1
|
Singh M, Wambua S, Lee SI, Okoth K, Wang Z, Fayaz FFA, Eastwood KA, Nelson-Piercy C, Reynolds JA, Nirantharakumar K, Crowe F. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Med 2024; 22:94. [PMID: 38438886 PMCID: PMC10913233 DOI: 10.1186/s12916-024-03309-y] [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: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND There is a high prevalence of autoimmune conditions in women specially in the reproductive years; thus, the association with adverse pregnancy outcomes has been widely studied. However, few autoimmune conditions/adverse outcomes have been studied more than others, and this umbrella review aims to consolidate existing knowledge in this area with the aim to provide new knowledge and also identify gaps in this research area. METHODS Medline, Embase, and Cochrane databases were searched from inception to December 2023. Screening, data extraction, and quality appraisal (AMSTAR 2) were done by two independent reviewers. Data were synthesised narratively and quantitatively. Relative risks (RR)/odds ratio (OR) with 95% confidence intervals were reported. RESULTS Thirty-two reviews were included consisting of 709 primary studies. The review reported the association between 12 autoimmune conditions and 16 adverse pregnancy outcomes. Higher risk of miscarriage is reported in women with Sjögren's syndrome RR 8.85 (95% CI 3.10-25.26) and systemic lupus erythematosus (SLE) OR 4.90 (3.10-7.69). Pre-eclampsia was reported higher in women with type 1 diabetes mellitus (T1DM) OR 4.19 (3.08-5.71) and SLE OR 3.20 (2.54-4.20). Women reported higher risk of diabetes during pregnancy with inflammatory bowel disease (IBD) OR 2.96 (1.47-5.98). There was an increased risk of intrauterine growth restriction in women with systemic sclerosis OR 3.20 (2.21-4.53) and coeliac disease OR 1.71 (1.36-2.14). Preterm birth was associated with T1DM OR 4.36 (3.72-5.12) and SLE OR 2.79 (2.07-3.77). Low birth weight babies were reported in women with women with SLE or systemic sclerosis OR 5.95 (4.54-7.80) and OR 3.80 (2.16-6.56), respectively. There was a higher risk of stillbirth in women with T1DM OR 3.97 (3.44-4.58), IBD OR 1.57 (1.03-2.38), and coeliac disease OR 1.57 (1.17-2.10). T1DM in women was associated with 32% lower odds of small for gestational age baby OR 0.68 (0.56-0.83). CONCLUSIONS Pregnant women with autoimmune conditions are at a greater risk of developing adverse pregnancy outcomes. Further research is required to develop better preconception to postnatal care for women with autoimmune conditions.
Collapse
Affiliation(s)
- Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kelly-Ann Eastwood
- Centre for Public Health, University of Belfast, Belfast, Queen, BT7 1NN, UK
- Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8EG, UK
| | | | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
2
|
Bailey SC, Pack AP, Wismer G, Calderon N, Velazquez E, Batio S, Ekong A, Eggleston A, Wallia A, Wolf MS, Schauer JM, Tenfelde S, Liebovitz DM, Grobman WA. Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes. BMJ Open 2023; 13:e078282. [PMID: 37940161 PMCID: PMC10632823 DOI: 10.1136/bmjopen-2023-078282] [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: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care. METHODS AND ANALYSIS We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to 'hardwire' preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18-44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic's assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects. ETHICS AND DISSEMINATION This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04976881).
Collapse
Affiliation(s)
- Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison P Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Norma Calderon
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evelyn Velazquez
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Amisha Wallia
- Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob M Schauer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sandi Tenfelde
- Family and Community Health Department, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - David M Liebovitz
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
3
|
Racial and Ethnic Disparities in Healthcare Rating, Diabetes Self-efficacy, and Diabetes Management Among Non-pregnant Women of Childbearing Age: Does Socioeconomic Status Matter? J Racial Ethn Health Disparities 2021; 9:967-978. [PMID: 33826077 DOI: 10.1007/s40615-021-01036-1] [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: 02/08/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Patient perceptions of healthcare ratings, diabetes self-efficacy, and diabetes management play a role in diabetes-related outcomes, particularly among women of childbearing age. Guided by a modified Interaction Model of Client Health Behavior framework, the objective was to compare differences in perceptions of health care ratings, diabetes self-efficacy, and diabetes management among non-Hispanic Black, Hispanic, and non-Hispanic White women of childbearing age. METHODS The sample comprised 7 years (2012-2018) of Medical Expenditure Panel Survey data. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 691; weighted n = 932,426). Dependent variables were health care rating, diabetes self-efficacy, and diabetes care management. The key independent variable was race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White). We adjusted for sociodemographic characteristics and perceived health status using multiple linear and multivariable logistic regressions. RESULTS Non-Hispanic Black women (41.6%) self-reported their health status as fair or poor (44.9%) compared to non-Hispanic White (33.3%) and Hispanic (37.6%). In adjusted models, non-Hispanic Black women had 46% lower odds (95% CI = 0.31, 0.94) of reporting high health care ratings compared to non-Hispanic White women. Non-Hispanic Black women had 43% lower odds (95% CI = 0.35, 0.95) and Hispanic women had 47% lower odds (95% CI = 0.34, 0.80) of reporting higher levels of diabetes care management than non-Hispanic White women. CONCLUSIONS This study provides important information regarding diabetes health care ratings, self-efficacy, and self-management behaviors. Because of the increasing prevalence of diabetes among women of childbearing age, it is important to improve health care particularly for racial/ethnic minority women with diabetes.
Collapse
|
4
|
Townsend R, Sileo FG, Allotey J, Dodds J, Heazell A, Jorgensen L, Kim VB, Magee L, Mol B, Sandall J, Smith G, Thilaganathan B, von Dadelszen P, Thangaratinam S, Khalil A. Prediction of stillbirth: an umbrella review of evaluation of prognostic variables. BJOG 2020; 128:238-250. [PMID: 32931648 DOI: 10.1111/1471-0528.16510] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. OBJECTIVES To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. SEARCH STRATEGY MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. SELECTION CRITERIA We included systematic reviews of association of individual variables with stillbirth without language restriction. DATA COLLECTION AND ANALYSIS Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. RESULTS The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. CONCLUSION We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. TWEETABLE ABSTRACT Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
Collapse
Affiliation(s)
- R Townsend
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - F G Sileo
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Dodds
- Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Heazell
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - V B Kim
- The Robinson Institute, University of Adelaide, Adelaide, SA, Australia
| | - L Magee
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - B Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Vic., Australia
| | - J Sandall
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Women and Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK.,Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research (CTR), University of Cambridge, Cambridge, UK
| | - B Thilaganathan
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - P von Dadelszen
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - S Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A Khalil
- Molecular and Clinical Sciences Research Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Falqui SG, Bardanzellu F, Mecarini F, Fanos V, Neroni P. Could the E/A ratio be included in the cardiological evaluation of the offspring of diabetic mothers? A case-control study in South Sardinia. J Matern Fetal Neonatal Med 2020; 35:2741-2750. [PMID: 32757681 DOI: 10.1080/14767058.2020.1798397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Diabetes mellitus (DM) is a chronic disease widespread in the world. Sardinia represents, together with Finland, the region with the highest incidence of type 1 DM (DM1), as well as a high prevalence of gestational DM (GDM). Despite the improvement in obstetric surveillance, perinatal and long-term adverse outcomes are still frequent in the offspring of diabetic mothers. During gestations complicated by DM, fetal heart is one of the most affected organ potentially undergoing structural heart defects or several degrees of fetal myocardium hypertrophy and impaired cardiac function. AIM The aim of our study was to evaluate, through echocardiographic examination, cardiac features and performance in a South Sardinian population of newborns of diabetic mothers comparing them to a group of control subjects. CONCLUSIONS In our sample, the E/A ratio resulted a significant marker of early diastolic dysfunction in asymptomatic neonates born by diabetic mothers, even if such result should be confirmed on larger samples.
Collapse
Affiliation(s)
- Stella Giulia Falqui
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Federico Mecarini
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| | - Paola Neroni
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari. SS, Monserrato, Italy
| |
Collapse
|
6
|
Sletten J, Lund A, Ebbing C, Cornelissen G, Aßmus J, Kiserud T, Albrechtsen S, Kessler J. The fetal circadian rhythm in pregnancies complicated by pregestational diabetes is altered by maternal glycemic control and the morning cortisol concentration. Chronobiol Int 2019; 36:481-492. [PMID: 30621462 DOI: 10.1080/07420528.2018.1561460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Circadian rhythmicity is fundamental to human physiology, and is present even during fetal life in normal pregnancies. The impact of maternal endocrine disease on the fetal circadian rhythm is not well understood. The present study aimed to determine the fetal circadian rhythm in pregnancies complicated by pregestational diabetes mellitus (PGDM), compare it with a low-risk reference population, and identify the effects of maternal glycemic control and morning cortisol concentrations. Long-term fetal electrocardiogram recordings were made in 40 women with PGDM at 28 and 36 weeks of gestation. Two recordings were made in 18 of the women (45.0%) and one recording was made in 22 (55.0%). The mean fetal heart rate (fHR) and the fHR variation (root mean square of squared differences) were extracted in 1-min epochs, and circadian rhythmicity was detected by cosinor analysis. The study cohort was divided based on HbA1c levels and morning cortisol concentrations. Statistically, significant circadian rhythms in the fHR and the fHR variation were found in 45 (100%) and 44 (95.7%) of the 45 acceptable PGDM recordings, respectively. The rhythms were similar to those of the reference population. However, there was no statistically significant population-mean rhythm in the fHR among PGDM pregnancies at 36 weeks, indicating an increased interindividual variation. The group with higher HbA1c levels (>6.0%) had no significant population-mean fHR rhythm at 28 or 36 weeks, and no significant fHR-variation rhythm at 36 weeks. Similarly, the group with a lower morning cortisol concentration (≤8.8 µg/dl) had no significant population-mean fHR-variation rhythm at 28 and 36 weeks. These findings indicate that individual fetal rhythmicity is present in pregnancies complicated by PGDM. However, suboptimal maternal glycemic control and a lower maternal morning cortisol concentration are associated with a less-well-synchronized circadian system of the fetus.
Collapse
Affiliation(s)
- Julie Sletten
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Agnethe Lund
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Cathrine Ebbing
- b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Germaine Cornelissen
- c Department of Integrative Biology and Physiology, Halberg Chronobiology Center , University of Minnesota , Minneapolis , MN , USA
| | - Jörg Aßmus
- d Centre for Clinical Research , Haukeland University Hospital , Bergen , Norway
| | - Torvid Kiserud
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Susanne Albrechtsen
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| | - Jörg Kessler
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Department of Obstetrics and Gynecology , Haukeland University Hospital , Bergen , Norway
| |
Collapse
|
7
|
Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, Barzi F, McIntyre D, Lee I, Luey M, Shaw J, Brown ADH, Maple-Brown LJ. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. Diabetes Res Clin Pract 2017; 129:105-115. [PMID: 28521194 DOI: 10.1016/j.diabres.2017.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
Collapse
Affiliation(s)
- J Klein
- Royal Darwin Hospital, Darwin, Australia; Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia
| | - J A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Menzies School of Health Research, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - C Whitbread
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research, Darwin, Australia
| | - D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - I Lee
- Menzies School of Health Research, Darwin, Australia
| | - M Luey
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - J Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia
| | - L J Maple-Brown
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia.
| |
Collapse
|
8
|
Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:442-449. [PMID: 27062200 DOI: 10.1002/uog.15929] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate adverse pregnancy outcomes in singleton pregnancies diagnosed with oligohydramnios through a systematic review and meta-analysis of controlled trials. METHODS We searched electronic databases via OVID, EBSCO, Web of Science, Google Scholar and others from 1980 to 2015. Prospective and retrospective studies with a control group were included. Two authors independently reviewed the abstracts from the literature search. Inclusion criteria were: studies in English, singleton pregnancy, normal fetal anatomy, intact membranes and oligohydramnios determined by the amniotic fluid index (AFI) technique. We stratified the meta-analysis into two groups according to risk: high risk including studies of oligohydramnios with comorbid conditions (e.g. hypertension) and low risk including studies of isolated oligohydramnios. RESULTS Fifteen trials met the inclusion criteria. Nine were high-risk and six were low-risk studies, including 8067 and 27 526 women, respectively. Compared with women with normal AFI, those with isolated oligohydramnios had significantly higher rates of an infant with meconium aspiration syndrome (relative risk (RR), 2.83; 95% CI, 1.38-5.77), Cesarean delivery for fetal distress (RR, 2.16; 95% CI, 1.64-2.85) and admission to the neonatal intensive care unit (NICU) (RR, 1.71; 95% CI, 1.20-2.42). Patients with oligohydramnios and comorbidities were more likely to have an infant with low birth weight (RR, 2.35; 95% CI, 1.27-4.34). However, rates of 5-min Apgar score < 7 (RR, 1.85; 95% CI, 0.69-4.96), NICU admission (RR, 2.09; 95% CI, 0.80-5.45), meconium-stained amniotic fluid (RR, 1.32; 95% CI, 0.62-2.81) and Cesarean delivery for fetal distress (RR, 1.65; 95% CI, 0.81-3.36) were similar to those for women with normal AFI. Stillbirth rates were too low to analyze in the meta-analysis. CONCLUSIONS This review helps to delineate which adverse outcomes are increased with oligohydramnios in low-risk pregnancy (NICU admission, Cesarean delivery for fetal distress and meconium aspiration syndrome), but does not provide enough data to determine the optimal timing of delivery in such cases. Oligohydramnios in complicated pregnancy is associated with an increased risk of delivery of an infant with low birth weight, but this may be confounded by the comorbid condition. Therefore, in high-risk pregnancy, management should be dictated by the comorbid condition and not the presence of oligohydramnios. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- N Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - E Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Steelman
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
9
|
Abell SK, Boyle JA, de Courten B, Soldatos G, Wallace EM, Zoungas S, Teede HJ. Impact of type 2 diabetes, obesity and glycaemic control on pregnancy outcomes. Aust N Z J Obstet Gynaecol 2016; 57:308-314. [PMID: 27593528 DOI: 10.1111/ajo.12521] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. AIM To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index (BMI) and glycaemic control on outcomes. MATERIALS AND METHODS An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes. RESULTS Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes (P < 0.01). Their babies were born earlier (P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c ≥ 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice. CONCLUSIONS Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management.
Collapse
Affiliation(s)
- Sally K Abell
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Jacqueline A Boyle
- Refugee and Indigenous Women's Health, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Women's Services, Monash Health, Melbourne, Victoria, Australia
| | - Barbora de Courten
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.,Chronic Disease Prevention, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Euan M Wallace
- Monash Women's Maternity Services, Monash Health, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Ritchie Centre, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia.,Diabetes, Vascular Health and Ageing, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Abell SK, Boyle JA, Courten B, Knight M, Ranasinha S, Regan J, Soldatos G, Wallace EM, Zoungas S, Teede HJ. Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control. Med J Aust 2016; 205:162-7. [DOI: 10.5694/mja16.00443] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Sally K Abell
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Monash Women's Services, Monash Health, Melbourne, VIC
| | - Barbora Courten
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | | | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
| | - John Regan
- Monash Women's Services, Monash Health, Melbourne, VIC
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Euan M Wallace
- Monash Women's Services, Monash Health, Melbourne, VIC
- The Ritchie Centre, Monash University, Melbourne, VIC
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC
| |
Collapse
|
11
|
Abstract
BACKGROUND The rate of preexisting diabetes mellitus (DM) in Saudi Arabia is one of the highest in the world. The role of preconception care (PCC) is well-established as a means of improving pregnancy outcomes in DM. OBJECTIVES To assess the rate of preconception counseling, the level of PCC knowledge, and the rate of unplanned pregnancies in Saudi women with DM. MATERIALS AND METHODS A cross-sectional study was conducted among 355 Saudi women aged 18-49 years with self-reported DM. The study questionnaire contained variables about the provision of preconception counseling, knowledge of PCC facts, and the number of unplanned pregnancies after developing DM. The level of PCC knowledge was evaluated using a modified Likert scale. Statistical Package for Social Sciences 20 was used for statistical analysis. Descriptive statistics, mean and standard deviation, and percentages were calculated; t-test was used for statistical significance. RESULTS About one-third of the participants had received preconception counseling after being diagnosed with DM. Counseling on PCC for older and married participants was significantly less. Of the 355 participants, 42.8% had little or no PCC knowledge. All pregnancies that occurred after developing DM were unplanned. CONCLUSIONS The rate of preconception counseling, the level of PCC knowledge in the studied Saudi women with DM is suboptimal, and none of the pregnancies that occurred after developing DM was planned. The study highlights the need for PCC programs that target all Saudi women of child-bearing age with DM, and their families starting at the age of puberty and at diagnosis of type 2DM, to optimize women's health and improve pregnancy outcomes.
Collapse
Affiliation(s)
- Amal Y Madanat
- Diabetes Care Center, King Salman Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Eman A Sheshah
- Diabetes Care Center, King Salman Hospital, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
12
|
Abstract
Diabetic embryopathy is a theoretical enigma and a clinical challenge. Both type 1 and type 2 diabetic pregnancy carry a significant risk for fetal maldevelopment, and the precise reasons for the diabetes-induced teratogenicity are not clearly identified. The experimental work in this field has revealed a partial, however complex, answer to the teratological question, and we will review some of the latest suggestions.
Collapse
Affiliation(s)
- Ulf J. Eriksson
- CONTACT Ulf J. Eriksson Department of Medical Cell Biology, Uppsala University, Biomedical Center, PO Box 571, SE-751 23 Uppsala, Sweden
| | | |
Collapse
|
13
|
Noventa M, Quaranta M, Vitagliano A, Cinthya V, Valentini R, Campagnaro T, Marci R, Paola RD, Alviggi C, Gangemi M, Saccardi C, Nardelli GB, Gizzo S. May Underdiagnosed Nutrition Imbalances Be Responsible for a Portion of So-Called Unexplained Infertility? From Diagnosis to Potential Treatment Options. Reprod Sci 2015; 23:812-22. [PMID: 26692540 DOI: 10.1177/1933719115620496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to investigate whether women affected by unexplained infertility may have undiagnosed dietary imbalances which negatively affect fertility. Secondarily, we investigated whether varying degrees of nutritional abnormalities may benefit from different periconceptional dietary supplementations, evaluating the most effective intervention in improving pregnancy rate after in vitro fertilization (IVF). We conducted a survey on 2 cohorts of patients (group A: unexplained infertility and group B: healthy first trimester spontaneous pregnancies) with the scope of investigating and comparing their dietary status discriminating women without dietary abnormalities (cohort 1) from those with abnormalities exclusively in micronutrient intake (cohort 2) or combined abnormalities in both micronutrient and macronutrient intake and associated obesity (cohort 3). All women included in group A were offered the opportunity to receive a prescription for one of the 3 designated daily dietary supplementation schemes (subgroups A1, A2, and A3) which were to be implemented in the 3 months immediately prior to beginning IVF treatment. When compared with fertile women, patients having unexplained infertility showed significant abnormalities in dietary habits. These differences ranged from a minimal imbalance in micronutrient intake (potentially avoidable with dietary supplementation) to severe combined macronutrient and micronutrient imbalance frequently associated with obesity (partially amendable by inositol supplementation and frequently requiring long-term dietary reeducation before establishment of fertility). Nutritional investigation and treatment may explain and resolve a portion of cases of unexplained infertility, improving the outcome of IVF treatment and, with minimal imbalances, likely restore spontaneous fertility.
Collapse
Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | | | - Vescio Cinthya
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | | | - Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Rossana Di Paola
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Carlo Alviggi
- Department of Neurosciences and Reproductive Science, University Federico II of Naples, Naples, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| |
Collapse
|
14
|
An Update on Maternal Hydration Strategies for Amniotic Fluid Improvement in Isolated Oligohydramnios and Normohydramnios: Evidence from a Systematic Review of Literature and Meta-Analysis. PLoS One 2015; 10:e0144334. [PMID: 26658482 PMCID: PMC4684238 DOI: 10.1371/journal.pone.0144334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/11/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routine-clinical-practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH-therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes. MATERIALS AND METHODS A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (<2000 versus >2000), duration of hydration therapy: (1 day, >1 day but <1 week, >1 week), type of fluid administered (isotonic versus hypotonic versus combination). RESULTS In isolated-oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonic-fluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH. CONCLUSIONS Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH-therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).
Collapse
|
15
|
Laganà AS, Triolo O, D’Amico V, Cartella SM, Sofo V, Salmeri FM, Vrtačnik Bokal E, Spina E. Management of women with epilepsy: from preconception to post-partum. Arch Gynecol Obstet 2015; 293:493-503. [DOI: 10.1007/s00404-015-3968-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 11/16/2015] [Indexed: 02/07/2023]
|
16
|
Sahin E, Terzioglu F. The Effect of Gum Chewing, Early Oral Hydration, and Early Mobilization on Intestinal Motility After Cesarean Birth. Worldviews Evid Based Nurs 2015; 12:380-8. [PMID: 26613392 DOI: 10.1111/wvn.12125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to investigate the effect of gum chewing, early oral hydration, and early mobilization after cesarean birth on intestinal sounds, passing gas, and intestinal evacuation. DESIGN Randomized controlled study. SETTING This study was conducted at the Obstetrics Service of the one Obstetrics and Child Diseases Hospital. PARTICIPANTS A total of 240 females divided into 8 groups of 30 subjects each were included within the scope of the sample. METHODS The women who underwent cesarean birth were divided into eight groups by using 2(3) factorial test levels, depending on the use of three different methods of gum chewing, early oral hydration, and early mobilization. No intervention was applied to the women in the control group. For the other seven groups, the intestinal sounds were checked every 30 minutes with a stethoscope over the abdomen and the first time of passing gas and the first evacuation time were recorded by asking the mother. The data were evaluated with numbers, mean, and percentage calculations, Student's t test, one-way variance analysis, correlation, and Tukey HSD test. RESULTS The intestinal sounds were heard earlier, gas was passed earlier, and bowel movements were earlier in the first group that received all interventions compared to the other groups (p < .05). The patient could not be discharged before 48 hours had passed after the cesarean birth according to the hospital protocol and the time of discharge was therefore not affected by interventions. LINKING EVIDENCE TO ACTION All of the three different interventions, such as gum chewing, early oral hydration, and early mobilization after cesarean birth, increase intestinal motility. The interventions are recommended during postoperative routine care to shorten hospital stay and prevent postoperative ileus.
Collapse
Affiliation(s)
- Ebru Sahin
- Associate Professor, Ordu University, School of Nursing, Department of Obstetric and Gynecology Nursing, Ordu, Turkey
| | - Fusun Terzioglu
- Professor, Hacettepe University, Faculty of Health Sciences, Department of Obstetric and Gynecology Nursing, Ankara, Turkey
| |
Collapse
|
17
|
Gizzo S, Noventa M, Quaranta M, Vitagliano A, Esposito F, Andrisani A, Venturella R, Alviggi C, Plebani M, Gangemi M, Nardelli GB, D’Antona D. The Potential Role of GnRH Agonists and Antagonists in Inducing Thyroid Physiopathological Changes During IVF. Reprod Sci 2015; 23:515-23. [DOI: 10.1177/1933719115608000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | | | - Federica Esposito
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Roberta Venturella
- Department of Obstetrics and Gynecology, University of Catanzaro, Catanzaro, Italy
| | - Carlo Alviggi
- Department of Neurosciences and Reproductive Science, University Federico II of Naples, Naples, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, Padua, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Donato D’Antona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| |
Collapse
|
18
|
Abstract
Maternal metabolism changes substantially during pregnancy, which poses numerous challenges to physicians managing pregnancy in women with diabetes. Insulin is the agent of choice for glycemic control in pregnant women with diabetes, and the insulin analogs are particularly interesting for use in pregnancy. These agents may reduce the risk of hypoglycemia and promote a more physiological glycemic profile than regular human insulin in pregnant women with type 1 (T1D), type 2 (T2D), or gestational (GDM) diabetes. However, there have been concerns regarding potential risk for crossing the placental barrier, mitogenic stimulation, teratogenicity, and embryotoxicity. Insulin lispro protamine suspension (ILPS), an intermediate- to long-acting insulin, has a stable and predictable pharmacological profile, and appears to have a favorable time–action profile and produce desirable basal and postprandial glycemic control. As the binding of insulin lispro is unaffected by the protamine molecule, ILPS is likely to have the same mitogenic and immunogenic potential as insulin lispro. Insulin lispro produces similar outcomes to regular insulin in pregnant women with T1D, T2D, or GDM, does not cross the placental barrier, and is considered a useful treatment option for pregnant women with diabetes. Clinical data support the usefulness of ILPS for basal insulin coverage in non-pregnant patients with T1D or T2D, and suggest that the optimal regimen, in terms of balance between efficacy and hypoglycemic risk, is a once-daily injection, especially in patients with T2D. Available data concerning use of ILPS in pregnant women are currently derived from retrospective analyses that involved, in total, >1200 pregnant women. These analyses suggest that ILPS is at least as safe and effective as neutral protamine Hagedorn insulin. Thus, available experimental and clinical data suggest that ILPS once daily is a safe and effective option for the management of diabetes in pregnant women. Funding: Eli Lilly and Company.
Collapse
|
19
|
GIZZO SALVATORE, ANDRISANI ALESSANDRA, NOVENTA MARCO, MANFÈ SERENA, OLIVA ALESSANDRA, GANGEMI MICHELE, NARDELLI GIOVANNIBATTISTA, AMBROSINI GUIDO. Recombinant LH supplementation during IVF cycles with a GnRH-antagonist in estimated poor responders: A cross-matched pilot investigation of the optimal daily dose and timing. Mol Med Rep 2015; 12:4219-4229. [PMID: 26059981 PMCID: PMC4526099 DOI: 10.3892/mmr.2015.3904] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 04/24/2015] [Indexed: 11/06/2022] Open
Abstract
Although it is widely accepted that patients, who are considered poor responders to in vitro fertilization (IVF) benefit from recombinant luteinizing hormone (rLH) supplementation during an in vitro fertilization cycle, particularly when gonadotropin‑releasing hormone (GnRH)‑antagonist (ant) treatment is used the optimal administration timing and daily dose of rLH remains to be elucidated. The aim of the present study was to investigate the optimal timing of rLH‑supplementation to improve ovarian response, embryo quality, endometrial thickness and pregnancy rate in infertile, estimated poor responders to IVF, undergoing GnRH‑ant treatment. In addition, the present study aimed to evaluate the optimal daily dose to achieve the same outcomes. A prospective‑randomized‑cross‑matched investigation was performed on 40 patients undergoing a GnRH‑ant‑treatment‑cycle The patients were randomly assigned to either group A (rLH‑75 IU/day) or group B (rLH‑150 IU/day) and further randomized into subgroup A1/B1, in which rLH was administered at recombinant follicle stimulating hormone (rFSH) administration, and subgroup A2/B2, in which rLH was administered at GnRH‑ant administration. Patients who did not become pregnant during the first cycle (35 patients), were treated a second time, cross‑matched for groups and subgroups. Improved ovarian response, embryo quality and pregnancy rate were achieved by administering rLH at 150 IU/day, starting from GnRH‑ant administration, independently from the total rLH dose administered. Improved endometrial thickness at oocyte retrieval day was achieved by administering rLH at 150 IU from the start of rFSH administration. These data led to the hypothesis that ovarian responses are affected by the timing of administration more than the total‑dose of rLH. The optimal window to administer rLH appears to be the mid‑to‑late follicular phase, despite the fact that rLH‑supplementation in the early‑follicular phase appeared to increase endometrial thickness and to enhance its morphology. Standardization of the optimal daily dose and supplementation timing of rLH may resolve the debate regarding its efficacy in increasing the number of pregnancies and neonatal survival rates.
Collapse
Affiliation(s)
- SALVATORE GIZZO
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - ALESSANDRA ANDRISANI
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - MARCO NOVENTA
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - SERENA MANFÈ
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - ALESSANDRA OLIVA
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - MICHELE GANGEMI
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - GIOVANNI BATTISTA NARDELLI
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| | - GUIDO AMBROSINI
- Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
| |
Collapse
|
20
|
Gizzo S, Noventa M, Vitagliano A, Quaranta M, Giovanni VD, Borgato S, Saccardi C, D’Antona D. Sonographic assessment of placental location: a mere notional description or an important key to improve both pregnancy and perinatal obstetrical care? A large cohort study. Int J Clin Exp Med 2015; 8:13056-13066. [PMID: 26550228 PMCID: PMC4612913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/11/2015] [Indexed: 06/05/2023]
Abstract
During a standard obstetrical sonogram, the assessment of placental location (PL) is often limited to a mere notional description without formulating any association to possible implications on pregnancy and childbirth. The aim of the study was to speculate if different sites of PL may have a role in influencing fetal presentation-(FP) at birth and if certain pregnancy-complications may be more closely associated with one rather than with another PL. We conducted an observational-prospective-cohort study on pregnant women referred to the Ob/Gyn Unit of Padua University for routine third-trimester ultrasound scan. For all eligible patients we evaluated the correlation between sites of PL and perinatal maternal/fetal outcomes. Non-cephalic presentation was found in 1.4% of anterior, 8.9% of posterior, 6.2% of fundal and 7.2% of lateral insertions. FP at the beginning of the third trimester as opposed to presentation at birth was concordant in 90.3% of anterior, 63.3% of posterior and 76.5% of lateral insertions. Considering only non-cephalic fetuses we observed a decreasing probability for spontaneous rotation in the following lies: 88% anterior-PL, 80% posterior-PL, 77% lateral-PL, and 70% fundal-PL. Patients with posterior-PL (significantly associated with previous-CS) had a significantly higher CS-rate (due to previous-CS and breech-presentation). Significant differences were found in terms of gestational-hypertension and fresh-placental-weight between different sites of PL. In conclusion our data showed that an understanding of the role that PL plays in influencing the incidence of certain maternal-fetal conditions may assist Clinicians in improving perinatal maternal/fetal outcomes.
Collapse
Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health-University of PaduaPadua, Italy
| | - Marco Noventa
- Department of Woman and Child Health-University of PaduaPadua, Italy
| | | | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of VeronaVerona, Italy
| | | | - Shara Borgato
- Department of Woman and Child Health-University of PaduaPadua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health-University of PaduaPadua, Italy
| | - Donato D’Antona
- Department of Woman and Child Health-University of PaduaPadua, Italy
| |
Collapse
|
21
|
Noventa M, Vitagliano A, Quaranta M, Borgato S, Abdulrahim B, Gizzo S. Preventive and Therapeutic Role of Dietary Inositol Supplementation in Periconceptional Period and During Pregnancy. Reprod Sci 2015; 23:278-88. [DOI: 10.1177/1933719115594018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Verona, Italy
| | - Shara Borgato
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Baydaa Abdulrahim
- Department of Obstetrics and Gynecology, NHS Trust, Northampton General Hospital, Northampton, United Kingdom
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
- Department of Obstetrics and Gynecology, NHS Trust, Northampton General Hospital, Northampton, United Kingdom
| |
Collapse
|
22
|
Gizzo S, Andrisani A, Noventa M, Quaranta M, Esposito F, Armanini D, Gangemi M, Nardelli GB, Litta P, D'Antona D, Ambrosini G. Menstrual cycle length: a surrogate measure of reproductive health capable of improving the accuracy of biochemical/sonographical ovarian reserve test in estimating the reproductive chances of women referred to ART. Reprod Biol Endocrinol 2015; 13:28. [PMID: 25884482 PMCID: PMC4396168 DOI: 10.1186/s12958-015-0024-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aim of the study was to investigate whether menstrual cycle length may be considered as a surrogate measure of reproductive health, improving the accuracy of biochemical/sonographical ovarian reserve test in estimating the reproductive chances of women referred to ART. METHODS A retrospective-observational-study in Padua' public tertiary level Centre was conducted. A total of 455 normo-ovulatory infertile women scheduled for their first fresh non-donor IVF/ICSI treatment. The mean menstrual cycle length (MCL) during the preceding 6 months was calculated by physicians on the basis of information contained in our electronic database (first day of menstrual cycle collected every month by telephonic communication by single patients). We evaluated the relations between MCL, ovarian response to stimulation protocol, oocytes fertilization ratio, ovarian sensitivity index (OSI) and pregnancy rate in different cohorts of patients according to the class of age and the estimated ovarian reserve. RESULTS In women younger than 35 years, MCL over 31 days may be associated with an increased risk of OHSS and with a good OSI. In women older than 35 years, and particularly than 40 years, MCL shortening may be considered as a marker of ovarian aging and may be associated with poor ovarian response, low OSI and reduced fertilization rate. When AMH serum value is lower than 1.1 ng/ml in patients older than 40 years, MCL may help Clinicians discriminate real from expected poor responders. Considering the pool of normoresponders, MCL was not correlated with pregnancy rate while a positive association was found with patients' age. CONCLUSIONS MCL diary is more predictive than chronological age in estimating ovarian biological age and response to COH and it is more predictive than AMH in discriminating expected from real poor responders. In women older than 35 years MCL shortening may be considered as a marker of ovarian aging while chronological age remains most accurate parameter in predicting pregnancy.
Collapse
Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Alessandra Andrisani
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Michela Quaranta
- Department of Obstetrics and Gynaecology, University of Verona, Piazzale Ludovico Scuro 10 street, 37134, Verona, Italy.
| | - Federica Esposito
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Decio Armanini
- Department of Medicine-Endocrinology, University of Padua, Giustiniani 2 street, 35128, Padua, Italy.
| | - Michele Gangemi
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Giovanni B Nardelli
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Pietro Litta
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Donato D'Antona
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| | - Guido Ambrosini
- Department of Woman and Child Health, University of Padua, Gynecologic and Obstetric Clinic, Giustiniani 3 street, 35128, Padua, Italy.
| |
Collapse
|
23
|
Gizzo S, Andrisani A, Noventa M, Di Gangi S, Quaranta M, Cosmi E, D’Antona D, Nardelli GB, Ambrosini G. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review. PLoS One 2015; 10:e0114190. [PMID: 25646621 PMCID: PMC4315586 DOI: 10.1371/journal.pone.0114190] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/05/2014] [Indexed: 02/06/2023] Open
Abstract
The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.
Collapse
Affiliation(s)
- Salvatore Gizzo
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Marco Noventa
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Stefania Di Gangi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Erich Cosmi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Donato D’Antona
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Guido Ambrosini
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| |
Collapse
|
24
|
Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:638093. [PMID: 24955365 PMCID: PMC4052104 DOI: 10.1155/2014/638093] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.
Collapse
|
25
|
An Unusual Case of Fulminant Type 1 Diabetes during the Second Trimester of Pregnancy. Case Rep Obstet Gynecol 2014; 2014:968547. [PMID: 25184062 PMCID: PMC4144077 DOI: 10.1155/2014/968547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/23/2022] Open
Abstract
Fulminant type 1 diabetes is a new subtype of rapid-onset type 1 diabetes, with pancreatic exocrine dysfunction, that usually develops during the third trimester of pregnancy. We describe a patient with fulminant type 1 diabetes onset during her second trimester, resulting in premature delivery. The 34-year-old woman, without any known risk factors for diabetes mellitus, experienced a sudden stillbirth at 24-weeks gestation. Her blood glucose level was 950 mg/dL and she was positive for urine ketone bodies. The condition met all the diagnostic criteria for fulminant type 1 diabetes, and was diagnosed as such. Although this disease is rare, its progression is rapid, and its clinical course is severe and occasionally leads to death; therefore, a full knowledge of the disease is important to facilitate an accurate diagnosis.
Collapse
|
26
|
Gizzo S, Andrisani A, Esposito F, Noventa M, Di Gangi S, Angioni S, Litta P, Gangemi M, Nardelli GB. Which luteal phase support is better for each IVF stimulation protocol to achieve the highest pregnancy rate? A superiority randomized clinical trial. Gynecol Endocrinol 2014; 30:902-8. [PMID: 25268567 DOI: 10.3109/09513590.2014.964638] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In vitro fertilization (IVF) cycles generate abnormalities in luteal-phase sex steroid concentrations and this represent an important limiting factor to achieve a good pregnancy rate. Although there are evidences about the usefulness of luteal phase support (LPS) after IVF cycles, no consensus exist about the best dose and way of progesterone (PG) administration, the advantages of estradiol (E2) supplementation and which IVF protocol could benefit from one more than other LPS scheme. Aim of the study was to assess the best LPS (low-dose PG, high-dose PG, high-dose PG and E2 supplementation) to achieve the highest clinical/ongoing pregnancy rate according to stimulation protocol, E2 at ovulation induction, endometrial thickness at pick-up and women's age. We conducted a randomized trial on 360 women undergoing IVF (180 treated by long-GnRH agonist, 90 by short-GnRH agonist and 90 by short-GnRH antagonist protocol) and stimulated by recombinant follicle-stimulating hormone alone. Our data demonstrated that high-dose PG is better than low-dose to increase both clinical and ongoing pregnancy rate. E2 supplementation are mandatory in case of short-GnRH antagonist protocol and strongly suggested in all protocols when E2max <5 nmol/l and endometrial thickness <10 mm. In long-GnRH agonist protocols, as well as in patients >35 years, the real advantages of E2 supplementation remain debatable and require further confirmation.
Collapse
Affiliation(s)
- Salvatore Gizzo
- a Department of Woman and Child Health, University of Padua Padova Italy
| | | | - Federica Esposito
- a Department of Woman and Child Health, University of Padua Padova Italy
| | - Marco Noventa
- a Department of Woman and Child Health, University of Padua Padova Italy
| | - Stefania Di Gangi
- a Department of Woman and Child Health, University of Padua Padova Italy
| | - Stefano Angioni
- b Department of Surgical Sciences, University of Cagliari Cagliari Italy
| | - Pietro Litta
- a Department of Woman and Child Health, University of Padua Padova Italy
| | - Michele Gangemi
- a Department of Woman and Child Health, University of Padua Padova Italy
| | | |
Collapse
|