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Autoimmune, obstetrics

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https://www.readbyqxmd.com/read/28917612/thyroid-stimulating-hormone-anti-thyroid-antibodies-and-pregnancy-outcomes
#1
Torie C Plowden, Enrique F Schisterman, Lindsey A Sjaarda, Neil J Perkins, Robert Silver, Rose Radin, Keewan Kim, Noya Galai, Alan H DeCherney, Sunni L Mumford
BACKGROUND: Overt thyroid dysfunction has been associated with adverse obstetrical outcomes. However, less is known regarding subclinical hypothyroidism or thyroid autoimmunity and their relationship to pregnancy complications. OBJECTIVE: To examine the association between pre-pregnancy anti-thyroid antibodies and subclinical hypothyroidism and preterm delivery (PTD), gestational diabetes (GDM), and preeclampsia. STUDY DESIGN: Secondary analysis of a prospective cohort of 18-40 year old women with 1-2 prior pregnancy losses (n=1193) participating in a multi-center randomized, placebo-controlled trial of low-dose aspirin...
September 13, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28899640/status-epilepticus-in-pregnancy-etiology-management-and-clinical-outcomes
#2
Keni Ravish Rajiv, Ashalatha Radhakrishnan
BACKGROUND: Status epilepticus (SE) in pregnancy carries significant risk to both mother and fetus. There is limited literature available on SE occurring in pregnancy world-over, with majority being from obstetric centers. METHODS: All women who developed SE related to pregnancy (gestation, labor, or puerperium) between January 2000 and December 2016 were included in the study. Data were collected from our SE registry, maintained, and archived in the institute. The variables influencing the maternal and fetal outcome were compared using Student's t-test for continuous variables and Fisher's exact test for discrete variables...
September 9, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28742523/pregnancy-outcomes-among-patients-with-recurrent-pregnancy-loss-and-uterine-anatomic-abnormalities
#3
Daniel Gabbai, Avi Harlev, Michael Friger, Naama Steiner, Ruslan Sergienko, Andrey Kreinin, Asher Bashiri
BACKGROUND: Different etiologies for recurrent pregnancy loss have been identified, among them are: anatomical, endocrine, genetic, chromosomal and thrombophilia pathologies. AIMS: To assess medical and obstetric characteristics, and pregnancy outcomes, among women with uterine abnormalities and recurrent pregnancy loss (RPL). This study also aims to assess the impact of uterine anatomic surgical correction on pregnancy outcomes. METHODS: A retrospective case control study of 313 patients with two or more consecutive pregnancy losses followed by a subsequent (index) pregnancy...
July 25, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28576307/serological-evolution-in-women-with-positive-antiphospholipid-antibodies
#4
Leyre Riancho-Zarrabeitia, Germán Daroca, Pedro Muñoz, Marcos López-Hoyos, Ana Haya, Víctor M Martínez-Taboada
OBJECTIVES: To explore the clinical and serological course of fertile women with positive antiphospholipid (aPL), and the factors and therapeutic implications associated with aPL negativization. METHODS: Retrospective study including 105 women with a positive aPL serology between 1995 and 2013 attending the obstetric autoimmune pathology clinic of a tertiary facility. Patients were classified into the following 3 groups: patients with primary antiphospholipid syndrome (pAPS, 49), patients with a positive serology for aPL, not meeting clinical criteria (42), and patients with systemic lupus erythematosus and a positive aPL serology (14)...
May 10, 2017: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/28572466/longterm-outcome-of-patients-with-primary-antiphospholipid-syndrome-a-retrospective-multicenter-study
#5
Mara Taraborelli, Rossella Reggia, Francesca Dall'Ara, Micaela Fredi, Laura Andreoli, Maria Gerosa, Ariela Hoxha, Laura Massaro, Marta Tonello, Nathalie Costedoat-Chalumeau, Patrice Cacoub, Franco Franceschini, Pier Luigi Meroni, Jean Charles Piette, Amelia Ruffatti, Guido Valesini, Eon Nigel Harris, Angela Tincani
OBJECTIVE: To assess the longterm frequency of thrombotic recurrences, obstetrical complications, organ damage, severe comorbidities, and evolution toward connective tissue disease (CTD) in primary antiphospholipid syndrome (PAPS). METHODS: Medical records of patients with PAPS followed in 6 centers for ≥ 15 years were retrospectively reviewed. RESULTS: One hundred fifteen patients were studied: 88% women, followed between 1983 and 2014 with a mean (± SD) age at diagnosis of 33 (± 10) years...
August 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28521326/the-yield-of-abdominal-ultrasound-in-the-evaluation-of-elevated-liver-enzymes-during-the-second-and-the-third-trimester-of-pregnancy
#6
Aya Mohr-Sasson, Eyal Schiff, Ramy Rahamim Suday, Zehava Hayman, Yeruham Kleinbaum, Anat Kalter-Farber, Roy Mashiach, Yoav Yinon, Moti Dulitzki, Eyal Sivan, Shali Mazaki-Tovi
AIMS: To determine the clinical yield of abdominal ultrasound in the evaluation of elevated liver enzymes (ELEs) in the second and the third trimester of pregnancy. METHODS: A retrospective cohort study including all pregnant women admitted to a single tertiary care center was conducted between April 2011 and January 2015 with ELE. Inclusion criteria included gestational age above 24 weeks and ELEs, abdominal ultrasound report, and live fetus. Exclusion criteria included known maternal liver disease, structural or chromosomal fetal anomalies, and positive serology for viral hepatitis...
2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28473138/antiphospholipid-syndrome-role-of-vascular-endothelial-cells-and-implications-for-risk%C3%A2-stratification-and-targeted-therapeutics
#7
REVIEW
Michel T Corban, Ali Duarte-Garcia, Robert D McBane, Eric L Matteson, Lilach O Lerman, Amir Lerman
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by venous thromboembolism, arterial thrombosis, and obstetric morbidities in the setting of persistently positive levels of antiphospholipid antibodies measured on 2 different occasions 12 weeks apart. Patients with APS are at increased risk for accelerated atherosclerosis, myocardial infarction, stroke, and valvular heart disease. Vascular endothelial cell dysfunction mediated by antiphospholipid antibodies and subsequent complement system activation play a cardinal role in APS pathogenesis...
May 9, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28471597/women-s-issues-in-antiphospholipid-syndrome
#8
Emmanouil Papadakis, Anastasia Banti, Anna Kioumi
Antiphospholipid syndrome (APS) is an autoimmune systemic disease characterized by vascular thrombosis (arterial or venous) and/or pregnancy complications associated with the occurrence of autoantibodies, specifically lupus anticoagulant, anticardiolipin antibodies, and/or anti-β2 glycoprotein-I antibodies confirmed at least twice over a 12 week period according to the 2006 Sydney criteria. Antiphospholipid antibodies are encountered  in the general population with a reported prevalence of 1% to 5%  However, APS is far more infrequent with a prevalence of 40-50/100,000 persons and an incidence of about 5 new patients/100,000 persons...
September 2016: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28432736/severe-primary-autoimmune-thrombocytopenia-in-pregnancy-a-national-cohort-study
#9
A Care, S Pavord, M Knight, Z Alfirevic
OBJECTIVE: To quantify the incidence of severe autoimmune thrombocytopenia (ITP) in pregnancy in the UK, determine current treatment strategies, and establish maternal and neonatal morbidity and mortality associated with severe ITP in pregnancy. DESIGN: A prospective national cohort study. SETTING: UK. POPULATION: Women with severe ITP, defined as platelets <50 × 10(9) /L in pregnancy or antenatal treatment of isolated low platelets...
April 22, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28390568/outcomes-in-children-born-to-women-with-rheumatic-diseases
#10
REVIEW
Évelyne Vinet, Sasha Bernatsky
Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are the most prevalent autoimmune rheumatic diseases, predominantly occurring in women during childbearing years. Research has focused on assessing the risk of immediate complications during SLE and RA pregnancies, with studies documenting a higher risk of adverse obstetric outcomes, such as preterm births and infants small for gestational age. Until recently, little was known regarding the long-term health of children born to affected women. We present a review of the current evidence regarding the risk of adverse health outcomes in SLE and RA offspring, and potential mechanisms involved in their pathogenesis...
May 2017: Rheumatic Diseases Clinics of North America
https://www.readbyqxmd.com/read/28331377/management-of-systemic-lupus-erythematosus-during-pregnancy-challenges-and-solutions
#11
REVIEW
Caroline L Knight, Catherine Nelson-Piercy
Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal-neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy...
2017: Open Access Rheumatology: Research and Reviews
https://www.readbyqxmd.com/read/28319657/risk-of-autism-spectrum-disorders-in-children-born-to-mothers-with-rheumatoid-arthritis-a-systematic-literature-review
#12
Sophie Wojcik, Sasha Bernatsky, Robert W Platt, Christian A Pineau, Ann E Clarke, Éric Fombonne, Anick Bérard, Évelyne Vinet
OBJECTIVE: Recent evidence suggests in utero exposure to maternal antibodies and cytokines as important risk factors for autism spectrum disorders (ASD). We aimed to systematically review the risk of ASD in children born to mothers with rheumatoid arthritis (RA) compared to children born to mothers without RA. METHODS: We conducted a systematic review of original articles using electronic databases: PubMed, EMBase, and Web of Science. RESULTS: Our literature search identified a total of 70 articles...
March 20, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28280642/severe-preeclampsia-in-the-setting-of-myasthenia-gravis
#13
Adam J Lake, Antoun Al Khabbaz, Renée Keeney
Myasthenia gravis (MG) is a rare autoimmune disease that leads to progressive muscle weakness and is common during female reproductive years. The myasthenic mother and her newborn must be observed carefully, as complications during all stages of pregnancy and the puerperium may arise suddenly. Preeclampsia is a common obstetrical condition for which magnesium sulfate is used for seizure prophylaxis. However, magnesium sulfate is strongly contraindicated in MG as it impairs already slowed nerve-muscle connections...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28212640/urinary-iodine-in-early-pregnancy-is-associated-with-subclinical-hypothyroidism-in-tianjin-china-an-observational-study
#14
Kunling Wang, Jie Zhang, Fengao Li, Wanqi Zhang, Hao Wang, Li Ding, Yaxin Liu, Laixiang Lin, Shuang Zhang, Mei Zhu
BACKGROUND: Subclinical hypothyroidism (SH) is associated with adverse obstetric outcomes and neurodevelopment disorders. Both iodine deficiency and excess are associated with SH; however, few data regarding iodine nutrition status of pregnant women with SH are available. This study aimed to clarify whether iodine deficiency or excess is associated with SH, especially, when test results for anti-thyroid autoantibodies are negative. METHODS: A total of 115 women with SH and 104 women with euthyroidism (EH) in early pregnancy in Tianjin, China were investigated, and their serum thyroid-stimulating hormone, free thyroxine, free triiodothyronine, anti-thyroid peroxidase antibody (TPOAb), anti-thyroid globulin antibody (TGAb), urinary iodine (UIC), and urinary creatinine (UCr) concentrations were measured...
February 17, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28173738/pregnancy-failure-in-patients-with-obstetric-antiphospholipid-syndrome-with-conventional-treatment-the-influence-of-a-triple-positive-antibody-profile
#15
J O Latino, S Udry, F M Aranda, S D A Perés Wingeyer, D S Fernández Romero, G F de Larrañaga
Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20-30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28153662/antiphospholipid-antibody-profile-based-obstetric-outcomes%C3%A2-of-primary-antiphospholipid-syndrome-the%C3%A2-pregnants-study
#16
MULTICENTER STUDY
Gabriele Saccone, Vincenzo Berghella, Giuseppe Maria Maruotti, Tullio Ghi, Giuseppe Rizzo, Giuliana Simonazzi, Nicola Rizzo, Fabio Facchinetti, Andrea Dall'Asta, Silvia Visentin, Laura Sarno, Serena Xodo, Dalila Bernabini, Francesca Monari, Amanda Roman, Ahizechukwu Chigoziem Eke, Ariela Hoxha, Amelia Ruffatti, Ewoud Schuit, Pasquale Martinelli
BACKGROUND: Antiphospholipid syndrome is an autoimmune, hypercoagulable state that is caused by antiphospholipid antibodies. Anticardiolipin antibodies, anti-β2 glycoprotein-I, and lupus anticoagulant are the main autoantibodies found in antiphospholipid syndrome. Despite the amassed body of clinical knowledge, the risk of obstetric complications that are associated with specific antibody profile has not been well-established. OBJECTIVE: The purpose of this study was to assess the risk of obstetric complications in women with primary antiphospholipid syndrome that is associated with specific antibody profile...
May 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28152557/perinatal-outcome-of-placental-massive-perivillous-fibrin-deposition-a-case-control-study
#17
Louise Devisme, Claire Chauvière, Hélène Franquet-Ansart, Anastasia Chudzinski, Morgane Stichelbout, Véronique Houfflin-Debarge, Damien Subtil
OBJECTIVE: The objectives of the study are to describe the obstetric outcomes associated with massive perivillous fibrin deposition (MFD) compared with a control series and to determine if outcome differs according to the extent of fibrin deposition. METHOD: Retrospective case-control study based on placentas analyzed over a consecutive 12-year period. MFD was considered severe if it extended over more than 50% of the placenta and moderate between 25% and 50%. RESULTS: During the study period, MFD was observed on 71 placentas, 39 severe and 32 moderate...
April 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/28101614/-dermatological-topical-and-systemic-therapy-during-pregnancy
#18
REVIEW
S Grunewald, P Staubach
During pregnancy, a successful and safe therapeutic management of patients is possible to lower the burden of disease. Often topical therapy in combination with intensive basic skin care is sufficient. Drug therapies may also be used, most often for systemic diseases such as autoimmune diseases or psoriasis. An early change in therapy is also key during planned pregnancies so that treatments can be switched, adjusted, reduced or closely monitored. Another point to consider is to keep drug dosing as low as possible (without occlusion in local therapy) or short termed (with the exception of autoimmune or malignant diseases)...
February 2017: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
https://www.readbyqxmd.com/read/28054230/tumor-necrosis-factor-alpha-and-pregnancy-focus-on-biologics-an-updated-and-comprehensive-review
#19
REVIEW
Jaume Alijotas-Reig, Enrique Esteve-Valverde, Raquel Ferrer-Oliveras, Elisa Llurba, Josep Maria Gris
Tumor necrosis factor-α (TNF-α) is a central regulator of inflammation, and TNF-α antagonists may be effective in treating inflammatory disorders in which TNF-α plays a major pathogenic role. TNF-α has also been associated with inflammatory mechanisms related to implantation, placentation, and pregnancy outcome. TNF-α is secreted by immune cells and works by binding to TNFR1 and TNFR2 cell receptors. TNF-α is also related to JAK/STAT pathways, which opens up hypothetical new targets for modifying. The accurate balance between Th1 cytokines, mainly TNF-α, Th17, and Th2, particularly IL-10 is essential to achieve good obstetric outcomes...
August 2017: Clinical Reviews in Allergy & Immunology
https://www.readbyqxmd.com/read/28050066/antiphospholipid-syndrome-a-diagnostic-challenge
#20
REVIEW
R S Mallhi, Neerja Kushwaha, T Chatterjee, J Philip
The antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilic disorder that is characterized by thrombosis (venous, arterial and microvascular) and obstetric morbidity due to a diverse family of antibodies against phospholipid-binding proteins present in plasma. The term antiphospholipid antibody is actually a misnomer as the antibodies are not against the phospholipid per se, but target the plasma protein co-factors, which bind to anionic PLs. The exact etiology has not been elucidated and is multifactorial...
December 2016: Medical Journal, Armed Forces India
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