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OB Medicine

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85 papers 25 to 100 followers
By Alyssa Shariff GIM Fellow
Bonnie L Bermas
PURPOSE OF REVIEW: To review the recent literature on the safety of nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and traditional disease-modifying antirheumatic drugs before and during pregnancy. RECENT FINDINGS: Recent data suggest that the risk of cleft palate formation after in-utero glucocorticoid exposure is lower than previously reported. Two studies of inadvertent leflunomide exposure during early pregnancy suggest that this medication may be less teratogenic than previously thought...
May 2014: Current Opinion in Rheumatology
Hilal Ince-Askan, Radboud J E M Dolhain
Fertility is impaired in female patients with rheumatoid arthritis (RA), which is related to disease activity and the use of certain medication. During pregnancy, disease activity usually improves, but less than previously thought. Especially in women with high disease activity, the pregnancy outcome is also impaired. All of this underscores the importance of strict control of disease activity in RA patients who wish to conceive. Management of RA disease activity during pregnancy might be a challenge as the treatment options are limited...
August 2015: Best Practice & Research. Clinical Rheumatology
Zoe A Stewart, Malgorzata E Wilinska, Sara Hartnell, Rosemary C Temple, Gerry Rayman, Katharine P Stanley, David Simmons, Graham R Law, Eleanor M Scott, Roman Hovorka, Helen R Murphy
BACKGROUND: In patients with type 1 diabetes who are not pregnant, closed-loop (automated) insulin delivery can provide better glycemic control than sensor-augmented pump therapy, but data are lacking on the efficacy, safety, and feasibility of closed-loop therapy during pregnancy. METHODS: We performed an open-label, randomized, crossover study comparing overnight closed-loop therapy with sensor-augmented pump therapy, followed by a continuation phase in which the closed-loop system was used day and night...
August 18, 2016: New England Journal of Medicine
Marc Blondon, Alessandro Casini, Kara K Hoppe, Françoise Boehlen, Marc Righini, Nicholas L Smith
BACKGROUND: Cesarean sections (CS) are believed to be associated with greater risks of postpartum VTE. Our objective was to systematically review the evidence on this association and on the absolute risk of VTE following CS. METHODS: We searched PubMed, Embase, and conference proceedings from 1980 to November 2015 for reports on the associations of delivery methods with postpartum VTE and on the incidence of VTE following CS. Studies on thrombophilia or recurrent VTE were excluded, and the search was restricted to prospective studies when assessing the incidence of VTE...
September 2016: Chest
Sherif W Ayad, Mahmoud M Hassanein, Elsayed A Mohamed, Ahmed M Gohar
BACKGROUND: Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes include an increase in cardiac output, sodium, and water retention leading to blood volume expansion, and reductions in systemic vascular resistance and systemic blood pressure. In addition, pregnancy results in a hypercoagulable state that increases the risk of thromboembolic complications. OBJECTIVES: The aim of this study is to assess the maternal and fetal outcomes of pregnant women with mechanical prosthetic heart valves (PHVs)...
2016: Clinical Medicine Insights. Cardiology
T Marchetti, P de Moerloose, J C Gris
BACKGROUND: pre-eclampsia (PEecl) can be defined as non-severe (NS-PEecl) or severe (S-PEecl). Our study aimed to determine the incidence of antiphospholipid antibodies (aPLs) in women with a past history of NS-PEecl or S-PEecl. PATIENTS AND METHODS: This case-control study includes 195 control women, 199 NS-PEecl patients and 143 S-PEecl patients whose plasma samples were collected 6 months after their first delivery. Each plasma was tested for lupus anticoagulant (LA), anticardiolipin (aCL) and antiβ2GP1 antibodies, as well as antibodies against phosphatidylserine/prothrombin complex (aPS/PT) and domain I of the β2GP1...
April 2016: Journal of Thrombosis and Haemostasis: JTH
Diana Aguiar de Sousa, Patrícia Canhão, José M Ferro
BACKGROUND AND PURPOSE: Pregnancy and puerperium are associated with an increased risk of venous thrombotic events (VTEs), including cerebral venous thrombosis (CVT). We aimed to systematically review, in pregnant woman with previous CVT, (1) the risk of recurrence of CVT or other VTE; (2) the result of pregnancy; and (3) the association of antithrombotic prophylaxis with these outcomes. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials...
March 2016: Stroke; a Journal of Cerebral Circulation
Victoria L Meah, John R Cockcroft, Karianne Backx, Rob Shave, Eric J Stöhr
OBJECTIVE: Cardiac output, a fundamental parameter of cardiovascular function, has consistently been shown to increase across healthy pregnancy; however, the time course and magnitude of adaptation remains equivocal within published literature. The aim of the present meta-analyses was to comprehensively describe the pattern of change in cardiac output during healthy pregnancy. METHOD: A series of meta-analyses of previously published cardiac output data during healthy, singleton pregnancies was completed...
April 2016: Heart: Official Journal of the British Cardiac Society
Geoffrey C Nguyen, Cynthia H Seow, Cynthia Maxwell, Vivian Huang, Yvette Leung, Jennifer Jones, Grigorios I Leontiadis, Frances Tse, Uma Mahadevan, C Janneke van der Woude
BACKGROUND & AIMS: The management of inflammatory bowel disease (IBD) poses a particular challenge during pregnancy because the health of both the mother and the fetus must be considered. METHODS: A systematic literature search identified studies on the management of IBD during pregnancy. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS: Consensus was reached on 29 of the 30 recommendations considered...
March 2016: Gastroenterology
Eliot R Spindel, Cindy T McEvoy
Use of e-cigarettes, especially among the young, is increasing at near-exponential rates. This is coupled with a perception that e-cigarettes are safe and with unlimited advertising geared toward vulnerable populations, the groups most likely to smoke or vape during pregnancy. There is now wide appreciation of the dangers of maternal smoking during pregnancy and the lifelong consequences this has on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma. Recent evidence strongly supports that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy will have the same harmful effects on offspring lung function and health as do conventional cigarettes...
March 1, 2016: American Journal of Respiratory and Critical Care Medicine
Frauke Bergmann, Werner Rath
BACKGROUND: Thrombocytopenia is, after anemia, the second most common abnormality of the complete blood count in pregnancy, with a reported frequency of 6.6% to 11.2%. It has many causes. Thrombocytopenia should be diagnostically evaluated as early as possible in pregnancy, so that the obstetrical management can be accordingly planned to minimize harm to the mother and child. As the various underlying diseases share clinical features and laboratory findings, the differential diagnosis is often a difficult interdisciplinary challenge...
November 20, 2015: Deutsches Ärzteblatt International
Aina Ruiz, Queralt Ferrer, Olga Sánchez, Irene Ribera, Silvia Arévalo, Onofre Alomar, Manel Mendoza, Lluís Cabero, Elena Carrerras, Elisa Llurba
INTRODUCTION: Recent studies pointed to an intrinsically angiogenic imbalance in CHD in the maternal and foetal circulation suggestive of impaired placentation. OBJECTIVES: To assess whether pregnant women with a CHD foetus are at greater risk of placenta-related complications. METHODS: Perinatal results of women with a CDH foetus were compared with those of a non-selected population followed up at our centre. Multiple pregnancies and chromosomal abnormalities were excluded from the analysis...
October 2016: Journal of Maternal-fetal & Neonatal Medicine
Ditte Mølgaard-Nielsen, Henrik Svanström, Mads Melbye, Anders Hviid, Björn Pasternak
IMPORTANCE: Vaginal candidiasis is common during pregnancy. Although intravaginal formulations of topical azole antifungals are first-line treatment for pregnant women, oral fluconazole is often used despite limited safety information. OBJECTIVE: To study the association between oral fluconazole exposure during pregnancy and the risk of spontaneous abortion and stillbirth. DESIGN, SETTING, AND PARTICIPANTS: Nationwide register-based cohort study in Denmark, 1997-2013...
January 5, 2016: JAMA: the Journal of the American Medical Association
Harald Zeisler, Elisa Llurba, Frederic Chantraine, Manu Vatish, Anne Cathrine Staff, Maria Sennström, Matts Olovsson, Shaun P Brennecke, Holger Stepan, Deirdre Allegranza, Peter Dilba, Maria Schoedl, Martin Hund, Stefan Verlohren
BACKGROUND: The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is elevated in pregnant women before the clinical onset of preeclampsia, but its predictive value in women with suspected preeclampsia is unclear. METHODS: We performed a prospective, multicenter, observational study to derive and validate a ratio of serum sFlt-1 to PlGF that would be predictive of the absence or presence of preeclampsia in the short term in women with singleton pregnancies in whom preeclampsia was suspected (24 weeks 0 days to 36 weeks 6 days of gestation)...
January 7, 2016: New England Journal of Medicine
Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say
BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports)...
January 30, 2016: Lancet
Sven Cnattingius, Eduardo Villamor
BACKGROUND: Maternal overweight and obesity are risk factors for stillbirth and infant mortality. Whether temporal changes in maternal weight affect these risks is not clear. We aimed to assess whether change of BMI between first and second pregnancies affects risks of stillbirth and infant mortality in the second-born offspring. METHODS: In a Swedish population-based cohort of women who gave birth to their first and second child between Jan 1, 1992, and Dec 31, 2012, we investigated associations between change in maternal body-mass index (BMI) during early pregnancy from first to second pregnancies and risks of stillbirth and neonatal, postneonatal, and infant mortality after the second pregnancy...
February 6, 2016: Lancet
Nathalie Auger, William D Fraser, Jessica Healy-Profitós, Laura Arbour
IMPORTANCE: The risk of congenital heart defects in infants of women who had preeclampsia during pregnancy is poorly understood, despite shared angiogenic pathways in both conditions. OBJECTIVE: To determine the prevalence of congenital heart defects in offspring of women with preeclampsia. DESIGN, SETTING, AND PARTICIPANTS: Population-level analysis of live births before discharge, 1989-2012, was conducted for the entire province of Quebec, comprising a quarter of Canada's population...
October 20, 2015: JAMA: the Journal of the American Medical Association
Christine Sävervall, Freja Lærke Sand, Simon Francis Thomsen
Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.
2015: Dermatology Research and Practice
Anke R Hodes, Crystal Tichnell, Anneline S J M Te Riele, Brittney Murray, Judith A Groeneweg, Abhishek C Sawant, Stuart D Russell, Karin Y van Spaendonck-Zwarts, Maarten P van den Berg, Arthur A Wilde, Harikrishna Tandri, Daniel P Judge, Richard N W Hauer, Hugh Calkins, J Peter van Tintelen, Cynthia A James
OBJECTIVES: To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). METHODS: From a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1-4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised...
February 15, 2016: Heart: Official Journal of the British Cardiac Society
Rachel M Wald, Candice K Silversides, John Kingdom, Ants Toi, Cathy S Lau, Jennifer Mason, Jack M Colman, Mathew Sermer, Samuel C Siu
BACKGROUND: The mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated. METHODS AND RESULTS: Pregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small-for-gestational-age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome...
November 23, 2015: Journal of the American Heart Association
2016-01-08 02:52:08
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