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Bettolini L, Perantoni M, Mezzana S, Bighetti S, Bassissi S, Calzavara-Pinton P, Maione V. A case of rosacea fulminans during pregnancy. J Dtsch Dermatol Ges 2023; 21:1399-1403. [PMID: 37814397 DOI: 10.1111/ddg.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/22/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Luca Bettolini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Perantoni
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sara Mezzana
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Bighetti
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Bassissi
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Piergiacomo Calzavara-Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- Faculty of Medicine and Surgery, University of Brescia, Brescia, Italy
| | - Vincenzo Maione
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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Bettolini L, Perantoni M, Mezzana S, Bighetti S, Bassissi S, Calzavara-Pinton P, Maione V. Ein Fall von Rosazea fulminans während der Schwangerschaft. J Dtsch Dermatol Ges 2023; 21:1399-1404. [PMID: 37946639 DOI: 10.1111/ddg.15193_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/22/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Luca Bettolini
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
| | - Martina Perantoni
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
| | - Sara Mezzana
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
| | - Stefano Bighetti
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
| | - Stefania Bassissi
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
| | - Piergiacomo Calzavara-Pinton
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
- Fakultät für Medizin und Chirurgie, Universität Brescia, Brescia, Italien
| | - Vincenzo Maione
- Dermatologische Abteilung, Universität Brescia, ASST Spedali Civili di Brescia, Brescia, Italien
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Shen G, Swaminathan M, Huang I, Louden D, Feterman D, Tahir MW, Singh N. Racial disparities in pregnancy outcomes among women with rheumatic diseases: A systematic literature review. Semin Arthritis Rheum 2023; 60:152193. [PMID: 36966601 PMCID: PMC10148907 DOI: 10.1016/j.semarthrit.2023.152193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE There is a limited understanding of racial disparities in adverse pregnancy outcomes (APO) among women with rheumatic diseases. The aim of our study was to conduct a systematic literature review to evaluate the impact of race on APO in women with rheumatic diseases. METHODS Databases were searched to find reports of APO stratified by race among women with rheumatic diseases. The initial searches were conducted in July 2020 and updated in March 2021. Of the final included articles, the full text was reviewed, and data was extracted from each study using a standard data abstraction form. RESULTS Ten studies with a total of 39,720 patients met our eligibility criteria. There was a greater propensity for APO in racial minorities with rheumatic diseases compared to their White counterparts. Among women with systemic lupus erythematosus (SLE), Black women had the highest odds of APOs, particularly those with a concomitant diagnosis of antiphospholipid syndrome. Pooled meta-analysis could not be done due to multiple factors, including heterogeneity between studies. CONCLUSION Racial minorities with rheumatic diseases are more prone to APO compared to their White counterparts. One limitation is the lack of standardized criteria for APO, which prohibited direct comparison between studies. There is also a paucity of data looking at APOs among women with rheumatic diseases other than SLE. Further research is needed to explore the drivers of these racial disparities to guide targeted solutions for those in the greatest need.
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Affiliation(s)
- Gloria Shen
- University of Washington, Seattle, WA, United States
| | - Maya Swaminathan
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Irvin Huang
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Diana Louden
- University Libraries, University of Washington, Seattle, WA, United States
| | - Dominique Feterman
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Muhammad Waqas Tahir
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Namrata Singh
- Division of Rheumatology, Department of Internal Medicine, University of Washington, Seattle, WA, United States.
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Serbetci H, Kara O, Sahin D. Assessment of fetal pulmonary artery Doppler indices in pregnant women with rheumatoid arthritis and ankylosing spondylitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 37119433 DOI: 10.1002/jcu.23471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To investigate fetal pulmonary artery Doppler parameters in pregnant women with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). METHODS This case-control study included 24 pregnant women diagnosed with 13 AS and 11 RA and 48 healthy pregnant women at 29-30 weeks of gestation. The demographic and clinical features were recorded, including disease type and duration, attacks during pregnancy, and medications. Pulmonary artery acceleration time (AT), ejection time (ET), and pulmonary artery acceleration time to ejection time (PATET) ratio were measured by manual trace with spectral Doppler ultrasound. RESULTS A shorter pulmonary AT and lower PATET ratio were found in the case group (34.8 ± 2.3, p < 0.001, 0.18 ± 0.02, p < 0.001, respectively). When comparing the groups that had an attack during pregnancy and had not, there were no significant differences in the pulmonary artery indices. We also demonstrated a moderate correlation between maternal disease years and the PATET ratio (r = -0.562, p = 0.004). CONCLUSION This is the first study to evaluate the effect of RA and AS on fetal pulmonary indices. Maternal inflammation might affect pulmonary development and circulation. Fetal pulmonary Doppler indices can be used to obtain further information about neonatal respiratory morbidities in rheumatological disorders.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hakkı Serbetci
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Jølving LR, Nielsen J, Andersen ML, Friedman S, Nørgård BM. Adverse birth outcomes and early-life infections after in utero exposure to corticosteroids for inflammatory bowel disease: a Danish nationwide cohort study. BMC Med 2023; 21:140. [PMID: 37046314 PMCID: PMC10091841 DOI: 10.1186/s12916-023-02817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Systemic corticosteroids are often used to treat inflammatory bowel disease (IBD) flares during pregnancy as maintenance of disease remission is crucial to optimize pregnancy outcomes. However, there is little data regarding the effect of in utero exposure to corticosteroids on the risk of adverse birth outcomes and early-life infections in the offspring. METHODS We used the Danish national registries to establish a nationwide cohort of all singleton live births in women with IBD from 1995 to 2015. Outcomes in children exposed in utero to corticosteroids were compared to those who were not exposed. In logistic and Cox proportional hazard regression models, we adjusted the outcomes (major congenital malformation, preterm birth, small for gestational age, low 5-min Apgar score, and infections) for confounders such as body mass index, smoking, comorbidity, and additional medical IBD treatment. RESULTS After in utero exposure to corticosteroids at any time between 30 days prior to conception through the first trimester (n = 707), the adjusted hazard ratio of major congenital malformation was 1.28 (95% CI: 0.82-2.00) compared to children born to women with IBD, but not exposed to corticosteroids in utero (n = 9371). After in utero exposure to corticosteroids at any time during pregnancy (n = 1336), the adjusted odds ratios for preterm birth, small for gestational age, and low 5-min Apgar score were 2.45 (95% CI: 1.91-3.13), 1.21 (95% CI: 0.76-1.90), and 0.91 (95% CI: 0.33-2.52), respectively. Finally, the adjusted hazard ratio of overall infections in the first year of life was 1.14 (95% CI: 0.94-1.39). CONCLUSIONS This nationwide cohort study suggests that children of women with IBD exposed to corticosteroids in utero had an almost 2.5-fold increased risk of preterm birth. Use of corticosteroids is closely related to disease activity and we cannot adjust for the independent role of disease activity. It is however reassuring that the other examined birth and early-life outcomes were not statistically significantly increased.
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Affiliation(s)
- Line Riis Jølving
- Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, 5000, Odense C, Denmark.
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, 5000, Odense C, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Louise Andersen
- Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, 5000, Odense C, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sonia Friedman
- Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, 5000, Odense C, Denmark
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, Entrance 216, 5000, Odense C, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
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Hart DA. Sex Differences in Biological Systems and the Conundrum of Menopause: Potential Commonalities in Post-Menopausal Disease Mechanisms. Int J Mol Sci 2022; 23:4119. [PMID: 35456937 PMCID: PMC9026302 DOI: 10.3390/ijms23084119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Sex-specific differences in biology and physiology likely start at the time of conception and progress and mature during the pre-puberty time frame and then during the transitions accompanying puberty. These sex differences are impacted by both genetics and epigenetic alterations during the maturation process, likely for the purpose of preparing for successful reproduction. For females, later in life (~45-50) they undergo another transition leading to a loss of ovarian hormone production at menopause. The reasons for menopause are not clear, but for a subset of females, menopause is accompanied by an increased risk of a number of diseases or conditions that impact a variety of tissues. Most research has mainly focused on the target cells in each of the affected tissues rather than pursue the alternative option that there may be commonalities in the development of these post-menopausal conditions in addition to influences on specific target cells. This review will address some of the potential commonalities presented by an integration of the literature regarding tissue-specific aspects of these post-menopausal conditions and data presented by space flight/microgravity (a condition not anticipated by evolution) that could implicate a loss of a regulatory function of the microvasculature in the risk attached to the affected tissues. Thus, the loss of the integration of the paracrine relationships between endothelial cells of the microvasculature of the tissues affected in the post-menopausal environment could contribute to the risk for post-menopausal diseases/conditions. The validation of this concept could lead to new approaches for interventions to treat post-menopausal conditions, as well as provide new understanding regarding sex-specific biological regulation.
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Affiliation(s)
- David A. Hart
- Department of Surgery and Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 4N1, Canada; ; Tel.: +1-403-220-4571
- Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
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Martínez N, Villar O, Armijo O, Castellanos M, Marin Huarte N, Mareque M, Casado MÁ, Martínez-Barrio J. Economic impact of obstetric events on women of reproductive age living with psoriatic arthritis, rheumatoid arthritis, axial spondyloarthritis and psoriasis in Spain. REUMATOLOGIA CLINICA 2022; 18:105-113. [PMID: 35153033 DOI: 10.1016/j.reumae.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€,2019) were obtained from national, local databases. RESULTS During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3642 for a preconception consultation in patients with PsA, RA and axSpA and €4339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1214 for a miscarriage in the first trimester, €4419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
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Affiliation(s)
| | - Olga Villar
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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Palmsten K, Bandoli G, Vazquez-Benitez G, Chambers CD. Differences in the association between oral corticosteroids and risk of preterm birth by data source: Reconciling the results. Arthritis Care Res (Hoboken) 2022; 74:1332-1341. [PMID: 35089649 PMCID: PMC9438740 DOI: 10.1002/acr.24865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate causes of discrepancies in the association between early pregnancy oral corticosteroid (OCS) use and preterm birth (PTB) risk among women with rheumatoid arthritis (RA) in health care utilization [California Medicaid (Medi-Cal)] and prospective cohort (MotherToBaby Pregnancy Studies) data. METHODS Separately, we estimated risk ratios (RR) between OCS exposure before gestational day 140 and PTB risk in Medi-Cal (2007-2013; n=844) and MotherToBaby (2003-2014; n=528) data. We explored differences in socio-economic status, OCS dose distribution, exposure misclassification, and confounding by RA severity across the data sources. RESULTS PTB risk in women without OCS's was 17.3% in Medi-Cal and was 9.7% in MotherToBaby. There was no association between OCS and PTB in Medi-Cal (adjusted (a)RR: 1.00 (95% CI: 0.71, 1.42)), and a 1.85-fold (95% CI: 1.20, 2.84) increased PTB risk in MotherToBaby. When restricting each sample to women with a high school degree or less, PTB risk following no OCS exposure was 15.9% in Medi-Cal and 16.7% in MotherToBaby; aRR's were 1.16 (95% CI: 0.74, 1.80) in Medi-Cal and 0.81 (95% CI: 0.25, 2.64) in MotherToBaby. Cumulative OCS dose was higher in MotherToBaby (median: 684 mg) than Medi-Cal (median: 300 mg). OCS dose ≤300 mg was not associated with increased PTB risk. Exposure misclassification and confounding by RA severity were unlikely explanations of differences. DISCUSSION Higher baseline PTB risk and lower OCS dose distribution in Medi-Cal may explain the discrepancies. Studies are needed to understand the effects of autoimmune disease severity and under-treatment on PTB risk in low-income populations.
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Affiliation(s)
- Kristin Palmsten
- HealthPartners Institute, Minneapolis, MN.,Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
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Shimada H, Wakiya R, Kanenishi K, Miyatake N, Nakashima S, Mansour MMF, Kato M, Miyagi T, Sugihara K, Ushio Y, Mino R, Mizusaki M, Kameda T, Kadowaki N, Dobashi H. Preterm birth is strongly affected by the glucocorticoid dose during pregnancy in women complicated by systemic lupus erythematosus. Arthritis Res Ther 2022; 24:10. [PMID: 34980235 PMCID: PMC8722014 DOI: 10.1186/s13075-021-02699-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect of glucocorticoid doses on adverse pregnancy outcomes (APOs) in women complicated by systemic lupus erythematosus (SLE). METHODS We investigated 74 pregnancies complicated by SLE or SLE-dominant mixed connective tissue disease. The pregnancies were managed from conception to delivery in our institution. We retrospectively evaluated whether the mean glucocorticoid dose during pregnancy is associated with APOs, including preterm birth (PB), low birth weight (LBW), and light-for-date (LFD). We also calculated the cut-off dose of glucocorticoid that affected APOs. RESULTS All APOs occurred in 35 (50.7%) patients, with 14 cases of PB, 23 cases of LBW, and 10 cases of LFD. Patients with all APOs or PB had a higher dose of glucocorticoid during pregnancy than patients without all APOs or with full-term birth (P = 0.03, P < 0.01, respectively). Logistic regression analysis for all APOs and PB showed that the cut-off values of the mean glucocorticoid dose were 6.5 and 10.0 mg/day, respectively. Patients who delivered LBW or LFD newborns showed no significant difference in the glucocorticoid dose used during pregnancy than patients without LBW or LFD newborns. Patients who delivered LBW newborns were more likely to have used glucocorticoids during pregnancy (P < 0.01). CONCLUSIONS In pregnancies complicated by SLE, a relatively lower dose of glucocorticoid than previously reported is significantly related to APOs, especially PB. Therefore, the disease activity of patients with SLE should be managed with the appropriate lower dose of glucocorticoid during pregnancy.
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Affiliation(s)
- Hiromi Shimada
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan.
| | - Risa Wakiya
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shusaku Nakashima
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Mai Mahmoud Fahmy Mansour
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Mikiya Kato
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Taichi Miyagi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Koichi Sugihara
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Yusuke Ushio
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Rina Mino
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Mao Mizusaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Tomohiro Kameda
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kida-gun, Miki-cho, Kagawa, Japan
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Audio-vestibular disorders and pregnancy: A systematic review. Am J Otolaryngol 2021; 42:103136. [PMID: 34182351 DOI: 10.1016/j.amjoto.2021.103136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders. MATERIALS AND METHODS A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database. RESULTS After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo. CONCLUSIONS According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.
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Hashimoto Y, Yamana H, Michihata N, Shigemi D, Ishimaru M, Matsui H, Yasunaga H, Aihara M. Eye drops for dry eye disease during pregnancy and adverse neonatal outcomes: high-dimensional propensity score analyses. Ophthalmic Epidemiol 2021; 29:384-393. [PMID: 34459318 DOI: 10.1080/09286586.2021.1971263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We investigated the association between exposure to eye drops prescribed for dry eye disease (DED) during pregnancy and adverse neonatal outcomes. Pregnant women with DED in the JMDC Claims Database (JMDC Inc., Tokyo, Japan) between 2005 and 2020 were included. According to their prescriptions during the first trimester, the women were classified into three exposed groups (hyaluronate 0.1% alone, hyaluronate 0.3% alone, and diquafosol alone) and an unexposed group (no eye drops for DED). We compared adverse neonatal outcomes (congenital anomalies, preterm birth, low birthweight, and composite outcome of these three) between the exposed and unexposed groups. We conducted a high-dimensional propensity score analysis using many variables in the database together with known potential confounders such as chronic comorbidities. We identified 4,808 eligible women, of whom 936 (19.5%) received eye drops for DED. Congenital anomalies occurred in 7.2% and 6.0%, preterm birth in 3.1% and 4.0%, low birthweight in 7.9% and 6.0%, and composite outcome in 14.9% and 12.3% of women in the hyaluronate 0.1% alone and unexposed groups, respectively. The high-dimensional propensity score analysis showed that hyaluronate 0.1% alone was not significantly associated with increases in congenital anomalies (risk difference, 0.4% [95% confidence interval, -1.9% to 2.7%]), preterm birth (-0.6% [-2.2% to 0.9%]), low birthweight (1.8% [-0.6% to 4.1%]), or composite outcome (1.9% [-1.3% to 5.1%]). Similar results were obtained in the hyaluronate 0.3% alone and diquafosol alone groups. Use of eye drops for DED in pregnant women was not associated with adverse neonatal outcomes.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
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Treatment Patterns and Resource Utilization of Pregnant Women with Inflammatory Rheumatic Diseases or Psoriasis in Germany: A Claims Database Analysis. Rheumatol Ther 2021; 8:1565-1584. [PMID: 34427895 PMCID: PMC8572290 DOI: 10.1007/s40744-021-00347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Uncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany. METHODS Data were extracted from the BARMER sickness fund (2013-2017). Pregnant women (18-45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported. RESULTS Overall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD (before: 9.0%; during: 5.1%; after: 11.1%) and PSO (before: 3.5%; during: 1.9%; after: 2.7%). CONCLUSIONS A reduction in pharmacological treatment during pregnancy was observed for women with IRD in Germany. Many women with IRD did not return to pre-pregnancy treatments after delivery, despite signs of disease exacerbation, such as hospitalization and initiation of treatment with corticosteroids/biologics, in this period.
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Palmsten K, Bredesen D, JaKa MM, Kumar PC, Ziegenfuss JY, Kharbanda EO. "I know my body better than you:" patient focus groups to inform a decision aid on oral corticosteroid use during pregnancy. Pharmacoepidemiol Drug Saf 2021; 30:451-461. [PMID: 33314542 PMCID: PMC8686489 DOI: 10.1002/pds.5183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/07/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE There is unmet need for decision support regarding medication use during pregnancy. We aimed to inform the development of a decision aid on oral corticosteroid (OCS) use during pregnancy through focus groups. METHODS We invited patients from one health system who had a recent live birth and a condition for which OCSs may be prescribed (ie, asthma or other autoimmune disease) to participate in focus groups. We conducted conventional qualitative content analysis of verbatim transcripts of the focus groups using inductive coding. RESULTS There were 30 participants across five focus groups from May to June 2019. Women endorsed the need for patient-provider discussions about OCS use during pregnancy in which the provider shares risks and benefits and the patient makes her decision. Furthermore, women generally expressed support for patient-centered handouts about OCS use during pregnancy that the provider discusses with the patient. When considering whether to take OCSs in pregnancy, women had concerns about: the medication's impact on their baby (eg, miscarriage, birth defects, long-term effects), themselves (eg, effects on mood, sleep, weight gain), pregnancy complications (eg, preterm birth, increased blood pressure), and lactation. Women wanted information on OCSs (eg, indications, length of treatment, and cost), alternative treatments, and risks of not taking OCSs. CONCLUSIONS We established patient need for a decision aid on OCS use during pregnancy that providers can discuss with patients. To address patient concerns, the aid should at a minimum describe the medication's impact on baby, including long-term effects, maternal health, pregnancy complications, and lactation.
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Hashimoto Y, Michihata N, Yamana H, Shigemi D, Morita K, Matsui H, Yasunaga H, Aihara M. Ophthalmic Corticosteroids in Pregnant Women with Allergic Conjunctivitis and Adverse Neonatal Outcomes: Propensity Score Analyses. Am J Ophthalmol 2020; 220:91-101. [PMID: 32681904 DOI: 10.1016/j.ajo.2020.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The risks of topical ophthalmic corticosteroids during pregnancy remain unclear. This study investigated the association between exposure to topical ophthalmic corticosteroids during pregnancy and adverse neonatal outcomes. DESIGN Retrospective, cohort, database study. METHODS Pregnant women with allergic conjunctivitis in the JMDC claims database (JMDC, Tokyo, Japan) between 2005 and 2018 were included. Adverse neonatal outcomes (congenital anomalies [CA], preterm birth [PB], low birthweight [LB], and the composite of these 3 outcomes) were compared between mothers who did and did not receive topical ophthalmic corticosteroids during the first trimester. Controls were women who were not prescribed topical ophthalmic corticosteroids during the first trimester. First, propensity scores were calculated with known confounders, including disorders during pregnancy, other chronic comorbidities, and use of antihistamines. Logistic regression was then conducted with propensity score adjustment. RESULTS A total of 6,847 eligible women were identified of whom 898 (13%) had received topical ophthalmic corticosteroids. CA occurred in 5.5% and 4.9%, respectively; PB in 3.4% and 3.9%, respectively; LB in 5.9% and 7.0%, respectively; and the composite outcome in 11.7% and 11.7% of unexposed and exposed mothers, respectively. Corticosteroid eye drops were not significantly associated with an increase in CA (adjusted odds ratio [aOR], 0.78; 95% confidence interval [CI], 0.54-1.14; P = .20); PB (aOR, 1.23; 95% CI, 0.80-1.88; P = .35); LB (aOR, 1.17; 95% CI, 0.84-1.61; P = .35), or composite outcome (aOR, 0.95; 95% CI, 0.73-1.22; P = .68). CONCLUSIONS The use of topical ophthalmic corticosteroids in pregnant women with allergic conjunctivitis was not associated with any increase in CA, PB, or LB.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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15
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Martínez N, Villar O, Armijo O, Castellanos M, Marin Huarte N, Mareque M, Casado MÁ, Martínez-Barrio J. Economic Impact of Obstetric Events on Women of Reproductive Age Living With Psoriatic Arthritis, Rheumatoid Arthritis, Axial Spondyloarthritis and Psoriasis in Spain. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30230-8. [PMID: 33257237 DOI: 10.1016/j.reuma.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/30/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases. RESULTS During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
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Affiliation(s)
| | - Olga Villar
- Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | | | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, España
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Palmsten K, Bandoli G, Vazquez-Benitez G, Xi M, Johnson DL, Xu R, Chambers CD. Oral corticosteroid use during pregnancy and risk of preterm birth. Rheumatology (Oxford) 2020; 59:1262-1271. [PMID: 31566229 DOI: 10.1093/rheumatology/kez405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the associations between oral corticosteroid (OCS) dose early and late in pregnancy and preterm birth (PTB) among women with RA. METHODS Pregnant women in the MotherToBaby Pregnancy Studies (2003-2014) with RA (n = 528) were included in the primary analysis. Information was collected by phone interview and from medical records. We estimated risk ratios (RR) for OCS dose trajectories and other disease-related medications before gestational day 140 and hazard ratios (HR) for time-varying exposures after gestational day 139. RESULTS PTB risk was 15.5% overall. Compared with no OCS, PTB risk was increased in high (adjusted (a)RR: 4.77 (95% CI: 2.76, 8.26)) and medium (aRR: 1.81 (95% CI: 1.10, 2.97)) cumulative OCS dose trajectories during the first 139 gestational days. The low cumulative trajectory group was associated with an increased risk of PTB that was not statistically significant (aRR: 1.38 (95% CI: 0.79, 2.38)), and DMARDs were not associated with PTB (biologic DMARDs aHR: 1.08 (95% CI: 0.70, 1.66); non-biologic DMARDs aHR: 0.87 (95% CI: 0.55, 1.38)). OCS exposure to ⩾10 mg of prednisone equivalent daily dose after gestational day 139 vs none was associated with increased PTB rate (aHR: 2.45 (95% CI: 1.32, 4.56)), whereas <10 mg was associated with a modestly increased rate of PTB that was not statistically significant (aHR: 1.18 (95% CI: 0.60, 2.30)). CONCLUSION Higher OCS doses vs no OCS use, both earlier and later in pregnancy, were associated with an increase in PTB among women with RA.
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Affiliation(s)
- Kristin Palmsten
- HealthPartners Institute, Minneapolis, MN.,Department of Pediatrics, University of California, CA, USA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, CA, USA.,Department of Family Medicine and Public Health, University of California, CA, USA
| | | | - Min Xi
- HealthPartners Institute, Minneapolis, MN
| | | | - Ronghui Xu
- Department of Family Medicine and Public Health, University of California, CA, USA.,Department of Mathematics, University of California, CA, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California, CA, USA.,Department of Family Medicine and Public Health, University of California, CA, USA
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17
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Palmsten K, Bandoli G, Watkins J, Vazquez-Benitez G, Gilmer TP, Chambers CD. Oral Corticosteroids and Risk of Preterm Birth in the California Medicaid Program. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:375-384.e5. [PMID: 32791247 DOI: 10.1016/j.jaip.2020.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited information regarding the impact of dose and gestational timing of oral corticosteroid (OCS) use on preterm birth (PTB), especially among women with asthma. OBJECTIVES To evaluate OCS dose and timing on PTB for asthma and, as a comparison, systemic lupus erythematosus (SLE). METHODS We used health care data from California Medicaid enrollees linked to birth certificates (2007-2013), identifying women with asthma (n = 22,084) and SLE (n = 1174). We estimated risk ratios (RR) for OCS cumulative dose trajectories and other disease-related medications before gestational day 140 and hazard ratios (HR) for time-varying exposures after day 139. RESULTS For asthma, PTB risk was 14.0% for no OCS exposure and 14.3%, 16.8%, 20.5%, and 32.7% in low, medium, medium-high, and high cumulative dose trajectory groups, respectively, during the first 139 days. The high-dose group remained associated with PTB after adjustment (adjusted RR [aRR]: 1.46; 95% confidence interval [CI]: 1.00, 2.15). OCS dose after day 139 was not clearly associated with PTB, nor were controller medications. For SLE, PTB risk for no OCS exposure was 24.9%, and it was 39.1% in low- and 61.2% in high-dose trajectory groups. aRR were 1.80 (95% CI: 1.34, 2.40) for high and 1.24 (95% CI: 0.97, 1.58) for low groups. Only prednisone equivalent dose >20 mg/day after day 139 was associated with increased PTB (adjusted HR: 2.54; 95% CI: 1.60, 4.03). CONCLUSIONS For asthma, higher OCS doses early in pregnancy, but not later, were associated with increased PTB. For SLE, higher doses early and later in pregnancy were associated with PTB.
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Affiliation(s)
- Kristin Palmsten
- Research Division, HealthPartners Institute, Minneapolis, Minn; Department of Pediatrics, University of California, San Diego, Calif.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, Calif; Department of Family Medicine and Public Health, University of California, San Diego, Calif
| | - Jim Watkins
- Research and Analytic Studies Division, California Department of Health Services, Sacramento, Calif
| | | | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, Calif
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, Calif; Department of Family Medicine and Public Health, University of California, San Diego, Calif
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Xing Y, Zhang W, Zhao H, Shen Z, Liang W, Zhou J, Shi L, Chen J, Zhong X, Tang S. Multi‑organ assessment via a 9.4‑Tesla MRS evaluation of metabolites during the embryonic development of cleft palate induced by dexamethasone. Mol Med Rep 2019; 20:3326-3336. [PMID: 31432193 PMCID: PMC6755240 DOI: 10.3892/mmr.2019.10558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/19/2019] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to determine the association between maternal metabolism and development of the fetal palate, and to suggest a potential non‑invasive prenatal diagnostic method for fetal cleft palate (CP). Dexamethasone (DXM) was used to create a CP mouse model. A 9.4‑Tesla (T) magnetic resonance spectroscopy (MRS) imager was used to measure an array of metabolites in the maternal serum, placental tissue, amniotic fluid and fetal palates. Multivariate statistical analysis was performed using SIMCA‑P 14.1 software. Following DXM treatment, variations were detected in multiple metabolites in the female mice and their fetuses based on 9.4T MRS. It was indicated that in the experimental group during CP formation, leucine, valine, creatine, acetate and citrate levels in the palatal tissue were lower, whereas lactate, alanine, proline/inositol and glutamate‑containing metabolite levels were higher, compared with the levels in the control group. In placental tissue and amniotic fluid, succinate and choline levels were lower in the experimental group. The relative concentrations of cholesterol and lipids in palatal tissues from mice treated with DXM were higher compared with the concentrations in tissues from mice in the control group, with the exception of (CH2)n lipids. In the placental tissue, the alteration in cholesterol level exhibited the opposite trend. Lipid levels for the different lipid forms varied and most of them were unsaturated lipids.
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Affiliation(s)
- Yue Xing
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Wancong Zhang
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Hanxing Zhao
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Zhiwei Shen
- Department of Medical Imaging, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Weijie Liang
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Jianda Zhou
- Department of Plastic and Reconstructive Surgery, Central South University Third Xiangya Hospital, Changsha, Hunan 410013, P.R. China
| | - Lungang Shi
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Jiasheng Chen
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Xiaoping Zhong
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Shijie Tang
- Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
- Correspondence to: Dr Shijie Tang, Department of Burns and Plastic Surgery, and Cleft Lip and Palate Treatment Center, The Second Affiliated Hospital of Shantou University Medical College, 69 Dongxia Road, Shantou, Guangdong 515041, P.R. China, E-mail: ;
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Uchino E, Takada D, Mogami H, Matsubara T, Tsukamoto T, Yanagita M. Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report. CEN Case Rep 2018; 7:101-106. [PMID: 29349731 DOI: 10.1007/s13730-018-0304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Pregnancy and membranous nephropathy (MN) can occur concurrently with nephrotic syndrome. However, the pathophysiology of MN associated with pregnancy remains unclear, including the involvement of anti-M-type phospholipase A2 receptor (PLA2R) antibody, the major antigen of idiopathic MN (iMN). A treatment for the condition is also not established. We present the case of a 43-year-old pregnant female with incidental proteinuria and hypoalbuminemia. We made a diagnosis of nephrotic syndrome at 11 week gestation. Renal biopsy revealed iMN using predominant granular staining of IgG4 along the glomerular basement membrane. No secondary cause was identified. Oral glucocorticoid therapy was started from 17 week gestation and induced complete remission at 28 week gestation. A healthy infant was born at 38 week gestation. Glucocorticoid therapy was stopped postpartum without MN relapse. Anti-PLA2R antibody was later found to be positive using serum reserved from before treatment. In conclusion, we presented the case of a pregnant woman with iMN and anti-PLA2R antibodies, whose nephrotic syndrome was successfully controlled with oral glucocorticoids to reach complete remission, even after tapering off the medication. Pregnancy per se might be associated with iMN onset.
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Affiliation(s)
- Eiichiro Uchino
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Daisuke Takada
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.,Division of Nephrology and Dialysis, Department of Medicine, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ougi-machi, Kita-ku, Osaka, 530-8480, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Bandoli G, Chambers CD. Autoimmune conditions and comorbid depression in pregnancy: examining the risk of preterm birth and preeclampsia. J Perinatol 2017; 37:1082-1087. [PMID: 28749487 PMCID: PMC5630484 DOI: 10.1038/jp.2017.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether prenatal depression interacts with autoimmune conditions to further increase the risk of preterm birth or preeclampsia. STUDY DESIGN Our sample included 3034 pregnant women with rheumatoid arthritis (RA), Crohn's disease (CD) or psoriasis, or controls that were prospectively enrolled into MothertoBaby pregnancy studies. We estimated the independent and joint effects of the three autoimmune conditions and depression on the select outcomes. RESULTS We found an increased risk of preterm birth among women with RA (2.10; 95% confidence interval (CI) 1.54, 2.87), CD (1.87; 95% CI 1.25, 2.81) or psoriasis (1.88; 95% CI 1.27, 2.79) independent of depression status. RA was also independently associated with preeclampsia. Prenatal depression was not independently associated with preterm birth or preeclampsia, nor was there any synergism with autoimmune conditions. CONCLUSION If these findings are confirmed, the absence of synergism should be encouraging news to the many women with select autoimmune conditions and depression in pregnancy.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego. 7910 Frost Street, Suite 370. San Diego, CA 92123
| | - Christina D. Chambers
- Department of Pediatrics, University of California, San Diego. 7910 Frost Street, Suite 370. San Diego, CA 92123
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Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A Review of Systemic Corticosteroid Use in Pregnancy and the Risk of Select Pregnancy and Birth Outcomes. Rheum Dis Clin North Am 2017; 43:489-502. [PMID: 28711148 PMCID: PMC5604866 DOI: 10.1016/j.rdc.2017.04.013] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The evidence to date regarding corticosteroid exposure in pregnancy and select pregnancy and birth outcomes is limited and inconsistent. The authors provide a narrative review of published literature summarizing the findings for oral clefts, preterm birth, birth weight, preeclampsia, and gestational diabetes mellitus. Whenever possible, the results are limited to oral or systemic administration with a further focus on use in autoimmune disease. Although previous studies of corticosteroid exposure in pregnancy reported an increased risk of oral clefts in the offspring, more recent studies have not replicated these findings.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0828, La Jolla, CA 92093-0412, USA.
| | - Kristin Palmsten
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0828, La Jolla, CA 92093-0412, USA
| | - Chelsey J Forbess Smith
- Department of Rheumatology, University of California, San Diego, 9500 Gilman Drive, Mail Code 0656, La Jolla, CA 92093-0412, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0828, La Jolla, CA 92093-0412, USA
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Paydar K, Niakan Kalhori SR, Akbarian M, Sheikhtaheri A. A clinical decision support system for prediction of pregnancy outcome in pregnant women with systemic lupus erythematosus. Int J Med Inform 2016; 97:239-246. [PMID: 27919382 DOI: 10.1016/j.ijmedinf.2016.10.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/14/2016] [Accepted: 10/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pregnancy among systemic lupus erythematosus (SLE)-affected women is highly associated with poor obstetric outcomes. Predicting the risk of foetal outcome is essential for maximizing the success of pregnancy. This study aimed to develop a clinical decision support system (CDSS) to predict pregnancy outcomes among SLE-affected pregnant women. METHODS We performed a retrospective analysis of 149 pregnant women with SLE, who were followed at Shariati Hospital (104 pregnancies) and a specialized clinic (45 pregnancies) from 1982 to 2014. We selected significant features (p<0.10) using a binary logistic regression model performed in IBM SPSS (version 20). Afterward, we trained several artificial neural networks (multi-layer perceptron [MLP] and radial basis function [RBF]) to predict the pregnancy outcome. In order to evaluate and select the most effective network, we used the confusion matrix and the receiver operating characteristic (ROC) curve. We finally developed a CDSS based on the most accurate network. MATLAB 2013b software was applied to design the neural networks and develop the CDSS. RESULTS Initially, 45 potential variables were analysed by the binary logistic regression and 16 effective features were selected as the inputs of neural networks (P-value<0.1). The accuracy (90.9%), sensitivity (80.0%), and specificity (94.1%) of the test data for the MLP network were achieved. These measures for the RBF network were 71.4%, 53.3%, and 79.4%, respectively. Having applied a 10-fold cross-validation method, the accuracy for the networks showed 75.16% accuracy for RBF and 90.6% accuracy for MLP. Therefore, the MLP network was selected as the most accurate network for prediction of pregnancy outcome. CONCLUSION The developed CDSS based on the MLP network can help physicians to predict pregnancy outcomes in women with SLE.
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Affiliation(s)
- Khadijeh Paydar
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Mahmoud Akbarian
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Bazzani C, Andreoli L, Agosti M, Nalli C, Tincani A. Antirheumatic drugs and reproduction in women and men with chronic arthritis. RMD Open 2015; 1:e000048. [PMID: 26557371 PMCID: PMC4632146 DOI: 10.1136/rmdopen-2015-000048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/26/2015] [Accepted: 05/01/2015] [Indexed: 12/23/2022] Open
Abstract
The impact of rheumatic disease on fertility and reproduction can be remarkable. Many disease-related factors can influence patients' sexual functioning, perturb fertility and limit family planning. Antirheumatic pharmacological treatment can also have a crucial role in this field. Proper counselling, preferably provided by a multidisciplinary team of rheumatologists, obstetricians, gynaecologists and neonatologists, is recommended for patients taking antirheumatic drugs, not only at the beginning, but also during the course of treatment. Paternal exposure to antirheumatic drugs was not found to be specifically associated with congenital malformation and adverse pregnancy outcome, therefore discontinuation of these drugs while planning for conception should be weighed against the risk of disease flare. Drugs in Food and Drug Administration (FDA) category 'X' should be withdrawn in a timely manner in women who desire a pregnancy. Meanwhile, disease control can be achieved with anti-tumour necrosis factor (TNF)-α agents, which are not teratogenic drugs. If maternal disease control is permissive, they can be stopped as soon as the pregnancy test turns positive and be resumed during pregnancy in case of a flare.
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Affiliation(s)
- Chiara Bazzani
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michele Agosti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Sousou J, Smart C. Care of the Childbearing Family With Intrauterine Fetal Demise. Nurs Womens Health 2015; 19:236-46; quiz 247. [PMID: 26058906 DOI: 10.1111/1751-486x.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intrauterine fetal demise (IUFD), or stillbirth, is the death of a fetus greater than 20 weeks gestation. Several factors contribute to risk for IUFD, although in many cases the exact etiology is unknown. Nurses are a vital part of the interdisciplinary health care team caring for families with IUFD, who require timely and sensitive care to enable an uncomplicated birth and grieving process.
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Petri M, Daly RP, Pushparajah DS. Healthcare costs of pregnancy in systemic lupus erythematosus: retrospective observational analysis from a US health claims database. J Med Econ 2015; 18:967-73. [PMID: 26121160 DOI: 10.3111/13696998.2015.1066796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus is a complex autoimmune disease, most frequently affecting women of childbearing age. Women with lupus are at increased risk of pregnancy complications that are exacerbated by active disease. Despite this, their use of medications and hospital resources has not been extensively studied. METHODS Retrospective analyses of the Truven Health MarketScan database (2006-2012) aimed to quantify drug and resource utilization in pregnant women with lupus, as well as the incidence of pregnancy complications in these patients. Records of women aged 12-54 were reviewed and both lupus patients and pregnancies identified. Pregnant women with lupus were matched 1:5 with either pregnant women without lupus, or non-pregnant women with lupus. RESULTS Pregnancies with lupus were associated with increased complications when compared to pregnancies without lupus. During pregnancy, the use of immunosuppressants decreased in pregnant women with lupus, as did rheumatologist visits, while the number of women not treated with any immunosuppressant increased. Pregnant women with lupus showed higher overall treatment costs than controls. However, compared to non-pregnant women with lupus, medication costs actually dropped, possibly due to the withdrawal of medications from these patients or women becoming pregnant while disease activity was low. CONCLUSIONS The large database analyses reported here revealed that pregnancies in women with lupus were associated with a higher risk of complications, higher healthcare costs, and fewer prescribed medications, including immunosuppressants, than the control groups. The increased risk of complications and decreased immunosuppressant use suggest that patients require additional guidance from physicians to give them the best chance of experiencing a safe pregnancy. Indeed, despite the recognized role active lupus plays in increasing pregnancy complications, women with lupus had fewer rheumatology visits during pregnancy, although their visits to their general practitioner/primary healthcare provider increased, highlighting the need for team-based co-ordination care between OBGYN physicians and rheumatologists.
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Affiliation(s)
- M Petri
- a a Division of Rheumatology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - R P Daly
- b b Lupus Foundation of America , Washington , WA , USA
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Pennell LM, Galligan CL, Fish EN. Sex affects immunity. J Autoimmun 2012; 38:J282-91. [DOI: 10.1016/j.jaut.2011.11.013] [Citation(s) in RCA: 288] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 11/27/2011] [Accepted: 11/27/2011] [Indexed: 11/26/2022]
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Viktil KK, Engeland A, Furu K. Outcomes after anti-rheumatic drug use before and during pregnancy: a cohort study among 150 000 pregnant women and expectant fathers. Scand J Rheumatol 2012; 41:196-201. [DOI: 10.3109/03009742.2011.626442] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Walldorf J, Dollinger MM, Seufferlein T. [Pregnancy under immunosuppression]. Internist (Berl) 2011; 52:1178-84. [PMID: 21792600 DOI: 10.1007/s00108-011-2822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The desire to have children and pregnancy itself are important topics in the treatment of patients under immunosuppression. In this review the risks of frequently prescribed immunosuppressants are discussed regarding the safety of mother and child during and after pregnancy. Knowledge of the specific risks of immunosuppressants in pregnancy is important to balance the therapy between the patients' desire to be treated most effectively and to deliver a healthy child after an uncomplicated pregnancy. Generally, an interdisciplinary approach is advisable in treating and counseling immunosuppressed patients with a desire to have children and during pregnancy.
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Affiliation(s)
- J Walldorf
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle, Ernst-Grube-Straße 40, 06120, Halle, Deutschland.
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Kuriya B, Hernández-Díaz S, Liu J, Bermas BL, Daniel G, Solomon DH. Patterns of medication use during pregnancy in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011; 63:721-8. [DOI: 10.1002/acr.20422] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Current World Literature. Curr Opin Rheumatol 2011; 23:219-26. [DOI: 10.1097/bor.0b013e3283448536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Historically, pregnancy in women with many inflammatory rheumatic diseases was not considered safe and was discouraged. Combined care allows these pregnancies to be managed optimally, with the majority of outcomes being favorable. Disease activity at the time of conception and anti-phospholipid antibodies are responsible for most complications. Disease flares, pre-eclampsia, and thrombosis are the main maternal complications, whereas fetal loss and intrauterine growth restriction are the main fetal complications. Antirheumatic drugs used during pregnancy and lactation to control disease activity are corticosteroids, hydroxychloroquine, sulphasalzine, and azathioprine. Vaginal delivery is possible in most circumstances, with cesarean section being reserved for complications.
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