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bij de Weg JM, de Boer MA, Meijer C, Lugtenburg N, Melles M, de Vries JI, de Groot CJ. The value of a mobile educative Application additional to Standard counselling on aspirin Adherence in Pregnancy: the ASAP study, a randomised controlled trial. PEC Innov 2024; 4:100268. [PMID: 38435238 PMCID: PMC10907203 DOI: 10.1016/j.pecinn.2024.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
Objective To assess the added value of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy versus standard counselling alone. Methods Participants were randomly assigned for additional use of a mobile educative application or standard counselling alone. Main outcome measures were adherence to aspirin measured by two validated questionnaires: Simplified Medication Adherence Questionnaire (SMAQ), Believes and Behaviour Questionnaire (BBQ), and patients reported tablet intake >90%. Results A total of 174 women with an indication for aspirin during pregnancy were included. The questionnaires were filled in by 126 out of the 174 participants (72.4%). Similar results were found in the app group and the standard counselling groups for both validated questionnaires. Tablet intake >90% was seen in 88.7% and 87.5% (p = 0.834) of the app group and standard counselling group respectively. Subgroup analyses demonstrated a negative effect of BMI and a positive effect of educational level on adherence. Conclusions Our study revealed no added effect of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy. Tablet intake was equally high in both groups probably explained by our high educated population. Innovation Future studies should focus on tailored counselling on medication to pregnant women's needs including medication reminders, addressing concerns, adequate health literacy and side effects, offering rewards to further stimulate aspirin adherence in pregnancy with optimal outcome for mother and their neonate.
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Affiliation(s)
- Jeske M. bij de Weg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Marjon A. de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Cynthia Meijer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Noëlle Lugtenburg
- Delft University of Technology, Faculty of Industrial Design Engineering, Department of Human-Centered Design, Delft, Netherlands
| | - Marijke Melles
- Delft University of Technology, Faculty of Industrial Design Engineering, Department of Human-Centered Design, Delft, Netherlands
| | - Johanna I.P. de Vries
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Christianne J.M. de Groot
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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2
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Blomjous BS, de Boer MA, van Weissenbruch MM, Laan KCJ, Rispens T, Voskuyl AE, Bultink IEM. Concentrations of subcutaneously administered belimumab in human breast milk of a woman with systemic lupus erythematosus: a case report. Lupus Sci Med 2024; 11:e001167. [PMID: 38499356 PMCID: PMC10953294 DOI: 10.1136/lupus-2024-001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Birgit S Blomjous
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Mirjam M van Weissenbruch
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Emma Children's hospital Department IC Neonatology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koen C J Laan
- Department of Rheumatology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - Theo Rispens
- Amsterdam institute for Infection and Immunity, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Antibodies and Immunogenicity, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Irene E M Bultink
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
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3
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Abheiden CNH, Blomjous BS, Slaager C, Landman AJEMC, Ket JCF, Salmon JE, Buyon JP, Heymans MW, de Vries JIP, Bultink IEM, de Boer MA. Systemic lupus erythematosus is associated with an increased frequency of spontaneous preterm births: systematic review and meta-analysis. Am J Obstet Gynecol 2024:S0002-9378(24)00439-3. [PMID: 38492714 DOI: 10.1016/j.ajog.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Preterm birth is one of the most frequent complications of pregnancy in women with systemic lupus erythematosus. The high indicated preterm birth proportion due to hypertensive disorders of pregnancy and/or fetal growth restriction is well known, and preventive measures and screening for early detection are performed. The risk of spontaneous preterm birth is less well recognized. This study aimed to determine the proportions of spontaneous and indicated preterm birth in pregnancies of women with systemic lupus erythematosus. DATA SOURCES A systematic literature search using Pubmed, Embase, Web of Science, and Google Scholar was performed in June 2021. STUDY ELIGIBILITY CRITERIA Studies in pregnant women with systemic lupus erythematosus reporting spontaneous and indicated preterm birth rates were selected. Original research articles published from 1995 to June 2021 were included. METHODS Quality and risk of bias of the included studies were assessed using the Newcastle-Ottawa quality assessment scale. To estimate the pooled event rates and 95% confidence intervals, meta-analysis of single proportions with a random-effects model was performed. RESULTS We included 21 articles, containing data of 8157 pregnancies in women with systemic lupus erythematosus. On average, 31% (95% prediction interval, 0.14-0.50) of the pregnancies resulted in preterm birth, including 14% (95% prediction interval, 0.04-0.27) spontaneous and 16% (95% prediction interval, 0.03-0.35) indicated preterm birth. CONCLUSION In pregnant women with systemic lupus erythematosus, spontaneous and indicated preterm birth proportions are high. This information should be applied in (prepregnancy) counseling and management in pregnancy. The knowledge obtained by this meta-analysis paves the way for further research of associated risk factors and development of interventions to reduce spontaneous preterm birth in systemic lupus erythematosus pregnancies.
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Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Birgit S Blomjous
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Ciska Slaager
- Department of Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Anadeijda J E M C Landman
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Jill P Buyon
- NYU Grossman School of Medicine, New York University, New York, NY
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Irene E M Bultink
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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van Dijk CE, van Gils AL, van Zijl MD, Koullali B, van der Weide MC, van den Akker ES, Hermsen BJ, van Baal WM, Visser H, van Drongelen J, Vollebregt KC, Muller M, van der Made FW, Gordijn SJ, de Mooij YM, Oudijk MA, de Boer MA, Mol BW, Kazemier BM, Pajkrt E. Cervical pessary versus vaginal progesterone in women with a singleton pregnancy, a short cervix, and no history of spontaneous preterm birth at less than 34 weeks' gestation: open label, multicentre, randomised, controlled trial. BMJ 2024; 384:e077033. [PMID: 38471724 DOI: 10.1136/bmj-2023-077033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To compare the effectiveness of cervical pessary and vaginal progesterone in the prevention of adverse perinatal outcomes and preterm birth in pregnant women of singletons with no prior spontaneous preterm birth at less than 34 weeks' gestation and who have a short cervix of 35 mm or less. DESIGN Open label, multicentre, randomised, controlled trial. SETTING 20 hospitals and five obstetric ultrasound practices in the Netherlands. PARTICIPANTS Women with a healthy singleton pregnancy and an asymptomatic short cervix of 35 mm or less between 18 and 22 weeks' gestation were eligible. Exclusion criteria were prior spontaneous preterm birth at less than 34 weeks, a cerclage in situ, maternal age of younger than 18 years, major congenital abnormalities, prior participation in this trial, vaginal blood loss, contractions, cervical length of less than 2 mm or cervical dilatation of 3 cm or more. Sample size was set at 628 participants. INTERVENTIONS 1:1 randomisation to an Arabin cervical pessary or vaginal progesterone 200 mg daily up to 36 weeks' of gestation or earlier in case of ruptured membranes, signs of infection, or preterm labour besides routine obstetric care. MAIN OUTCOME MEASURES Primary outcome was a composite adverse perinatal outcome. Secondary outcomes were rates of (spontaneous) preterm birth at less than 28, 32, 34, and 37 weeks. A predefined subgroup analysis was planned for cervical length of 25 mm or less. RESULTS From 1 July 2014 to 31 March 2022, 635 participants were randomly assigned to pessary (n=315) or to progesterone (n=320). 612 were included in the intention to treat analysis. The composite adverse perinatal outcome occurred in 19 (6%) of 303 participants with a pessary versus 17 (6%) of 309 in the progesterone group (crude relative risk 1.1 (95% confidence interval (CI) 0.60 to 2.2)). The rates of spontaneous preterm birth were not significantly different between groups. In the subgroup of cervical length of 25 mm or less, spontaneous preterm birth at less than 28 weeks occurred more often after pessary than after progesterone (10/62 (16%) v 3/69 (4%), relative risk 3.7 (95% CI 1.1 to 12.9)) and adverse perinatal outcomes seemed more frequent in the pessary group (15/62 (24%) v 8/69 (12%), relative risk 2.1 (0.95 to 4.6)). CONCLUSIONS In women with a singleton pregnancy with no prior spontaneous preterm birth at less than 34 weeks' gestation and with a midtrimester short cervix of 35 mm or less, pessary is not better than vaginal progesterone. In the subgroup of a cervical length of 25 mm or less, a pessary seemed less effective in preventing adverse outcomes. Overall, for women with single baby pregnancies, a short cervix, and no prior spontaneous preterm birth less than 34 weeks' gestation, superiority of a cervical pessary compared with vaginal progesterone to prevent preterm birth and consecutive adverse outcomes could not be proven. TRIAL REGISTRATION International Clinical Trial Registry Platform (ICTRP, EUCTR2013-002884-24-NL).
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Affiliation(s)
- Charlotte E van Dijk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Annabelle L van Gils
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Maud D van Zijl
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Bouchra Koullali
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Marijke C van der Weide
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eline S van den Akker
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Brenda J Hermsen
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | | | - Henricus Visser
- Department of Obstetrics and Gynaecology, Ter Gooi Medical Center, Blaricum, Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Radboud University, Nijmegen, Netherlands
| | - Karlijn C Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, Netherlands
| | - Moira Muller
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, Netherlands
| | - Flip W van der Made
- Department of Obstetrics and Gynaecology, Sint Fransiscus Gasthuis, Rotterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Yolanda M de Mooij
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ben Wj Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Brenda M Kazemier
- Department of Obstetrics, Wilhelmina's Children Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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5
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Janssen LE, de Boer MA, von Königslöw ECE, Dal Canto E, Oudijk MA, Robbers-Visser D, de Groot CJM. Corrigendum to "Left ventricular diastolic function in the fifth decade of life in women with a history of spontaneous preterm birth" [Eur. J. Obstet. Gynecol. Reprod. Biol. 286 (2023) 40-46]. Eur J Obstet Gynecol Reprod Biol 2024; 292:89-90. [PMID: 37979307 DOI: 10.1016/j.ejogrb.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Affiliation(s)
- Laura E Janssen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Marjon A de Boer
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Eline C E von Königslöw
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elisa Dal Canto
- Department of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, The Netherlands
| | - Martijn A Oudijk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | | | - Christianne J M de Groot
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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6
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Janssen LE, Gieskes AA, Kok M, de Groot CJM, Oudijk MA, de Boer MA. Stress-reducing interventions in pregnancy for the prevention of preterm birth: a systematic review and meta-analysis. J Psychosom Obstet Gynaecol 2023; 44:2281238. [PMID: 38064297 DOI: 10.1080/0167482x.2023.2281238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 12/18/2023] Open
Abstract
Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality. Maternal stress during pregnancy is an established risk factor for PTB. We aimed to review the effects of stress-reducing interventions during pregnancy on PTB. Studies reporting on stress-reducing interventions during pregnancy and PTB rates in general low-risk obstetric populations were included. PTB rates, low birth weight (LBW) rates, mean gestational age and birth weight, maternal anxiety and stress, and adverse perinatal outcomes were investigated. Data were extracted using a standardized extraction form, pooled effect sizes were calculated with the random effects model. Ten studies with a total of 4.816 women were included. The interventions included Pilates, yoga, a multidisciplinary stress reduction program, combination therapy (combining mindfulness, yoga, music, baby bonding, and education), and hypnosis. The incidence of PTB was significantly lower in the intervention group (RR 0.50, 95% CI 0.35 - 0.71). The overall quality of the included studies was low, and the risk of bias was high. In conclusion, this study provides evidence supporting the potential efficacy of stress-reducing interventions in reducing the incidence of PTB in low-risk women. We propose a RCT of high quality to determine the effectiveness of stress-reducing interventions in reducing PTB risk.
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Affiliation(s)
- Laura E Janssen
- Department of Obstetrics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Adelia A Gieskes
- Department of Obstetrics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjolein Kok
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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7
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van Baar PM, Bij de Weg JM, Ten Hove EA, Schoonmade LJ, van de Mheen L, Pajkrt E, de Groot CJM, de Boer MA. Hypertensive disorders of pregnancy after multifetal pregnancy reduction: a systematic review and meta-analysis. Hypertens Pregnancy 2023; 42:2225597. [PMID: 37337887 DOI: 10.1080/10641955.2023.2225597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To systematically review the literature on hypertensive disorders of pregnancy (HDP) after multifetal pregnancy reduction (MFPR). METHODS A comprehensive search in PubMed, Embase, Web of Science, and Scopus was performed. Prospective or retrospective studies reporting on MFPR from triplet or higher-order to twin compared to ongoing (i.e., non-reduced) triplets and/or twins were included. A meta-analysis of the primary outcome HDP was carried out using a random-effects model. Subgroup analyses of gestational hypertension (GH) and preeclampsia (PE) were performed. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Thirty studies with a total of 9,811 women were included. MFPR from triplet to twin was associated with a lower risk for HDP compared to ongoing triplets (OR 0.55, 95% CI, 0.37-0.83; p = 0.004). In a subgroup analysis, the decreased risk of HDP was driven by GH, and PE was no longer significant (OR 0.34, 95% CI, 0.17-0.70; p = 0.004 and OR 0.64, 95% CI, 0.38-1.09; p = 0.10, respectively). HDP was also significantly lower after MFPR from all higher-order (including triplets) to twin compared to ongoing triplets (OR 0.55, 95% CI, 0.38-0.79; p = 0.001). In a subgroup analysis, the decreased risk of HDP was driven by PE, and GH was no longer significant (OR 0.55, 95% CI 0.32-0.92; p = 0.02 and OR 0.55, 95% CI 0.28-1.06; p = 0.08, respectively). No significant differences in HDP were found in MFPR from triplet or higher-order to twin versus ongoing twins. CONCLUSIONS MFPR in women with triplet and higher-order multifetal pregnancies decreases the risk of HDP. Twelve women should undergo MFPR to prevent one event of HDP. These data can be used in the decision-making process of MFPR, in which the individual risk factors of HDP can be taken into account.
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Affiliation(s)
- Petra M van Baar
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Jeske M Bij de Weg
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Eibert A Ten Hove
- Department of Obstetrics and Gynecology, ETZ Hospital, Tilburg, The Netherlands
| | | | - Lidewij van de Mheen
- Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
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8
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Schreurs AMF, Overtoom EM, de Boer MA, van der Houwen LEE, Lier MCI, van den Akker T, Cornette J, Vogelvang TE, Beenakkers ICM, Rosman AN, Maas JWM, Heineman DJ, Finken MJJ, de Vries JJJ, Burger NB, Schaap TP, Bloemenkamp KWM, Mijatovic V. Spontaneous haemoperitoneum in pregnancy: Nationwide surveillance and Delphi audit system. BJOG 2023; 130:1620-1628. [PMID: 37280664 DOI: 10.1111/1471-0528.17556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP. DESIGN A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS). SETTING Nationwide, the Netherlands. POPULATION All pregnant women between April 2016 and April 2018. METHODS This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP. MAIN OUTCOME MEASURES Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP. RESULTS In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention. CONCLUSIONS SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.
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Affiliation(s)
- Anneke M F Schreurs
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Evelien M Overtoom
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisette E E van der Houwen
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marit C I Lier
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Jerome Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Ingrid C M Beenakkers
- Department of Anaesthesiology, Division Vital Functions, Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Jacques W M Maas
- Department of Obstetrics and Gynaecology and GROW - School for Oncology and Reproduction, Maastricht UMC+, Maastricht, the Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timme P Schaap
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Division Woman and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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9
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Breuking S, Oudijk MA, van Eekelen R, de Boer MA, Pajkrt E, Hermans F. Assessment of cervical softening and the prediction of preterm birth (STIPP): protocol for a prospective cohort study. BMJ Open 2023; 13:e071597. [PMID: 37989370 PMCID: PMC10668305 DOI: 10.1136/bmjopen-2023-071597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Preterm birth (PTB) is among the leading causes of perinatal and childhood morbidity and mortality. Therefore, accurate identification of pregnant women at high risk of PTB is key to enable obstetric healthcare professionals to apply interventions that improve perinatal and childhood outcomes. Serial transvaginal cervical length measurement is used to screen asymptomatic pregnant women with a history of PTB and identify those at high risk for a recurrent PTB. Cervical length measurement, fetal fibronectin test or a combination of both can be used to identify women at high risk of PTB presenting with symptoms of threatened PTB. The predictive capacity of these methods can be improved. Cervical softening is a precursor of cervical shortening, effacement and dilatation and could be a new marker to identify women a high risk of PTB. However, the predictive value of cervical softening to predict spontaneous PTB still needs to be determined. METHODS AND ANALYSIS This is a single-centre, prospective cohort study, conducted at the Amsterdam University Medical Centers in the Netherlands. Cervical softening will be investigated with a non-invasive CE-marked device called the Pregnolia System. This device has been developed to evaluate consistency of the cervix based on tissue elasticity. Two different cohorts will be investigated. The first cohort includes women with a history of spontaneous PTB <34 weeks. These women undergo biweekly measurements between 14 and 24 weeks of gestation. The second cohort includes women with symptoms of threatened PTB. These women will receive the measurement once at presentation between 24 and 34 weeks of gestation. The primary outcome is spontaneous PTB before 34 weeks for women with a history of PTB and delivery within 7 days for women with threatened PTB. The minimum sample size required to analyse the primary outcome is 227 women in the cohort of women with a history of PTB and 163 women in the cohort of women with symptoms of threatened PTB. Once this number is achieved, the study will be continued to investigate secondary objectives. ETHICS AND DISSEMINATION The study is approved by the Medical Ethics Committee of Amsterdam UMC (METC2022.0226). All patients will give oral and written informed consent prior to study entry. Results will be disseminated via a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05477381.
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Affiliation(s)
- Sofie Breuking
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North-Holland, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC Location VUmc, Amsterdam, North-Holland, Netherlands
| | - Rik van Eekelen
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Obstetrics and Gynaecology, Amsterdam UMC Location VUmc, Amsterdam, North-Holland, Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North-Holland, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Frederik Hermans
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, North-Holland, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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10
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Janssen LE, Laarman ARC, van Dijk-Lokkart EM, Bröring-Starre T, Oudijk MA, de Groot CJM, de Boer MA. Long-Term Maternal Mental Health after Spontaneous Preterm Birth. Am J Perinatol 2023. [PMID: 37758204 DOI: 10.1055/a-2182-4131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The aim of this study is to investigate whether a history of spontaneous preterm birth (SPTB) is associated with maternal depressive and anxiety symptoms, or psychosocial distress in the fifth decade of life. STUDY DESIGN This is a secondary analysis of the PreCaris-study, a prospective observational study in which we included 350 women with a history of SPTB between 220/7 and 366/7 weeks of gestation and compared them to 115 women who had a term birth. Primary outcomes were the Depression and Anxiety scores measured using the Hospital Anxiety Depression Scale and Psychosocial distress assessed with the Distress Thermometer for Parents. Secondary outcomes were self-reported impact of the birth in daily life and psychosocial support after delivery. RESULTS After a median of 13 years after delivery, no significant differences were found in primary outcomes. Significantly more women with a history of SPTB reported that the birth still had impact in daily life; adjusted odds ratio: 2.46 (95% confidence interval: 1.35-4.48). A total of 57 (16.3%) women after SPTB reported to have needed professional psychosocial support after delivery but did not receive it. These women more often had a high Anxiety score (p = 0.030), psychosocial distress (p = 0.001), and influence of birth in daily life (p = 0.000). CONCLUSION There are no long-term effects on depressive and anxiety symptoms and psychosocial distress in women who experienced SPTB compared with women who had a full-term pregnancy. A significant part of the women who delivered preterm needed psychosocial support but did not receive it and were at higher risk of anxiety, psychosocial distress, and impact in daily life. We therefore recommend offering all women after SPTB psychosocial support after delivery. KEY POINTS · No long-term effects on depressive and anxiety symptoms and psychosocial distress after SPTB.. · A total of 16.3% of the cases needed professional psychosocial support after delivery but did not receive it.. · This subgroup was at higher risk of anxiety symptoms, psychosocial distress, and impact on daily life..
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Affiliation(s)
- Laura E Janssen
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Aranka R C Laarman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Tinka Bröring-Starre
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
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11
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Janssen LE, de Boer MA, van Amesfoort JE, van der Voorn PJ, Oudijk MA, de Groot CJM. Spontaneous preterm birth with placental maternal vascular malperfusion is associated with cardiovascular risk in the fifth decade of life. J Reprod Immunol 2023; 158:103951. [PMID: 37201457 DOI: 10.1016/j.jri.2023.103951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Women with a history of spontaneous preterm birth (SPTB) have a mildly elevated cardiovascular risk (CVR) later in life and women with a history of preeclampsia have a highly elevated CVR. In placentas of women with preeclampsia pathological signs of maternal vascular malperfusion (MVM) are often seen. These signs of MVM are also seen in a substantial part of the placentas of women with SPTB. We therefore hypothesize that in women with a history of SPTB, the subgroup with placental MVM has an elevated CVR. This study is a secondary analysis of a cohort study including women 9-16 years after a SPTB. Women with pregnancy complications known to be associated with CVR were excluded. The primary outcome was hypertension defined as blood pressure ≥ 130/80 mmHg and/or treatment with antihypertensive medication. Secondary outcomes were mean blood pressure, anthropometrics, blood measurements including cholesterol and HbA1c, and creatinine in urine. Placental histology was available in 210 (60.0%) women. MVM was found in 91 (43.3%) of the placentas, most often diagnosed by the presence of accelerated villous maturation. Hypertension was diagnosed in 44 (48.4%) women with MVM and in 42 (35.3%) women without MVM (aOR 1.76, 95% CI 0.98 - 3.16). Women with a SPTB and placental MVM showed significantly higher mean diastolic blood pressure, mean arterial pressure and HbA1c approximately 13 years after delivery, compared to women with a SPTB without placental MVM. We therefore conclude that placental malperfusion in women with a SPTB might differentiate in CVR later in life.
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Affiliation(s)
- Laura E Janssen
- Department of Obstetrics, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands.
| | - Marjon A de Boer
- Department of Obstetrics, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Jojanneke E van Amesfoort
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
| | | | - Martijn A Oudijk
- Department of Obstetrics, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, the Netherlands
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12
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Janssen LE, de Boer MA, von Königslöw ECE, Dal Canto E, Oudijk MA, Robbers-Visser D, de Groot CJM. Left ventricular diastolic function in the fifth decade of life in women with a history of spontaneous preterm birth. Eur J Obstet Gynecol Reprod Biol 2023; 286:40-46. [PMID: 37201317 DOI: 10.1016/j.ejogrb.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the number one cause of death in women and defining its risk factors is necessary to reduce its prevalence. A history of preeclampsia is shown to be associated with hypertension and alterations in left ventricular (LV) diastolic function parameters. Because of overlapping mechanisms between preeclampsia and spontaneous preterm birth (SPTB), our most recent study investigated the association between SPTB and hypertension, and found an almost 2 times higher prevalence of hypertension after SPTB. No previous studies have focused on the association between SPTB and LV diastolic function. The aim of this study is to investigate LV diastolic function as potential early parameter of CVD in women with a history of SPTB. STUDY DESIGN We included cases with a history of SPTB between 22 and 37 weeks and controls who had a term birth. Women with hypertensive disorders or gestational diabetes in any of their pregnancies, were excluded. Both groups underwent cardiovascular risk assessment and transthoracic echocardiography 9 to 16 years after pregnancy. Echocardiographic measures were adjusted using a linear regression analysis accounting for hypertension and other risk factors known to be associated with CVD. A subgroup analysis was performed based on hypertension at follow-up. RESULTS A total of 94 cases and 94 controls were included, on average 13 years after pregnancy. There were no significant differences in LV diastolic function parameters. Women with a history of SPTB and diagnosed hypertension at follow-up, showed significant higher late diastolic mitral flow velocity, lower e'septal velocity and higher E/e'ratio, compared to women with a history of SPTB without hypertension, although within normal ranges. CONCLUSIONS When a history of SPTB is accompanied by hypertension at follow-up, significant changes in LV diastolic function were seen. Therefore, hypertension is the central factor in preventive screening methods, and transthoracic echocardiography has no additional value at this follow-up duration.
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Affiliation(s)
- Laura E Janssen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Marjon A de Boer
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Eline C E von Königslöw
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elisa Dal Canto
- Department of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, The Netherlands
| | - Martijn A Oudijk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | | | - Christianne J M de Groot
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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13
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Janssen LE, Verduin RJT, de Groot CJM, Oudijk MA, de Boer MA. Sexual intercourse during pregnancy and its association with spontaneous preterm birth. Sex Reprod Healthc 2023; 36:100849. [PMID: 37099844 DOI: 10.1016/j.srhc.2023.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
This study investigated whether sexual intercourse during pregnancy is associated with spontaneous preterm birth (SPTB). We included 77 women with SPTB and 145 women with a term birth. A total of 195 (87.8%) women had sexual intercourse during pregnancy, which was comparable between the groups. Primiparas with SPTB tended to report more often having sexual intercourse 3 - 4 times a week compared to primiparas with a term birth (8.8% vs. 0%, p =.082). We advise not to completely discourage sexual intercourse among pregnant women. Yet, high sexual intercourse frequency could be associated with SPTB.
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Affiliation(s)
- Laura E Janssen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics. De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute. Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Rubin J T Verduin
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics. De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute. Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Christianne J M de Groot
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics. De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute. Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Martijn A Oudijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics. De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute. Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Marjon A de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics. De Boelelaan 1117, 1081HV Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute. Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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14
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Janssen LE, de Boer MA, von Königslöw ECE, Oudijk MA, de Groot CJM. The association between spontaneous preterm birth and maternal hypertension in the fifth decade of life: a retrospective case-control study. BJOG 2023; 130:507-513. [PMID: 36519491 DOI: 10.1111/1471-0528.17368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether a history of spontaneous preterm birth (SPTB) predisposes to maternal hypertension. DESIGN Retrospective case-control study. SETTING Two affiliated university medical hospitals in Amsterdam, the Netherlands. POPULATION We included 350 women with a history of SPTB between 22 and 36+6 weeks and 166 women with a history of a term birth. Women with pregnancy complications that are known to be associated with cardiovascular disease were excluded. METHODS Both groups underwent cardiovascular risk assessment 9-16 years after pregnancy. We performed a subgroup analysis based upon the severity of SPTB. MAIN OUTCOME MEASURES Hypertension. Secondary outcomes - metabolic syndrome, mean blood pressure, anthropometrics, blood and urine sampling, Framingham Risk Score and Systematic Coronary Risk Evaluation. RESULTS A history of SPTB was significantly associated with hypertension; adjusted odds ratio 1.60 (95% confidence interval 1.04-2.46, p = 0.033). Abdominal obesity was more often diagnosed after SPTB (n = 163, 46.6% versus n = 54, 32.5%, p = 0.003) and was more pronounced with more severe preterm birth (p = 0.002). CONCLUSIONS The presence of hypertension 9-16 years after pregnancy was statistically significantly higher among women with a history of SPTB than among women with a history of uncomplicated term birth. Women with a history of SPTB were more often diagnosed with abdominal obesity, especially those with a history of extreme preterm birth.
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Affiliation(s)
- Laura E Janssen
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Centre, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Centre, Amsterdam, The Netherlands
| | - Eline C E von Königslöw
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Centre, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Centre, Amsterdam, The Netherlands.,Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
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15
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Bij de Weg JM, Landman AJEMC, de Vries JIP, Thijs A, Harmsze AM, Oudijk MA, de Boer MA. Authors' response to Letter to the Editor on The effect of low-dose aspirin on platelet function during pregnancy compared to placebo: An explorative study. Eur J Obstet Gynecol Reprod Biol 2023; 282:172. [PMID: 36639304 DOI: 10.1016/j.ejogrb.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Jeske M Bij de Weg
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.
| | - Anadeijda J E M C Landman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Johanna I P de Vries
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Abel Thijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, De Boelelaan 1117, Amsterdam, Netherlands
| | - Ankie M Harmsze
- St. Antonius Hospital, Clinical Pharmacy, Koekoekslaan 1, Nieuwegein, Netherlands
| | - Martijn A Oudijk
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Marjon A de Boer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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16
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de Vaan MDT, Croll DMR, Verhoeven CJM, de Boer MA, Jozwiak M, Ten Eikelder MLG, Mol BW, Bloemenkamp KWM, de Heus R. The influence of various induction methods on adverse outcomes in small for gestational age neonates: A secondary analysis of the PROBAAT 1 and 2 trials. Eur J Obstet Gynecol Reprod Biol 2023; 282:89-93. [PMID: 36701821 DOI: 10.1016/j.ejogrb.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the safety aspects of different induction methods in pregnancies with small-for-gestational-age neonates. STUDY DESIGN This was a secondary analysis of two previously reported multicenter, randomized controlled trials conducted in the Netherlands. In the original trials, women were randomized to either a 30 cc Foley catheter, vaginal prostaglandin E2 (PROBAAT-1) or oral misoprostol (PROBAAT-2). A total of 425 patients with a term, singleton pregnancy in cephalic presentation with an indication for labor induction and a small-for-gestational-age neonate were included in this secondary analysis. Our primary outcome was a composed adverse neonatal outcome of Apgar score < 7 after 5 min and/or a pH in the umbilical artery < 7.05 and/or NICU admission. Secondary outcomes were mode of birth, operative birth for fetal distress and pH < 7.10 in the umbilical artery. For these outcome measures, multivariate as well as bivariate analyses were performed. RESULTS An adverse neonatal outcome occurred in 4.7 % (10/214) induction with a Foley catheter, versus 12.8 % (19/149) after misoprostol (RR 0.36; 95 % CI 0.17-0.76) and 4.7 % (3/64) after Prostaglandin E2 (RR 0.98; 95 %CI 0.28-3.51). For individual components of the composed outcome of adverse events, a difference was found between a Foley catheter and misoprostol for Apgar score < 7 at 5 min (0.5 % versus 3.4; RR 0.14; 95 %CI 0.02-1.16) and NICU admission (1.9 % versus 6.1 %; RR 0.31; 0.10-0.97). No differences were found for mode of birth. CONCLUSIONS For women who gave birth to a small-for-gestational-age neonate, a Foley catheter is probably a safer induction method compared to oral misoprostol.
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Affiliation(s)
- Marieke D T de Vaan
- Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, 's-Hertogenbosch, the Netherlands; Rotterdam University of Applied Sciences, Department of Health Care Studies, Division Master Physician Assistant, Rotterdam, the Netherlands.
| | - Dorothée M R Croll
- Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Division Woman and Baby, Utrecht, the Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC, Location VUmc, Midwifery Science, AVAG/APH research institute, Amsterdam, the Netherlands; University of Nottingham, Division of Midwifery, School of Health Sciences, Nottingham, UK
| | - Marjon A de Boer
- Amsterdam UMC, VU Medical Center, Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Marta Jozwiak
- Erasmus Medical Centre, Department of Gynaecologic Oncology, Rotterdam, the Netherlands
| | - Mieke L G Ten Eikelder
- Radboud University Medical Centre, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Ben Willem Mol
- Monash University, Department of Obstetrics and Gynaecology, Melbourne, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Kitty W M Bloemenkamp
- Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Division Woman and Baby, Utrecht, the Netherlands
| | - Roel de Heus
- Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Division Woman and Baby, Utrecht, the Netherlands; St. Antonius Hospital, Department of Obstetrics and Gynaecology, Utrecht, the Netherlands
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17
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Flanagan MF, Vollgraff Heidweiller-Schreurs CA, Li W, Ganzevoort W, de Boer MA, Vazquez-Sarandeses A, Turan OM, Bossuyt PM, Mol BWJ, Rolnik DL. Added prognostic value of Doppler ultrasound for adverse perinatal outcomes: A pooled analysis of three cohort studies. Aust N Z J Obstet Gynaecol 2023; 63:19-26. [PMID: 35678065 DOI: 10.1111/ajo.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fetal growth restriction (FGR) is an obstetric complication associated with adverse perinatal outcomes. Doppler ultrasound can improve perinatal outcomes through monitoring at-risk fetuses and helping time delivery. AIM To investigate the prognostic value of different Doppler ultrasound measurements for adverse perinatal outcomes. MATERIALS Individual participant data. METHODS We performed a pooled analysis on individual participant data. We compared six prognostic models using multilevel logistic regression, where each subsequent model added a new variable to a base model that included maternal characteristics. Estimated fetal weight (EFW) and four Doppler ultrasound measurements were added in turn: umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and mean uterine artery pulsatility index (mUtA PI). The primary outcome was a composite adverse perinatal outcome, defined as perinatal mortality, emergency caesarean delivery for fetal distress, or neonatal admission. Discriminative ability was quantified with area under the curve (AUC). RESULTS Three data sets (N = 3284) were included. Overall, the model that included EFW and UA PI improved AUC from 0.650 (95% CI 0.624-0.676) to 0.673 (95% CI 0.646-0.700). Adding more ultrasound measurements did not improve further the discriminative ability. In subgroup analysis, the addition of EFW and UA PI improved AUC in both preterm (AUC from 0.711 to 0.795) and small for gestational age pregnancies (AUC from 0.729 to 0.770), but they did not improve the models in term delivery or normal growth subgroups. CONCLUSIONS Umbilical artery pulsatility index added prognostic value for adverse perinatal outcomes to the already available information, but the combination of other Doppler ultrasound measurements (MCA PI, CPR or UtA PI) did not improve further prognostic performance.
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Affiliation(s)
- Madeline F Flanagan
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | | | - Wentao Li
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Wessel Ganzevoort
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Alicia Vazquez-Sarandeses
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Ozhan M Turan
- Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick M Bossuyt
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Daniel L Rolnik
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
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18
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van Gils AL, Ravelli AC, Kamphuis E, Kazemier BM, Pajkrt E, Oudijk MA, de Boer MA. Risk of recurrent preterm birth following spontaneous immature and extreme preterm birth in the Netherlands. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Crouwel F, Simsek M, de Boer MA, Mulder CJJ, van Andel EM, Creemers RH, van Asseldonk DP, van Bodegraven AA, Horjus CS, Visschedijk MC, Weusthuis ALM, Seinen ML, Jharap B, van Schaik FDM, Ahmad I, Boekema PJ, Tack GJ, Wormmeester L, Lutgens MWMD, van Boeckel PGA, Gilissen LPL, Kerkhof M, Russel MGVM, Hoentjen F, Bartelink ME, Kuijvenhoven JP, Maljaars JWJ, van Dop WA, Wonders J, van der Voorn MMPJA, Buiter HJC, de Boer NK. Exposure to thioguanine during 117 pregnancies in women with inflammatory bowel disease. J Crohns Colitis 2022; 17:738-745. [PMID: 36521000 PMCID: PMC10155742 DOI: 10.1093/ecco-jcc/jjac183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Safety of thioguanine in pregnant patients with inflammatory bowel disease (IBD) is sparsely recorded. This study was aimed to document the safety of thioguanine during pregnancy and in birth. METHODS In this multicenter case series, IBD patients treated with thioguanine during pregnancy were included. Data regarding disease and medication history, pregnancy course, obstetric complications and neonatal outcomes were collected. RESULTS Data on 117 thioguanine-exposed pregnancies in 99 women were collected. Most (78%) had Crohn's disease and the mean age at delivery was 31 years. In eighteen pregnancies (15%) IBD flared. Obstetric and infectious complications were seen in 15% (n=17) and 7% (n=8) of pregnancies, respectively. Ten pregnancies (8.5%) resulted in a first trimester miscarriage and one in a stillbirth at 22 weeks gestational age. Congenital abnormalities were observed in one induced abortion (trisomy 21) and in one of the live-born children (cleft palate) . In total 109 neonates were born from 101 singleton pregnancies and 4 twin pregnancies. In the singleton pregnancies, ten children were born prematurely and ten were born small for gestational age. Screening for myelosuppresion was performed in sixteen neonates (14.7%); two had anemia in umbilical cord blood. All outcomes were comparable to either the general Dutch population or to data from 3 Dutch cohort studies on the use of conventional thiopurines in pregnant IBD patients. CONCLUSION In this large case series the use of thioguanine during pregnancy is not associated in excess with adverse maternal or neonatal outcomes.
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Affiliation(s)
- Femke Crouwel
- Corresponding author: Femke Crouwel, MD, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Tel: +31204440799; Fax: +31204440554;
| | - Melek Simsek
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gyneacology, Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Emma M van Andel
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Rob H Creemers
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine [Co-MIK], Zuyderland Medical Centre, Heerlen-Sittard-Geleen, The Netherlands
| | - Dirk P van Asseldonk
- Department of Gastroenterology and Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Ad A van Bodegraven
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine [Co-MIK], Zuyderland Medical Centre, Heerlen-Sittard-Geleen, The Netherlands
| | - Carmen S Horjus
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marijn C Visschedijk
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Margien L Seinen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Bindia Jharap
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Fiona D M van Schaik
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ishfaq Ahmad
- Department of Gastroenterology and Hepatology, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | - Paul J Boekema
- Department of Gastroenterology and Hepatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Greetje J Tack
- Department of Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Louktje Wormmeester
- Department of Gastroenterology and Hepatology, Treant Zorggroep, Emmen-Hoogeveen-Stadskanaal, The Netherlands
| | - Maurice W M D Lutgens
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Petra G A van Boeckel
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Lennard P L Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marjon Kerkhof
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
| | - Maurice G V M Russel
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maartje E Bartelink
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Johan P Kuijvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Jeroen W J Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willemijn A van Dop
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Wonders
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Hans J C Buiter
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Nanne K de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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20
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Bij de Weg JM, Landman AJEMC, de Vries JIP, Thijs A, Harmsze AM, Oudijk MA, de Boer MA. The effect of low-dose aspirin on platelet function during pregnancy compared to placebo: An explorative study. Eur J Obstet Gynecol Reprod Biol 2022; 278:67-71. [PMID: 36116392 DOI: 10.1016/j.ejogrb.2022.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the effect of aspirin 80 mg compared to placebo on platelet function tests in the second and third trimester of pregnancy. STUDY DESIGN An explorative study was performed to assess laboratory platelet function in a subpopulation of the APRIL trial: a randomized double-blind trial comparing aspirin 80 mg once daily to placebo for the prevention of recurrent preterm birth. Platelet function was measured between 18 and 22, and between 28 and 32 weeks gestational age with three platelet function tests: VerifyNow®, Chronolog light transmission aggregometry (Chronolog LTA) and serum thromboxane B2 (TxB2). Medication adherence was evaluated by pill counts, self-reported diaries and structured interviews. RESULTS We included 11 women, six in the aspirin and five in the placebo group. In women receiving aspirin, platelet function was significantly lower compared to women receiving placebo for all three tests: VerifyNow® Aspirin Reaction Units (450.5 vs 648.0, p = 0.017); Chronolog LTA (9.5% vs 94.5%, p = 0.009); serum TxB2 levels (11.9 ng/mL versus 175.9 ng/mL, p = 0.030). For all three tests, platelet function did not differ between the second and third trimester of pregnancy in the aspirin group. In the placebo group, serum TxB2 levels were significantly higher in the third trimester. One non-adherent participant in the aspirin group showed results similar to the placebo group. CONCLUSION Aspirin 80 mg has a clear inhibitory effect on laboratory platelet function during pregnancy compared to placebo. This effect is similar in the second and third trimester of pregnancy.
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Affiliation(s)
- Jeske M Bij de Weg
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Anadeijda J E M C Landman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Abel Thijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Ankie M Harmsze
- St. Antonius Hospital, Clinical Pharmacy, Koekoekslaan 1, Nieuwegein, The Netherlands
| | - Martijn A Oudijk
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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21
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van Limburg Stirum EVJ, van der Windt LI, van Dijk CE, van Baar AL, Leemhuis AG, van Wely M, de Boer MA, van 't Hooft J, Oudijk MA, Pajkrt E. Pessary or progesterone to prevent preterm birth in women with short cervical length: protocol of the 4-6 year follow-up of a randomised controlled trial (Quadruple-P). BMJ Open 2022; 12:e064049. [PMID: 36002221 PMCID: PMC9413189 DOI: 10.1136/bmjopen-2022-064049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child's health at 4-6 years of corrected age. METHODS AND ANALYSIS This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4-6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach. ETHICS AND DISSEMINATION The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER Dutch Trial Register (NL9646).
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Affiliation(s)
- Emilie V J van Limburg Stirum
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Larissa I van der Windt
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Charlotte E van Dijk
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | | | - Aleid G Leemhuis
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Neonatology and Paediatrics, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
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22
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Landman AJEMC, van Limburg Stirum EVJ, van 't Hooft J, Leemhuis AG, Finken MJJ, van Baar AL, Roseboom TJ, Ravelli ACJ, van Wely M, Oosterlaan J, Painter RC, Pajkrt E, Oudijk MA, de Boer MA. Long-term outcomes following antenatal exposure to low-dose aspirin: study protocol for the 4-year follow-up of the APRIL randomised controlled trial. BMJ Open 2022; 12:e060632. [PMID: 35940829 PMCID: PMC9364408 DOI: 10.1136/bmjopen-2021-060632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The use of low-dose aspirin by pregnant women to prevent preterm pre-eclampsia is gradually increasing. The administration of aspirin during pregnancy improves perinatal outcome, which could translate into improved child outcome in the long term. However, antenatal exposure to aspirin could have adverse effects on child development that may manifest later in life. The aim of this follow-up study is to assess the long-term effects of antenatal exposure to low-dose aspirin compared with placebo on survival, (neuro)development, behaviour and general health at 4 years corrected age. METHODS AND ANALYSIS This is a follow-up study of the Dutch double-blind randomised controlled APRIL trial which assessed the effectiveness of treatment with aspirin (80 mg daily) compared with placebo for the prevention of preterm birth in women with a previous spontaneous preterm birth. Treatment was initiated before 16 weeks of gestation and continued until 36 weeks or birth. We aim to follow-up all 379 children born to women who participated in the APRIL trial and survived the neonatal period, at the corrected age of 4 years. The main outcomes are (neuro)development as assessed by the Ages and Stages Questionnaire, and behaviour as assessed by the Strength and Difficulties Questionnaire. Additional outcomes include mortality, growth and general health from birth up to 4 years, and a composite outcome including mortality, abnormal (neuro)development and problem behaviour. Analyses will be performed by intention-to-treat using a superiority design. ETHICS AND DISSEMINATION Institutional Review Board approval was obtained from the Medical Research Ethics Committee from Amsterdam Medical Center (no. W20 289#20.325). The results will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER The APRIL trial (NTR5675, NL5553; EudraCT number 2015-003220-31) and the APRIL follow-up study (NL8950) are registered in the Dutch trial register. The study is funded by the Amsterdam Reproduction & Development research institute.
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Affiliation(s)
- Anadeijda J E M C Landman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Emilie V J van Limburg Stirum
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janneke van 't Hooft
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Aleid G Leemhuis
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Emma Children's Hospital, Department of Paediatric Endocrinology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anneloes L van Baar
- Utrecht University, Department of Child and Adolescent Studies, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Tessa J Roseboom
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of Neonatology and Paediatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Amsterdam UMC Follow-Me program & Emma Neuroscience Group, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Don EE, Landman AJEMC, Vissers G, Jordanova ES, Post Uiterweer ED, de Groot CJM, de Boer MA, Huirne JAF. Uterine Fibroids Causing Preterm Birth: A New Pathophysiological Hypothesis on the Role of Fibroid Necrosis and Inflammation. Int J Mol Sci 2022; 23:ijms23158064. [PMID: 35897637 PMCID: PMC9331897 DOI: 10.3390/ijms23158064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
According to recent studies and observations in clinical practice, uterine fibroids increase the risk of preterm birth. There are several theories on the pathogenesis of preterm birth in the presence of fibroids. One theory proclaims that fibroid necrosis leads to preterm birth, though pathophysiological mechanisms have not been described. Necrotic tissue secretes specific cytokines and proteins and we suggest these to be comparable to the inflammatory response leading to spontaneous preterm birth. We hypothesize that fibroid necrosis could induce preterm parturition through a similar inflammatory response. This new hypothesis generates novel perspectives for future research and the development of preventative strategies for preterm birth. Moreover, we emphasize the importance of the recognition of fibroids and especially fibroid necrosis by clinicians during pregnancy.
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Affiliation(s)
- Emma E. Don
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-444-4444
| | - Anadeijda J. E. M. C. Landman
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Guus Vissers
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
| | - Ekaterina S. Jordanova
- Center for Gynecologic Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Emiel D. Post Uiterweer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; (A.J.E.M.C.L.); (G.V.); (C.J.M.d.G.); (M.A.d.B.); (J.A.F.H.)
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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24
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Janssen LE, Verduin RJT, de Groot CJM, Oudijk MA, de Boer MA. The association between vaginal hygiene practices and spontaneous preterm birth: A case-control study. PLoS One 2022; 17:e0268248. [PMID: 35771798 PMCID: PMC9246112 DOI: 10.1371/journal.pone.0268248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Spontaneous preterm birth (SPTB) is a major cause of neonatal morbidity and mortality worldwide and defining its risk factors is necessary to reduce its prevalence. Recent studies have pointed out that bacterial vaginosis, a disturbance in the vaginal microbiome, is associated with SPTB. It is hypothesized that vaginal hygiene practices can alter the vaginal microbiome and are therefore associated with SPTB, but there are no studies investigating this matter.
Methods and findings
A case-control study was conducted between August 2018 and July 2021 in two affiliated university medical centers in Amsterdam, the Netherlands. We included a total of 79 women with a SPTB and compared them with 156 women with a term birth. Women with uterine anomalies, a history of cervical surgery or major congenital anomalies of the fetus were excluded. All participants filled in a questionnaire about vaginal washing with water, soap or gel, the use of intravaginal douches and vaginal steaming, both before and during pregnancy. Most women washed vaginally with water, 144 (61.3%) women before pregnancy and 135 (57.4%) women during pregnancy. A total of 43 (18.3%) washed with soap before and 36 (15.3%) during pregnancy. Before pregnancy, 40 (17.0%) women washed with vaginal gel and 27 (11.5%) during pregnancy. We found that the use of vaginal gel before pregnancy (aOR 2.29, 95% CI: 1.08–4.84) and even more during pregnancy, was associated with SPTB (aOR 3.45, 95% CI: 1.37–8.67). No association was found between washing with water or soap, intravaginal douching, or vaginal steaming and SPTB.
Conclusions
Our findings suggest that the use of vaginal gel is associated with SPTB. Women should be informed that vaginal use of gels might not be safe.
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Affiliation(s)
- Laura E. Janssen
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Rubin J. T. Verduin
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martijn A. Oudijk
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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Croll DMR, Meuleman T, de Heus R, de Boer MA, Verhoeven CJM, Bloemenkamp KWM, van Dillen J. Pregnant women's willingness to participate in a randomized trial comparing induction of labor at 39 weeks versus expectant management: A survey in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2022; 273:7-11. [PMID: 35436644 DOI: 10.1016/j.ejogrb.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A randomized controlled trial (RCT) in the United States, the ARRIVE trial, has indicated that induction of labor (IOL) in low-risk nulliparous women with a gestational age (GA) of 39 weeks compared to expectant management (EM) resulted in a significant lower rate of cesarean deliveries. The Dutch maternity care system is different compared to the United States with, among other factors, an overall significantly lower percentage of caesarean sections (CS). To investigate whether IOL has a favorable outcome in the Dutch maternity care system, a new trial is advised. In this questionnaire-based study we aim to evaluate whether Dutch low-risk pregnant women would be willing to participate in an RCT comparing IOL at 39 weeks to EM. MATERIALS AND METHODS We conducted an online survey in 2020 in the Netherlands. Respondent recruitment took place both in outpatient clinics at hospitals and midwife practices and via social media. Inclusion criteria were pregnant women with singleton gestation, GA ≤ 39 weeks, age 18 years or older and residency in the Netherlands. Exclusion criteria were multiple gestation, a history of a CS, planned IOL or CS in current pregnancy and GA > 39 weeks. A subgroup was formed of low risk (receiving primary care) nulliparous women with a gestational age between 34 and 39 weeks, comparable with the ARRIVE trial. RESULTS Three hundred eighty respondents participated. Of all respondents (nulli- and multiparous), 47 (12.4%) would be willing to participate in the hypothetical RCT and 70 (18.4%) might be willing to participate. Amongst the 70 women in the subgroup 11 women (15.7%) would be willing to participate and 17 (24.3%) might be willing to participate. DISCUSSION AND CONCLUSION Calculating sample size in a country with a low CS rate, in relation to 69.2% of women are not willing to participate in an RCT comparing IOL at 39 weeks with EM, would require >18.000 women to be counselled for participation. We believe such a study is a challenge in the Netherlands.
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Affiliation(s)
- Dorothée M R Croll
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
| | - Tessa Meuleman
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
| | - Roel de Heus
- St. Antonius Hospital, Department of Gynecology & Obstetrics, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Pregnancy and Birth, Amsterdam, the Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC, Location VUmc, Midwifery Science, AVAG, APH Research Institute, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, United Kingdom; Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, the Netherlands
| | - Kitty W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
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Bruinsma MAW, de Boer MA, Prins S, Abheiden CNH. Does placental abruption cause neonatal anemia? Acta Obstet Gynecol Scand 2022; 101:917-922. [PMID: 35582929 DOI: 10.1111/aogs.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/27/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Placental abruption can result in serious perinatal morbidity and mortality. However, it is not clear whether placental abruption could lead to neonatal anemia, as a direct relationship has not been described yet. The objective of this study is to investigate whether there is a relationship between occurrence of placental abruption and neonatal anemia. MATERIAL AND METHODS All women with a clinical diagnoses of placental abruption between January 2016 and April 2021 in Amsterdam UMC, from both the VU University Medical Center and Amsterdam Medical Center, were included. Demographic data and delivery outcomes were collected retrospectively using the medical files. The primary outcome was neonatal anemia, defined as hemoglobin levels less than the fifth percentile for gestational age. RESULTS A total of 65 mothers and 65 neonates were included in our study. Average gestational age was 30 + 5 weeks. Mean hemoglobin level of the neonates at birth was 16.5 g/dl (10.2 mmol/L) with hemoglobin levels comparable to the reference curve. Two neonates (3.6%) were diagnosed with anemia based on their hemoglobin level at birth, and six (9.2%) neonates received a blood transfusion within 24 h after birth. CONCLUSIONS With this study, we found that the hemoglobin levels of the neonates born after placental abruption are comparable to the reference curve and do not show more neonates than expected below the fifth percentile for gestational age. It remains unclear whether there is fetal blood loss during a placental abruption but our results suggest that at least a big amount of fetal blood is not lost, since we did not found a large number of anemic neonates. Severe neonatal anemia in the case of placental abruption does not need to be expected.
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Affiliation(s)
- Marieke A W Bruinsma
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Sandra Prins
- Neonatology Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Child Development, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Carolien N H Abheiden
- Obstetrics and Gynecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Pregnancy and Birth, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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27
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Landman AJEMC, de Boer MA, Visser L, Nijman TAJ, Hemels MAC, Naaktgeboren CN, van der Weide MC, Mol BW, van Laar JOEH, Papatsonis DNM, Bekker MN, van Drongelen J, van Pampus MG, Sueters M, van der Ham DP, Sikkema JM, Zwart JJ, Huisjes AJM, van Huizen ME, Kleiverda G, Boon J, Franssen MTM, Hermes W, Visser H, de Groot CJM, Oudijk MA. Evaluation of low-dose aspirin in the prevention of recurrent spontaneous preterm labour (the APRIL study): A multicentre, randomised, double-blinded, placebo-controlled trial. PLoS Med 2022; 19:e1003892. [PMID: 35104279 PMCID: PMC8806064 DOI: 10.1371/journal.pmed.1003892] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/14/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Preterm birth is the leading cause of neonatal morbidity and mortality. The recurrence rate of spontaneous preterm birth is high, and additional preventive measures are required. Our objective was to assess the effectiveness of low-dose aspirin compared to placebo in the prevention of preterm birth in women with a previous spontaneous preterm birth. METHODS AND FINDINGS We performed a parallel multicentre, randomised, double-blinded, placebo-controlled trial (the APRIL study). The study was performed in 8 tertiary and 26 secondary care hospitals in the Netherlands. We included women with a singleton pregnancy and a history of spontaneous preterm birth of a singleton between 22 and 37 weeks. Participants were randomly assigned to aspirin 80 mg daily or placebo initiated between 8 and 16 weeks of gestation and continued until 36 weeks or delivery. Randomisation was computer generated, with allocation concealment by using sequentially numbered medication containers. Participants, their healthcare providers, and researchers were blinded for treatment allocation. The primary outcome was preterm birth <37 weeks of gestation. Secondary outcomes included a composite of poor neonatal outcome (bronchopulmonary dysplasia, periventricular leukomalacia > grade 1, intraventricular hemorrhage > grade 2, necrotising enterocolitis > stage 1, retinopathy of prematurity, culture proven sepsis, or perinatal death). Analyses were performed by intention to treat. From May 31, 2016 to June 13, 2019, 406 women were randomised to aspirin (n = 204) or placebo (n = 202). A total of 387 women (81.1% of white ethnic origin, mean age 32.5 ± SD 3.8) were included in the final analysis: 194 women were allocated to aspirin and 193 to placebo. Preterm birth <37 weeks occurred in 41 (21.2%) women in the aspirin group and 49 (25.4%) in the placebo group (relative risk (RR) 0.83, 95% confidence interval (CI) 0.58 to 1.20, p = 0.32). In women with ≥80% medication adherence, preterm birth occurred in 24 (19.2%) versus 30 (24.8%) women (RR 0.77, 95% CI 0.48 to 1.25, p = 0.29). The rate of the composite of poor neonatal outcome was 4.6% (n = 9) versus 2.6% (n = 5) (RR 1.79, 95% CI 0.61 to 5.25, p = 0.29). Among all randomised women, serious adverse events occurred in 11 out of 204 (5.4%) women allocated to aspirin and 11 out of 202 (5.4%) women allocated to placebo. None of these serious adverse events was considered to be associated with treatment allocation. The main study limitation is the underpowered sample size due to the lower than expected preterm birth rates. CONCLUSIONS In this study, we observed that low-dose aspirin did not significantly reduce the preterm birth rate in women with a previous spontaneous preterm birth. However, a modest reduction of preterm birth with aspirin cannot be ruled out. Further research is required to determine a possible beneficial effect of low-dose aspirin for women with a previous spontaneous preterm birth. TRIAL REGISTRATION Dutch Trial Register (NL5553, NTR5675) https://www.trialregister.nl/trial/5553.
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Affiliation(s)
- Anadeijda J. E. M. C. Landman
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Laura Visser
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Tobias A. J. Nijman
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Den Haag, the Netherlands
| | | | - Christiana N. Naaktgeboren
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Marijke C. van der Weide
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Aberdeen Centre for Women’s Health Research, University of Aberdeen Aberdeen, United Kingdom
| | | | | | - Mireille N. Bekker
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Marieke Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - David P. van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, the Netherlands
| | - J. Marko Sikkema
- Department of Obstetrics and Gynaecology, Hospital Group Twente Almelo, Almelo, the Netherlands
| | - Joost J. Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Anjoke J. M. Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands
| | | | - Gunilla Kleiverda
- Department of Obstetrics and Gynaecology, Flevo Hospital Almere, Almere, the Netherlands
| | - Janine Boon
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Maureen T. M. Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Wietske Hermes
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre, Den Haag, the Netherlands
| | - Harry Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Martijn A. Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
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Simons NE, van Limburg Stirum EVJ, van Wassenaer-Leemhuis AG, Finken MJJ, Aarnoudse-Moens CSH, Oosterlaan J, van Baar A, Roseboom TJ, Lim AC, van Wely M, de Boer MA, Painter RC, Pajkrt E, Oudijk MA, van T Hooft J. Long-term follow-up of children exposed in-utero to progesterone treatment for prevention of preterm birth: study protocol of the AMPHIA follow-up. BMJ Open 2021; 11:e053066. [PMID: 34548367 PMCID: PMC8458362 DOI: 10.1136/bmjopen-2021-053066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Preterm birth is one of the main problems in obstetrics, and the most important cause of neonatal mortality, morbidity and neurodevelopmental impairment. Multiple gestation is an important risk factor for preterm birth, with up to 50% delivering before 37 weeks. Progesterone has a role in maintaining pregnancy and is frequently prescribed to prevent (recurrent) preterm birth and improve pregnancy outcomes in high-risk patients. However, little is known about its long-term effects in multiple gestations. The objective of this follow-up study is to assess long-term benefits and harms of prenatal exposure to progesterone treatment in multiple gestations on child development. METHODS AND ANALYSIS This is a follow-up study of a multicentre, double-blind, placebo-controlled randomised trial (AMPHIA trial, ISRCTN40512715). Between 2006 and 2009 women with a multiple gestation were randomised at 16-20 weeks of gestation to weekly injections 250 mg 17α-hydroxyprogesterone caproate or placebo, until 36 weeks of gestation or delivery. The current long-term follow-up will assess all children (n=1355) born to mothers who participated in the AMPHIA trial, at 11-14 years of age, with internationally validated questionnaires, completed by themselves, their parents and their teachers. MAIN OUTCOMES ARE CHILD COGNITION AND BEHAVIOUR Additional outcomes are death (perinatal and up to age 14), gender identity, educational performance and health-related problems. We will use intention-to-treat analyses comparing experimental and placebo group. To adjust for the correlation between twins, general linear mixed-effects models will be used. ETHICS AND DISSEMINATION Amsterdam UMC MEC provided a waiver for the Medical Research Involving Human Subjects Act (W20_234#20.268). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders, patients and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER NL8933.
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Affiliation(s)
- Noor E Simons
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Emilie V J van Limburg Stirum
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Aleid G van Wassenaer-Leemhuis
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital Amsterdam, Amsterdam Reproduction & Development, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Cornelieke S H Aarnoudse-Moens
- Department of Neonatology and Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Paediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Anneloes van Baar
- Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Arianne C Lim
- Department of Obstetrics and Gynaecology, Maastricht UMC, Maastricht, The Netherlands
| | - Madelon van Wely
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Janneke van T Hooft
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Croll DMR, Hoge PC, Verhoeven CJM, de Boer MA, Bloemenkamp KWM, de Heus R. Changes in local protocols on inpatient cervical priming and introduction of outpatient priming: A nationwide survey in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2021; 263:148-152. [PMID: 34214801 DOI: 10.1016/j.ejogrb.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aims of this study are to assess (changes in) local procedures for inpatient cervical priming as part of induction of labor and to identify the implementation of outpatient cervical priming in the Netherlands. METHODS This survey study was conducted from October 2019 until January 2020; obstetricians of all 72 hospitals with a maternity unit in the Netherlands received a questionnaire. The questionnaire consisted of three parts: basic hospital data, local protocol on methods of inpatient induction of labor (IPI), local protocol for outpatient induction of labor (OPI). RESULTS A response was received from 66/72 hospitals, giving a response rate of 92%. For IPI the most preferred method was a Foley catheter (87.9%), 27.6% protocols switched to prostaglandins after day 1 if the cervix was not ripe yet. A prostaglandin gel or pessary was not the preferred method on day 1 but only used after 24 h in 5 hospitals (7.6%). OPI was offered in 53% (35/66 hospitals), all using a Foley catheter. CONCLUSION In the Netherlands, local protocols for IPI have shifted towards the use of a Foley catheter. More than half of the hospitals offer OPI. As safety and efficacy data of OPI are lacking, research on this topic is urgently warranted.
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Affiliation(s)
- Dorothée M R Croll
- Wilhelmina Children's Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Lundlaan 6, Utrecht, The Netherlands.
| | - Peter C Hoge
- Wilhelmina Children's Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Lundlaan 6, Utrecht, The Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC, Location VUmc, Midwifery Science, AVAG/APH research institute, van der Boechorststraat 7, Amsterdam, The Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; Maxima Medical Center, Department of Obstetrics and Gynecology, De Run 4600, Veldhoven, The Netherlands
| | - Marjon A de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kitty W M Bloemenkamp
- Wilhelmina Children's Hospital Birth Centre, Division Woman and Baby, University Medical Centre Utrecht, Lundlaan 6, Utrecht, The Netherlands
| | - Roel de Heus
- St. Antonius Hospital, Department of Obstetrics and Gynecology, Soestwetering 1, Utrecht, The Netherlands
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Vollgraff Heidweiller-Schreurs CA, van Osch IR, Heymans MW, Ganzevoort W, Schoonmade LJ, Bax CJ, Mol BWJ, de Groot CJM, Bossuyt PMM, de Boer MA. Authors' reply re: Cerebroplacental ratio in predicting adverse perinatal outcome: a meta-analysis of individual participant data. BJOG 2020; 127:1439-1440. [PMID: 32686891 DOI: 10.1111/1471-0528.16375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ivy R van Osch
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Linda J Schoonmade
- Department of Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVE To elucidate patients' knowledge and counseling perspective on aspirin reducing the risk of hypertensive disorders of pregnancy (HDP). METHODS A quantitative survey was performed including women who are members of the patient orgasnization Dutch HELLP Foundation due to a history of HDP. RESULTS Awareness of the risk-reducing effect of aspirin on HDP was present in 51.9% of the 189 women. The majority was informed by their gynecologist (89.8%) and preferred to be informed by a gynecologist (79.4%), at the postpartum checkup (42.3%) or in the consecutive pregnancy (30.7%), both orally and written (62.4%). CONCLUSION Half of the women with a history of HDP were aware of the risk-reducing effect of aspirin in a consecutive pregnancy.
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Affiliation(s)
- Jeske M Bij de Weg
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VUmc Amsterdam , Amsterdam, The Netherlands
| | - Carolien N H Abheiden
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VUmc Amsterdam , Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VUmc Amsterdam , Amsterdam, The Netherlands
| | | | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VUmc Amsterdam , Amsterdam, The Netherlands
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Visser L, de Boer MA, Ravelli ACJ, Groen H, Mol BW, de Groot CJM. Increased incidence of hypertensive disorders of pregnancy in women with a history of spontaneous preterm birth: A longitudinal linked national cohort study. Pregnancy Hypertens 2020; 22:59-63. [PMID: 32739719 DOI: 10.1016/j.preghy.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/30/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Determine the risk of hypertensive disorders of pregnancy (HD) in women with a history of spontaneous preterm birth (SPTB). STUDY DESIGN Longitudinal linked national cohort study within the Dutch Perinatal Registry (1999-2009) on linked data among 349,291 women with a first and second singleton pregnancy in the Netherlands. MAIN OUTCOME MEASURES The incidence of HD, small for gestational age (SGA) and placental abruption in the second pregnancy. RESULTS Out of 349,291 women with a singleton first pregnancy, 19,991 (5.7%) had a SPTB. The incidence of HD in the second pregnancy was 8.1% in women with a previous SPTB, as compared to 5.6% in women with a previous term birth (aOR 1.49 (CI 1.41-1.57)). Also after excluding HD, SGA and/or placental abruption in the first pregnancy, women with a history of SPTB had a higher risk of HD in their second pregnancy compared to women with a previous term birth (4.6% versus 2.7%, aOR 1.77 (CI 1.64-191)). Similarly, the incidence of SGA and placental abruption was higher in the second pregnancy in women with a history of SPTB compared to term birth in the first pregnancy. CONCLUSIONS Women with a history of SPTB are at elevated risk of HD in the subsequent pregnancy. These results support shared pathophysiology between SPTB and HD.
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Affiliation(s)
- Laura Visser
- Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Monash University, Clayton, Australia.
| | - Marjon A de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Monash University, Clayton, Australia.
| | - Anita C J Ravelli
- Amsterdam UMC, University of Amsterdam, The Netherlands; Monash University, Clayton, Australia.
| | - Henk Groen
- University of Groningen, The Netherlands; Monash University, Clayton, Australia.
| | - Ben Willem Mol
- University of Groningen, The Netherlands; Monash University, Clayton, Australia.
| | - Christianne J M de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands; Monash University, Clayton, Australia.
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Abstract
INTRODUCTION Preterm birth (PTB) is one of the greatest challenges in obstetric and children's healthcare. PTB remains the most important cause of perinatal morbidity and mortality worldwide. We studied the number of publications concerning PTB over the last two decades using advanced bibliometric visualization methodology. We put the number of publications in perspective of growing awareness of PTB as a major health problem. METHODS We analyzed publications over time and performed bibliometric analysis of publications on PTB in the Web of Science from 1997 to 2016. The subjects of publications were visualized using a term map showing the relevant terms occurring in titles and abstracts. RESULTS We identified 47,811 publications. The annual number of publications on PTB increased significantly by 443% in 2016 (n = 5027) compared to 1997 (n = 1135). Obstetrics & Gynecology is the leading research field (with 10.4% on the subject PTB in 2016) followed closely by Pediatrics (7.6% on the subject PTB in 2016), within the field Public, Environmental & Occupational Health minimal increase was observed (only 1% was published on the subject PTB in 2016). The publications on PTB have increased at higher rates than the overall increase of publications. In recent years we found more publications on PTB describing epidemiology and clinical characteristics/outcomes whereas in earlier years publications focused more on translational, basic research. CONCLUSION A significant increase in research concerning PTB was observed over the last two decades. This increase of publications is in line with the growing global awareness of the need to reduce PTB by clinical research.
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Affiliation(s)
- Laura Visser
- Department of Obstetrics and Gynecology, UMC Amsterdam, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, UMC Amsterdam, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, UMC Amsterdam, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
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Georgiadou D, Boussata S, Ranzijn WHM, Root LEA, Hillenius S, Bij de Weg JM, Abheiden CNH, de Boer MA, de Vries JIP, Vrijkotte TGM, Lambalk CB, Kuijper EAM, Afink GB, van Dijk M. Peptide hormone ELABELA enhances extravillous trophoblast differentiation, but placenta is not the major source of circulating ELABELA in pregnancy. Sci Rep 2019; 9:19077. [PMID: 31836787 PMCID: PMC6911039 DOI: 10.1038/s41598-019-55650-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Preeclampsia is a frequent gestational hypertensive disorder with equivocal pathophysiology. Knockout of peptide hormone ELABELA (ELA) has been shown to cause preeclampsia-like symptoms in mice. However, the role of ELA in human placentation and whether ELA is involved in the development of preeclampsia in humans is not yet known. In this study, we show that exogenous administration of ELA peptide is able to increase invasiveness of extravillous trophoblasts in vitro, is able to change outgrowth morphology and reduce trophoblast proliferation ex vivo, and that these effects are, at least in part, independent of signaling through the Apelin Receptor (APLNR). Moreover, we show that circulating levels of ELA are highly variable between women, correlate with BMI, but are significantly reduced in first trimester plasma of women with a healthy BMI later developing preeclampsia. We conclude that the large variability and BMI dependence of ELA levels in circulation make this peptide an unlikely candidate to function as a first trimester preeclampsia screening biomarker, while in the future administering ELA or a derivative might be considered as a potential preeclampsia treatment option as ELA is able to drive extravillous trophoblast differentiation.
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Affiliation(s)
- Danai Georgiadou
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Souad Boussata
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Willemijn H M Ranzijn
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Leah E A Root
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Sanne Hillenius
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Jeske M Bij de Weg
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Carolien N H Abheiden
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Esther A M Kuijper
- Reproductive Medicine, Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, location VUmc, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Gijs B Afink
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Marie van Dijk
- Reproductive Biology Laboratory, Amsterdam University Medical Centers, location AMC, Reproduction & Development Research Institute, Amsterdam, The Netherlands.
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Visser L, van Buggenum H, van der Voorn JP, Heestermans LAPH, Hollander KWP, Wouters MGAJ, de Groot CJM, de Boer MA. Maternal vascular malperfusion in spontaneous preterm birth placentas related to clinical outcome of subsequent pregnancy. J Matern Fetal Neonatal Med 2019; 34:2759-2764. [PMID: 31665946 DOI: 10.1080/14767058.2019.1670811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Spontaneous preterm birth (SPTB) has several causes and its pathophysiology remains unclear. In a significant proportion of SPTB, placental histology shows signs of maternal vascular malperfusion (MVM); commonly associated with hypertensive disorders of pregnancy (HD), fetal growth restriction (FGR) and placental abruption, together referred to as clinical ischemic placental diseases (IPD). We hypothesized that women with SPTB and placental MVM are at elevated risk for IPD in a subsequent pregnancy. METHODS We included women with SPTB in our cohort and followed the subsequent ongoing pregnancy (n = 110). Histological placental characteristics in the index were reported according to new international guidelines, and related to the clinical outcome of the subsequent pregnancy. RESULTS In the SPTB placentas, we observed MVM in 61.8% (n = 68). In the subsequent pregnancies in 19.1% (n = 21) at least one clinical sign of IPD was present (HD (12.7%), FGR (5.5%) or placental abruption (0.9%)). There was no significant difference in the prevalence of clinical IPD or recurrence of SPTB in the subsequent pregnancy between women with and without placental MVM in the index pregnancy, although our study was not powered to detect small differences. DISCUSSION Women with a history of SPTB have an elevated risk of IPD in the subsequent pregnancy. MVM is present in a large proportion of SPTB placentas. The presence of placental MVM in the index pregnancy does not predict clinical IPD or recurrent SPTB in a subsequent pregnancy.
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Affiliation(s)
- Laura Visser
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hannah van Buggenum
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Patrick van der Voorn
- Department of Pathology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lotte A P H Heestermans
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kees W P Hollander
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maurice G A J Wouters
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Amsterdam UMC - Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bij de Weg JM, de Groot CJ, Pajkrt E, de Boer MA. Recovery of second trimester pre-eclampsia after fetal reduction of a triplet. BMJ Case Rep 2019; 12:12/9/e227667. [PMID: 31537585 DOI: 10.1136/bcr-2018-227667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.
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Affiliation(s)
- Jeske M Bij de Weg
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christianne J de Groot
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Vollgraff Heidweiller-Schreurs CA, de Boer MA, van der Meij KRM, Bax CJ, de Groot CJM, Henneman L. Women's experiences of monitoring the small-for-gestational age fetus by ultrasound: A qualitative study. PLoS One 2019; 14:e0216052. [PMID: 31042753 PMCID: PMC6493740 DOI: 10.1371/journal.pone.0216052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/14/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To explore experiences among pregnant women diagnosed with a small-for-gestational age (SGA) fetus, and monitored by frequent ultrasounds. Methods We performed a qualitative study at the outpatient clinic of the Gynecology and Obstetrics department of a large academic hospital in Amsterdam. Semi-structured interviews were conducted with fifteen women, diagnosed with an SGA fetus during their pregnancy and having had at least two monitoring ultrasounds since. Themes were identified following analysis of the interview transcripts. Results Most women experienced the frequent ultrasounds as a source of support providing comfort and a feeling of safety. It was considered necessary, in the best interest of the baby, which outweighed the discomfort caused by having to come to the hospital frequently. Women described anxiety building up prior to each ultrasound, but feeling reassured and relieved afterwards. During the ultrasound a continuous explanation was preferred, which provided confirmation and a feeling of security. Women identified the uncertainty of SGA’s cause and prognosis as one of the biggest challenges to cope with, for which they used different strategies. Many women expressed a need for more detailed information and counselling, including non-medical aspects of pregnancy and delivery as well. Lastly, many women reported that seeing different doctors negatively influenced the perceived quality of care. Conclusions In general, women in this study were satisfied with the ultrasounds for their small-for-gestational age pregnancies. However, women expressed a need for additional information to help cope with a feeling of uncertainty regarding cause and prognosis. Their medical team should preferably provide this in a consistent and continuous manner.
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Affiliation(s)
- Charlotte A. Vollgraff Heidweiller-Schreurs
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
- * E-mail:
| | - Marjon A. de Boer
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Karuna R. M. van der Meij
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline J. Bax
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Amsterdam Reproduction and Development Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Martin L, Gitsels-van der Wal JT, de Boer MA, Vanstone M, Henneman L. Introduction of non-invasive prenatal testing as a first-tier aneuploidy screening test: A survey among Dutch midwives about their role as counsellors. Midwifery 2018; 56:1-8. [DOI: 10.1016/j.midw.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
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van Zijl MD, Koullali B, Naaktgeboren CA, Schuit E, Bekedam DJ, Moll E, Oudijk MA, van Baal WM, de Boer MA, Visser H, van Drongelen J, van de Made FW, Vollebregt KC, Muller MA, Bekker MN, Brons JTJ, Sueters M, Langenveld J, Franssen MT, Schuitemaker NW, van Beek E, Scheepers HCJ, de Boer K, Tepe EM, Huisjes AJM, Hooker AB, Verheijen ECJ, Papatsonis DN, Mol BWJ, Kazemier BM, Pajkrt E. Pessary or Progesterone to Prevent Preterm delivery in women with short cervical length: the Quadruple P randomised controlled trial. BMC Pregnancy Childbirth 2017; 17:284. [PMID: 28870155 PMCID: PMC5584011 DOI: 10.1186/s12884-017-1454-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments. METHODS/DESIGN The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately. It is a nationwide open-label multicentre randomized clinical trial (RCT) with a superiority design and will be accompanied by an economic analysis. Pregnant women undergoing the routine anomaly scan will be offered cervical length measurement between 18 and 22 weeks in a singleton and at 16-22 weeks in a multiple pregnancy. Women with a short cervix, defined as less than, or equal to 35 mm in a singleton and less than 38 mm in a multiple pregnancy, will be invited to participate in the study. Eligible women will be randomly allocated to receive either progesterone or a cervical pessary. Following randomization, the silicone cervical pessary will be placed during vaginal examination or 200 mg progesterone capsules will be daily self-administered vaginally. Both interventions will be continued until 36 weeks gestation or until delivery, whichever comes first. Primary outcome will be composite adverse perinatal outcome of perinatal mortality and perinatal morbidity including bronchopulmonary dysplasia, intraventricular haemorrhage grade III and IV, periventricular leukomalacia higher than grade I, necrotizing enterocolitis higher than stage I, Retinopathy of prematurity (ROP) or culture proven sepsis. These outcomes will be measured up until 10 weeks after the expected due date. Secondary outcomes will be, among others, time to delivery, preterm birth rate before 28, 32, 34 and 37 weeks, admission to neonatal intensive care unit, maternal morbidity, maternal admission days for threatened preterm labour and costs. DISCUSSION This trial will provide evidence on whether vaginal progesterone or a cervical pessary is more effective in decreasing adverse perinatal outcome in both singletons and multiples. TRIAL REGISTRATION Trial registration number: NTR 4414 . Date of registration January 29th 2014.
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Affiliation(s)
- Maud D van Zijl
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Bouchra Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Christiana A Naaktgeboren
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Julius Centre for General Practice and Health Sciences, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Ewoud Schuit
- Julius Centre for General Practice and Health Sciences, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Dick J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis (OLVG) Oost, Amsterdam, The Netherlands
| | - Etelka Moll
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis (OLVG) West, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | | | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU Medical Centre (VUmc), Amsterdam, The Netherlands
| | - Henricus Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospital, Hilversum, The Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Flip W van de Made
- Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Karlijn C Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Moira A Muller
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Jozien T J Brons
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynaecology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Maureen T Franssen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Nico W Schuitemaker
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Erik van Beek
- Department of Obstetrics and Gynaecology, Antonius Hospital, Nieuwegein, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eveline M Tepe
- Department of Obstetrics and Gynaecology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Anjoke J M Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Angelo B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medical Centre (ZMC), Zaandam, The Netherlands
| | - Evelyn C J Verheijen
- Department of Obstetrics and Gynaecology, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | - Dimitri N Papatsonis
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Ben Willem J Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Brenda M Kazemier
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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Visser L, de Boer MA, de Groot CJM, Nijman TAJ, Hemels MAC, Bloemenkamp KWM, Bosmans JE, Kok M, van Laar JO, Sueters M, Scheepers H, van Drongelen J, Franssen MTM, Sikkema JM, Duvekot HJJ, Bekker MN, van der Post JAM, Naaktgeboren C, Mol BWJ, Oudijk MA. Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: a multicenter randomized placebo controlled trial. BMC Pregnancy Childbirth 2017; 17:223. [PMID: 28705190 PMCID: PMC5513323 DOI: 10.1186/s12884-017-1338-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/19/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5 million pregnancies each year. A recent meta-analysis showed possible benefits of the use of low dose aspirin in the prevention of recurrent spontaneous preterm birth. We will assess the (cost-)effectiveness of low dose aspirin in comparison with placebo in the prevention of recurrent spontaneous preterm birth in a randomized clinical trial. METHODS/DESIGN Women with a singleton pregnancy and a history of spontaneous preterm birth in a singleton pregnancy (22-37 weeks of gestation) will be asked to participate in a multicenter, randomized, double blinded, placebo controlled trial. Women will be randomized to low dose aspirin (80 mg once daily) or placebo, initiated from 8 to 16 weeks up to maximal 36 weeks of gestation. The primary outcome measure will be preterm birth, defined as birth at a gestational age (GA) < 37 weeks. Secondary outcomes will be a composite of adverse neonatal outcome and maternal outcomes, including subgroups of prematurity, as well as intrauterine growth restriction (IUGR) and costs from a healthcare perspective. Preterm birth will be analyzed as a group, as well as separately for spontaneous or indicated onset. Analysis will be performed by intention to treat. In total, 406 pregnant women have to be randomized to show a reduction of 35% in preterm birth from 36 to 23%. If aspirin is effective in preventing preterm birth, we expect that there will be cost savings, because of the low costs of aspirin. To evaluate this, a cost-effectiveness analysis will be performed comparing preventive treatment with aspirin with placebo. DISCUSSION This trial will provide evidence as to whether or not low dose aspirin is (cost-) effective in reducing recurrence of spontaneous preterm birth. TRIAL REGISTRATION Clinical trial registration number of the Dutch Trial Register: NTR 5675 . EudraCT-registration number: 2015-003220-31.
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Affiliation(s)
- Laura Visser
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Marjon A. de Boer
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Tobias A. J. Nijman
- Department of Obstetrics and Gynecology, Birth Centre Wilhelmina Children Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marieke A. C. Hemels
- Department of Neonatology, Isala Clinic, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics and Gynecology, Birth Centre Wilhelmina Children Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Judith O. van Laar
- Department of Obstetrics and Gynecology, Maxima Medical Center in Veldhoven, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Hubertina Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Maureen T. M. Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J. Marko Sikkema
- Department of Obstetrics and Gynecology, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands
| | - Hans J. J. Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center, ‘s- Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynecology, Birth Centre Wilhelmina Children Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Joris A. M. van der Post
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Christiana Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ben W. J. Mol
- Department of Obstetrics and Gynecology, Robinson Research Institute, University of Adelaide, 72 King William St, North Adelaide, SA 5006 Australia
| | - Martijn A. Oudijk
- Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Koullali B, van Kempen LEM, van Zijl MD, Naaktgeboren CA, Schuit E, Bekedam DJ, Franssen MTM, Nij Bijvank SWA, Sueters M, van Baal M, de Boer MA, Hooker AB, Hermsen BBJ, Toolenaar TAAM, Zwart JJ, van der Ham DP, van der Made FW, Prefumo F, Martinez de Tejada B, Papatsonis DNM, Huisjes AJM, Scheepers LHCJ, van Hoorn ME, Hasaart THM, Schuitemaker NWE, Vollebregt KC, Müller MA, Evers IM, Post MS, de Boer K, Visser H, Mensing van Charante NA, Langenveld J, Steemers NYC, Mol BWJ, Oudijk MA, Pajkrt E. A multi-centre, non-inferiority, randomised controlled trial to compare a cervical pessary with a cervical cerclage in the prevention of preterm delivery in women with short cervical length and a history of preterm birth - PC study. BMC Pregnancy Childbirth 2017; 17:215. [PMID: 28683739 PMCID: PMC5501372 DOI: 10.1186/s12884-017-1393-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bouchra Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
| | - Liselotte E M van Kempen
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Maud D van Zijl
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Center for General Practice and Health Sciences, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Ewoud Schuit
- Julius Center for General Practice and Health Sciences, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Dick J Bekedam
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis (OLVG) Oost, Amsterdam, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynaecology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | | | - Marieke Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marchien van Baal
- Department of Obstetrics and Gynaecology, Flevoziekenhuis, Almere, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU Medical Center (VUmc), Amsterdam, The Netherlands
| | - Angelo B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medical Center (ZMC), Zaandam, The Netherlands
| | - Brenda B J Hermsen
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis (OLVG) West, Amsterdam, The Netherlands
| | - Toon A A M Toolenaar
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands
| | - Flip W van der Made
- Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Begoña Martinez de Tejada
- Department of Obstetrics and Gynaecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | | | - Anjoke J M Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Liesbeth H C J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Marion E van Hoorn
- Department of Obstetrics and Gynaecology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Tom H M Hasaart
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Karlijn C Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Moira A Müller
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inge M Evers
- Department of Obstetrics and Gynaecology, Meander Medical Center, Amersfoort, The Netherlands
| | - Marinka S Post
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Henricus Visser
- Department of Obstetrics and Gynaecology, Tergooi Hospital, Hilversum, The Netherlands
| | | | - Josje Langenveld
- Department of Obstetrics and Gynaecology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Nicole Y C Steemers
- Department of Obstetrics and Gynaecology, Elizabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Ben W J Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center (AMC), Amsterdam, The Netherlands
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Visser L, van Buggenum H, van der Voorn JP, Heestermans LA, Hollander KW, Wouters MG, de Groot C, de Boer MA. P 23 Maternal vascular malperfusion in spontaneous preterm birth and outcome of subsequent pregnancy. Pregnancy Hypertens 2017. [DOI: 10.1016/j.preghy.2017.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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van Schendel RV, Page-Christiaens GCML, Beulen L, Bilardo CM, de Boer MA, Coumans ABC, Faas BHW, van Langen IM, Lichtenbelt KD, van Maarle MC, Macville MVE, Oepkes D, Pajkrt E, Henneman L. Women's Experience with Non-Invasive Prenatal Testing and Emotional Well-being and Satisfaction after Test-Results. J Genet Couns 2017; 26:1348-1356. [PMID: 28667567 PMCID: PMC5672853 DOI: 10.1007/s10897-017-0118-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Increasingly, high-risk pregnant women opt for non-invasive prenatal testing (NIPT) instead of invasive diagnostic testing. Since NIPT is less accurate than invasive testing, a normal NIPT result might leave women less reassured. A questionnaire study was performed among pregnant women with elevated risk for fetal aneuploidy based on first-trimester combined test (risk ≥1:200) or medical history, who were offered NIPT in the nationwide Dutch TRIDENT study. Pre- and post-test questionnaires (n = 682) included measures on: experiences with NIPT procedure, feelings of reassurance, anxiety (State-Trait Anxiety Inventory, STAI), child-related anxiety (PRAQ-R), and satisfaction. The majority (96.1%) were glad to have been offered NIPT. Most (68.5%) perceived the waiting time for NIPT results (mean: 15 days, range 5–32) as (much) too long. Most women with a normal NIPT result felt reassured (80.9%) or somewhat reassured (15.7%). Levels of anxiety and child-related anxiety were significantly lower after receiving a normal NIPT result as compared to the moment of intake (p < 0.001). Women with inadequate health literacy or a medical history (e.g. previous child with trisomy) experienced significantly higher post-test-result anxiety (Mean (M) STAI = 31.6 and 30.0, respectively) compared to those with adequate health literacy (M = 28.6) and no medical history (M = 28.6), indicating these women might benefit from extra information and/or guidance when communicating NIPT test-results. Introducing NIPT as an alternative to invasive testing, led to an offer that satisfied and largely reassured high-risk pregnant women.
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Affiliation(s)
- Rachèl V van Schendel
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Lean Beulen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caterina M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC +, Maastricht, the Netherlands
| | - Brigitte H W Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC +, Maastricht, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Affiliation(s)
| | | | - Ben W Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,The South Australian Health and Medical Research Institute Adelaide, Adelaide, South Australia, Australia
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Tamminga S, van Dussen L, Verweij EJJ, de Boer MA, Cornel MC, Henneman L. What do people want to know about NIPT? Content analysis of questions emailed to national NIPT information websites. Prenat Diagn 2017; 37:412-415. [PMID: 28124373 PMCID: PMC5413829 DOI: 10.1002/pd.5011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/06/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
What's already known about this topic?
Several countries, including the Netherlands, have implemented non‐invasive prenatal testing (NIPT) in their national prenatal screening program Access to relevant online health information is important as it increases informed decision making What does this study add?
Visitors of national NIPT websites mostly request more information about testing beyond the currently available NIPT: a broader range of disorders (such as monogenic disorders) and increasing target group eligibility (such as low‐risk or twin pregnancies) © 2017 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Saskia Tamminga
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | | | - E J Joanne Verweij
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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Abheiden CNH, Fuijkschot WW, Arduç A, van Diemen JJK, Harmsze AM, de Boer MA, Thijs A, de Vries JIP. Post-pregnancy aspirin resistance appears not to be related with recurrent hypertensive disorders of pregnancy. Eur J Obstet Gynecol Reprod Biol 2016; 210:139-143. [PMID: 28033561 DOI: 10.1016/j.ejogrb.2016.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/01/2016] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The FRUIT-RCT concluded that low-molecular-weight heparin added to aspirin compared to treatment with aspirin alone is beneficial in the prevention of early-onset hypertensive disorders of pregnancy (HD) in women with inheritable thrombophilia and prior HD and/or a small-for-gestational age (SGA) infant leading to delivery before 34 weeks gestation. The aim of this study is to answer the question whether aspirin resistance is associated with recurrent HD. STUDY DESIGN Women with and without recurrent HD matched for age, study arm, and chronic hypertension were invited for this follow-up study 6-16 years after they participated in the FRUIT-RCT. Aspirin resistance was tested after 10days of aspirin intake using three complementary tests: PFA-200, VerifyNow® and serum thromboxane B2 (TXB2). An independent t-test, Mann-Whitney U test, Fisher's Exact test and Chi2 test were used for the statistical analyses. RESULTS Thirteen of 24 women with recurrent HD and 16 of 24 women without recurrent HD participated. The prevalence of laboratory aspirin resistance was 34.5% according to the PFA-200, 3.4% according to the VerifyNow® and 24.1% according to TXB2. The prevalence of aspirin resistance by any test was 51.7%. Aspirin resistance per individual test did not differ between women with and without recurrent HD. Aspirin resistance measured by any test occurred more frequently in women without recurrent HD (p<0.01), irrespective of low-molecular-weight heparin. CONCLUSIONS No relation could be demonstrated between recurrent HD and aspirin resistance per test, measured up to 16 years after pregnancy. On the contrary, complementary aspirin resistance measurements were encountered more frequently in women without recurrent HD.
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Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Wessel W Fuijkschot
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Arda Arduç
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Jeske J K van Diemen
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ankie M Harmsze
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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van Schendel RV, Page-Christiaens GCL, Beulen L, Bilardo CM, de Boer MA, Coumans ABC, Faas BH, van Langen IM, Lichtenbelt KD, van Maarle MC, Macville MVE, Oepkes D, Pajkrt E, Henneman L. Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part II-women's perspectives. Prenat Diagn 2016; 36:1091-1098. [PMID: 27739584 PMCID: PMC5213994 DOI: 10.1002/pd.4941] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/02/2016] [Accepted: 10/11/2016] [Indexed: 12/14/2022]
Abstract
Objective To evaluate preferences and decision‐making among high‐risk pregnant women offered a choice between Non‐Invasive Prenatal Testing (NIPT), invasive testing or no further testing. Methods Nationwide implementation study (TRIDENT) offering NIPT as contingent screening test for women at increased risk for fetal aneuploidy based on first‐trimester combined testing (>1:200) or medical history. A questionnaire was completed after counseling assessing knowledge, attitudes and participation following the Multidimensional Measure of Informed Choice. Results A total of 1091/1253 (87%) women completed the questionnaire. Of these, 1053 (96.5%) underwent NIPT, 37 (3.4%) invasive testing and 1 (0.1%) declined testing. 91.7% preferred NIPT because of test safety. Overall, 77.9% made an informed choice, 89.8% had sufficient knowledge and 90.5% had positive attitudes towards NIPT. Women with intermediate (odds ratio (OR) = 3.51[1.70–7.22], p < 0.001) or high educational level (OR = 4.36[2.22–8.54], p < 0.001) and women with adequate health literacy (OR = 2.60[1.36–4.95], p = 0.004) were more likely to make an informed choice. Informed choice was associated with less decisional conflict and less anxiety (p < 0.001). Intention to terminate the pregnancy for Down syndrome was higher among women undergoing invasive testing (86.5%) compared to those undergoing NIPT (58.4%) (p < 0.001). Conclusions The majority of women had sufficient knowledge and made an informed choice. Continuous attention for counseling is required, especially for low‐educated and less health‐literate women. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?NIPT is offered as alternative to invasive testing to screen pregnant women at high risk for fetal aneuploidy. Although NIPT has many advantages, concerns have been raised about the consequences for informed decision‐making.
What does this study adds?Implementation of NIPT in a national healthcare‐funded prenatal screening program, accompanied by pre‐test counseling, results in most women having sufficient knowledge and making an informed choice Compared to women choosing invasive testing, women undergoing NIPT have less intention to terminate the pregnancy for Down syndrome.
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Affiliation(s)
- Rachèl V van Schendel
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Lean Beulen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catia M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Brigitte H Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Abheiden CNH, Thijs A, de Vries JIP, de Boer MA. Cardiovascular risk factors in women with inheritable thrombophilia a decade after single or recurrent hypertensive disorder of pregnancy. Hypertens Pregnancy 2016; 35:461-469. [PMID: 27322349 DOI: 10.1080/10641955.2016.1183674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To described cardiovascular risk factors in women with inheritable thrombophilia 8-19 years after early-onset hypertensive disorders of pregnancy (HD) with or without recurrent HD. METHODS Women with recurrent HD were compared with women with single HD, for physical examination and cardiovascular parameters in serum. RESULTS Systolic blood pressure, diastolic blood pressure, and albumin: creatinine ratio were higher in women with recurrent HD compared with women with single HD (p = 0.046, p = 0.029, and p = 0.008, respectively). In both groups 72.7% had an increased cardiovascular risk. CONCLUSION Women with inheritable thrombophilia after single or recurrent HD have a high cardiovascular risk.
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Affiliation(s)
- Carolien N H Abheiden
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Abel Thijs
- b Department of Internal Medicine , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Johanna I P de Vries
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
| | - Marjon A de Boer
- a Department of Obstetrics and Gynaecology , Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center , Amsterdam , The Netherlands
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49
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Abheiden CNH, Blomjous BS, Kroese SJ, Bultink IEM, Fritsch-Stork RDE, Lely AT, de Boer MA, de Vries JIP. Low-molecular-weight heparin and aspirin use in relation to pregnancy outcome in women with systemic lupus erythematosus and antiphospholipid syndrome: A cohort study. Hypertens Pregnancy 2016; 36:8-15. [PMID: 27599157 DOI: 10.1080/10641955.2016.1217337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To relate anticoagulant use to pregnancy complications in women with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). METHODS All ongoing pregnancies, 184, in two Dutch tertiary centers between 2000 and 2015. RESULTS LMWH and aspirin was prescribed in 15/109 SLE women without antiphospholipid antibodies (aPL), 5/14 with aPL, 11/13 with APS, 45/48 with primary APS. Main complications in the four treatment groups (no anticoagulant treatment, aspirin, LMWH, aspirin and LMWH) included hypertensive disorders of pregnancy (9.4%, 23.3%, 50%, 18.4%, respectively, p = 0.12) and preterm birth (16.7%, 34.3%, 75%, 36.8%, respectively, p < 0.001). CONCLUSION Maternal and perinatal complications occurred frequently, despite LMWH and aspirin use.
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Affiliation(s)
- Carolien N H Abheiden
- a Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands
| | - Birgit S Blomjous
- a Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands.,b Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, VU University Medical Center , Amsterdam , The Netherlands
| | - Sylvia J Kroese
- c Department of Rheumatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Irene E M Bultink
- b Department of Rheumatology , Amsterdam Rheumatology and Immunology Center, VU University Medical Center , Amsterdam , The Netherlands
| | - Ruth D E Fritsch-Stork
- c Department of Rheumatology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Titia Lely
- d Department of Obstetrics and Gynaecology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marjon A de Boer
- a Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands
| | - Johanna I P de Vries
- a Department of Obstetrics and Gynaecology , VU University Medical Center , Amsterdam , The Netherlands
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Verweij EJJ, Oepkes D, de Vries M, van den Akker MEE, van den Akker ES, de Boer MA. Non-invasive prenatal screening for trisomy 21: what women want and are willing to pay. Patient Educ Couns 2013; 93:641-645. [PMID: 24011429 DOI: 10.1016/j.pec.2013.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/04/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the attitude among pregnant women regarding non-invasive prenatal testing (NIPT) for detecting trisomy 21 (T21) and to quantify their willingness to pay for NIPT. METHODS A questionnaire was administered to pregnant women who received counselling for first-trimester screening (FTS) in two hospitals and nine midwife practices in the Netherlands. RESULTS A total of 147 women completed the questionnaire, yielding a response rate of 43%. If NIPT for detecting T21 were available, 81% stated they would choose to have this test, and 57% of women who elected not to undergo FTS in their current pregnancy would perform NIPT if available. Willingness to pay for NIPT was correlated with age and income, but not education level. The price that participants were willing to pay for NIPT was similar to the current price for FTS. CONCLUSION The pregnant women in our study had a positive attitude regarding NIPT for T21, and more than half of the women who rejected prenatal screening would receive NIPT if available. PRACTICE IMPLICATIONS Due to the elimination of iatrogenic miscarriage, caregivers should be aware that informed decision-making can change with respect to prenatal screening with the introduction of NIPT.
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Affiliation(s)
- E J Joanne Verweij
- Department of Obstetrics, Leiden University Medical Centre, The Netherlands.
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