scholarly journals Benzodiazepine use before conception and risk of ectopic pregnancy

2020 ◽  
Vol 35 (7) ◽  
pp. 1685-1692 ◽  
Author(s):  
Elizabeth Wall-Wieler ◽  
Thalia K Robakis ◽  
Deirdre J Lyell ◽  
Reem Masarwa ◽  
Robert W Platt ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Ectopic Pregnancy ◽  
Data Access ◽  
Prescription Data ◽  
Translational Science ◽  
Gestational Length ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Competing Interest ◽  
Ectopic Pregnancies

Abstract STUDY QUESTION Are women who fill a benzodiazepine prescription before conception at increased risk of ectopic pregnancy? SUMMARY ANSWER Risk of ectopic pregnancy is 50% higher among women who fill a benzodiazepine prescription before conception. WHAT IS KNOWN ALREADY Benzodiazepine use in pregnancy increases the risk of miscarriage, adverse birth outcomes and adverse child development outcomes. STUDY DESIGN, SIZE, DURATION Using data from US commercial insurance claims, we performed a cohort study of 1 691 366 pregnancies between 1 November 2008 and 30 September 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified ectopic pregnancies using diagnosis and procedure codes and used unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Two sub-groups of women with specific indications for benzodiazepine use were also examined—women who had a least one diagnosis for anxiety disorder and women who had at least one diagnosis of insomnia in the year before conception. MAIN RESULTS AND THE ROLE OF CHANCE Of the 1 691 366 pregnancies, 1.06% filled at least two benzodiazepine prescriptions totaling at least 10 days supply in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10 000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. LIMITATIONS, REASONS FOR CAUTION We relied on outpatient prescription data to identify benzodiazepine use before conception, which could result in over- or under-estimation of actual benzodiazepine consumption. We relied on medical claim codes to identify pregnancies and conception date, which may result in misclassification of pregnancy outcomes and gestational length. WIDER IMPLICATIONS OF THE FINDINGS This study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women, and their healthcare providers make more fully informed decisions about benzodiazepine use in their reproductive years. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by a Banting Postdoctoral Fellowship and a Stanford Maternal and Child Health Research Institute Postdoctoral Award. Data access for this project was provided by the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The authors have no competing interest. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Benzodiazepine Use Before Conception and Risk of Ectopic Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Elizabeth Wall-Wieler ◽  
Thalia K Robakis ◽  
Deirdre J Lyell ◽  
Reem Masarwa ◽  
Robert W Platt ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Ectopic Pregnancy ◽  
Health Care Providers ◽  
Group Analysis ◽  
Care Providers ◽  
Relative Risks ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Using Data ◽  
Ectopic Pregnancies

IntroductionEctopic pregnancy occurs in 1% to 2% of the all recognized pregnancies, yet half of women who have an ectopic pregnancy do not have any known risk factors. A potential but unstudied risk factor for ectopic pregnancy is benzodiazepine use, which could affect muscle contraction in the fallopian tube. Objectives and ApproachWe compared the risk of ectopic pregnancy among women with and women without benzodiazepine prescriptions before conception. using data from United States commercial insurance claims (IBM® MarketScan® Databases). We performed a cohort study of 1,691,366 pregnancies between November 1, 2008 and September 30, 2015, and used unadjusted and inverse probability of treatment (IPT) weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Sub-group analysis was conducted on women who had anxiety and women who had insomnia diagnoses in the year before conception. ResultsOf the 1,691,366 pregnant women, 1.06% filled at least two benzodiazepine prescriptions in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10,000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. Conclusion / ImplicationsThis study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women and their health care providers make more fully informed decisions about benzodiazepine use in their reproductive years.

scholarly journals Chlamydia infection as a risk factor in ectopic pregnancy: a case control study

2018 ◽  
Vol 7 (10) ◽  
pp. 4254
Author(s):  
Angela George ◽  
Shaila S.
Keyword(s):  
Ectopic Pregnancy ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Case Control Study ◽  
Case Control ◽  
Chlamydia Infection ◽  
Increased Risk ◽  
History Of ◽  
Ectopic Pregnancies ◽  
Control Study

Background: Chlamydia trachomatis has been linked to 30-50% of all ectopic pregnancies, due to irreversible tissue damage.  Hence it is pertinent to explore the risk factors pertaining to Chlamydia infection and ectopic pregnancies. The aim is to study whether Chlamydia infection is a risk factor for ectopic pregnancy in comparison with early intrauterine pregnancy, and study other risk factors in ectopic pregnancyMethods: Case-control study conducted at Sree Avittom Thirunal Hospital, Thiruvananthapuram over a period of six months taking 43 subjects in each group, i.e., cases and controls. An interview followed by collection of venous blood sample was done, which was subjected to Enzyme linked immunoassay test to detect Immunoglobulin G antibodies to Chlamydia. Comparison of qualitative variables such as age, socioeconomic status, history of infertility, history of pelvic inflammatory disease, previous history of ectopic pregnancy, use of IUCD, history of IVF, use of OCP or progesterone only pills and presence of Chlamydia IgG antibodies - between two groups was analyzed by chi-square test and the strength of association expressed in terms of Odds Rati. A p-value <0.05 was considered statistically significant.Results: Out of 86 samples 54 were positive for Chlamydia infection. Subjects with Chlamydia infection had an increased risk of developing ectopic pregnancy. Among the other risk factorshistory of pelvic inflammatory disease and history of infertility were the most significant with Odds of 3.46 and 3.98 respectively. History of oral contraceptive use also had a significant risk associated with developing ectopic pregnancy. Other factors with significant association included, age more than 25 years, Upper Socioeconomic Class, previous ectopic pregnancy and history of IUCD use for more than 5 years.Conclusions: The increased number of Chlamydia infection and its increased risk for developing irreversible sequels such as ectopic pregnancy, it is pertinent to vigilantly diagnose, treat and prevent vaginal infection and pelvic inflammatory disease.

scholarly journals Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Stéphanie Baggio ◽  
Vladan Starcevic ◽  
Patrick Heller ◽  
Karen Brändle ◽  
Irina Franke ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aggressive Behavior ◽  
Propensity Score Matching ◽  
Potential Role ◽  
Behavioral Disinhibition ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Logistic Regressions ◽  
Relationship Of ◽  
The Relationship

Abstract Background Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. Methods Data were extracted from the electronic database of an “open” Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. Results After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. Conclusions Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

Muscular strain as risk factor of somatic symptom of mix anxiety and depression

2017 ◽  
Vol 41 (S1) ◽  
pp. S406-S406
Author(s):  
M. Bhadar ◽  
S. Asghar ◽  
Z. Mukhtar
Keyword(s):  
Poor Prognosis ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
The Body ◽  
Anxiety And Depression ◽  
Body Parts ◽  
Muscular Tension ◽  
Increased Risk ◽  
Severity Of Depression ◽  
Competing Interest

IntroductionSomatic symptoms in depression are not uncommon. There is increased sicidality, poor prognosis, and increased risk of relapse. Neurological and l muscloskeletal symptoms can be explained on basis of increased muscular tension in the body.MethodsAn internet search was made using key words muscular tension, SSRIs depression, anxiety, somatic symptoms.ResultsNinety-eight percent patients reported at least one of somatic symptoms. Forty-five percent reported six somatic symptom. GIT symptoms in 67% patients. Fatigue in 78% % of patients. Weakness in body parts 45% and headache in 43% to 65%. Chest pain more common in male. Patient over 40 showed pain in limbs or joints. Number of symptoms was directly related to severity of depression.DiscussionIncreased muscular tension is one component of mix anxiety and depression. Main nerves and their branches pass in between muscular bellies. When there is increased muscular tone, it puts extra compression on major nerves and their branches. This will cause dysesthesia in body parts. Stretching of muscles produce pain due to hypoxia. This produces headache, strain neck and backache pain in chest. Fatigue is result of over consumption of energy due to hypertonia. One of their side effect is of SSRIs is muscular hypertonia which will not be very helpful for these symptoms. Drugs like tricyclics, SNRI can have better results when used alone, gabapentine, pregabline tinazidine used as adjunct can alleviate symptoms. Non-pharmacological treatment includes massage, relaxation technique, and warm water therapy.ConclusionSomatic symptoms of mix anxiety and depression should be important consideration in its treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals ECTOPIC PREGNANCY SOCIAL MEDIA SUPPORT: AN ANALYSIS OF CONTENT AND ACCURACY OF FACEBOOK GROUPS FOR WOMAN EXPERIENCING ECTOPIC PREGNANCIES

2021 ◽  
Vol 116 (1) ◽  
pp. e38-e39
Author(s):  
Kaleigh A. Russell ◽  
Roselyn Tran ◽  
Mallory Stuparich ◽  
Samar Nahas ◽  
Sadikah Behbehani
Keyword(s):  
Social Media ◽  
Ectopic Pregnancy ◽  
Ectopic Pregnancies

scholarly journals Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

2020 ◽  
pp. bmjsrh-2020-200888
Author(s):  
Clara I Duncan ◽  
John J Reynolds-Wright ◽  
Sharon T Cameron
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Clinical Care ◽  
Significant Risk ◽  
Intrauterine Pregnancy ◽  
Retrospective Case ◽  
Case Record ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Record Review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.MethodsRetrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.ResultsOnly 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.ConclusionsEctopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

Pregabalin use in adults with intellectual disabilities

2017 ◽  
Vol 41 (S1) ◽  
pp. S597-S597 ◽  
Author(s):  
K. Courtenay ◽  
S. Jaydeokar ◽  
B. Perera
Keyword(s):  
Anxiety Disorder ◽  
Intellectual Disabilities ◽  
Dose Range ◽  
Case Series ◽  
Generalised Anxiety Disorder ◽  
Anti Epileptic Drug ◽  
Mental Health Difficulties ◽  
People With Intellectual Disabilities ◽  
Adults With Intellectual Disabilities ◽  
Competing Interest

IntroductionPregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.ObjectivesTo describe the use of pregabalin in adults with intellectual disabilities.MethodA descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).ResultsFourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.ConclusionsPregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Surgical intervention in ectopic pregnancies

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Fouzia Rasool Memon ◽  
Mini Poothavelil ◽  
Samreen Memon
Keyword(s):  
Ectopic Pregnancy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
University Hospital ◽  
Time Interval ◽  
Presenting Symptoms ◽  
Beta Hcg ◽  
Ultrasound Findings ◽  
Ectopic Pregnancies ◽  
Study Setting

Objectives: To find out the negative laparoscopy rate for suspected ectopic pregnancy. Study Design: Retrospective cohort study. Setting: Electronic medical record databases in North Cumbria University Hospital, Carlisle, United Kingdom. Period: August 2014 to August 2018. Material and Methods: The data of total 150 laparoscopies performed for ectopic pregnancy management was collected for gestational age at presentation, symptoms, serial beta human chorionic gonadotrophic hormone (HCG) levels, ultrasound findings, time interval for diagnosis, time to surgery and histology. Results: One hundred and fifty patients (52 under 5 weeks and 98 over 5 weeks’ gestation) were incorporated into this study. The primary presenting symptoms were pain and vaginal bleeding. Suboptimal rise in serial beta HCG (performed 48 hours apart) was seen in 69 patients (46%) while other 81 patients (54%) had confirmed ectopic on USS and were offered surgical management after the scan. One hundred forty for women (96%) went for surgical management and one patient had conservative management as she was asymptomatic with low HCG(less than 1000IU) at the first visit and rapid drop in serial BHG results. Fifty three women (35%) had surgery on the same day when they had ectopic pregnancies seen on USS, 63 (42%) went to theatre for surgery between 0-6 days, while 34 patients (23%) had surgery between 7-14 days of USS. All women were operated through laparoscopic route and tubal ectopic pregnancies were confirmed at laparoscopy. There was no negative laparoscopy in our study period. Conclusion: Judicious and timely surgical intervention made it possible to treat every case through laparoscopic route with zero negative laparoscopy rate.

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