1
|
Ursache A, Lozneanu L, Bujor I, Cristofor A, Popescu I, Gireada R, Mandici CE, Găină MA, Grigore M, Matasariu DR. Epidemiology of Adverse Outcomes in Teenage Pregnancy-A Northeastern Romanian Tertiary Referral Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1226. [PMID: 36673977 PMCID: PMC9859398 DOI: 10.3390/ijerph20021226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/18/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Background: Despite being a very well-documented subject in the literature, there are still conflicting results regarding teenage pregnancies and their fetal outcomes. Methods: We conducted a retrospective, comparative cohort study that included 1082 mothers aged less than 18 years, compared to 41,998 mothers aged over 18 years, who delivered in our tertiary referral center between January 2015 and December 2021. To check for significant differences between the two groups, the chi-qquared or Fisher’s test for categorical variables were used. Results: We detected statistically significant higher rates of fetal malformation, premature birth, FGR and SGA fetal growth conditions, preeclampsia, condylomatosis and vaginal infection with E. coli in our cohort of teenagers. In this subpopulation of teenagers, the rate for premature birth at less than 32 weeks of gestation was 3.26-fold higher and 3.25-fold higher for condylomatosis, and these results referred to the cohort of adult patients (>18 years old) that gave birth in the same interval of time. Conclusions: Teenage pregnancies still remain a major health problem that burdens all countries worldwide regardless of their income. It needs solutions initially to prevent pregnancy in this young age segment and last but not least to improve both maternal and fetal outcomes.
Collapse
Affiliation(s)
- Alexandra Ursache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iasi, Romania
| | - Ludmila Lozneanu
- Department of Morpho-Functional Sciences I—Histology, Pathology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Iuliana Bujor
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Alexandra Cristofor
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Ioana Popescu
- Department of Dermatology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Roxana Gireada
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Cristina Elena Mandici
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Marcel Alexandru Găină
- Psychiatry, Department of Medicine III, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iasi, Romania
| | - Daniela Roxana Matasariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iasi, Romania
| |
Collapse
|
2
|
Linglart L, Bonnet D. Epigenetics and Congenital Heart Diseases. J Cardiovasc Dev Dis 2022; 9:185. [PMID: 35735814 PMCID: PMC9225036 DOI: 10.3390/jcdd9060185] [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: 04/22/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/22/2022] Open
Abstract
Congenital heart disease (CHD) is a frequent occurrence, with a prevalence rate of almost 1% in the general population. However, the pathophysiology of the anomalous heart development is still unclear in most patients screened. A definitive genetic origin, be it single-point mutation or larger chromosomal disruptions, only explains about 35% of identified cases. The precisely choreographed embryology of the heart relies on timed activation of developmental molecular cascades, spatially and temporally regulated through epigenetic regulation: chromatin conformation, DNA priming through methylation patterns, and spatial accessibility to transcription factors. This multi-level regulatory network is eminently susceptible to outside disruption, resulting in faulty cardiac development. Similarly, the heart is unique in its dynamic development: growth is intrinsically related to mechanical stimulation, and disruption of the intrauterine environment will have a direct impact on fetal embryology. These two converging axes offer new areas of research to characterize the cardiac epigenetic regulation and identify points of fragility in order to counteract its teratogenic consequences.
Collapse
Affiliation(s)
- Léa Linglart
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France;
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France;
- School of Medicine, Université de Paris Cité, 75006 Paris, France
| |
Collapse
|
3
|
Sussman BL, Chopra P, Poder L, Bulas DI, Burger I, Feldstein VA, Laifer-Narin SL, Oliver ER, Strachowski LM, Wang EY, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Screening for Fetal Anomaly. J Am Coll Radiol 2021; 18:S189-S198. [PMID: 33958112 DOI: 10.1016/j.jacr.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
The Appropriateness Criteria for the imaging screening of second and third trimester fetuses for anomalies are presented for fetuses that are low risk, high risk, have had soft markers detected on ultrasound, and have had major anomalies detected on ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont.
| | - Prajna Chopra
- Research Author, The University of Vermont Medical Center, Burlington, Vermont
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | - Dorothy I Bulas
- Children's National Hospital and George Washington University, Washington, District of Columbia, Chair, ACR International Outreach Committee, Director, Fetal Imaging Prenatal Pediatric Institute, Childrens National Hospital
| | | | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, American College of Obstetricians and Gynecologists
| | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York, American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Karai A, Gyurkovits Z, Nyári TA, Sári T, Németh G, Orvos H. Adverse perinatal outcome in teenage pregnancies: an analysis of a 5-year period in Southeastern Hungary. J Matern Fetal Neonatal Med 2018; 32:2376-2379. [PMID: 29409369 DOI: 10.1080/14767058.2018.1438393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine the risks of adverse perinatal outcomes of teenage mothers. MATERIAL AND METHODS A retrospective analysis was performed on teenage mothers (under 20 years of age) who delivered in the period of 2010-2014 at the Department of Obstetrics and Gynecology, University of Szeged (study group). All mothers who delivered in Hungary during the same period were studied as a control group. The following parameters were analyzed: demographic data of the mothers, maternal complications, perinatal outcome and congenital malformations of the newborns. The binominal test, Student's t-test and Poisson's regression were applied using STATA 9.0 (StataCorp, College Station, TX, USA) statistical software (p < .05 was considered to be statistically significant). RESULTS During this 5-year period, 12,845 births were recorded at the Department, of these 274 (2.1%) were teenage pregnancies with 275 newborns. The offsprings of teenage mothers had significantly lower mean birth weight (3110.2 ± 564.03 g versus 3247 g), higher rate of congenital malformations (8.0 versus 5.0%) and higher admission to neonatal intensive care unit (12.4 versus 8.0%) than the infants in the control group. CONCLUSIONS Younger maternal age was significantly associated with lower mean birth weight, higher risk of congenital malformations, and increased admission rate to neonatal intensive care unit.
Collapse
Affiliation(s)
- Adrienn Karai
- a Department of Pediatrics , University of Szeged , Szeged , Hungary
| | - Zita Gyurkovits
- b Department of Obstetrics and Gynecology , University of Szeged , Szeged , Hungary
| | - Tibor András Nyári
- c Department of Medical Physics and Informatics , University of Szeged , Szeged , Hungary
| | - Tamás Sári
- b Department of Obstetrics and Gynecology , University of Szeged , Szeged , Hungary
| | - Gábor Németh
- b Department of Obstetrics and Gynecology , University of Szeged , Szeged , Hungary
| | - Hajnalka Orvos
- b Department of Obstetrics and Gynecology , University of Szeged , Szeged , Hungary
| |
Collapse
|
5
|
Wemaux-Denis C, Garabedian C, Huc A, Cailleret O, Depoortere MH, Hammou Y, Subtil D. [Pregnancy and delivery of teenagers: Is the obstetrical prognosis worst between 13-15years old?]. ACTA ACUST UNITED AC 2017; 45:5-8. [PMID: 28238317 DOI: 10.1016/j.gofs.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the prognosis of pregnancy and delivery of 13-15years old patients compared to teenagers aged of 16-17. METHODS Single-center retrospective study of a continuous series of 13-15 teenagers followed in a public maternity between 1996 and 2012 compared to a series of patients aged of 16-17 matched on the day of the delivery (two controls for a case). RESULTS Seventy-three teens 13-15 were followed during the study period, and 146 adolescents aged 16-17 were included and matched. The two groups did not differ regarding size, weight or medical history. Younger patients were more often educated than older ones (46.6 vs 27.4%, P<0.01). The incidence of congenital malformations was high but substantially identical in the two groups (9.6 vs 11.0%, NS), as well as prematurity concerned that almost one third of patients (27.4 vs 30.1%, NS). The Caesarean section rate was low (11.0 vs 10.3%, NS). The frequency of birth weight below the 10th percentile did not differ between groups (15.1 vs 19.9%, NS). CONCLUSION Teenage girls of 13-15years old have high perinatal risk (prematurity, congenital malformation), and frequently delivery vaginally. These risks do not seem superior to those of adolescent girls aged of 16-17years old.
Collapse
Affiliation(s)
- C Wemaux-Denis
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; Service de protection maternelle et infantile, 106, rue Pierre-Legrand, 59000 Lille, France.
| | - C Garabedian
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - A Huc
- Service de protection maternelle et infantile, 106, rue Pierre-Legrand, 59000 Lille, France
| | - O Cailleret
- Service de protection maternelle et infantile hôpital Jeanne-de-Flandre, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - M-H Depoortere
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; Service de protection maternelle et infantile hôpital Jeanne-de-Flandre, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - Y Hammou
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - D Subtil
- Département obstétrique et gynécologie, hôpital Jeanne-de-Flandre, pôle Femme-Mère Nouveau-né, université Lille Nord de France, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 2694, PRES université Lille Nord de France, 59000 Lille, France
| |
Collapse
|