EPA-0890 – Effects of prenatal exposure to psychotropic medication on neonatal outcomes: the role of the psychiatric - obstetric liaison consultation

Abstract Persistent Organic Pollutants (POPs) are exogenous, artificially made chemicals that can disrupt the biological system of individuals and animals. POPs encompass a variety of chemicals including, dioxins, organochlorines (OCs), polychlorinated biphenyl (PCBs), and perfluoroalkyl substances (PFASs) that contain a long half-life and highly resistant to biodegradation. These environmental pollutants accumulate over time in adipose tissues of living organisms and alter various insulin function-related genes. Childhood Metabolic Syndrome (MetS) consists of multiple cardiovascular risk factors, insulin function being one of them. Over the years, the incidence of the syndrome has increased dramatically. It is imperative to explore the role of persistent organic pollutants in the development of Childhood Metabolic Syndrome. Some epidemiological studies have reported an association between prenatal exposure to POPs and offspring MetS development throughout childhood. These findings have been replicated in animal studies in which these pollutants exercise negative health outcomes such as obesity and increased waist circumference. This review discusses the role of prenatal exposure to POPs among offspring who develop MetS in childhood, the latest research on the MetS concept, epidemiological and experimental findings on MetS, and the POPs modes of action. This literature review identified consistent research results on this topic. Even though the studies in this review had many strengths, one major weakness was the usage of different combinations of MetS criteria to measure the outcomes. These findings elucidate the urgent need to solidify the pediatric MetS definition. An accurate definition will permit scientists to measure the MetS as a health outcome properly and allow clinicians to diagnose pediatric MetS and provide individualized treatment appropriately.

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Comparison of Maternal Sera, Cord Blood, and Neonatal Sera for Detecting Presumptive Congenital Syphilis: Relationship With Maternal Treatment

PEDIATRICS ◽

10.1542/peds.91.1.88 ◽

1993 ◽

Vol 91 (1) ◽

pp. 88-91

Author(s):

Rakesh S. Chhabra ◽

Luc P. Brion ◽

Martha Castro ◽

Lawrence Freundlich ◽

Joy H. Glaser

Keyword(s):

Cord Blood ◽

Prenatal Exposure ◽

Congenital Syphilis ◽

Multiple Comparisons ◽

Serologic Test ◽

Blood Samples ◽

The Past ◽

Maternal Treatment ◽

Treatment Administration

The incidence of congenital syphilis has increased rapidly over the past few years. Most infected mothers and their newborns are asymptomatic at birth and diagnosis depends on serologic testing during pregnancy and at delivery. This study was initiated to compare maternal sera, cord blood, and neonatal sera for detecting presumptive congenital syphilis and to assess the role of maternal treatment (administration of penicillin to the mother at least 1 month before delivery) on the serologic results at the time of delivery. The serologic results from all live deliveries complicated by a positive maternal and/or neonatal test for syphilis during a 12-month period were compared using χ2 analysis and multiple comparisons for proportions. Of 3306 livebirths, 73 (2.2%) were complicated by a positive maternal or neonatal serology. At delivery, the serologic test was positive in 68 (94%) of 72 maternal sera, 30 (50%) of 60 cord sera, and 43 (63%) of 68 neonatal sera. In the absence of maternal treatment, 95% of the maternal sera, 66% of the cord blood samples, and 86% of the neonatal sera were positive. If the mother had been treated, 94% of maternal sera, 36% of cord sera, and 39% of neonatal sera were positive. Cord blood and neonatal sera appear to be inferior to maternal sera for detecting prenatal exposure to syphilis. Cord serology is also inferior to neonatal serology at 2 to 3 days of age. The most effective way to identify newborns at risk for congenital syphilis is to obtain a maternal serologic diagnosis during pregnancy and to test maternal and neonatal sera at delivery.

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Bipolar disorder and psychotropic medication: Impact on pregnancy and neonatal outcomes

Journal of Affective Disorders ◽

10.1016/j.jad.2018.09.045 ◽

2019 ◽

Vol 243 ◽

pp. 220-225 ◽

Cited By ~ 8

Author(s):

Katherine L. Wisner ◽

Dorothy Sit ◽

Kelly O'Shea ◽

Debra L. Bogen ◽

Crystal T. Clark ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychotropic Medication ◽

Neonatal Outcomes

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P-646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Human Reproduction ◽

10.1093/humrep/deab125.051 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Feferkorn ◽

A Badeghiesh ◽

H Baghlaf ◽

M Dahan

Keyword(s):

Gestational Diabetes ◽

Maternal Death ◽

Pregnancy Outcomes ◽

Post Partum ◽

Population Based ◽

Neonatal Outcomes ◽

Pituitary Hormone ◽

Population Based Study ◽

Post Partum Hemorrhage

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p < 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p < 0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p < 0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p < 0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p < 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p = 0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p = 0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p = 0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78-1.97), gestational hypertension (95%CI:0.14-1.41), preeclampsia (95%CI:0.96-2.99), gestational diabetes (95%CI:0.30-1.01), preterm delivery (95%CI:0.74-1.91), preterm premature rupture of membranes (95%CI:0.17-2.82), operative vaginal delivery (95%CI: 0.23-1.19), small for gestational age neonates (95%CI:0.27-2.02) or intra-uterine fetal demise (95%CI:0.13-6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number not applicable

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P–646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Human Reproduction ◽

10.1093/humrep/deab130.645 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

I Feferkorn ◽

A Badeghiesh ◽

H Baghlaf ◽

M Dahan

Keyword(s):

Gestational Diabetes ◽

Maternal Death ◽

Pregnancy Outcomes ◽

Post Partum ◽

Population Based ◽

Neonatal Outcomes ◽

Pituitary Hormone ◽

Population Based Study ◽

Post Partum Hemorrhage

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p < 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p<0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p<0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p<0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p< 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p=0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p=0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p=0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78–1.97), gestational hypertension (95%CI:0.14–1.41), preeclampsia (95%CI:0.96–2.99), gestational diabetes (95%CI:0.30–1.01), preterm delivery (95%CI:0.74–1.91), preterm premature rupture of membranes (95%CI:0.17–2.82), operative vaginal delivery (95%CI:0.23–1.19), small for gestational age neonates (95%CI:0.27–2.02) or intra-uterine fetal demise (95%CI:0.13–6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings: Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number Not applicable

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Reducing Recidivism Among Mentally III Offenders: The Role of Psychotropic Medication in Correctional Psychiatry

Psychiatric Annals ◽

10.3928/0048-5713-20010701-05 ◽

2001 ◽

Vol 31 (7) ◽

pp. 409-418 ◽

Cited By ~ 2

Author(s):

Howard M Kravitz ◽

John M Davis ◽

Joel Silberberg

Keyword(s):

Psychotropic Medication ◽

Reducing Recidivism

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Hypothetical roadmap towards endometriosis: prenatal endocrine-disrupting chemical pollutant exposure, anogenital distance, gut-genital microbiota and subclinical infections

Human Reproduction Update ◽

10.1093/humupd/dmz044 ◽

2020 ◽

Vol 26 (2) ◽

pp. 214-246 ◽

Cited By ~ 3

Author(s):

Pilar García-Peñarrubia ◽

Antonio J Ruiz-Alcaraz ◽

María Martínez-Esparza ◽

Pilar Marín ◽

Francisco Machado-Linde

Keyword(s):

Prenatal Exposure ◽

Genital Tract ◽

Endocrine Disrupting Chemicals ◽

Active Role ◽

Faecal Microbiota ◽

Clinical Progression ◽

Anogenital Distance ◽

Endocrine Disrupting ◽

Microbial Infections

Abstract BACKGROUND Endometriosis is a gynaecological hormone-dependent disorder that is defined by histological lesions generated by the growth of endometrial-like tissue out of the uterus cavity, most commonly engrafted within the peritoneal cavity, although these lesions can also be located in distant organs. Endometriosis affects ~10% of women of reproductive age, frequently producing severe and, sometimes, incapacitating symptoms, including chronic pelvic pain, dysmenorrhea and dyspareunia, among others. Furthermore, endometriosis causes infertility in ~30% of affected women. Despite intense research on the mechanisms involved in the initial development and later progression of endometriosis, many questions remain unanswered and its aetiology remains unknown. Recent studies have demonstrated the critical role played by the relationship between the microbiome and mucosal immunology in preventing sexually transmitted diseases (HIV), infertility and several gynaecologic diseases. OBJECTIVE AND RATIONALE In this review, we sought to respond to the main research question related to the aetiology of endometriosis. We provide a model pointing out several risk factors that could explain the development of endometriosis. The hypothesis arises from bringing together current findings from large distinct areas, linking high prenatal exposure to environmental endocrine-disrupting chemicals with a short anogenital distance, female genital tract contamination with the faecal microbiota and the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. SEARCH METHODS We performed a search of the scientific literature published until 2019 in the PubMed database. The search strategy included the following keywords in various combinations: endometriosis, anogenital distance, chemical pollutants, endocrine-disrupting chemicals, prenatal exposure to endocrine-disrupting chemicals, the microbiome of the female reproductive tract, microbiota and genital tract, bacterial vaginosis, endometritis, oestrogens and microbiota and microbiota–immune system interactions. OUTCOMES On searching the corresponding bibliography, we found frequent associations between environmental endocrine-disrupting chemicals and endometriosis risk. Likewise, recent evidence and hypotheses have suggested the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. Hence, we can envisage a direct relationship between higher prenatal exposure to oestrogens or estrogenic endocrine-disrupting compounds (phthalates, bisphenols, organochlorine pesticides and others) and a shorter anogenital distance, which could favour frequent postnatal episodes of faecal microbiota contamination of the vulva and vagina, producing cervicovaginal microbiota dysbiosis. This relationship would disrupt local antimicrobial defences, subverting the homeostasis state and inducing a subclinical inflammatory response that could evolve into a sustained immune dysregulation, closing the vicious cycle responsible for the development of endometriosis. WIDER IMPLICATIONS Determining the aetiology of endometriosis is a challenging issue. Posing a new hypothesis on this subject provides the initial tool necessary to design future experimental, clinical and epidemiological research that could allow for a better understanding of the origin of this disease. Furthermore, advances in the understanding of its aetiology would allow the identification of new therapeutics and preventive actions.

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