scholarly journals The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes

2018 ◽  
Vol 08 (03) ◽  
pp. e146-e157 ◽  
Author(s):  
Dotun Ogunyemi ◽  
Andrew Jovanovski ◽  
James Liu ◽  
Perry Friedman ◽  
Nathaniel Sugiyama ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychotropic Drugs ◽  
Postpartum Hemorrhage ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Anxiety And Depression ◽  
Cesarean Deliveries ◽  
Adverse Neonatal Outcomes ◽  
Neonatal Adaptation ◽  
Anxiety Depression

Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.

Prediction of complex gastroschisis: The evolution of therapeutic techniques and their relation with fetal sonographic features

2021 ◽  
pp. 1-9
Author(s):  
G. Mazzoni ◽  
D. Alberti ◽  
F. Torri ◽  
M. Motta ◽  
C. Platto ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Adverse Outcomes ◽  
Prenatal Ultrasound ◽  
Neonatal Outcomes ◽  
Single Center Study ◽  
Adverse Neonatal Outcomes ◽  
Length Of Hospitalization

BACKGROUND: To analyze prenatal ultrasound (US) markers to predict treatment and adverse neonatal outcome in fetal gastroschisis. METHODS: It was conducted a retrospective single-center study considering all pregnancies with isolated gastroschisis that were treated in our department between 2008 and 2020. 17 US markers were analyzed. Moreover, the association between prenatal ultrasound signs and neonatal outcomes was analyzed: need of bowel resection, techniques of reduction, type of closure, adverse neonatal outcomes, time to full enteral feeding, length of total parenteral nutrition and length of hospitalization. RESULTS: The analysis included 21 cases. We found significant associations between intestinal dilation (≥10 mm) appeared before 30 weeks of gestation and the need of bowel resection (p = 0.001), the length of total parenteral nutrition (p = 0,0013) and the length of hospitalization (p = 0,0017). Intrauterine growth restriction (IUGR) is a risk factor for serial reduction (p = 0,035). There were no signs significantly associated with the type of closure. Hyperbilirubinemia is related with gestational age (GA) at the diagnosis of intra-abdominal bowel dilation (IABD) (p = 0.0376) and maximum IABD (p = 0.05). All newborns with sepsis had echogenic loops in uterus (p = 0.026). The relation between the GA at delivery and the GA at the extra-abdominal bowel dilation (EABD)≥10 mm was r = 0.70. CONCLUSION: We showed the significant role of the early presence of bowel dilation in predicting intestinal resection and adverse outcomes. All IUGR fetuses needed staged reduction through the silo-bag technique. The echogenic bowel was related to neonatal sepsis, while IABD was associated with hyperbilirubinemia.

Assessment of Gestational Diabetes Mellitus Outcomes for Hispanic Women Living in the Rio Grande Valley

2019 ◽  
Vol 17 (3) ◽  
pp. 111-117 ◽  
Author(s):  
Norma Somohano-Mendiola ◽  
Jane Dimmitt Champion ◽  
Kristina Vatcheva
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Hispanic Women ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Oral Glucose ◽  
Mexican Origin ◽  
Adverse Neonatal Outcomes

Introduction: Gestational diabetes mellitus (GDM) among women living along the U.S.–Mexico border are approximately twice that of the general population of pregnant U.S. women. This study compared outcomes for Hispanic pregnant women diagnosed and treated for GDM (i.e., two abnormal 3-hour oral glucose tolerance tests [OGTT]) with those who were screened but had only one abnormal 3-hour OGTT and therefore received no treatment. Methods: Retrospective chart review of pregnant Hispanic women of Mexican origin ( N = 95), with GDM ( N = 41) or one abnormal 3-hour OGTT value ( N = 54) who delivered between January 1, 2015, and December 31, 2017. Results: No significant differences were found between the two groups with regard to sociodemographic variables, hyperbilirubinemia, or other adverse neonatal outcomes. Comparisons identified differences between women with and without adverse neonatal outcomes concerned type of delivery; there were more C-sections among women with GDM. Conclusion: Pregnant women with one abnormal 3-hour OGTT value are at risk of giving birth to neonates with biomarkers similar to those diagnosed and treated for GDM. The treatment of hyperglycemia in Hispanic women of Mexican origin with one abnormal 3-hour OGTT value may improve the health outcomes and quality of life of the mother and the neonate. More research is warranted to clarify the risk of adverse outcomes of diverse pregnant women who do not meet guidelines for diagnosis of GDM.

scholarly journals Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ya-Wen Lin ◽  
Ming-Hung Lin ◽  
Lee-Wen Pai ◽  
Jen-Wei Fang ◽  
Chih-Hsin Mou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Birth Outcomes ◽  
Ductus Arteriosus ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Adverse Neonatal Outcomes

AbstractTo evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34–5.40) and 3.92 (95% CI 3.65–4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63–3.33) and 1.90 (95% CI 1.76–2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56–7.75) and 5.81 (95% CI 5.15–6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.

scholarly journals Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Gunhild Felde ◽  
Anders Engeland ◽  
Steinar Hunskaar
Keyword(s):  
Urinary Incontinence ◽  
Drug Use ◽  
Psychotropic Drugs ◽  
Anxiety And Depression ◽  
Defined Daily Dose ◽  
Prescription Database ◽  
Cross Sectional ◽  
Daily Dose ◽  
Anxiety Depression ◽  
The Impact

Abstract Background Anxiety and depression are in both cross-sectional and longitudinal studies associated with urinary incontinence (UI) in women, strongest for the urgency component of UI. The role of psychotropic drugs in this association, especially antidepressants, has been questioned, but not clarified. The present study aimed to explore the associations between UI and anxiety/depression and the possible impact of psychotropic drugs on these associations. Methods We conducted a cross-sectional, population-based study with questionnaire data from 21,803 women ≥20 years in the Norwegian Nord-Trøndelag Health Study merged with the Norwegian Prescription Database, which contains information on all dispensed prescriptions. We used multivariate logistic regression to investigate the association between UI (any UI, and by type and severity) and anxiety/depression (by different score on Hospital anxiety and depression scale), and the influence of psychotropic drugs on this association (by different volume of drug use). Results Compared with normal anxiety- and depression score, having moderate/severe anxiety or depression (HADS≥11) increased the prevalence of UI from 27.6 to 37.8% (OR 1.59 (1.40–1.81), p < 0.001) for anxiety and from 28.0 to 43.7% (OR 1.79 (1.46–2.21), p < 0.001) for depression. According to type of UI, mixed UI was most strongly associated with a high HADS-score with an odds ratio 1.84 (1.65–2.05) for anxiety and 1.85 (1.61–2.13) for depression. Compared to no UI, severe UI was associated with depression with odds ratios of 2.04 (1.74–2.40), compared with no UI. Psychotropic drug use did not influence the associations between UI and anxiety/depression. We found high prevalence of UI among users of various psychotropic drugs. After adjustments, only antidepressants were associated with UI, with OR 1.36 (1.08–1.71) for high defined daily dose of the drug. Anxiolytics were associated with less UI with OR 0.64 (0.45–0.91) after adjustments for anxiety. Conclusion This study showed that anxiety, depression and use of antidepressants are associated factors with UI, strongest for urgency and mixed type of UI, with increasing ORs by increasing severity of the conditions and increased daily dose of the medication. Use of antidepressants did not influence the associations between UI and anxiety/depression.

The interaction between maternal smoking, illicit drug use and alcohol consumption associated with neonatal outcomes

2019 ◽  
Vol 42 (2) ◽  
pp. 277-284
Author(s):  
Ciara M E Reynolds ◽  
Brendan Egan ◽  
Niamh Daly ◽  
Aoife McKeating ◽  
Sharon R Sheehan ◽  
...  
Keyword(s):  
Drug Use ◽  
Maternal Smoking ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Smoking During Pregnancy ◽  
Adverse Neonatal Outcomes ◽  
Maternal Smoking During Pregnancy

Abstract Background The adverse effects of smoking on neonatal outcomes, such as small-for-gestational-age (SGA), has been extensively studied however, the consequences of smoking combined with alcohol and/or drug use is less clear. Methods This retrospective observational study analyzed clinical and sociodemographic details of 40156 women who delivered a singleton baby between the years 2011 and 2015. Results Compared with women who had never smoked, smokers who did not engage in alcohol or drug use had an odds ratio (OR) of delivering a baby who was SGA of 3.2 (95% CI: 3.1–3.5). Smokers who used illicit drugs in isolation or in combination with alcohol during pregnancy had higher ORs for SGA (1.4, 95% CI: 1.1–1.7, P = 0.006 and 1.8, 95% CI: 1.2–2.7, P = 0.007) compared to women who smoked but did not engage in alcohol or drug use in pregnancy. These women also delivered babies with lower mean birthweights (125 g, P &lt; 0.001 and 181.4 g, P = 0.003) and head circumferences (0.4 cm, P &lt; 0.001 and 0.3 cm, P = 0.048). Women who smoked and used alcohol, but not illicit drugs were not associated adverse outcomes above that of smoking in isolation. Conclusion Illicit drug use combined with maternal smoking during pregnancy increases the risk of adverse neonatal outcomes above that of smoking in isolation.

Risk of Neonatal Short-Term Adverse Outcomes Associated with Noninfectious Intrapartum Hyperthermia: A Nested Case-Control Retrospective Study

2019 ◽  
Author(s):  
Hao Zhu ◽  
Jiangnan Wu ◽  
Yijia Yang ◽  
Xiaotian Li ◽  
Rong Hu
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Amniotic Fluid ◽  
Induction Of Labor ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Positive Pressure ◽  
Neonatal Infections ◽  
Adverse Neonatal Outcomes ◽  
Meconium Stained Amniotic Fluid

Abstract Objective Aim of this study was to identify risk factors for adverse neonatal outcomes in neonates born to mothers with noninfectious intrapartum hyperthermia. Study Design A retrospective study was conducted of 460 singleton deliveries diagnosed with noninfectious intrapartum hyperthermia. Logistic regression was used to estimate the association between ante- and intrapartum risk factors and neonatal outcomes. Results The 460 singleton pregnant women were 19 to 43 years of age. They developed an intrapartum temperature of ≥37.5°C somewhere between 340/7 to 414/7 weeks' gestation; 437 (95%) were nulliparous. Meconium-stained amniotic fluid was associated with positive pressure ventilation or intubation ventilation (odds ratio [OR] = 5.940, 95% confidence interval [CI]: 2.038–17.318), birth depression (OR = 6.288, 95% CI: 2.273–17.399), and wet lung (OR = 2.747, 95% CI: 1.322–5.709). Induction of labor with artificial rupture of membranes (AROM; OR = 2.632, 95% CI: 1.325–5.228) was associated with neonatal infections. Maternal temperature ≥ 38°C was associated with neonate's artery blood gas pH < 7.3 (OR = 2.366, 95%CI: 1.067–5.246) and wet lung (OR = 2.909, 95% CI: 1.515–5.586). Maternal elevated C-reactive protein (CRP) was associated with neonatal infections (OR = 1.993, 95% CI: 1.260–3.154) and wet lung (OR = 2.600, 95% CI: 1.306–5.178). Conclusion Meconium-stained amniotic fluid, induction of labor, maternal temperature ≥ 38°C, and elevated CRP during labor were risk factors for adverse neonatal outcomes.

Considering Criteria for Active Phase Labor Management of Nulliparous Women: A Cost-Effectiveness Analysis

2021 ◽  
Author(s):  
Eleanor M. Schmidt ◽  
Alyssa R. Hersh ◽  
Methodius Tuuli ◽  
Alison G. Cahill ◽  
Aaron B. Caughey
Keyword(s):  
Sensitivity Analysis ◽  
Brachial Plexus Injury ◽  
Cost Effective ◽  
Active Phase ◽  
Neonatal Outcomes ◽  
Maternal Outcomes ◽  
Cervical Dilation ◽  
Cesarean Deliveries ◽  
Active Labor ◽  
Adverse Neonatal Outcomes

Objective The aim of the study is to evaluate differences in maternal and neonatal outcomes based on updated criteria for defining active labor at 6 cm of cervical dilation and to determine if these recommendations are cost-effective. Study Design A decision-analytic model was built using TreeAge Pro 2020 software. We included maternal outcomes of mode of delivery, endometritis, postpartum hemorrhage requiring transfusion, and death. Neonatal outcomes included rates of shoulder dystocia and permanent brachial plexus injury. Costs and quality-adjusted life years (QALYs) were included from the maternal and infant perspectives. We used a willingness-to-pay threshold of $100,000 per QALY and all model inputs were subjected to sensitivity analysis. Results In a theoretical cohort of 1.4 million women, a threshold of 6 cm to define active labor resulted in 373,668 fewer cesarean deliveries, 33,181 fewer cases of endometritis, 143 fewer postpartum hemorrhages requiring transfusions, and seven fewer maternal deaths when compared with a threshold of 4 cm. However, there were higher rates of adverse neonatal outcomes, including 484 more cases of shoulder dystocia and 17 more instances of permanent brachial plexus injury. Using 6 cm as the threshold resulted in lower costs and greater effectiveness, making it a dominant strategy. Multivariate sensitivity analysis demonstrated the model was robust over a wide range of assumptions. Conclusion In this model, considering 6 cm of cervical dilation as the threshold for the active phase of labor compared with 4 cm was a cost-effective strategy to prevent primary cesarean deliveries, lower costs, and improve maternal outcomes, despite associated increased adverse neonatal outcomes. Key Points

Risk factors and outcomes in “well-selected” vaginal breech deliveries: a retrospective observational study

2017 ◽  
Vol 45 (3) ◽  
Author(s):  
Georg Macharey ◽  
Veli-Matti Ulander ◽  
Seppo Heinonen ◽  
Karel Kostev ◽  
Mika Nuutila ◽  
...  
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Epidural Anesthesia ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Retrospective Observational Study ◽  
Secondary Outcome ◽  
Multivariate Logistic Regression Model ◽  
Severe Morbidity ◽  
Adverse Neonatal Outcomes

AbstractObjective:To assess risk factors for adverse perinatal and neonatal outcomes in “well-selected” singleton vaginal breech deliveries at term.Methods:During the time span from January 2008 up to April 2015 a total of 786 singleton term breech deliveries with a planned vaginal delivery were identified in a retrospective observational study at Helsinki University Central Hospital, Finland. The study’s end point was a composite of adverse perinatal and neonatal outcomes. Infants with an adverse outcome were compared to all spontaneous singleton vaginal breech deliveries with normal perinatal and neonatal outcomes. A multivariate logistic regression model was used to analyze associations between adverse neonatal outcomes and several variables. The secondary outcome was the severe morbidity rate according to the criteria of the term breech trial.Results:An adverse neonatal outcome was recorded for 38 (4.8%) infants. According to the study the second delivery stage lasting <40 min [adjusted odds ratio (aOR): 0.34, 95% confidence interval (95% CI): 0.15–0.79] was associated with lower odds and had a protective effect against adverse outcomes. Epidural anesthesia (aOR: 2.88, 95% CI: 1.08–7.70) was associated with higher adverse outcomes. The incidence rate of severe morbidity was 1.3% (10/787).Conclusion:Adverse neonatal outcomes in well-selected breech deliveries are associated with a prolonged second delivery stage lasting >40 min and with epidural anesthesia.

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