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Preconception management

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https://www.readbyqxmd.com/read/29757070/racial-ethnic-disparities-in-diabetes-diagnosis-and-glycemic-control-among-women-of-reproductive-age
#1
Laura E Britton, Jon M Hussey, Jamie L Crandell, Diane C Berry, Jada L Brooks, Amy G Bryant
BACKGROUND: Types 1 and 2 diabetes mellitus complicate pregnancies and threaten the health of women of reproductive age and their children. Among older adults, diabetes morbidity disproportionately burdens racial/ethnic minorities, but diabetes emergence among younger adults has not been as well characterized. The objective of this study was to describe the distribution of diagnosed diabetes, undiagnosed diabetes, suboptimal preconception glycemic control, and prediabetes among women of reproductive age across racial/ethnic backgrounds...
May 14, 2018: Journal of Women's Health
https://www.readbyqxmd.com/read/29754767/preconception-carrier-screening-by-genome-sequencing-results-from-the-clinical-laboratory
#2
Sumit Punj, Yassmine Akkari, Jennifer Huang, Fei Yang, Allison Creason, Christine Pak, Amiee Potter, Michael O Dorschner, Deborah A Nickerson, Peggy D Robertson, Gail P Jarvik, Laura M Amendola, Jennifer Schleit, Dana Kostiner Simpson, Alan F Rope, Jacob Reiss, Tia Kauffman, Marian J Gilmore, Patricia Himes, Benjamin Wilfond, Katrina A B Goddard, C Sue Richards
Advances in sequencing technologies permit the analysis of a larger selection of genes for preconception carrier screening. The study was designed as a sequential carrier screen using genome sequencing to analyze 728 gene-disorder pairs for carrier and medically actionable conditions in 131 women and their partners (n = 71) who were planning a pregnancy. We report here on the clinical laboratory results from this expanded carrier screening program. Variants were filtered and classified using the latest American College of Medical Genetics and Genomics (ACMG) guideline; only pathogenic and likely pathogenic variants were confirmed by orthologous methods before being reported...
May 3, 2018: American Journal of Human Genetics
https://www.readbyqxmd.com/read/29751732/population-screening-for-hemoglobinopathies
#3
H W Goonasekera, C S Paththinige, V H W Dissanayake
Hemoglobinopathies are the most common single-gene disorders in the world. Their prevalence is predicted to increase in the future, and low-income hemoglobinopathy-endemic regions need to manage most of the world's affected persons. International organizations, governments, and other stakeholders have initiated national or regional prevention programs in both endemic and nonendemic countries by performing population screening for α- and β-thalassemia, HbE disease, and sickle cell disease in neonates, adolescents, reproductive-age adults (preconceptionally or in the early antenatal period), and family members of diagnosed cases...
May 11, 2018: Annual Review of Genomics and Human Genetics
https://www.readbyqxmd.com/read/29749581/preconception-counseling-for-patients-with-thoracic-aortic-aneurysms
#4
REVIEW
Prashant Rao, Eric M Isselbacher
PURPOSE OF THE REVIEW: Acute aortic dissection is a potentially catastrophic cardiovascular emergency that is associated with a high mortality rate. Pregnancy, with its attendant hormonal and physiological changes, increases the risk of dissection in women with known thoracic aortic aneurysms. In this review, we highlight the importance of preconception counseling to help women with known thoracic aortic aneurysms better understand their risk of dissection and the heritable nature of thoracic aortic disease and its associated syndromes...
May 10, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29706030/preconception-management-of-thyroid-dysfunction
#5
Onyebuchi E Okosieme, Ishrat Khan, Peter N Taylor
Uncorrected thyroid dysfunction in pregnancy has well recognised deleterious effects on fetal and maternal health. The early gestation period is one of critical fetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre-empt and mirror the adaptive changes of the thyroid gland by careful levothyroxine dose adjustments to ensure adequate fetal thyroid hormone delivery in pregnancy...
April 29, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29696409/valvular-heart-disease-and-pregnancy
#6
REVIEW
Emily S Lau, Nandita S Scott
With improving reproductive assistive technologies, advancing maternal age, and improved survival of patients with congenital heart disease, valvular heart disease has become an important cause of morbidity and mortality in pregnant women. In general, stenotic lesions, even those in the moderate range, are poorly tolerated in the face of hemodynamic changes of pregnancy. Regurgitant lesions, however, fare better due to the physiologic afterload reduction that occurs. Intervention on regurgitant valve preconception follows the same principles as a non-pregnant population...
April 26, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29627031/pregnancy-outcomes-in-women-with-spinal-muscular-atrophy-a-review
#7
REVIEW
Elena Abati, Stefania Corti
Spinal muscular atrophy (SMA) is an autosomal recessive disease characterized by muscle weakness and atrophy resulting from progressive degeneration and loss of the anterior horn cells in the spinal cord and brain stem nuclei. The onset of weakness ranges from prenatal age to young adulthood. Thus, many female patients reach fertile age and may consider getting pregnant. However, only little information is available about outcomes and complications of pregnancy in women with SMA. In this review, we compared different studies on the subject, then we analyzed outcomes in the different stages of the pregnancy (preconceptional period, embryonal period, fetal period, delivery and post partum), with a special focus on maternal and fetal complications, prematurity, mode of delivery, anesthesiological risk, respiratory function and influence of pregnancy on the disease course...
May 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29617772/providers-perceptions-and-training-needs-for-counseling-adolescents-undergoing-voluntary-medical-male-circumcision
#8
Aaron A R Tobian, Kim H Dam, Lynn M Van Lith, Karin Hatzold, Arik V Marcell, Webster Mavhu, Catherine Kahabuka, Lusanda Mahlasela, Eshan U Patel, Emmanuel Njeuhmeli, Kim Seifert Ahanda, Getrude Ncube, Gissenge Lija, Collen Bonnecwe, Michelle R Kaufman
Background: The majority of individuals who seek voluntary medical male circumcision (VMMC) services in sub-Saharan Africa are adolescents (ages 10-19 years). However, adolescents who obtain VMMC services report receiving little information on human immunodeficiency virus (HIV) prevention and care. In this study, we assessed the perceptions of VMMC facility managers and providers about current training content and their perspectives on age-appropriate adolescent counseling. Methods: Semistructured in-depth interviews were conducted with 33 VMMC providers in Tanzania (n = 12), South Africa (n = 9), and Zimbabwe (n = 12) and with 4 key informant facility managers in each country (total 12)...
April 3, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29507751/graves-hyperthyroidism-in-pregnancy-a-clinical-review
#9
REVIEW
Caroline T Nguyen, Elizabeth B Sasso, Lorayne Barton, Jorge H Mestman
Background: Graves' hyperthyroidism affects 0.2% of pregnant women. Establishing the correct diagnosis and effectively managing Graves' hyperthyroidism in pregnancy remains a challenge for physicians. Main: The goal of this paper is to review the diagnosis and management of Graves' hyperthyroidism in pregnancy. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy-related complications, maternal management, including thyroid storm, anti-thyroid drugs and the complications for mother and fetus, fetal and neonatal thyroid function, neonatal management, and maternal post-partum management...
2018: Clinical Diabetes and Endocrinology
https://www.readbyqxmd.com/read/29480926/evaluation-and-management-of-maternal-congenital-heart-disease-a-review
#10
Maeve K Hopkins, Sarah A Goldstein, Cary C Ward, Jeffrey A Kuller
Objective: Congenital heart defects represent the most common major congenital anomalies. The objective of this review was to define the most common forms of congenital heart disease (CHD) in pregnancy, outline preconception counseling, discuss the associated morbidity and mortality of each lesion, and review current recommendations for management of CHD in pregnancy. Evidence Acquisition: A MEDLINE search of "congenital heart disease in pregnancy" and specific conditions in pregnancy including "ventricular septal defect," "atrial septal defect," "left outflow obstruction," "right outflow obstruction," "tetralogy of Fallot," and "transposition of the great vessels" was performed...
February 2018: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/29463390/managing-congenital-heart-disease-in-the-obstetric-patient
#11
REVIEW
Heidi M Connolly
OBJECTIVE: Cardiovascular disease is the major cause of pregnancy-related maternal mortality in the United States, and congenital heart disease (CHD) is the most common form of structural heart disease affecting women of childbearing age. Most females born with CHD will reach childbearing age and consider pregnancy. Adult CHD and maternal-fetal medicine (MFM) specialists managing women with CHD should provide preconception counseling, cardiovascular risk assessment prior to pregnancy that estimates maternal and fetal risk, management during pregnancy, and in the peripartum period and also know the potential complications and special circumstances that may occur in the post-partum period...
February 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29428288/ethnicity-based-carrier-screening
#12
REVIEW
Jennifer R King, Susan Klugman
Ethnicity-based carrier screening for single-gene disorders is an integral part of preconception and prenatal care. The role of ethnicity-based carrier screening has expanded over time with advancing technology. Patients and providers should understand the benefits and limitations of their screening options and engage in appropriate pretest and posttest counseling. The future management of single-gene disorders is changing and a time may be approaching when ethnicity-based carrier screening will be replaced with expanded carrier screening...
March 2018: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29305820/authoring-the-identity-of-learner-before-doctor-in-the-figured-world-of-medical-school
#13
Evangeline Stubbing, Esther Helmich, Jennifer Cleland
INTRODUCTION: Students enter the 'figured world' of medical school with preconceptions of what it means to be a doctor. The meeting of these early preconceptions and their newly developing identities can create emotional tensions. The aim of this study was to advance our understanding of how such tensions were experienced and managed. Using figured worlds as a theoretical framework we explored students' interactions of preconceptions with their newly developing professional identities in their first year at medical school...
February 2018: Perspectives on Medical Education
https://www.readbyqxmd.com/read/29245354/anesthesia-for-a-parturient-with-intraneural-perineurioma-a-case-report
#14
Jiao Li, Hong Zeng, Zhengqian Li, Jun Wang
RATIONALE: Intraneural perineurioma is an extremely rare form of peripheral nerve sheath tumor; and the anesthetic management of a parturient with intraneural perineurioma, especially affecting spinal roots and nerves of extremities, is very rare. PATIENT CONCERNS: A 28-year-old woman was referred to the hospital at 37+5 weeks' gestation, presenting with a 10-year history of paroxysmal acroanesthesia and aching with distal limbs. DIAGNOSES: Based on the biopsy results, including immunohistochemical and electron microscopic findings, and molecular studies, her condition was diagnosed as intraneural perineurioma...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29240048/why-patients-are-afraid-of-opioid-analgesics-a-study-on-opioid-perception-in-patients-with-chronic-pain
#15
Michał Graczyk, Alina Borkowska, Małgorzata Krajnik
INTRODUCTION    Opiophobia is deemed one of the key barriers in effective pain management. OBJECTIVES    The study aimed to assess the overall perception of opioids in cancer patients treated for chronic pain, as well as to determine the nature of their most common related fears. PATIENTS AND METHODS     The study included 100 palliative care patients who suffered from chronic cancer or noncancer pain. Initially, they had to complete a survey exploring their knowledge on analgesics and potential fear of using opioids...
February 28, 2018: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/29203504/frequencies-and-ethnic-distribution-of-abo-and-rhd-blood-groups-in-china-a-population-based-cross-sectional-study
#16
Jue Liu, Shikun Zhang, Qiaomei Wang, Haiping Shen, Yiping Zhang, Min Liu
OBJECTIVES: ABO and RhD blood groups are key factors affecting blood transfusion safety. The distribution of ABO and RhD blood groups varies globally, but limited data exist for ethnic distributions of these blood groups in Asian populations. We aimed to evaluate the distribution of ABO and RhD blood groups among Chinese ethnic groups. DESIGN: A population-based cross-sectional study. SETTING: Data on ABO groups and ethnicities were obtained from the National Free Preconception Health Examination Project (NFPHEP) with participants from 220 counties of 31 provinces in China PARTICIPANTS: There were 3 832 034 participants aged 21-49 years who took part in the NFPHEP from January 2010 to December 2012 and were included in this study...
December 3, 2017: BMJ Open
https://www.readbyqxmd.com/read/29165607/an-evidence-based-approach-to-pre-pregnancy-counselling-for-patients-with-systemic-lupus-erythematosus
#17
Y K Onno Teng, Edwin O W Bredewold, Ton J Rabelink, Tom W J Huizinga, H C Jeroen Eikenboom, Maarten Limper, Ruth D E Fritsch-Stork, Kitty W M Bloemenkamp, Marieke Sueters
Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification...
November 20, 2017: Rheumatology
https://www.readbyqxmd.com/read/29116720/the-croatian-model-of-integrative-prospective-management-of-epilepsy-and-pregnancy
#18
Snježana Miškov, Romana Gjergja Juraški, Ivan Mikula, Silvio Bašić, Marija Bošnjak Pašić, Vesna Košec, Zlatko Sabol, Aleksandra Fučić, Tomislav Sajko, Vanja Bašić Kes
Epilepsy is the most common neurological complication in pregnancy. Women with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are treated by neurologists at tertiary centers according to the place of residence. We prospectively followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors responsible for their delivery outcomes and development of their babies. Healthy pregnant women had a higher level of education and economic status, but pregnant women with epilepsy took folic acid in a higher proportion than controls, possibly due to timely preconception counseling...
December 2016: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29116583/innovative-clinical-pathways-for-obese-pregnant-women-design-and-feasibility-of-the-padua-project-north-eastern-italy
#19
A Lapolla, D Scibetta, P Gallina, G Iorizzo, M G Dalfrà, S Visentin, G B Nardelli, R Vettor
BACKGROUND: Obesity during pregnancy can adversely affect the wellbeing of the mother and the newborn, as well as the latter's long-term health. Preconception counseling, careful prenatal management, and strict follow-up during pregnancy are, therefore, essential for obese fertile women in order to prevent the negative effects of obesity. METHODS: In this setting, we developed a project that consisted in creating an integrated network of primary, secondary, and tertiary care providers and designing new clinical pathways for managing pregnancy in obese women...
November 7, 2017: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/29115118/adenomyosis-fertility-and-obstetric-outcome-a-comprehensive-literature-review
#20
Laura Buggio, Ermelinda Monti, Umberto Gattei, Dhohua Dridi, Paolo Vercellini
Adenomyosis is a benign condition characterized by the presence of endometrial glands and stroma deep within the myometrium. In recent years, the potential negative impact of adenomyosis on in vitro fertilization clinical outcomes has gained momentum, as well as, the possible link of this condition with obstetrical complications. The aim of this narrative review is to elucidate the possible association between uterine adenomyosis, infertility, and poor obstetrical outcomes. Several theories have been proposed to clarify the potential harmful impact of adenomyosis on fertility, such as a functional and structural defect of both the eutopic endometrium and the inner myometrium, an impairment of the uterine system of sperm transport, the presence of uterine dysperistalsis and of high levels of free radicals in the uterine milieu of women with the disease...
November 7, 2017: Minerva Ginecologica
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