.90-4.69; P < .001) were noted among the pregnancies of women who were exposed to antihypertensive medications during the third trimester. Importantly, a similar association was detected when we compared women with chronic hypertension who were not treated during pregnancy (n = 1074) to women who had no chronic hypertension and who were unexposed to antihypertensive medications (n = 97,820). CONCLUSION Chronic hypertension with or without treatment during pregnancy is an independent and significant risk factor for adverse perinatal outcomes such as intrauterine growth restriction, small for gestational age, and preterm delivery.
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Blais L, Kettani FZ, Forget A. Relationship between maternal asthma, its severity and control and abortion. Hum Reprod 2013; 28:908-15. [PMID: 23427230 DOI: 10.1093/humrep/det024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION Are women with asthma, and more specifically those with severe or uncontrolled asthma, at higher risk of spontaneous and induced abortions? SUMMARY ANSWER Pregnant women with asthma, notably when uncontrolled, are at higher risk of spontaneous abortion. WHAT IS KNOWN ALREADY Only one study has examined the association between asthma and spontaneous and induced abortions and revealed a modest increase in the risk of spontaneous abortions, particularly in women with more severe asthma and those with previous exacerbations, and a marginal decrease in the risk of induced abortions. STUDY DESIGN, SIZE, DURATION A cohort of pregnancies from asthmatic (n = 15,107) and non-asthmatic (n = 34,331) women was reconstructed by linking three administrative databases from Quebec (Canada), between 1992 and 2002. The cohort included 7870 spontaneous abortions, 14,596 induced abortions and 26,972 live births. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnant women with and without asthma were analyzed. Asthma was defined by at least one asthma diagnosis and one dispensed prescription for an asthma medication in the 2 years prior to or during pregnancy. Asthma severity and control were assessed using validated indexes in the year before the 20th week of pregnancy or the termination of the pregnancy. Logistic polytomous regression models were used to estimate the relationship between asthma and asthma severity and control on the risk of abortion, while adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of spontaneous and induced abortions was 15.9 and 29.5%, respectively. Maternal asthma was associated with an increased risk of a spontaneous abortion [odds ratio (OR) = 1.41; 95% confidence interval (CI): 1.33-1.49] and a decreased risk of induced abortions (OR = 0.92; 0.88-0.97). No association was observed between asthma severity and abortion, while uncontrolled asthma increased the risk of a spontaneous abortion by 26% (95% CI: 14-41%) and the risk of induced abortions by 11% (95% CI: 1-21%). LIMITATIONS, REASONS FOR CAUTION It is possible that the study results were confounded by imbalances between groups in variables that are not recorded in the databases, but that are known to be associated with spontaneous abortions, such as alcohol consumption, obesity or maternal smoking. However, we performed sensitivity analyses which revealed that these factors are unlikely to explain the observed increased risk for a spontaneous abortion. It is also possible that women with asthma are more likely to have abortions recorded in the databases, because subjects with a chronic disease tend to visit a physician more often than those without asthma. Therefore, our odds estimates for these outcomes may be overestimated when asthmatic women were compared with non-asthmatic women. A further limitation of the study is that it would have been more appropriate to measure the severity and control of asthma only during the pregnancy. WIDER IMPLICATIONS OF THE FINDINGS Our cohort is less representative of women in the upper socio-economic level. This is not a threat to internal validity, but it could limit the external validity if the impact of asthma on the risk of abortion differed according to the socio-economic status of the mother. Despite the absence of supporting data, this possibility cannot be completely excluded. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Canadian Institutes of Health Research and Genentech. L.B. received research grants from Astra-Zeneca, Pfizer, sanofi-aventis, Novartis and Merck for research projects and co-chairs the Astra-Zeneca Endowment Pharmaceutical Chair in Respiratory Health. F.Z.K and A.F. have no competing interests to declare.
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Affiliation(s)
- Lucie Blais
- Faculté de pharmacie, Université de Montréal, CP 6128, succursale Centre-ville, Montréal, QC, Canada H3C 3J7.
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