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Adverse Pregnancy Outcomes (adverse + pregnancy_outcome)

Distribution by Scientific Domains

Medical Sciences	75%
Life Sciences	25%

Selected Abstracts

Micronutrients and Adverse Pregnancy Outcomes in the Context of HIV Infection

NUTRITION REVIEWS, Issue 7 2004
Dr.P.H., Wafaie Fawzi M.B.
HIV infection is a global public health problem, particularly in Africa. Concurrently, micronutrient deficiencies and adverse pregnancy outcomes are prevalent in the same settings. Supplements containing B complex and vitamins C and E were efficacious in reducing adverse pregnancy outcomes, including fetal loss, low birth weight, and prematurity among HIV-infected women; the generalizability of this finding to uninfected women is being examined. There is little encouragement from published studies to provide prenatal vitamin A supplements in HIV infection, particularly in light of significantly higher risk of mother-to-child transmission observed in one trial. The efficacy and safety of prenatal zinc and selenium supplements on these outcomes need to be examined in randomized trials. [source]

Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2008
Denis Kinane
Abstract Introduction: The remit of this group was to update the knowledge base on periodontal diseases and health. Material and Methods: The literature was systematically searched and critically reviewed in five specific topics. Results: Prevalence of periodontitis: The data suggest a trend towards a lower prevalence of periodontitis in recent years. Adverse pregnancy outcome: The findings indicate a likely association between periodontal disease and an increased risk of adverse pregnancy outcomes. There is no evidence that treating periodontal disease decreases the rate of adverse pregnancy outcomes. Prevalence and distribution of periodontal pathogens: Genetic analysis of bacteria has demonstrated an unanticipated diversity within species. Carriage rates and particular subsets of these species vary between ethnic groups. Few of these differences can be related to differences in disease prevalence. Diabetes mellitus: Evidence on the association supports the concept of increased severity but not extent of periodontitis in subjects with poorly controlled diabetes. It is inconclusive that periodontal treatment results in improved metabolic control. Cardiovascular diseases: Evidence suggests that having periodontitis contributes to the total infectious and inflammation burden and may contribute to cardiovascular events and stroke in susceptible subjects. The impact of periodontal therapy must be further investigated. [source]

How does the periapical inflammatory process compromise general health?

ENDODONTIC TOPICS, Issue 1 2004
Idikó.
Several lines of evidence support the causative role of oral inflammatory lesions and certain systemic diseases, such as atherosclerosis and cardiovascular diseases, adverse pregnancy outcome and lung diseases. Properly executed epidemiologic studies identified increased odds ratios. Local or metastatic spread of oral microorganisms, local production of microbial or host-derived soluble regulatory molecules, that may initiate or sustain inflammatory events in remote tissues and organs and the presence of (a) common , extrinsic- or intrinsic-pathological mechanism(s) may result in or contribute to both local and systemic inflammation. A number of cross-sectional studies addressing a possible association between oral health and systemic diseases have also investigated the presence or the absence of periapical lesions. However, these studies cannot either confirm or refute a role of the periapical inflammatory lesion in the observed associations, since other variables of oral health might have exerted an inestimable influence on general health of the assessed population. The literature, dealing with patients with root canal infections and apical periodontitis as sole oral inflammatory lesions is extremely sparse. Our group has demonstrated that young adults with apical periodontitis exhibit certain biochemical changes, such as elevated levels of C-reactive protein and an increased whole blood chemiluminescence, which have been shown to elevate the risk for cardiovascular diseases. Future research will be required to determine whether and to what extent may endodontic diseases affect general health. [source]

Acute Q fever in pregnancy: report and literature review

INTERNAL MEDICINE JOURNAL, Issue 7 2009
J. Denman
Abstract Acute Q fever in pregnancy is uncommon, but is probably underrecognized. It results in a significant risk of adverse pregnancy outcome and also predisposes to the development of chronic Q fever in the mother. Here, we review the clinical features, epidemiology, treatment and follow-up of acute Q fever in pregnancy. The potential for transmission of Coxiella to the neonate and birthing suite staff will also be highlighted. [source]

Are patients with positive screening but negative diagnostic test for gestational diabetes under risk for adverse pregnancy outcome?

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2008
Ilknur I. Gumus
Abstract Objective:, Our aim was to determine the obstetrics outcomes of patients with positive 1-h glucose challenge test (GCT), but negative diagnostic test for gestational diabetes. Methods:, Pregnancy records of 409 pregnants were reviewed. Patients were screened for gestational diabetes mellitus (GDM) with one-hour 50 g glucose challenge test (GCT) at 24,28 weeks of gestation. Patients with glucose challenge tests values , 130 mg/dL were refered for the 3 h, 100-g oral glucose tolerance test (OGTT). Positive GCT but negative for OGTT group (Group A) were compared retrospectively with the group of negative GCT (Group B) for obstetrics outcomes. Result:, GDM and impared glucose tolerance (IGT) were diagnosed in 33 (7.6%) and 46 (10.5%) patients, respectively. We identified 141 (34.4%) patients with positive GCT but negative for OGTT (Group A) and 189 (46.2%) patients with negative GCT (Group B). Gestational weight gain, polyhydramnios, family history of diabetes mellitus were significantly higher in group A than group B (P < 0.05). Prevalance of preterm labor, hypertension, cesarean delivery, mean birthweight, proportion of babies admitted to neonatal intensive care unit were similar in both groups. Conclusion:, There are some differences for pregnancy outcomes between pregnants with positive GCT but negative for OGTT and negative GCT. These patients should be followed up carefully during the antepartum and intrapartum period. [source]

Impact of maternal body mass index on obstetric outcome

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2007
Meenakshi T. Sahu
Abstract Aim:, The purpose of the present study was to correlate effect of maternal body mass index (BMI) on obstetric outcome. The studies conducted so far are from Western developed countries and there is a paucity of data from developing countries. Methods:, A prospective evaluation was carried out of 380 women in one unit of a tertiary care teaching hospital in North India from May 2005 to June 2006 on the effect of maternal BMI on pregnancy outcome. BMI was calculated as weight (kg) divided by height (m2). BMI was used to characterize women as lean (BMI < 19.8 kg/m2), normal (BMI 19.9,24.9 kg/m2), overweight (BMI 25,29.9 kg/m2) or obese (,30 kg/m2). Results:, Forty-six women (12.1%) out of 380 were underweight, 99 (26.1%) were overweight, 30 (7.9%) were obese and the remaining 205 (53.9%) had normal BMI. Anemia (P = 0.02) and low birthweight (P = 0.008) was significantly present among lean women. Obese women had a significant risk for gestational diabetes (P = 0.0004), pre-eclampsia (P = 0.004), cesarean delivery (P = 0.01) and macrosomia (P = 0.02). Conclusion:, Both lean and obese women carry a risk for adverse pregnancy outcome, therefore pregnant women should maintain a normal BMI to achieve a healthy pregnancy outcome. [source]

United States vital statistics and the measurement of gestational age

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2007
Joyce A. Martin
Summary Estimates of the gestational age of the newborn based on US Birth Certificate data are extensively used to monitor trends in infant and maternal health and to improve our understanding of adverse pregnancy outcome. Two measures of gestational age, the ,date of the last normal menses' (LMP) and the ,clinical estimate of gestation' (CE), have been available from birth certificate data since 1989. Reporting irregularities with the LMP-based measure are well-documented, and important questions remain regarding the derivation of the CE. Changes in perinatal medicine and in vital statistics reporting in recent years may have importantly altered gestational age data based on vital statistics. This study describes how gestational age measures are collected and edited in US national vital statistics, and examines changes in the reporting of these measures by race and Hispanic origin between 1990 and 2002. Data are drawn from the National Center for Health Statistics' restricted use US birth files for 1990,2002. Bivariable statistics are used. The percentage of records with missing LMP dates declined markedly over the study period, overall, and for each racial/Hispanic origin group studied. A marked shift in the distribution of the CE of gestational age was also observed, suggesting changes both in the true distribution of age at birth, and in the derivation of this measure. Agreement between the LMP-based and CE estimates increased over the study period, especially among preterm births. However, a high proportion of LMP dates continue to be missing or invalid and the derivation of the CE is still uncertain. In sum, although the reporting of gestational age measures in vital statistics appears to have improved between 1990 and 2002, substantial concerns with both the LMP-based and the CE persist. Efforts to identify approaches to further improve upon the quality of these data are needed. [source]

Increased nuchal translucency in euploid fetuses,what should we be telling the parents?

PRENATAL DIAGNOSIS, Issue 2 2010
C.M. Bilardo
Abstract Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development. Copyright © 2010 John Wiley & Sons, Ltd. [source]

The proform of eosinophil major basic protein: a new maternal serum marker for adverse pregnancy outcome

PRENATAL DIAGNOSIS, Issue 11 2009
Kasper Pihl
Abstract Objective To establish the first trimester serum levels of the proform of eosinophil major basic protein (proMBP) in pregnancies with adverse outcome. Furthermore, to determine the screening performance using proMBP alone and in combination with other first trimester markers. Methods A case-control study was conducted in a primary hospital setting. The proMBP concentration was measured in cases with small-for-gestational age (SGA) (n = 150), spontaneous preterm delivery (n = 88), preeclampsia (n = 40), gestational hypertension (n = 10) and in controls (n = 500). Concentrations were converted to multiples of the median (MoM) in controls and groups were compared using Mann,Whitney U -test. Logistic regression analysis was used to determine significant factors for predicting adverse pregnancy outcome. Screening performance was assessed using receiver operating characteristic curves. Results The proMBP median was significantly reduced in pregnancies with SGA (0.81 MoM), spontaneous preterm delivery (0.83 MoM), preeclampsia (0.88 MoM) and gestational hypertension (0.60 MoM). The best screening performance was found for preeclampsia including the covariates proMBP and nulliparity yielding an area under the curve equal to 0.737 (p < 0.0005) and a 75% detection rate for a 30% false positive rate. Conclusion The proMBP is a novel first trimester serum marker for adverse pregnancy outcome. Copyright © 2009 John Wiley & Sons, Ltd. [source]

First-trimester maternal serum matrix metalloproteinase-9 (MMP-9) and adverse pregnancy outcome

PRENATAL DIAGNOSIS, Issue 6 2009
Leona C. Y. Poon
Abstract Objective To investigate the potential value of maternal serum matrix metalloproteinase-9 (MMP-9) in first-trimester screening for preeclampsia and spontaneous early preterm delivery. Methods The concentrations of MMP-9, tumour necrosis factor soluble receptor-1 (TNF-R1), pregnancy-associated plasma protein-A (PAPP-A) and uterine artery pulsatility index (UA-PI) were measured at 11+0 , 13+6 weeks in cases of preeclampsia (n = 128), gestational hypertension (n = 88), small for gestational age (n = 296), spontaneous early preterm delivery (n = 57) and controls (n = 569). The distributions of measured metabolites and UA-PI in the control and adverse outcome groups were compared. Logistic regression analysis was used to determine the significant contributors in the prediction of adverse outcomes. Results The median MMP-9 was higher than controls in the preeclampsia (1.190 MoM) and preterm delivery (1.187 MoM) groups. In the preeclampsia group there was a significant association between serum MMP-9 and TNF-R1 (r = 0.523, P < 0.0001). Significant prediction of preeclampsia was provided by history and UA-PI, and prediction of preterm delivery was provided by history and neither was improved by the addition of MMP-9. Conclusion In pregnancies developing preeclampsia, the increased level of MMP-9 and the good correlation with TNF-R1 suggest the presence of an underlying inflammatory process. In the pregnancies resulting in spontaneous preterm delivery the small increase in MMP-9 is not useful in the prediction of preterm delivery. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Unexplained elevated maternal serum ,-HCG concentration and adverse pregnancy outcome

PRENATAL DIAGNOSIS, Issue 11 2007
Ramesh Ganapathy
Abstract Objective To investigate the association between unexplained elevated maternal serum ,-Human chorionic gonadotrophin (HCG) in the second trimester of pregnancy and adverse pregnancy outcome. Methods In a case-controlled study of 3463 women who opted for second-trimester serum screening for Down syndrome, 142 were found to have a serum ,-HCG of ,3.5 multiples of the median (MoM), 56 of whom had a serum ,-HCG of ,5.0 MoM. These women were compared with a control group of women with serum ,-HCG within the 95% confidence interval around the median. Results In the elevated ,-HCG group (,5 MoM) significantly more babies required admission to the special care baby unit (p = 0.02) and were small for gestational age (SGA) (p = 0.03). The mean birth weight was also significantly lower in the group with elevated ,-HCG. Women with a serum ,-HCG of ,5, ,6, ,7 or ,8 MoM were associated with SGA babies in 40, 44, 64 and 86% respectively. All babies born to the six women with ,-HCG of 8.75,24.1 MoM were SGA. Conclusion Increased surveillance is necessary in pregnancies where the maternal serum ,-HCG in the second trimester is inexplicably elevated to ,5 MoM. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Sonographic atypical vascular coiling of the umbilical cord

PRENATAL DIAGNOSIS, Issue 1 2005
Antonella Cromi
Abstract Objective To investigate whether an atypical umbilical coiling pattern at prenatal sonography is associated with adverse pregnancy outcome. Methods A targeted sonographic evaluation of the umbilical cord (UC) was performed in 758 women with singleton gestation, and gestational age above 20 weeks. Atypical coiling was defined as the presence of a spring-shape UC (supercoiling) or an unusual, aperiodic coiling pattern (uncoordinated coiling). Umbilical artery Doppler assessment was conducted in cases with atypical coiling. Pregnancy and neonatal outcomes were investigated. Results Of the study population, 7 and 16 fetuses had an umbilical cord with uncoordinated coiling and supercoiling respectively. Three umbilical cords had a single umbilical artery. Eight patients delivered before 34 weeks of gestation. Eight fetuses were growth restricted. In seven cases, abnormal sonographic findings were detected (three meconium peritonitis, two severe hydronephrosis and two cardiac anomalies). One fetus affected by trisomy 18 presented multiple anomalies. Perinatal death occurred in three cases. Of the surviving newborns, eight were admitted to NICU. Umbilical artery Doppler waveforms presented a systolic notch in seven (30.4%) cases. Conclusions The presence of an atypical umbilical cord vascular coiling is associated with an increased risk of unfavourable pregnancy outcome. The identification of an umbilical artery notch at Doppler investigation is frequently associated with an atypical UC coiling pattern. Copyright © 2005 John Wiley & Sons, Ltd. [source]

A further case of confined placental mosaicism for trisomy 2 associated with adverse pregnancy outcome

PRENATAL DIAGNOSIS, Issue 7 2003
Eileen Roberts
Abstract Objectives To add to the knowledge base concerning confined placental mosaicism for trisomy 2. Methods Cytogenetic study of a late CVS referred for hyperechogenic bowel and raised AFP, and cytogenetic and molecular genetic study of a follow-up amniocentesis. Ultrasound monitoring at regular intervals following the CVS result. Results All cells examined from direct and cultured CVS showed a 47,XY,+2 karyotype. Amniocentesis showed a mosaic 47,XY,+2[8]/46,XY[81] karyotype. Uniparental disomy (UPD) studies on the amniotic fluid showed normal biparental inheritance. The pregnancy developed oligohydramnios and IUGR and resulted in a 26-week liveborn male infant with a 46,XY karyotype, which died after 3 days because of complications of severe prematurity. Placental villi post delivery showed only the 47,XY,+2 cell line. Conclusions This case represents a further example of confined placental mosaicism (CPM) for trisomy 2 associated with oligohydramnios, IUGR and poor pregnancy outcome. Copyright © 2003 John Wiley & Sons, Ltd. [source]

ORIGINAL ARTICLE: Abnormal Pattern of Lymphocyte Subpopulations in the Endometrium of Infertile Women with Chronic Endometritis

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2009
Maria Matteo
Problem, Endometrial lymphocytes play a critical role in endometrial receptivity. This study aimed at evaluating the variations induced by chronic endometritis (CE) on endometrial lymphocyte subsets. We compared the results in infertile women diagnosed with CE with those in unexplained infertile women without any sign of CE. Method of study, Twenty-three women referring for unexplained infertility had hysteroscopy and endometrial biopsy in the follicular phase; in nine women, CE was diagnosed (group CE+), while in 14 it was not (group CE,). All patients in the late secretory phase of the subsequent cycle underwent endometrial biopsy. By flow cytometry, the percentage and phenotype of the endometrial lymphocyte subpopulations were analyzed. Results, The secretory endometrium of patients with CE displayed significantly lower percentage of CD56+ CD16, and of CD56bright CD16, cells (47.8% ± 18.6 and 30.1% ± 20.5 versus 79.5% ± 3.9 and 67.3% ± 8.1, respectively; P < 0.01) as compared with group CE(,), while the percentage of CD3+ cells was significantly higher (25% ± 12.2 versus 10.5 ± 5; P < 0.01). Conclusion, Infertile women with CE showed an abnormal percentage of endometrial lymphocyte subsets compared with unexplained infertile women suggesting that different mechanisms underlie the adverse pregnancy outcome of the two groups of patients. [source]

Stress and Pregnancy Loss: Role of Immune Mediators, Hormones and Neurotransmitters

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2001
Petra Clara Arck
This review highlights recent studies investigating the impact of stress on pregnancy health or loss. Spontaneous abortion is the most common adverse pregnancy outcome, and stress has been suggested to be abortogenic in mice and humans. A wealth of information has been published on the effect of stress on the nervous, endocrine and immune systems during the past two decades. Stress- and/or pregnancy-related hormones (corticotropin releasing hormone, adrenocorticotropin, prolactin, and progesterone) might interact with peripheral and local immuncompetent cells, such as certain T cell subsets, mast cells or NK cells, and result in changes of cytokine production. Since a well-balanced interaction of nervous, endocrine and immune system is crucial for the maintenance of successful pregnancy, putative mechanisms and recent observations on stress-triggered pregnancy failure have been reviewed. [source]

Pregnancy and Birth After Kidney Donation: The Norwegian Experience

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009
A. V. Reisæter
Reports on pregnancies in kidney donors are scarce. The aim was to assess pregnancy outcomes for previous donors nationwide. The Medical Birth Registry of Norway holds records of births since 1967. Linkage with the Norwegian Renal Registry provided data on pregnancies of kidney donors 1967,2002. A random sample from the Medical Birth Registry was control group, as was pregnancies in kidney donors prior to donation. Differences between groups were assessed by two-sided Fisher's exact tests and with generalized linear mixed models (GLMM). We identified 326 donors with 726 pregnancies, 106 after donation. In unadjusted analysis (Fisher) no differences were observed in the occurrence of preeclampsia (p = 0.22). In the adjusted analysis (GLMM) it was more common in pregnancies after donation, 6/106 (5.7%), than in pregnancies before donation 16/620 (2.6%) (p = 0.026). The occurrence of stillbirths after donation was 3/106 (2.8%), before donation 7/620 (1.1%), in controls (1.1%) (p = 0.17). No differences were observed in the occurrence of adverse pregnancy outcome in kidney donors and in the general population in unadjusted analysis. Our finding of more frequent preeclampsia in pregnancies after kidney donation in the secondary analysis must be interpreted with caution, as the number of events was low. [source]

Update on the impact of Chlamydia trachomatis infection on male fertility

ANDROLOGIA, Issue 1 2004
G. F. Gonzales
Summary. With approximately 90 million cases annually, infection with Chlamydia trachomatis is the most prevalent sexually transmitted bacterial disease in the world. Considering that these infections are often asymptomatic and cause major complications like acute pelvic inflammatory disease, ectopic pregnancy, infertility or infant pneumonia, the estimated costs for diagnosis and treatment in the USA amounts to 2.2 million US dollars for each 500 cases. Therefore, there is a high need for correct, quick and cost-effective diagnosis and treatment of this urogenital tract infection. New innovative therapies provide good results with regard to efficacy and patients' compliance. The success rates of treatments are at least 95%. However, the occurrence of antibiotic resistance should not be ignored and new treatment schemes must be developed. The state-of-the-art of diagnosis and treatment of chlamydial infections as well as the pathophysiology is discussed in this review. In conclusion, infections with C. trachomatis is an important public health problem, especially in third world and developing countries, and more socio-economic studies linking secondary prevention of chlamydial infections, infertility and adverse pregnancy outcome are needed to understand more of its aetiology. In addition, diagnosis and treatment should be improved. Data in men revealed that past infections but not present infections are more related to male infertility. There is still controversial results. In future studies, function of the seminal vesicles and evaluation of the antioxidant capacity should be taken into account when role of C. trachomatis infection on male fertility is assessed. [source]

Detection and management of decreased fetal movements in Australia and New Zealand: A survey of obstetric practice

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009
Vicki FLENADY
Background:, Decreased fetal movement (DFM) is associated with increased risk of adverse pregnancy outcome. However, there is limited research to inform practice in the detection and management of DFM. Aims:, To identify current practices and views of obstetricians in Australia and New Zealand regarding DFM. Methods:, A postal survey of Fellows and Members, and obstetric trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Results:, Of the 1700 surveys distributed, 1066 (63%) were returned, of these, 805 (76% of responders) were currently practising and included in the analysis. The majority considered that asking women about fetal movement should be a part of routine care. Sixty per cent reported maternal perception of DFM for 12 h was sufficient evidence of DFM and 77% DFM for 24 h. KICK charts were used routinely by 39%, increasing to 66% following an episode of DFM. Alarm limits varied, the most commonly reported was < 10 movements in 12 h (74%). Only 6% agreed with the internationally recommended definition of < 10 movements in two hours. Interventions for DFM varied, while 81% would routinely undertake a cardiotocograph, 20% would routinely perform ultrasound and 20% more frequent antenatal visits. Conclusions:, While monitoring fetal movement is an important part of antenatal care in Australia and New Zealand, variation in obstetric practice for DFM is evident. Large-scale randomised controlled trials are required to identify optimal screening and management options. In the interim, high quality clinical practice guidelines using the best available advice are needed to enhance consistency in practice including advice provided to women. [source]

Comparability of the amniotic fluid index and single deepest pocket measurements in clinical practice

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2003
Everett F. Magann
Abstract Two ultrasound techniques, the amniotic fluid index (AFI) and the single deepest pocket (SDP), are currently used to detect oligohydramnios, predict variable decelerations, risk of Caesarean delivery for fetal distress, Apgar scores, umbilical cord artery pH, perinatal mortality, and cerebral palsy. Both techniques poorly identify oligohydramnios. Both techniques identify pregnancies at risk for variable decelerations, low Apgar scores, and Caesarean delivery for fetal distress. Only the SDP is predictive of a compromised fetus,umbilical artery pH, as a stand-alone test, has been correlated with perinatal mortality, and as part of the biophysical profile has been linked to cerebral palsy. This brief communication reviews the comparability of these two techniques and which method, if either, is superior in the identification of oligohydramnios, the predictability of these techniques to identify an adverse pregnancy outcome, and the ability to predict cerebral palsy and perinatal mortality. [source]

Epstein,Barr virus infection during pregnancy and the risk of adverse pregnancy outcome

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2005
Anne Eskild
Objectives To study the association between Epstein,Barr virus (EBV) antibody status in early pregnancy and pregnancy outcomes including fetal death, length of gestation and fetal weight and length at birth. Design Nested control study. Setting Population based health registers. Population The source population comprised 35,940 pregnant women. Cases were all (280) women with fetal death and a random sample of 940 women with a live born child. Method Information on pregnancy outcome was obtained from the Norwegian Medical Birth Registry. Serum samples from the first trimester were tested for EBV antibodies. In women seronegative for EBV, further serum from late pregnancy was analysed to detect seroconversion. Main outcome measures Vital status, length of gestation, weight and length at birth. Results There was no association between EBV antibody status and fetal death. Women with significant EBV reactivation had a significantly shorter duration of pregnancy, and associated lighter babies, compared with women without significant reactivation (stillborn: 176 vs 197 days, P= 0.16, and live born: 271 vs 279 days, P= 0.03, respectively). Conclusion Significant reactivation of EBV infection during pregnancy may influence pregnancy duration. [source]

A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse pregnancy outcome

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2000
Tri huu Nguyen Research Fellow
Objective To determine if the discrepancy between gestational age estimated by last menstrual period and by biparietal diameter (GALMP, GABPD) is associated with adverse pregnancy outcome. Design Population-based follow up study. Population Singleton pregnancies were studied when a reliable date of last menstrual period and biparietal diameter measured between 12 and 22 weeks of gestation was available (n= 16,469). Methods Logistic regression analysis and Kaplan-Meier survival analysis were used to analyse the association between GALMP, GABPD and adverse pregnancy outcome. Main outcome measures Adverse outcome was defined as abortion after 12 weeks of gestation, stillbirth or postnatal death within one year of birth, delivery < 37 weeks of gestation, a birthweight < 2500 g or a sex-specific birthweight lower than 22% below the expected. Results The risk of death was more than doubled if GALMP, GABPD of , 8 days was compared with GALMP, GABPD of < 8 days (OR 2.2; 95% CI 1.6,3.1). The risk of death was a factor of 6.1 higher if GALMP, GABPD of , 8 days was combined with increased (> 2 × multiple of median) maternal alphafetoprotein measured in the 2nd trimester. Conclusions A discrepancy between GALMP and GABPD generally reflects the precision of the two methods used to predict term pregnancy. However, a positive discrepancy of more than seven days, particularly with high maternal alpha-fetoprotein, might indicate intrauterine growth retardation and an increased risk of adverse perinatal outcome. [source]

Increased rate of prematurity associated with antenatal antiretroviral therapy in a German/Austrian cohort of HIV-1-infected women

HIV MEDICINE, Issue 1 2008
I Grosch-Woerner
Objective The aim of the study was to assess the risk of adverse pregnancy outcomes after antenatal antiretroviral therapy in a well-defined prospective cohort of nontransmitting HIV-infected women. Methods Prospective monitoring of 183 mother,child pairs from 13 centres in Germany and Austria, delivering between 1995 and 2001, was carried out. Following German,Austrian guidelines recommending an elective Caesarean section (CS) at 36 weeks, prematurity was defined as <36 weeks' gestation for these analyses. Results Of 183 mother,child pairs, 42% were exposed to antenatal monotherapy and 17% to dual therapy. Of the 75 women exposed to highly active antiretroviral therapy (HAART), 21 (28%) received protease inhibitor (PI)-based HAART and the remaining 54 received nonnucleoside reverse transcriptase inhibitor-based HAART. In multivariable analysis (176 pregnancies), PI-based HAART exposure during pregnancy was associated with an increased risk of premature delivery [adjusted odds ratio 3.40; 95% confidence interval (CI) 1.13,10.2; P=0.029, compared with monotherapy]. Congenital abnormalities affected 3.3% infants. Perinatally, 18.9% of children (34 of 179) had respiratory problems requiring interventions, which were associated with prematurity but not with type of treatment exposure. From adjusted regression analysis, the mean birth weight z -score for children exposed to HAART with PI (+0.46; 95% CI 0.01,0.92; P=0.047) or dual therapy (+0.43; 95% CI 0.03,0.82; P=0.034) was slightly but significantly higher than that for those exposed to monotherapy; head circumference was appropriate for gestational age and there were no significant differences between treatment groups. Conclusions Use of antenatal PI-based HAART initiated before or during pregnancy was associated with a significantly increased risk of premature delivery at <36 weeks' gestation. The overall crude prematurity rate was 34% (63 of 183; 95% CI 28,42). [source]

Association between periodontal disease, bacterial vaginosis, and sexual risk behaviours

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2010
Emily Craig Zabor
Zabor EC, Klebanoff M, Yu K, Zhang J, Nansel T, Andrews W, Schwebke J, Jeffcoat M. Association between periodontal disease, bacterial vaginosis, and sexual risk behaviours. J Clin Periodontol 2010; 37: 888,893. doi: 10.1111/j.1600-051X.2010.01593.x. Abstract Background: Both periodontal disease and bacterial vaginosis may cause adverse pregnancy outcomes. This study evaluated the association between periodontal disease and bacterial vaginosis. Materials and Methods: Data from 3569 women enrolled in the Longitudinal Study of Vaginal Flora were used. Periodontal disease, defined as greater than three sites with ,4 mm attachment loss, was assessed by specially calibrated hygienists at baseline. Positive bacterial vaginosis status was based on a Nugent Gram stain score ,7. Pairs of independent variables were compared with Pearson's ,2 and risk ratios were calculated through log-binomial regression. Results: Twenty-eight per cent of women with bacterial vaginosis had periodontal disease compared with 22% without , corresponding to 1.29 (95% CI: 1.13, 1.47) times greater risk of periodontal disease among women with bacterial vaginosis. In adjusted analysis the risk ratio dropped to 1.23 (95% CI: 1.08, 1.40). Receptive oral sex with an uncircumcised partner was associated with 1.28 times (95% CI: 0.97, 1.69) the risk for periodontal disease compared with receptive oral sex with a circumcised partner, though the association is not statistically significant. Conclusions: In this population, there is a small but significant association between periodontal disease and bacterial vaginosis and a possible trend between receptive oral sex with an uncircumcised partner and periodontal disease. [source]

Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology

Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2008
Anna Agueda
Abstract Aim: The aim of this study was to determine the association between periodontitis and the incidence of preterm birth (PB), low birth weight (LBW) and preterm low birth weight (PLBW) Material and Methods: One thousand and ninty-six women were enrolled. Periodontal data, pregnancy outcome variables and information on other factors that may influence adverse pregnancy outcomes were collected. Data were analysed using a logistic regression model. Results: The incidence of PB and LBW was 6.6% and 6.0%, respectively. The incidence of PLBW was 3.3%. PB was related to mother's age, systemic diseases, onset of prenatal care, previous PBs, complications of pregnancy, type of delivery, the presence of untreated caries and the presence of periodontitis (odds ratio 1.77, 95% confidence interval: 1.08,2.88). LBW was related to mother's smoking habits, ethnicity, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. PLBW was related to mother's age, onset of prenatal care, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. Conclusions: The factors involved in many cases of adverse pregnancy outcomes have still not being identified, although systemic infections may play a role. This study found a modest association between periodontitis and PB. Further research is required to establish whether periodontitis is a risk factor for PB and/or LBW. [source]

Double inherited thrombophilias and adverse pregnancy outcomes: Fashion or science?

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010
Giovanni Larciprete
Abstract Aim:, To determine to what extent double inherited thrombophilias are associated with adverse obstetric complications correlated with fetoplacental insufficiency, such as preeclampsia, hemolytic anemia elevated liver enzymes and low platelet count (HELLP) syndrome, gestational hypertension, fetal growth restriction (FGR), intrauterine death (ID), abruptio placentae and disseminated intravascular coagulopathy. Methods:, Pregnant women coming to delivery were retrospectively divided into two groups: group A (controls) and group B (cases). Patients belonging to group B had one of the following: severe preeclampsia, HELLP syndrome, gestational hypertension, FGR, intrauterine death, abruptio placentae of disseminated intravascular coagulopathy. We detected methylenetetrahydrofolate reductase (MTHFR) A1298C, MTHFR C677T, factor V Leiden, PAI-1, mutant prothrombin G20210A, plasma homocysteine, antithrombin III, protein S and activated protein C resistance. Normal pregnant women or pregnant women with double defects were enrolled in this study. Results:, The combination of MTHFR C677T mutation with PAI-1 (5G/5G) mutation was significantly linked with the occurrence of ID. HELLP syndrome was significantly related to the simultaneous presence of factor VIII and X mutations. The combination of MTHFR C677T with factor VIII mutation and the combination of factor II and V mutations were significantly related to the occurrence of abruptio placentae. We found an association between double isoforms MTHFR mutation and FGR. Conclusion:, It seems that some thrombophilias and a combination of thrombophilic factors carry a greater risk than others for a given adverse outcome. Further studies are needed to check the link between thrombophilic gene mutations and adverse pregnancy outcomes, such as recurrent miscarriages and deep venous thrombosis. [source]

Obesity and Pregnancy: Implications and Management Strategies for Providers

MOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 6 2009
Taraneh Shirazian MD
Abstract Obesity in pregnancy (pregravid body mass ,30) has been linked to several adverse pregnancy outcomes, including spontaneous abortion, preeclampsia, gestational diabetes, fetal macrosomia, cesarean delivery, and wound complications post,cesarean section. Intrapartum and postpartum management of obese gravidas requires multidisciplinary consultations between obstetricians, anesthesiologists, nurses, and pediatricians in order to improve the pregnancy outcomes of the mother and neonate. The American College of Obstetricians and Gynecologists currently supports risk-reducing strategies for obese pregnant patients, including limiting weight gain to 15 lb (standardized by the Institute of Medicine). Interventions to reduce gestational weight gain may be important modifiable risk factors for maternal and fetal perinatal complications. Interventions have targeted modifications of diet and exercise with educational methods such as radio broadcasts, pamphlets, and counseling. Interventions have also focused on motivational methods, such as individual and group classes, and have been implemented both before conception and immediately after birth. Effective interventions appear to be individualized in approach, but there is a lack of data to support any specific model. Prospective interventional studies are needed to demonstrate the benefits of weight limitation on pregnancy outcomes. Mt Sinai J Med 76:539-545, 2009. © 2009 Mount Sinai School of Medicine [source]

Micronutrients and Adverse Pregnancy Outcomes in the Context of HIV Infection

Zinc Nutrition and HIV Infection

NUTRITION REVIEWS, Issue 3 2002
Roland Kupka BS
The trace element zinc is involved in many important immune processes. A number of immunologic impairments owing to zinc deficiency are also evident in HIV disease, most notably a reduction in the number of circulating T lymphocytes. Observational epidemiologic studies have provided conflicting results on the role of zinc status in HIV disease progression. Randomized, placebo-controlled trials are needed to resolve this controversy. Studies must also address the role of zinc in vertical transmission of HIV from mother to child and its role in reducing the risk of adverse pregnancy outcomes, both of which are of considerable public health importance in developing countries. [source]

Maternal use of nicotine replacement therapy during pregnancy and offspring birthweight: a study within the Danish National Birth Cohort

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2010
Tina H. Lassen
Summary Lassen TH, Madsen M, Skovgaard LT, Strandberg-Larsen K, Olsen J, Andersen A-MN. Maternal use of nicotine replacement therapy during pregnancy and offspring birthweight: a study within the Danish National Birth Cohort. Paediatric and Perinatal Epidemiology 2010; 24: 272,281. Smoking is a well-established risk factor for fetal growth restriction and other adverse pregnancy outcomes, and nicotine may be one of the chemical compounds that drive these associations. Nicotine replacement therapy (NRT) is a smoking cessation aid, which can facilitate smoking cessation. It is, however, unknown whether NRT used during pregnancy impairs fetal growth. The aim of this study was to estimate the association between the use of NRT during pregnancy and offspring birthweight. The study population consisted of 72 761 women enrolled in the Danish National Birth Cohort between 1996 and 2002. Information on NRT and potential confounders was obtained from two computer-assisted telephone interviews conducted in the second and third trimesters, respectively. Multiple linear regression in a multilevel model was used to estimate the association between NRT use and birthweight adjusted for gestational age and potential confounders. The adjusted analyses showed no significant association between the duration of NRT use and birthweight (b = 0.25 g per week of NRT use [95% CI ,2.31, 2.81]) and neither was the type of NRT product (patch, gum, inhaler) associated with reduced birthweight. However, simultaneous use of more than one NRT product was associated with reduced birthweight (b = ,10.73 g per week of NRT use [95% CI ,26.51, 5.05]), although the association was not statistically significant. The results of this study suggest that maternal use of NRT in pregnancy does not seriously affect birthweight, but there could be a negative effect on birthweight associated with simultaneous use of more than one type of NRT product. [source]