Endocrine and autoimmune disorders

2016 ◽  
Author(s):  
Mirjana Kendrisic ◽  
Borislava Pujic
Keyword(s):  
Gestational Diabetes ◽  
Autoimmune Diseases ◽  
Pregnancy Outcome ◽  
Intensive Therapy ◽  
Anaesthetic Management ◽  
Autoimmune Disorders ◽  
Endocrine Disorders ◽  
Childbearing Age ◽  
Long Term Outcome ◽  
In Pregnancy

Advanced maternal age and increasing numbers of women of childbearing age with endocrine and autoimmune disorders have become the challenge for both anaesthetists and obstetricians. Genetic studies have provided new insight into underlying causes of endocrine disorders and prenatal prediction of inheritance. The expression of endocrine disease may influence the interpretation of diagnostic laboratory testing during pregnancy. Better understanding of the pathophysiological mechanisms enables new therapeutic approaches which can compromise pregnancy outcome. Although only a small number of drugs have been shown through clinical studies to be safe for use in pregnancy, intensive therapy for chronic disease is usually needed. Thus, anaesthetic management of women with endocrine disorders in pregnancy has become more complex. The most frequently encountered endocrine disorders during pregnancy include gestational diabetes mellitus and thyroid and adrenal disorders. Gestational diabetes has become increasingly common in pregnant women. Not only does it influence pregnancy outcome, but it also carries a risk for mother and offspring of developing type 2 diabetes later in life. Intensive glucose control may prevent maternal and fetal complications and improve long-term outcome. Pregnancy itself has been found to influence the course of autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. However, autoimmune diseases may have adverse consequences for maternal, fetal, and neonatal health. There is a relative paucity of literature concerning anaesthetic management of autoimmune diseases. Early recognition and immediate treatment of the common complications have been the key elements to achieving the ultimate goal—good pregnancy outcome.

Diabetes in pregnancy: a practical guide for midwives

2019 ◽  
Vol 27 (7) ◽  
pp. 413-419
Author(s):  
Aarthi Surendran ◽  
Danielle Dixon ◽  
Martin Whyte
Keyword(s):  
Gestational Diabetes ◽  
Diabetes Management ◽  
Antenatal Clinic ◽  
Women Of Childbearing Age ◽  
Diabetes In Pregnancy ◽  
Childbearing Age ◽  
Pregnancy And Childbirth ◽  
Rising Incidence ◽  
Concise Guide ◽  
In Pregnancy

Diabetes is a growing concern. With the rising incidence of obesity in the younger people, the incidence of diabetes has also increased. This has resulted in more women of childbearing age attending antenatal clinic with a diagnosis of either pre-existing or gestational diabetes. Management of these women is vital to avoid complications in both the mother and the child during pregnancy and childbirth. This article aims to provide a concise guide to the management of diabetes in pregnancy for midwives, who are often the first point of contact for these women.

Obese vs non-obese in gestational diabetes: is there a difference in pregnancy outcome?

2003 ◽  
Vol 189 (6) ◽  
pp. S105
Author(s):  
Oded Langer ◽  
Yariv Yogev ◽  
Lois Brustman ◽  
Barak Rosenn
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcome ◽  
In Pregnancy

Autoimmune rheumatic disorders and vasculitis in pregnancy

2020 ◽  
pp. 2655-2670
Author(s):  
May Ching Soh ◽  
Catherine Nelson-Piercy
Keyword(s):  
Cardiovascular Disease ◽  
Autoimmune Diseases ◽  
Rheumatic Diseases ◽  
Disease Process ◽  
Childbearing Age ◽  
Autoimmune Rheumatic Diseases ◽  
Pregnancy And Lactation ◽  
Disease Modifying ◽  
New Generation ◽  
In Pregnancy

Autoimmune diseases affect 5–7% of people, are more common in women of childbearing age, and are frequently encountered in pregnancy. They may remit or improve during pregnancy, but can flare or present in pregnancy. Many women with autoimmune rheumatic diseases have been advised against pregnancy in the past, but this is no longer appropriate with a new generation of pregnancy-friendly disease-modifying antirheumatic drugs and biological agents that afford excellent disease control without compromising fertility. Nevertheless, many women with autoimmune rheumatic diseases are older and have more comorbidities (i.e. hypertension, obesity, diabetes, cardiovascular disease, and so on) when they do attempt pregnancy. This chapter looks at the importance of planned pregnancies with good preconception advice from clinicians knowledgeable in both the disease process and its effects on pregnancy (and lactation), and vice versa.

scholarly journals Diet and deprivation in pregnancy

2009 ◽  
Vol 102 (10) ◽  
pp. 1487-1497 ◽  
Author(s):  
Paul Haggarty ◽  
Doris M. Campbell ◽  
Susan Duthie ◽  
Katherine Andrews ◽  
Gwen Hoad ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnancy Outcome ◽  
Nutrient Intake ◽  
Pantothenic Acid ◽  
Processed Meat ◽  
Childbearing Age ◽  
Neonatal Treatment ◽  
Supplement Use ◽  
B Vitamin ◽  
In Pregnancy

Deprivation is associated with poor pregnancy outcome but the role of nutrition as a mediating factor is not well understood. We carried out a prospective cohort study of 1461 singleton pregnancies in Aberdeen, UK during 2000–6. We measured nutrient intake and supplement use, B vitamin and homocysteine status, birth weight, gestational age, neonatal treatment and socio-economic deprivation status. Women in the most deprived deciles were approximately 6 years younger and half as likely to take folic acid supplements periconceptually as the least deprived mothers. Deprivation was associated with low blood folate, high homocysteine and diets low in protein, fibre and many of the vitamins and minerals. The diets of the more deprived women were also characterised by low intakes of fruit, vegetables and oily fish and higher intakes of processed meat, fried potatoes, crisps and snacks. Deprivation was related to preterm birth (OR 1·14 (95 % CI 1·03, 1·25); P = 0·009) and whether the baby required neonatal treatment (OR 1·07 (95 % CI 1·01, 1·14); P = 0·028). Low birth weight was more common in women consuming diets low in vitamin C (OR 0·79 (95 % CI 0·64, 0·97); P = 0·028), riboflavin (OR 0·77 (95 % CI 0·63, 0·93); P = 0·008), pantothenic acid (OR 0·79 (95 % CI 0·65, 0·97); P = 0·023) and sugars (OR 0·78 (95 % CI 0·64, 0·96); P = 0·017) even after adjustment for deprivation index, smoking, marital status and parity. Deprivation in pregnancy is associated with diets poor in specific nutrients and poor diet appears to contribute to inequalities in pregnancy outcome. Improving the nutrient intake of disadvantaged women of childbearing age may potentially improve pregnancy outcome.

scholarly journals First Postembryo Transfer Beta-hCG Level and Pregnancy Outcome in an Assisted Reproductive Technology Program

2012 ◽  
Vol 3 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Radha Pandiyan ◽  
Krithika Devi Jayachandran ◽  
Pandiyan Natarajan
Keyword(s):  
Gestational Diabetes ◽  
Assisted Reproductive Technology ◽  
Pregnancy Outcome ◽  
Embryo Transfer ◽  
Well Being ◽  
Reproductive Technology ◽  
Technology Program ◽  
Art Program ◽  
Beta Hcg ◽  
In Pregnancy

ABSTRACT Aim To evaluate the prognostic value of first postembryo transfer beta human chorionic gonadotropin (hCG) levels in pregnancy outcome in an assisted reproductive technology (ART) program. Subjects Seventy-one women with an initial beta-hCG value of greater than 5 mIU/ml postembryo transfer in the ART program were taken in to the study. The beta-hCG test was done 14 days after embryo transfer. The period of study was from January 2008 to August 2010. Observations A significant correlation was found in beta-hCG values between viable and nonviable pregnancies. In women who had a day 2 embryo transfer the mean beta-hCG value was 608 ± 580 mIU/ml, in comparison to women who had a day 5 transfer 1,527 ± 2,024 mIU/ml, and this was statistically significant. Women who had a single embryo transfer had a mean betahCG level of 168 mIU/ml, two embryos 464 mIU/ml and three embryos 612 mIU /ml. Mean beta-hCG value was highest in women who developed gestational diabetes [2,074 mIU/ml] women with pregnancyinduced hypertension (PIH) had a mean beta-hCG value of 674 mIU/ml, and with antepartum hemorrhage the value was lower 220 mIU/ml. Conclusion To summarize, beta-hCG level is an useful marker for prognosticating early pregnancy well being, for predicting multiple pregnancies. When interpreting the first beta-hCG level uniformly after 2 weeks of embryo transfer, day of transfer of embryos should be taken into account. The number of embryos transferred does not alter the beta-hCG level significantly. BetahCG level implications in pregnancy complications, like gestational diabetes (GDM), PIH, APH, require further research and would be a useful tool for early screening and surveillance of pregnancy. How to cite this article Jayachandran KD, Natarajan P, Pandiyan R. First Postembryo Transfer Beta-hCG Level and Pregnancy Outcome in an Assisted Reproductive Technology Program. Int J Infertility Fetal Med 2012;3(2): 57-62.

scholarly journals Placental secretome characterization identifies candidates for pregnancy complications

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Tina Napso ◽  
Xiaohui Zhao ◽  
Marta Ibañez Lligoña ◽  
Ionel Sandovici ◽  
Richard G. Kay ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcome ◽  
Relative Abundance ◽  
Human Placenta ◽  
Pregnancy Complications ◽  
Endocrine Cells ◽  
Physiological Adaptation ◽  
Proof Of Concept ◽  
Growth Modulation ◽  
In Pregnancy

AbstractAlterations in maternal physiological adaptation during pregnancy lead to complications, including abnormal birthweight and gestational diabetes. Maternal adaptations are driven by placental hormones, although the full identity of these is lacking. This study unbiasedly characterized the secretory output of mouse placental endocrine cells and examined whether these data could identify placental hormones important for determining pregnancy outcome in humans. Secretome and cell peptidome analyses were performed on cultured primary trophoblast and fluorescence-activated sorted endocrine trophoblasts from mice and a placental secretome map was generated. Proteins secreted from the placenta were detectable in the circulation of mice and showed a higher relative abundance in pregnancy. Bioinformatic analyses showed that placental secretome proteins are involved in metabolic, immune and growth modulation, are largely expressed by human placenta and several are dysregulated in pregnancy complications. Moreover, proof-of-concept studies found that secreted placental proteins (sFLT1/MIF and ANGPT2/MIF ratios) were increased in women prior to diagnosis of gestational diabetes. Thus, placental secretome analysis could lead to the identification of new placental biomarkers of pregnancy complications.

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