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Mhatre M, Craigo S. General Principles for Counseling and Management of Triplet Pregnancies. Clin Obstet Gynecol 2023; 66:854-863. [PMID: 37963347 DOI: 10.1097/grf.0000000000000814] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Compared with singleton pregnancies, triplet pregnancies are associated with a significantly increased risk of adverse pregnancy outcomes. Early ultrasound examination is the best way to diagnose triplets, establish dating, and determine the number of placentas to provide appropriate counseling and monitoring. Dichorionic placentation adds risks specifically associated with a shared placenta, and limits options for intervention. Multifetal reduction is an option that can significantly improve pregnancy outcomes compared with non-reduced triplet pregnancies. Integration of a Maternal-Fetal Medicine specialist in the prenatal care for a triplet pregnancy reduces the risk of preeclampsia, preterm birth, low birthweight infants, perinatal mortality, and major neonatal morbidity.
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Affiliation(s)
- Mohak Mhatre
- Division of Maternal-Fetal Medicine, South Shore Hospital, South Weymouth
| | - Sabrina Craigo
- Division of Maternal-Fetal Medicine, Tufts Medical Center, Boston, Massachusetts
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Hostage J, Kolettis D, Sverdlov D, Ludgin J, Drzymalski D, Sweigart B, Mhatre M, House M. Increased Scheduled Intravenous Ketorolac After Cesarean Delivery and Its Effect on Opioid Use: A Randomized Controlled Trial. Obstet Gynecol 2023; 141:783-790. [PMID: 36897140 DOI: 10.1097/aog.0000000000005120] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate the efficacy of scheduled ketorolac in reducing opioid use after cesarean delivery. METHODS This was a single-center, randomized, double-blind, parallel-group trial to assess pain management after cesarean delivery with scheduled ketorolac compared with placebo. All patients undergoing cesarean delivery with neuraxial anesthesia received two doses of 30 mg intravenous ketorolac postoperatively and then were randomized to receive four doses of 30 mg of intravenous ketorolac or placebo every 6 hours. Additional nonsteroidal anti-inflammatory drugs were held until 6 hours after the last study dose. The primary outcome was total morphine milligram equivalents (MME) used in the first 72 postoperative hours. Secondary outcomes included the number of patients who used no opioid postoperatively, postoperative pain scores, postoperative change in hematocrit and serum creatinine, and postoperative satisfaction with inpatient care and pain management. A sample size of 74 per group (n=148) provided 80% power to detect a population mean difference in MME of 32.4, with an SD for both groups of 68.7 after accounting for protocol noncompliance. RESULTS From May 2019 to January 2022, 245 patients were screened and 148 patients were randomized (74 per group). Patient characteristics were similar between groups. The median (quartile 1-3) MME from arrival in the recovery room until postoperative hour 72 was 30.0 (0.0-67.5) for the ketorolac group and 60.0 (30.0-112.5) for the placebo group (Hodges-Lehmann median difference -30.0, 95% CI -45.0 to -15.0, P <.001). In addition, participants who received placebo were more likely to have numeric rating scale pain scores higher than 3 out of 10 ( P= .005). The mean±SD decrease from baseline hematocrit to postoperative day 1 was 5.5±2.6% for the ketorolac group and 5.4±3.5% for the placebo group ( P =.94). The mean±SD postoperative day 2 creatinine was 0.61±0.06 mg/dL in the ketorolac group and 0.62±0.08 mg/dL in the placebo group ( P =.26). Participant satisfaction with inpatient pain control and postoperative care was similar between groups. CONCLUSION Compared with placebo, scheduled intravenous ketorolac significantly decreased opioid use after cesarean delivery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT03678675.
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Affiliation(s)
- Jean Hostage
- Department of Obstetrics and Gynecology, the Department of Anesthesiology and Perioperative Medicine, and the Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
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Giuliani F, Oros D, Gunier RB, Deantoni S, Rauch S, Casale R, Nieto R, Bertino E, Rego A, Menis C, Gravett MG, Candiani M, Deruelle P, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Napolitano R, Liu B, Prefumo F, Savasi V, Do Vale MS, Baafi E, Ariff S, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Tavchioska G, Bako B, Benski C, Hassan-Hanga F, Savorani M, Sentilhes L, Carola Capelli M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Teji JS, Easter SR, Salomon LJ, Ayede AI, Cerbo RM, Agyeman-Duah J, Roggero P, Eskenazi B, Langer A, Bhutta ZA, Kennedy SH, Papageorghiou AT, Villar J. Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study. Am J Obstet Gynecol 2022; 227:488.e1-488.e17. [PMID: 35452653 PMCID: PMC9017081 DOI: 10.1016/j.ajog.2022.04.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 01/31/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. OBJECTIVE To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. STUDY DESIGN In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. RESULTS A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. CONCLUSION In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.
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Affiliation(s)
- Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children's Hospital, Turin, Italy.
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Robert B. Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Sonia Deantoni
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,Neonatal Care Unit, School of Medicine, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Enrico Bertino
- Neonatal Unit of the University, City of Health and Science of Turin, Turin, Italy
| | - Albertina Rego
- Departamento de Pediatria, Faculdade Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camilla Menis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michael G. Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Faculty of Medicine, Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | | | - Shabina Ariff
- Department of Paediatrics & Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nerea Maiz
- Department of Obstetrics, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Caroline Benski
- Hôpitaux Universitaires de Genève, Département de la Femme, de l'Enfant et de l'Adolescent, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria,Aminu Kano Teaching Hospital, Kano State, Nigeria
| | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Maria Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Irene Cetin
- Ospedale Vittore Buzzi Children's Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics & Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia,Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina,Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine and Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Laurent J. Salomon
- Hôpital Universitaire Necker-Enfants Malades, Assistance Publique–Hôpitaux de Paris, Université de Paris, France
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Josephine Agyeman-Duah
- Nuffield Department of Women's & Reproductive Health, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom,St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jose Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom,Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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Zhong L, Ruan J, Bell L, Chery J, Iyer V, Wang V, Sun C, Craigo S, Mhatre M, House M, Peterson A, Mauban E, Wang XY, Hensel DM, Min C, Oakes MC, Raghuraman N, Carter EB, Odibo AO, Kelly JC. Differences in obstetric complications between Asian and White patients at two tertiary care centers. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.683] [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: 11/24/2022]
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Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Simmons LE, Napolitano R, Deantoni S, Liu B, Prefumo F, Savasi V, do Vale MS, Baafi E, Zainab G, Nieto R, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Winsey A, Tavchioska G, Bako B, Oros D, Rego A, Benski AC, Hassan-Hanga F, Savorani M, Giuliani F, Sentilhes L, Risso M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Ferrazzi E, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Firlit ML, Easter SR, Sichitiu J, Bowale A, Casale R, Cerbo RM, Cavoretto PI, Eskenazi B, Thornton JG, Bhutta ZA, Kennedy SH, Villar J. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 2021; 225:289.e1-289.e17. [PMID: 34187688 PMCID: PMC8233533 DOI: 10.1016/j.ajog.2021.05.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
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Affiliation(s)
- Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Robert B Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Lavone E Simmons
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom; Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sonia Deantoni
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Neonatal Care Unit, Department of Public Health and Pediatrics, School of Medicine, University of Turin, Italy
| | - Becky Liu
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, zienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Department of BioMedical and Clinical Sciences, Ospedale Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | | | | | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, the Aga Khan University, Karachi, Pakistan
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Daniel Oros
- Obstetrics Department, Aragon Institute of Health Research, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Albertina Rego
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Anne Caroline Benski
- Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Milagros Risso
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, the Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, Ospedale Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia; Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina; Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Michelle L Firlit
- Department of Obstetrics and Gynecology, University of Illinois Hospital and Health Science System, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA; Division of Critical Care Medicine, Department of Anesthesia, Perioperative, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, France
| | | | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistana
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, Roggero P, Prefumo F, do Vale MS, Cardona-Perez JA, Maiz N, Cetin I, Savasi V, Deruelle P, Easter SR, Sichitiu J, Soto Conti CP, Ernawati E, Mhatre M, Teji JS, Liu B, Capelli C, Oberto M, Salazar L, Gravett MG, Cavoretto PI, Nachinab VB, Galadanci H, Oros D, Ayede AI, Sentilhes L, Bako B, Savorani M, Cena H, García-May PK, Etuk S, Casale R, Abd-Elsalam S, Ikenoue S, Aminu MB, Vecciarelli C, Duro EA, Usman MA, John-Akinola Y, Nieto R, Ferrazi E, Bhutta ZA, Langer A, Kennedy SH, Papageorghiou AT. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175:817-826. [PMID: 33885740 PMCID: PMC8063132 DOI: 10.1001/jamapediatrics.2021.1050] [Citation(s) in RCA: 702] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Importance Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
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Affiliation(s)
- José Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Robert B. Gunier
- School of Public Health, University of California, Berkeley, Berkeley
| | | | - Stephen Rauch
- School of Public Health, University of California, Berkeley, Berkeley
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - Paola Roggero
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d’Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Irene Cetin
- Ospedale Vittore Buzzi Children’s Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Savasi
- Ospedale Luigi Sacco University Hospital, Department of BioMedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
- Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Jagjit Singh Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Becky Liu
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carola Capelli
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Manuela Oberto
- S.C. Obstetrics 2U, Sant’Anna Hospital, AOU Città della Salute e della scienza di Torino, Turin, Italy
| | - Laura Salazar
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael G. Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | | | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Daniel Oros
- Aragon Institute of Health Research, Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Adejumoke Idowu Ayede
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, University of Pavia, Pavia, Italy
| | | | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Eduardo A. Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina
- Universidad de Moron, Moron, Argentina
| | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Yetunde John-Akinola
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Enrico Ferrazi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Zulfiqar A. Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana Langer
- Women and Health Initiative, Global Health and Population Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Bitas C, Stone JM, Mhatre M, Spadola A, Graham G, Ralston S, Craigo S. 878 Can maternal-fetal medicine fellows safely perform chorionic villus sampling procedures in ongoing pregnancies? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.901] [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: 11/15/2022]
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8
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Mhatre M, Craigo S. Triplet pregnancy: What do we tell the prospective parents. Prenat Diagn 2020; 41:1593-1601. [PMID: 33080664 DOI: 10.1002/pd.5852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/09/2022]
Abstract
Experience managing triplet pregnancies has increased over the past few decades as the incidence has changed related to assisted reproductive practices. Physicians caring for women carrying triplets cannot predict an individual outcome or pregnancy course but must educate patients about the challenges related to these high risk pregnancies. Obstetric providers can describe the wide range of risks associated with triplet gestations, and the general plan for management, but ultimately parents must make decisions with potentially lifelong consequences. Here, we present the diagnostic criteria, common complications, and management options for triplet pregnancies, to help obstetricians counsel patients on the medical and psychosocial consequences of triplet pregnancy, potential complications, and multifetal reduction.
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Affiliation(s)
- Mohak Mhatre
- Tufts Medical Center, Boston, Massachusetts, USA
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Duzyj CM, Cooper A, Mhatre M, Han CS, Paidas MJ, Illuzzi JL, Sfakianaki AK. Placenta Accreta: A Spectrum of Predictable Risk, Diagnosis, and Morbidity. Am J Perinatol 2019; 36:1031-1038. [PMID: 30500963 DOI: 10.1055/s-0038-1676111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/27/2022]
Abstract
OBJECTIVE Placenta accreta is a feared pathology, in part, because prenatal diagnosis is imperfect. It is not known whether clinical risk factors or sonographic features equally predict the entire graded pathological spectrum of placental overinvasion disease nor whether clinical outcomes differ along the spectrum. STUDY DESIGN We conducted a mixed methods retrospective study of a cohort of women screened sonographically for placenta accreta, cross-referenced against cases identified by pathological diagnosis (N = 416). Demographic, diagnostic, and outcome information were compared across the spectrum of invasive placentation: percreta, increta, accreta, and focal accreta not requiring hysterectomy. The t-test, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis across groups. RESULTS As the depth of invasion decreased, risk factors for placental overinvasion were less common, especially placenta previa and previous cesarean. There was also reduced anticipation by sonographic examination of the placenta. Rates of adverse outcomes were lower among women with focal accreta compared with those with deeper invasion. CONCLUSION As the depth of invasion decreases, clinical risk factors and sonographic evaluation are less reliable in the antenatal prediction of placenta accreta. The potential for unanticipated morbidity underscores the need for improved diagnostic tools for placenta accreta spectrum.
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Affiliation(s)
- Christina M Duzyj
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anne Cooper
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mohak Mhatre
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael J Paidas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.,Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, New Haven, Connecticut
| | - Jessica L Illuzzi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Anna K Sfakianaki
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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10
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Mhatre M, Clifford C, Lo C, Xiong K, Adalsteinsson V, Iyer V, Taymoori A, Phillippe M, Norwitz E, Craigo S, Edlow A. 909: Methylation profile of circulating cfDNA at term demonstrates relatively low placental contribution to hypomethylated cfDNA. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.933] [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: 10/27/2022]
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11
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Mhatre M, Clifford C, Lo C, Xiong K, Adalsteinsson V, Iyer V, Taymoori A, Phillippe M, Norwitz E, Craigo S, Edlow A. 587: The methylation profile of circulating cfDNA is affected by maternal obesity and labor. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.609] [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: 10/27/2022]
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Mhatre M, Adeli S, Norwitz E, Craigo S, Phillippe M, Edlow A. The Effect of Maternal Obesity on Placental Cell-Free DNA Release in a Mouse Model. Reprod Sci 2018; 26:1218-1224. [PMID: 30453834 DOI: 10.1177/1933719118811647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/05/2023]
Abstract
BACKGROUND The fetal fraction of cell-free DNA (cfDNA) in maternal plasma is decreased in obese women. The underlying mechanism is not well understood. The amount of cfDNA released from the placenta has not been directly examined in maternal obesity. OBJECTIVE We sought to quantify release of cfDNA from the placenta and fetal membranes in maternal diet-induced obesity using explant cultures in an established mouse model. STUDY DESIGN C57BL6/J females were fed either 60% high-fat diet or 10% fat-matched control diet for 14 weeks prepregnancy and throughout gestation. Placentas and fetal membranes were collected on e18 and randomly allocated to time 0-, 1-, or 6-hour culture times. The CfDNA was isolated from culture media, quantified, and normalized to tissue weight. RESULTS Placentas from obese dams released significantly less cfDNA compared to those of lean dams at time 0 (45.8 ± 4.3 ng/mg vs 65.6 ± 7.9 ng/mg, P = .02). Absolute cfDNA levels increased with longer placental culture, with no significant differences between obese and lean dams at 1 and 6 hours. Membranes released significantly less cfDNA than did placentas at every time point. CONCLUSIONS Maternal obesity is associated with decreased release of cfDNA from the placenta compared to lean controls immediately after tissue harvest. This may provide an alternative explanation for the lower fetal fraction of cfDNA noted in maternal obesity.
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Affiliation(s)
- Mohak Mhatre
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Sharareh Adeli
- 2 Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Errol Norwitz
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
| | - Sabrina Craigo
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
| | - Mark Phillippe
- 2 Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.,4 Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. Edlow is now with Vincent Center for Reproductive Biology and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA, and Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Andrea Edlow
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
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Mhatre M, Potter J, Krikun G, Abrahams V. 23: Synergistic effect of thrombin and bacterial LPS on human endometrial endothelial cell inflammatory cytokine response. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.056] [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: 11/26/2022]
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Cooper A, Mhatre M, Campbell K, Illuzzi J. 579: Placenta accreta in the setting of prior uterine surgery. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.612] [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: 11/15/2022]
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15
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Duzyj C, Han C, Mhatre M, Cooper A, Paidas M, Sfakianaki A. 555: Focal placenta accreta not requiring hysterectomy has alternate risk factors and morbidity. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Mhatre M, McAndrew T, Carpenter C, Burk RD, Einstein MH, Herold BC. Cervical intraepithelial neoplasia is associated with genital tract mucosal inflammation. Sex Transm Dis 2012; 39:591-7. [PMID: 22801340 DOI: 10.1097/olq.0b013e318255aeef] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical studies demonstrate increased prevalence of human papillomavirus (HPV)-associated disease in HIV-infected individuals and an increased risk of HIV acquisition in HPV-infected individuals. The mechanisms underlying this synergy are not defined. We hypothesize that women with cervical intraepithelial neoplasia (CIN) will exhibit changes in soluble mucosal immunity that may promote HPV persistence and facilitate HIV infection. METHODS The concentrations of immune mediators and endogenous anti-Escherichia coli activity in genital tract secretions collected by cervicovaginal lavage were compared in HIV-negative women with high-risk HPV-positive (HRHPV+) CIN-3 (n = 37), HRHPV+ CIN-1 (n = 12), or PAP-negative control subjects (n = 57). RESULTS Compared with control subjects, women with CIN-3 or CIN-1 displayed significantly higher levels of proinflammatory cytokines including interleukin (IL)-1α, IL-1β, and IL-8 (P < 0.002) and significantly lower levels of anti-inflammatory mediators and antimicrobial peptides, including IL-1 receptor antagonist, secretory leukocyte protease inhibitor (P < 0.01), and human β defensins 2 and 3 (P < 0.02). There was no significant difference in endogenous anti-E. coli activity after controlling for age and sample storage time. CONCLUSION HRHPV+ CIN is characterized by changes in soluble mucosal immunity that could contribute to HPV persistence. The observed mucosal inflammation suggests a mechanism that may also contribute to the epidemiologic link between persistent HPV and HIV.
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Affiliation(s)
- Mohak Mhatre
- Departments of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
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Abstract
Pediatric brain tumors have always been challenging as well as intriguing in their anatomical, surgical, and postsurgical management-related issues. They are a heterogeneous set of pathologies involving different age groups in childhood and also differ widely from their adult counterparts as far as adjuvant therapies are concerned. Though neurosurgeons across the world are radical in surgery for most of the pediatric tumors, it can often be at the cost of future quality of life in suprasellar tumors. As the time has gone by, the pendulum has swung toward rather conservative and maximal safe surgical resections with adjuvant therapies coming to the forefront. Hence, the aim is to achieve a good quality of life for these children along with a control of tumor growth (rather than cure) and to again tackle the tumors, if required, once these children reach adolescence or adulthood. We have reviewed the literature for different pediatric suprasellar tumors and discussed their current management giving our perspective with illustrative cases.
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Affiliation(s)
- C. E. Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Ashish Kumar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - V. S. Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - N. K. Biyani
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - M. Mhatre
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - N. J. Shah
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
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Mesquita PMM, Cheshenko N, Wilson SS, Mhatre M, Guzman E, Fakioglu E, Keller MJ, Herold BC. Disruption of tight junctions by cellulose sulfate facilitates HIV infection: model of microbicide safety. J Infect Dis 2009; 200:599-608. [PMID: 19586414 DOI: 10.1086/600867] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The lack of biomarkers that are predictive of safety is a critical gap in the development of microbicides. The present experiments were designed to evaluate the predictive value of in vitro models of microbicide safety. METHODS Changes in the epithelial barrier were evaluated by measuring transepithelial electrical resistance (TER) after exposure of human epithelial cells to candidate microbicides in a dual-chamber system. The significance of observed changes was addressed by challenging cultures with human immunodeficiency virus (HIV) and measuring the ability of virus to cross the epithelium and infect target T cells cultured in the lower chamber. RESULTS Exposure to nonoxynol-9 (N-9) or cellulose sulfate (CS), but not 9-[2-(phosphonomethoxy)propyl]adenine (also referred to as tenofovir) or PRO2000, resulted in a rapid and sustained reduction in TER and a marked increase in HIV infection of T cells cultured in the lower chamber. Moreover, CS triggered nuclear factor kappaB activation in peripheral blood mononuclear cells and increased HIV replication in chronically infected U1 cells. CONCLUSIONS Epithelial barrier disruption and enhanced viral replication may have contributed to the increased risk of HIV acquisition observed in phase 3 trials of N-9 and CS. Expansion of in vitro safety testing to include these models would provide a more stringent preclinical assessment of microbicide safety and may prove to be more predictive of clinical outcomes.
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Affiliation(s)
- Pedro M M Mesquita
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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19
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Mhatre M. The role of the 5-lipoxygenase pathway in Alzheimer's disease. DRUG FUTURE 2006. [DOI: 10.1358/dof.2006.031.01.963590] [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: 10/24/2022]
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20
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Abstract
The molecular mechanisms associated with ethanol-induced tolerance and physical dependence have yet to be elucidated. In previous studies we have demonstrated that chronic ethanol administration produced a decrease in the GABAA receptor mRNA level of alpha 1, alpha 2, alpha 5 subunits, and a decrease in the polypeptide (alpha 1, alpha 2, and alpha 3) expression in the rat cerebral cortex. In this study we examined the effect of chronic ethanol treatment on the mRNA levels and the expressions of the beta-subunits of the GABAA receptors in rat cerebral cortex. The results indicate that chronic ethanol administration produced an upregulation of the beta 1 subunit mRNA (12 kb) by 29 +/- 10%, beta 2 mRNA (8 kb) by 55 +/- 6% and the beta 3-subunit (6 kb) mRNA by 72 +/- 9% in cerebral cortex. The levels of the beta 2 and beta 3 subunit mRNAs remains elevated at 24 hr withdrawal. We also investigated the effect of chronic ethanol administration on the beta-subunit polypeptide expression using monoclonal antibody BD17, which recognizes the beta 2 (P56) and beta 3 (P58) polypeptides. Chronic ethanol treatment increased the levels of both of these polypeptides in cerebral cortex. Taken together, chronic ethanol administration produced an upregulation of the beta-subunit mRNA and the polypeptide expression of these subunits in rat cerebral cortex. In contrast, chronic ethanol treatment decreased the expression of various alpha-subunits in the cerebral cortex.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Mhatre
- Department of Pharmacology, University of Texas Health Science Center at San Antonio 78284-7764
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21
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Mhatre M, Ticku MK. Chronic ethanol treatment selectively increases the binding of inverse agonists for benzodiazepine binding sites in cultured spinal cord neurons. J Pharmacol Exp Ther 1989; 251:164-8. [PMID: 2552072] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The effect of chronic ethanol treatment, and its withdrawal on the binding of ligands to the benzodiazepine binding sites of gamma-aminobutyric acid (GABA) receptor complex, was investigated in C57BL/6J mice spinal cord cultured neurons. Chronic ethanol (50 mM) treatment increased the specific binding of inverse agonists of the benzodiazepine binding sites, without affecting the binding of agonist or antagonist to this site. Thus, chronic ethanol exposure of the neurons increased the binding of [3H] Ro 15-4513 [ethyl-8-azido-5,6-dihydro-5-methyl-6-oxo-4H-imidazo [1,5-alpha][1,4]benzodiazepine-3-carboxylate] and methyl-1-beta carboline-3-carboxylate [( 3H]beta-CCM), but not the binding of [3H]flunitrazepam or [3H]Ro 15-1788 [ethyl-8-fluro-5-6-dihydro-5-methyl-6-OxO-4H-imidazo[1,5-alpha][1, 4] benzodiazepine-3-carboxylate]. This increase was due to an increase in the number of binding sites for Ro 15-4513 and beta-CCM, and not due to a change in receptor affinity. The increase was observed as early as after a 12-hr exposure of the neurons with ethanol, and remained elevated at 24-hr withdrawal, returning to control values at 48-hr withdrawal. These results further strengthen the notion that Ro 15-4513 and related inverse agonists binding site on the GABA-benzodiazepine receptor complex may be involved in ethanol-s behavioral, biochemical and pharmacological effects which are mediated via GABAA receptor system. The significance of the enhanced binding sites for Ro 15-4513 and beta-CCM in the actions of ethanol, tolerance and withdrawal is discussed.
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Affiliation(s)
- M Mhatre
- Department of Pharmacology, University of Texas Health Science Center, San Antonio
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Mhatre M, Mehta AK, Ticku MK. Chronic ethanol administration increases the binding of the benzodiazepine inverse agonist and alcohol antagonist [3H]RO15-4513 in rat brain. Eur J Pharmacol 1988; 153:141-5. [PMID: 2850926 DOI: 10.1016/0014-2999(88)90599-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic ethanol treatment which produced intoxication and physical dependence in rats, produced an increase in the specific binding of ethanol antagonist [3H]RO15-4513 in rat brain cerebral cortex and cerebellum, but not in hippocampus and striatum. The increase in both the regions was due to an increase in the number (Bmax) of receptor sites. These results suggest that the RO15-4513 binding sites on the oligomeric GABA receptor complex are altered following chronic ethanol administration, and support the notion of a unique role of RO15-4513 as an ethanol antagonist.
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Affiliation(s)
- M Mhatre
- Department of Pharmacology, University of Texas Health Science Center, San Antonio 78284-7764
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Bapat VA, Mhatre M, Rao PS. Propagation of Morus indica L. (Mulberry) by encapsulated shoot buds. Plant Cell Rep 1987; 6:393-5. [PMID: 24248855 DOI: 10.1007/bf00269570] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/1987] [Revised: 07/10/1987] [Indexed: 05/07/2023]
Abstract
Axillary buds of mulberry (Morus indica L) were encapsulated in alginate and agar to produce individual beads. The beads could be stored at 4°C for 45 days without loss of viability. Amongst the encapsulating agents tested, sodium alginate was found to be a better matrix. Encapsulated buds regenerated complete plantlets on an appropriate medium. This technique would provide an easy and novel propagation system for the elite as well as difficult-to-root species of mulberry.
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Affiliation(s)
- V A Bapat
- Plant Biotechnology Section, Bio-Organic Division, Bhabha Atomic Research Centre, 400 085, Bombay, India
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Mhatre M, Bapat VA, Rao PS. Regeneration of plants from the culture of leaves and axillary buds in mulberry (Morus indica L.). Plant Cell Rep 1985; 4:78-80. [PMID: 24253689 DOI: 10.1007/bf00269211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/1984] [Revised: 02/21/1985] [Indexed: 06/02/2023]
Abstract
Stem segments, axillary buds and leaves excised from established shoot cultures of Morus indica were soaked in MS liquid medium containing benzyladenine (0.5, 1, 2 mg/1) and were cultured subsequently on semi solid medium of the same composition. Numerous shoot buds differentiated from leaf and axillary buds but stem segments were unresponsive. The shoot buds on isolation and culture developed into plantlets. Callus tissues which developed at the base of the leaf explant upon subculture also differentiated numerous shoot buds.
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Affiliation(s)
- M Mhatre
- Plant Biotechnology Section, Bio-Organic Division, Bhabha Atomic Research Centre, 400 085, Trombay, Bombay, India
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