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Preconception management

Tiffany Y Peng, Samantha F Ehrlich, Yvonne Crites, John L Kitzmiller, Michael W Kuzniewicz, Monique H Hedderson, Assiamira Ferrara
BACKGROUND: Despite concern for adverse perinatal outcomes in women with diabetes prior to pregnancy, recent data on the prevalence of pregestational type 1 and type 2 diabetes in the U.S. are lacking. OBJECTIVE: To estimate changes in the prevalence of overall pregestational diabetes (all types) and pregestational type 1 and type 2 diabetes, and whether changes varied by race-ethnicity between 1996 and 2014. STUDY DESIGN: Cohort study conducted among 655,428 pregnancies at a Northern California integrated health delivery system in 1996-2014...
October 14, 2016: American Journal of Obstetrics and Gynecology
Lucilla Poston, Rishi Caleyachetty, Sven Cnattingius, Camila Corvalán, Ricardo Uauy, Sharron Herring, Matthew W Gillman
Obesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth...
October 10, 2016: Lancet Diabetes & Endocrinology
Sudipa Sarkar, Lindsay A Bischoff
Hyperthyroidism can occur during pregnancy and the postpartum period, and the treatment of hyperthyroidism should be considered in the preconception phase. Pregnancy has multiple normal physiologic effects on thyroid hormone, which is a separate process distinct from syndromes such as transient hyperthyroidism of hyperemesis gravidarum. The rationale regarding antithyroid drug use during different stages of pregnancy is reviewed, including the literature regarding adverse neonatal outcomes such as aplasia cutis and methimazole embryopathy in the setting of first trimester maternal methimazole use...
October 14, 2016: Seminars in Reproductive Medicine
Susan M Sereika, Dorothy Becker, Patricia Schmitt, A Blair Powell, Ana Maria Diaz, Andrea F R Fischl, Jennifer Thurheimer-Cacciotti, William H Herman, Denise Charron-Prochownik
OBJECTIVE: Because unplanned pregnancies could cause maternal-fetal complications for women with diabetes, family planning vigilance (FPV) is imperative. The aims of this article are to operationalize and describe FPV and examine the associations among FPV behaviors and diabetes self-care management (DSM) and health outcomes of women with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Retrospective data were used from a follow-up study of adult women with T1D who participated as adolescents in a preconception counseling (PC) intervention trial and matched comparison women with T1D who did not receive the adolescent PC intervention...
October 11, 2016: Diabetes Care
Laura M Borgelt, Felecia M Hart, Jacquelyn L Bainbridge
In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications...
2016: International Journal of Women's Health
H Le Liepvre, A Dinh, B Idiard-Chamois, E Chartier-Kastler, V Phé, A Even, G Robain, P Denys
STUDY DESIGN: A retrospective observational study. OBJECTIVE: To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists. SETTING: NeuroUrology Department in a University Hospital, France. METHODS: All consecutive SCI pregnant women managed between 2001 and 2014 were included...
September 27, 2016: Spinal Cord
George Petrakos, Panagiotis Andriopoulos, Maria Tsironi
Advances in treatment of thalassemia have led to the aging of thalassemic patients, and consequently concern about successful reproductive outcome is augmented. Although women with thalassemia intermedia only were considered competent of achieving pregnancy, case series reveal the willingness of both thalassemia major and thalassemia intermedia women to have a family. Pregnancy in general is characterized by dynamic multiple-system changes and increased susceptibility to oxidative stress, while homozygous, transfusion-dependent, β-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload and thalassemia intermedia, usually nontransfused, is associated with augmented risk of thromboembolic events...
2016: International Journal of Women's Health
Pierre-Emmanuel Bouet, Ariane Godbout, Hady El Hachem, Maude Lefebvre, Lyne Bérubé, Marie-Danielle Dionne, Carole Kamga-Ngande, Louise Lapensée
Turner syndrome (TS) occurs in one in 2500 live female births and is one of the most common chromosomal abnormalities in women. Pregnancies in women with TS, conceived with either autologous or donated oocytes, are considered high risk because of the associated miscarriages and life-threatening cardiovascular complications (aortic dissection, severe hypertension). Therefore, it is imperative to conduct a full preconception evaluation and counselling that includes cardiac assessment with Holter blood pressure monitoring, echocardiography, and thoracic MRI...
August 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Kaitlyn Wald, Tom Easterling, Elizabeth M Swisher
BACKGROUND: Pregnancy after adulthood pelvic radiation is rare. There is a paucity of literature to guide preconception counseling and pregnancy management for these patients. CASE: A 36-year-old woman, gravida 2 para 1001, was referred at 28 weeks of gestation with spontaneous twins, preterm premature rupture of membranes, and a history of rectal cancer that had been treated 3 years previously with oophoropexy, chemoradiation, and abdominal perineal resection. Delivery was complicated by difficult fetal extraction and resulted in the demise of twin A...
October 2016: Obstetrics and Gynecology
Helmut Kleinwechter, Norbert Demandt
In Germany in 5.5% of all births diabetes is registered. In patients with type 1 and type 2 diabetes planning pregnancy, preconception counseling, diabetologic care with optimized periconceptional metabolic control and folic acid supplementation are essential for good pregnancy outcome. Gestational diabetes (GDM) should be diagnosed timely and managed according to existing guidelines. GDM is treated with insulin in approximately 20%. In 1-2% of GDM cases a glucokinase gene mutation is present (MODY 2). Pregnancies after bariatric-metabolic surgery are increasing and show high risks...
September 2016: Deutsche Medizinische Wochenschrift
Sally K Abell, Jacqueline A Boyle, Barbora de Courten, Georgia Soldatos, Euan M Wallace, Sophia Zoungas, Helena J Teede
BACKGROUND: There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. AIM: To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index (BMI) and glycaemic control on outcomes. MATERIALS AND METHODS: An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013...
September 5, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
Najmul Islam
The prevalence of Diabetes Mellitus is increasing worldwide. In developing countries 25% of adult females with diabetes are in the reproductive age. Thus in developing countries increased number of pregnancies are complicated by diabetes. Uncontrolled diabetes in pregnancy is associated with increased risk for both mother and foetus. These risks can be minimized by good control of diabetes before and during pregnancy. Management in the preconception period is discussed in this review article. Detailed management involves general advice of lifestyle modification followed by specific details of screening for complications of diabetes...
September 2016: JPMA. the Journal of the Pakistan Medical Association
Najmul Islam
The prevalence of Diabetes Mellitus is increasing worldwide. In developing countries 25% of adult females with diabetes are in the reproductive age. Thus in developing countries increased number of pregnancies are complicated by diabetes. Uncontrolled diabetes in pregnancy is associated with increased risk for both mother and foetus. These risks can be minimized by good control of diabetes before and during pregnancy. Management in the preconception period is discussed in this review article. Detailed management involves general advice of lifestyle modification followed by specific details of screening for complications of diabetes...
September 2016: JPMA. the Journal of the Pakistan Medical Association
Samantha L Harrison, Annemarie Lee, Roger S Goldstein, Dina Brooks
OBJECTIVE: To explore the views of healthcare professionals (HCPs) and patients towards mindfulness for individuals with COPD. METHODS: A qualitative study design informed by and analyzed using deductive thematic analysis. Twenty HCPs, with at least one year's clinical experience in COPD management and 19 individuals with moderate to severe COPD participated in semi-structured interviews. RESULTS: Analysis revealed seven themes. 1. Mindfulness is difficult to articulate and separate from relaxation...
August 20, 2016: Patient Education and Counseling
Rana Choudhary, Kavita Desai, Hetal Parekh, Kedar Ganla
Fetal growth restriction (FGR) and preeclampsia are the major causes of neonatal morbidity and mortality, which affect up to 8% of all pregnancies. The pathogenesis in FGR is an abnormal trophoblastic invasion leading to compromised uteroplacental circulation. However, in spite of this understanding and identification of high-risk patients, the management options are limited. There are some new studies which have demonstrated the role of sildenafil citrate in improving vasodilatation of small myometrial vessels and therefore improvement in amniotic fluid index, fetal weight, and even uterine and umbilical artery Doppler patterns...
2016: International Journal of Women's Health
Yu Kanzaki, Eiji Kondoh, Kaoru Kawasaki, Haruta Mogami, Yoshitsugu Chigusa, Ikuo Konishi
AIM: There are an increasing number of reports of pregnancy following liver transplantation, but many questions remain regarding preconception counseling and management of the pregnancy. The aim of this study was to report pregnancy outcomes in women who had undergone liver transplants and to gain insight into these issues. METHODS: We conducted a retrospective review of liver transplant recipients who had received prenatal care at Kyoto University Hospital between January 2001 and December 2015...
August 24, 2016: Journal of Obstetrics and Gynaecology Research
S L Kanis, C J van der Woude
Crohn's disease and ulcerative colitis, referred to as inflammatory bowel disease (IBD), are chronic, relapsing conditions. Patients are often diagnosed at a reproductive age, and therefore questions about fertility and reproductions often arise. Preconceptional counseling is the most important aspect in the management of IBD patients with a pregnancy wish. Patients should be counseled on the influence of IBD and IBD drugs on pregnancy. Most drugs are not related to adverse outcome while used during pregnancy...
2016: Digestive Diseases
Gianina Ravenscroft, Mark R Davis, Phillipa Lamont, Alistair Forrest, Nigel G Laing
Early-onset muscle disease includes three major entities that present generally at or before birth: congenital myopathies, congenital muscular dystrophies and congenital myasthenic syndromes. Almost exclusively there is weakness and hypotonia, although cases manifesting hypertonia are increasingly being recognised. These diseases display a wide phenotypic and genetic heterogeneity, with the uptake of next generation sequencing resulting in an unparalleled extension of the phenotype-genotype correlations and "diagnosis by sequencing" due to unbiased sequencing...
August 9, 2016: Seminars in Cell & Developmental Biology
Angela Assal, Janine Malcolm, Heather Lochnan, Erin Keely
BACKGROUND AND AIMS: Approximately 174 pregnancies in acromegaly have been reported. Our objectives were to identify the key challenges of preconception counselling in this population. METHODS: Case series of three acromegalic women with desire for pregnancy. Issues were identified from chart review and discussion with attending physicians. Literature review of acromegaly and pregnancy was conducted. RESULTS: Important issues identified included: impact of acromegaly on fertility, management of acromegaly in the peripartum period, screening for associated conditions, risk of progression of acromegaly/tumour growth during pregnancy, impact of acromegaly on pregnancy outcomes, surveillance during pregnancy, method of delivery and impact on neonatal outcomes and breastfeeding...
March 2016: Obstetric Medicine
Niamh Ramsay, Tracey Johnson, Tony Badrick
Objective Little research exists regarding the prevalence of patient non-adherence with completing pathology requests for chronic disease monitoring. The aims of the present study were to determine the extent to which this exists in diabetic patients and to identify possible reasons contributing to this behaviour.Methods Patients diagnosed with type 2 diabetes mellitus were recruited from three general practices with different demographics. Data were collected by recording demographic patient information at the time of visit...
August 11, 2016: Australian Health Review: a Publication of the Australian Hospital Association
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