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Liao YJ, Fang NW, Yao CS, Chang JT, Wang HP. Neonatal outcomes in infants conceived using assisted reproductive technologies: A single medical center cohort study. Pediatr Neonatol 2024:S1875-9572(24)00016-0. [PMID: 38471993 DOI: 10.1016/j.pedneo.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND A significant rise in the use of assisted reproductive technology (ART) has been observed, but concerns about its impact on neonatal outcomes have been considered. The aim of this retrospective cohort study is to determine the association between ART and the risk of neonatal complications and congenital anomalies within a recent time period. METHODS This retrospective study enrolled infants born after 20 weeks of gestation at a tertiary hospital in Taiwan between January 2019 and December 2021. The study population was divided into two groups: (1) ART pregnancy group and (2) natural pregnancy group. Maternal and neonatal characteristics, pregnancy complications, and neonatal outcomes were compared between the two groups. Multivariate logistic regression was used to adjust for maternal characteristics, preexisting maternal conditions, pregnancy complications, delivery methods, and infant characteristics. RESULTS This study enrolled 1770 infants comprising 289 in the ART pregnancy group and 1481 in the natural pregnancy group. The ART pregnancy group showed higher rates of multiple births, preterm births, low birth weights, and longer hospitalization periods. In the stratified analyses that were conducted on singleton births, no significant difference was observed. In the case of multiple births, lower rates of preterm birth, low birth weight, and respiratory support were observed in the ART pregnancy group. After adjusting for maternal and infant characteristics, ART was not considered a significant risk factor for adverse neonatal outcomes, including mortality, complications, and congenital anomalies. CONCLUSION Although ART pregnancies were more likely to result in multiple births and furthermore adverse outcomes, ART itself was not associated with an increased risk of poor neonatal outcomes. By implementing measures to control the number of implanted embryos, ensuring appropriate prenatal screening, and providing comprehensive postnatal care, the risks associated with increased multiple pregnancies caused by ART may be reduced.
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Affiliation(s)
- Yen-Jhih Liao
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Nai-Wen Fang
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Cai-Sin Yao
- Department of Business Management, National SunYat-Sen University, No.70 Lien-hai Road, Kaohsiung, Taiwan; Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Taiwan
| | - Jenn-Tzong Chang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Ping Wang
- Division of Pediatric Neonatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Stelzl P, Kehl S, Oppelt P, Mayr A, Fleckenstein T, Maul H, Enengl S, Berger R, Rath W. Maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in cervical cerclage - a Germany-wide survey on the current practice after dissemination of the German guideline. J Perinat Med 2023:jpm-2022-0572. [PMID: 36972689 DOI: 10.1515/jpm-2022-0572] [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: 11/25/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth". METHODS 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisher's exact test was used. RESULTS The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11 (9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269). CONCLUSIONS The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based guideline recommendations and daily clinical practice.
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Affiliation(s)
- Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21 - 23, Erlangen, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21 - 23, Erlangen, Germany
| | - Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Andreas Mayr
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Medizinische Fakultät, Universität Bonn, Bonn, Germany
| | - Tobias Fleckenstein
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Medizinische Fakultät, Universität Bonn, Bonn, Germany
| | - Holger Maul
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek, Hamburg, Germany
| | - Sabine Enengl
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Richard Berger
- Marienhaus Klinikum St. Elisabeth, Klinik für Gynäkologie und Geburtshilfe, Neuwied, Germany
| | - Werner Rath
- Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Smiianov VA, Markin LB, Fartushok TV, Slavitych SR. EFFECTIVENESS OF THE MAGNESIUM APPLICATION IN OBSTETRICAL PRACTICE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:920-927. [PMID: 37326071 DOI: 10.36740/wlek202305105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: Conducting an evaluation of the effectiveness and safety of the use of magnesium in pregnant women. PATIENTS AND METHODS Materials and methods: A comprehensive examination of 60 pregnant women was conducted, of which 30 were taking a magnesium preparation in a daily dose of 2473.72 mg of magnesium citrate and 40 mg of pyridoxine hydrochloride (the main group) and 30 pregnant women who were not taking a magnesium preparation (сomparison group). The analysis of the clinical course of the first half of the pregnancy with the determination the frequency and structure of complications, blood pressure levels, indicators of ultrasound, general and biochemical blood tests, urinalysis, lipid status and carbohydrarate metabolism. RESULTS Results: The main complications of the first half of pregnancy were: threatening miscarriage, abortion in progress, early gestosis, anemia, respiratory viral infection, exacerbation of extragenital pathology, hypertension. During the analysis of carbohydrate and lipid metabolism increased atherogenic potential. Analyzing the results of ultrasound studies reliably earlier comes down the local hypertonus. CONCLUSION Сonclusions: The correction of chronic magnesium deficiency, performed by the drug magnesium has allowed to reduce cases of threat of abortion, the abortion that was started, the symptoms of early preeclampsia, anemia of pregnant women, symptoms of respiratory viral infection, reduces the number of bed-days in the case of hospitalization. The use of magnesium helped to normalize blood pressure, carbohydrate and lipid metabolism, reduces hypertonus of the myometrium.
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Yang ST, Wang PH. Preterm premature rupture of membranes (PPROM) and secondary intra-amniotic infection/inflammation. Taiwan J Obstet Gynecol 2023; 62:187-188. [PMID: 36720540 DOI: 10.1016/j.tjog.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 01/30/2023] Open
Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Female Cancer Foundation, Taipei, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC.
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Kuo SC, Chen SF, Wang PH. Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants? J Chin Med Assoc 2022; 85:1160-1161. [PMID: 36194163 DOI: 10.1097/jcma.0000000000000821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Shu-Chen Kuo
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shu-Fen Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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Lee WL, Lee FK, Wang PH. When more can lose more: Comments to the long-term use of prophylactic antibiotics for very low birth weight infant resulting in the adverse outcomes. J Chin Med Assoc 2022; 85:1107-1108. [PMID: 36250869 DOI: 10.1097/jcma.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Fa-Kung Lee
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
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Lee FK, Liu CH, Wang PH. Timing for induction of labor (IOL). Taiwan J Obstet Gynecol 2022; 61:925-926. [DOI: 10.1016/j.tjog.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
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Shen HS, Chang WC, Chen YL, Wu DL, Wen SH, Wu HC. Chinese Herbal Medicines Have Potentially Beneficial Effects on the Perinatal Outcomes of Pregnant Women. Front Pharmacol 2022; 13:831690. [PMID: 35734397 PMCID: PMC9207412 DOI: 10.3389/fphar.2022.831690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Tocolytic treatment is beneficial to pregnant women with a risk of premature labor or miscarriage. However, previous reports have shown that progestogen might not be effective and ritodrine may increase the risk of maternal vascular-related diseases. Chinese herbal products (CHP) are used as alternative therapies for pregnant women. The goal was to evaluate the efficacy of combined tocolytic therapy and CHP therapy in pregnancy outcomes for pregnant women in Taiwan.Materials and Methods: We conducted a retrospective cohort study based on the National Health Insurance Research Database. A total of 47,153 pregnant women treated with tocolytics aged 18–50 years from 2001 to 2015 were selected from two million random samples. According to the medical use of tocolytics and CHP, we divided the users into two groups: western medicine (WM) only (n = 40,961) and WM/CHP (n = 6,192) groups. A propensity score (PS)-matched cohort (6,192 pairs) was established based on baseline confounders. All participants were followed up to perinatal outcomes. Conditional logistic regression analysis was used to examine the effects of CHP use on the odds of miscarriage and preterm birth.Results: The adjusted odds ratio (OR) for premature birth in the WM/CHP group (n = 411, 6.64%) was significantly lower than in the WM group (n = 471, 7,61%) (0,86, 95% confidence interval [CI], 0.74–0.99). Further subgroup analysis based on the usage of formulae that activate blood and remove stasis or purgative formulae, the adjusted OR of preterm birth of those using these formulae was significantly lower in the WM/CHP group (n = 215, 6.32%) than that in the WM group (n = 265, 7.77%) (OR: 0.79, 95% CI: 0.65–0.96).Conclusion: We found that the combination of CHP and tocolytics can be beneficial to pregnant women in the prevention of premature birth. Further research is required to investigate causal relationships.
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Affiliation(s)
- Hsuan-Shu Shen
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Sports Medicine Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Chuan Chang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yi-Lin Chen
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Dai-Lun Wu
- Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shu-Hui Wen
- Department of Public Health, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hsien-Chang Wu
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- *Correspondence: Hsien-Chang Wu,
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