How Maternal BMI Modifies the Impact of Personalized Asthma Management in Pregnancy

Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.

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Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report

Case Reports in Oncology ◽

10.1159/000513622 ◽

2021 ◽

pp. 141-146

Author(s):

Reda Youssef ◽

Gamal Sayed Ahmed ◽

Samir Alhyassat ◽

Sanaa Badr ◽

Ahmed Sabry ◽

...

Keyword(s):

Gestational Age ◽

Ovarian Neoplasms ◽

Imaging Modality ◽

Reproductive Age ◽

Diagnostic Challenge ◽

Short Period ◽

Ovarian Dysgerminoma ◽

The Impact ◽

In Pregnancy

Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2–1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.

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The Role of TNF-α and Anti-TNF-α Agents during Preconception, Pregnancy, and Breastfeeding

International Journal of Molecular Sciences ◽

10.3390/ijms22062922 ◽

2021 ◽

Vol 22 (6) ◽

pp. 2922

Author(s):

Katarzyna Romanowska-Próchnicka ◽

Anna Felis-Giemza ◽

Marzena Olesińska ◽

Piotr Wojdasiewicz ◽

Agnieszka Paradowska-Gorycka ◽

...

Keyword(s):

Inflammatory Cytokines ◽

First Trimester ◽

Endocrine Function ◽

Necrosis Factor Alpha ◽

Hormone Synthesis ◽

Migratory Activity ◽

Immune System Diseases ◽

Tnf Α ◽

The Impact ◽

In Pregnancy

Tumor necrosis factor-alpha (TNF-α) is a multifunctional Th1 cytokine and one of the most important inflammatory cytokines. In pregnancy, TNF-α influences hormone synthesis, placental architecture, and embryonic development. It was also shown that increased levels of TNF-α are associated with pregnancy loss and preeclampsia. Increased TNF-α levels in complicated pregnancy draw attention to trophoblast biology, especially migratory activity, syncytialisation, and endocrine function. Additionally, elevated TNF-α levels may affect the maternal-fetal relationship by altering the secretory profile of placental immunomodulatory factors, which in turn affects maternal immune cells. There is growing evidence that metabolic/pro-inflammatory cytokines can program early placental functions and growth in the first trimester of pregnancy. Furthermore, early pregnancy placenta has a direct impact on fetal development and maternal immune system diseases that release inflammatory (e.g., TNF-α) and immunomodulatory factors, such as chronic inflammatory rheumatic, gastroenterological, or dermatological diseases, and may result in an abnormal release of cytokines and chemokines in syncytiotrophoblasts. Pregnancy poses a challenge in the treatment of chronic disease in patients who plan to have children. The activity of the disease, the impact of pregnancy on the course of the disease, and the safety of pharmacotherapy, including anti-rheumatic agents, in pregnancy should be considered.

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Feasibility study of a communication and education asthma intervention for general practitioners in Australia

Australian Journal of Primary Health ◽

10.1071/py09056 ◽

2010 ◽

Vol 16 (1) ◽

pp. 75 ◽

Cited By ~ 10

Author(s):

Smita Shah ◽

Brett G. Toelle ◽

Susan M. Sawyer ◽

Jessica K. Roydhouse ◽

Peter Edwards ◽

...

Keyword(s):

General Practitioners ◽

Controlled Trial ◽

Communication Strategies ◽

Asthma Management ◽

Doctor Patient Communication ◽

Children With Asthma ◽

The Usa ◽

Randomised Controlled ◽

Communication Behaviours ◽

The Impact

The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor–patient communication. The impact of the modified PACE Australia program on the processes and outcomes of GP care of children with asthma is now being measured in a randomised controlled trial.

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Abstract 223: The Role Of Angiogenesis In The Myocardial Ischemia/reperfusion Injury In Pregnancy

Circulation Research ◽

10.1161/res.115.suppl_1.223 ◽

2014 ◽

Vol 115 (suppl_1) ◽

Author(s):

Jingyuan li ◽

Zoltan Pierre Arany ◽

Mansoureh Eghbali

Keyword(s):

Infarct Size ◽

Ischemia Reperfusion Injury ◽

Heart Function ◽

Ischemia Reperfusion ◽

Angiogenic Factor ◽

Daily Injection ◽

Rate Pressure Product ◽

Ctrl Group ◽

The Impact ◽

In Pregnancy

Angiogenesis plays an important role in the pathogenesis of cardiovascular disease. Pro-angiogenic and anti-angiogenic treatments have provided new insights into the impact of angiogenesis-based approaches on coronary artery disease. We have recently reported that the hearts of late pregnant (LP) mice are more prone to ischemia/reperfusion (I/R) injury compared to non pregnant(NP) mice. Provided the significant change of angiogenesis status in pregnancy, here we explored whether stimulating the angiogenesis with VEGF is able to protect the heart against I/R injury in late pregnancy, and whether anti-antigenic treatment with soluble endoglin(sENG), an anti-angiogenic factor, aggravates cardiac I/R injury in NP. Pregnant mice at day 12 either received daily injection of VEGF (100 ug/kg daily subcutaneous injection) or PBS(LP CTRL) for 7 days, and at day 19 the LP mice hearts were subjected to 20 min ischemia followed by 40 min reperfusion in Langendorff. NP mice either received a single adenovirus sENG(2х10 8particles via tail vein injection) or vehicle(NP CTRL), and 10 days later NP mice were subjected to 20 min ischemia followed by 40 min reperfusion in Langendorff. The heart function was recorded throughout the experiments, and the infarct size was measured by TTC staining at the end of experiments. Exogenous VEGF treatment significantly improved the cardiac function of LP mice after ischemia. The rate pressure product (RPP) at the end of reperfusion was improved from 1617±287 mmHg*beats/min (n=6) in LP CTRL to 11287±1783 mmHg*beats/min (n=3) in the VEGF group(p<0.01). The infarct size was also significantly reduced by VEGF treatment to 25.0±4.3% (n=3) from 57.4±5.2%(n=6) in CTRL (p<0.01). While sENG aggravated the cardiac I/R injury in NP, as the RPP at the end of reperfusion in the sENG group (4523±1281 mmHg*beats/min, n=4) was significantly lower compared with NP CTRL group(12818±1213 mmHg*beats/min, n=6)(p<0.01). Furthermore, the infarct size in the sENG group was markedly higher compared with NP CTRL group (34.0±3.3% (n=4) vs. 16.3±1.4%(n=6) in NP CTRL, p<0.05). In conclusion, anti-angiogenic treatment aggravates the cardiac I/R injury in NP, while angiogenic therapy protects the heart against I/R injury in LP.

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Excess weight and dyslipidemia and their complications during pregnancy: a systematic review

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-93042016000200002 ◽

2016 ◽

Vol 16 (2) ◽

pp. 93-101 ◽

Cited By ~ 2

Author(s):

Iramar Baptistella do Nascimento ◽

Willian Barbosa Sales ◽

Raquel Fleig ◽

Grazielle Dutra da Silva ◽

Jean Carl Silva

Keyword(s):

Systematic Review ◽

Key Words ◽

Excess Weight ◽

Cochrane Library ◽

Obstetric Outcomes ◽

Lipid Disorders ◽

Key Words Lipids ◽

The Cochrane Library ◽

The Impact ◽

In Pregnancy

Abstract Objectives: to identify bibliographically disorders related to excess weight, dyslipidemia and their complication during pregnancy and in the fetus and newborn. Methods: a systematic review including observational and interventional studies and reviews, based on MEDLINE, LILACS, Embase and the Cochrane Library between 2000 and 2015. The key-words "lipids, pregnancy, obesity and newborn" were used to establish a selective stage for inclusion/exclusion of titles, repeated studies, key-words, abstracts, methodological incompatibility and correlation with objectives. Results: 58 studies were selected, of which 36 (62%) addressed prevention and the risk in pregnancy of excess weight and lipid disorders and 19 (32.7%) suggestions and/or consequences for the fetus and newborn. Conclusions: excess weight and lipidemic disorders in pregnancy are causes for concern in scientific studies, posing risks both for the mother and the newborn. Higher prevalence of caesarian and pre-eclampsia were the two most noteworthy complications for gestational outcomes. In short, the impact on care of maternal habits and excess weight during pregnancy is highly significant, owing to the different degrees of complication in obstetric outcomes and their influence on the clinical characteristics of the newborn.

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Managing asthma in pregnancy

Breathe ◽

10.1183/20734735.007915 ◽

2015 ◽

Vol 11 (4) ◽

pp. 258-267 ◽

Cited By ~ 19

Author(s):

Vanessa E. Murphy

Keyword(s):

Pregnant Women ◽

Inhaled Corticosteroids ◽

Action Plan ◽

Asthma Management ◽

Perinatal Outcomes ◽

List Type ◽

Night Time ◽

Exacerbation Rate ◽

Common Chronic Disease ◽

In Pregnancy

Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis.Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (FeNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according toFeNOand added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice.Key pointsAsthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy.Educational aimsTo identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.

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Maternal Serum Lipid, Estradiol, and Progesterone Levels in Pregnancy, and the Impact of Placental and Hepatic Pathologies

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0042-107078 ◽

2016 ◽

Vol 76 (07) ◽

pp. 799-808 ◽

Cited By ~ 23

Author(s):

U. Pecks ◽

W. Rath ◽

N. Kleine-Eggebrecht ◽

N. Maass ◽

F. Voigt ◽

...

Keyword(s):

Serum Lipid ◽

Maternal Serum ◽

The Impact ◽

In Pregnancy

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Curcumin: Could This Compound Be Useful in Pregnancy and Pregnancy-Related Complications?

Nutrients ◽

10.3390/nu12103179 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3179 ◽

Cited By ~ 1

Author(s):

Tiziana Filardi ◽

Rosaria Varì ◽

Elisabetta Ferretti ◽

Alessandra Zicari ◽

Susanna Morano ◽

...

Keyword(s):

Molecular Mechanisms ◽

Curcuma Longa ◽

Growth Disorders ◽

Beneficial Effects ◽

Toxic Agents ◽

Health Promoting ◽

Short And Long Term ◽

The Impact ◽

In Pregnancy

Curcumin, the main polyphenol contained in turmeric root (Curcuma longa), has played a significant role in medicine for centuries. The growing interest in plant-derived substances has led to increased consumption of them also in pregnancy. The pleiotropic and multi-targeting actions of curcumin have made it very attractive as a health-promoting compound. In spite of the beneficial effects observed in various chronic diseases in humans, limited and fragmentary information is currently available about curcumin’s effects on pregnancy and pregnancy-related complications. It is known that immune-metabolic alterations occurring during pregnancy have consequences on both maternal and fetal tissues, leading to short- and long-term complications. The reported anti-inflammatory, antioxidant, antitoxicant, neuroprotective, immunomodulatory, antiapoptotic, antiangiogenic, anti-hypertensive, and antidiabetic properties of curcumin appear to be encouraging, not only for the management of pregnancy-related disorders, including gestational diabetes mellitus (GDM), preeclampsia (PE), depression, preterm birth, and fetal growth disorders but also to contrast damage induced by natural and chemical toxic agents. The current review summarizes the latest data, mostly obtained from animal models and in vitro studies, on the impact of curcumin on the molecular mechanisms involved in pregnancy pathophysiology, with the aim to shed light on the possible beneficial and/or adverse effects of curcumin on pregnancy outcomes.

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Risk and Resilience in Pregnancy and Birth

Multisystemic Resilience ◽

10.1093/oso/9780190095888.003.0004 ◽

2021 ◽

pp. 57-77

Author(s):

Cecily Young ◽

Susan Ayers

Keyword(s):

Transition To Parenthood ◽

Perinatal Period ◽

Personal Attributes ◽

Future Research ◽

Risk And Resilience ◽

The Third ◽

The Impact ◽

Different Levels ◽

Pregnancy And Birth ◽

In Pregnancy

Pregnancy, birth, and becoming a parent involves substantial changes at biological, psychological, social, and broader cultural levels. As such, it is a continuing process of adaptation to change and new demands. This chapter provides an overview of risk and resilience in pregnancy, birth, and the transition to parenthood and the impact of these experiences on both women and their infants. The first part of the chapter provides an overview of experiences of pregnancy and birth and risks that arise, in particular trauma that may be experienced during birth. The second part looks at resilience in pregnancy and birth, what we know, and what we still need to know in this area. The third part looks at theories of resilience relevant to the perinatal period and how it is important to look at resilience at different levels (e.g. epi/genetic, personal attributes, relationships, support systems, culture, and environment). The authors conclude with key considerations for future research and theory in this area.

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