The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽  
2021 ◽  
Author(s):  
Rugina I Neuman ◽  
Hieronymus T W Smeele ◽  
A H Jan Danser ◽  
Radboud J E M Dolhain ◽  
Willy Visser
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Disease Activity ◽  
Pregnant Women ◽  
Gestational Age ◽  
Third Trimester ◽  
Low Disease Activity ◽  
The Third ◽  
Observational Prospective Cohort Study ◽  
Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio > 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

scholarly journals Modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients: the PreCARA study

2021 ◽  
pp. annrheumdis-2020-219547 ◽  
Author(s):  
Hieronymus TW Smeele ◽  
Esther Röder ◽  
Hetty M Wintjes ◽  
Laura JC Kranenburg-van Koppen ◽  
Johanna MW Hazes ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Treatment Approach ◽  
Tnf Inhibitor ◽  
Third Trimester ◽  
Low Disease Activity ◽  
The Third ◽  
Modern Treatment ◽  
Reference Cohort ◽  
Over Time

ObjectivesIn patients with rheumatoid arthritis (RA), high disease activity impairs fertility outcomes and increases the risk of adverse pregnancy outcomes. The aim of this study was to determine the feasibility of a modern treatment approach, including treat-to-target (T2T) and the prescription of tumour necrosis factor (TNF) inhibitors, in patients with RA with a wish to conceive or who are pregnant.MethodsPatients were derived from the Preconception Counseling in Active RA (PreCARA) cohort. Patients with a wish to conceive or who are pregnant were treated according to a modified T2T approach, in which the obvious restrictions of pregnancy were taken into account. Results of the PreCARA study were compared with results of the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a historic reference cohort on RA during pregnancy. Patients in the PARA cohort were treated according to the standards of that time (2002–2010). Differences in disease activity over time between the two cohorts were tested using a linear mixed model.Results309 patients with RA were included in the PreCARA study, 188 children were born. 47.3% of the patients used a TNF inhibitor at any time during pregnancy. Mean disease activity over time in the PreCARA cohort was lower than in the reference cohort (p<0.001). In the PreCARA cohort, 75.4% of the patients were in low disease activity (LDA) or remission before pregnancy increasing to 90.4% in the third trimester, whereas in the PARA cohort, these percentages were 33.2% and 47.3%, respectively.ConclusionsThis first study on a modern treatment approach in pregnant patients with RA shows that LDA and remission are an attainable goal during pregnancy, with 90.4% of patients achieving this in the third trimester.

scholarly journals The course of ankylosing spondylitis during pregnancy: intermediate data of a prospective follow-up

2019 ◽  
Vol 13 (2) ◽  
pp. 61-72 ◽  
Author(s):  
O. A. Krichevskaya ◽  
Z. M. Gandaloeva ◽  
A. B. Demina ◽  
T. V. Dubinina
Keyword(s):  
Back Pain ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Pregnant Women ◽  
Functional Status ◽  
Gestational Age ◽  
First Trimester ◽  
Second Trimester ◽  
Third Trimester ◽  
The Third

The onset of ankylosing spondylitis (AS) more frequently occurs at the end of the third decade of life, which corresponds to the time of marriage and the birth of the first child and determines the relevance of a study of the interaction of AS and pregnancy.Objective: to describe the clinical presentations of AS and its therapy during pregnancy and to study AS activity dynamics and the patients' functional status during gestation.Patients and methods. The investigation enrolled 19 pregnant women who met the 1984 modified New York AS criteria. The mean age of the women was 32.2±1.1 years; their mean age at the onset of AS was 22.6±3.1 years; the duration of the disease was 147±20.7 months. The patients visited their physician at 10–11, 20–21, and 31–32 weeks of pregnancy. The investigators determined AS activity by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) and functional status by the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess enthesitis.Results and discussion. At the time of conception, 78.9% of the patients had inflammatory back pain with an intensity of 2.2±0.4 on a numerical rating scale; during pregnancy, 95% of the pregnant women experienced pain, its intensity increased by the second trimester (4.6±0.7) and remained at this level in the third trimester (p<0.05 between the month of conception and the second and third trimesters). By the third trimester, the nature of the pain changed: 55.5 and 61.1% of the patients reported reduced pain at rest and after exercise, respectively. The frequency and severity of enthesitis increased with gestational age: the MASES scores were higher in the third trimester (2.3±0.5) than that in the first-trimester (0.4±0.22; p<0.05). The frequency of extra-axial and extra-skeletal manifestations did not increase during gestation. Coxitis was detected in 27.8% of the pregnant women.The BASDAI increased from the time of conception (1.7±0.3) to the second trimester (3.3±0.5; p<0.05) and remained at this level in the third trimester. Multiple regression analysis revealed that the predictors of BASDAI levels in the third trimester were BASDAI scores (R2 =0.7) and back pain (R2 =0.9) at the time of conception, the use of biological agents 3 months before gestation (R2 =0.7) with their cumulative impact. Throughout pregnancy, the BASDAI was determined by a set of factors: the severity of pain in the back (β=0.6) and entheses (β=0.3) and weakness (β=0.6). By the end of the first trimester, the increased BASDAI scores were provided mainly by the higher level of general weakness (by 68.5%) and back pain (by 24.1%). In the second trimester, the higher BASDAI was due to the increased severity of enthesitis (by 30.7%) and back pain (by 27%).There were no changes in ASDAS-C-reactive protein (ASDAS-CRP), but there was its upward tendency in the second trimester as compared with the beginning of pregnancy. The BASMI did not change significantly (1.3±0.9; 1.8±0.2; 2.1±0.3, respectively, for trimesters). The BASFI increased by the third trimester (3.9±0.7) versus the first trimester (1.4±0.3; p<0.05).In the third trimester, this rise was due to difficulties in performing the actions related to both AS activity and pregnancy (forward bends; questions 1, 2, and 4).According to the trimesters, 31.6, 73.7, and 66.7% of the pregnant women took nonsteroidal anti-inflammatory drugs. The need for glucocorticoids was noted in 22% of patients in the second trimester and in 53% in the third trimester.Conclusion. The clinical activity of AS is increased by the second trimester of pregnancy and remains moderate and high until the end of gestation. The activity of AS at the time of conception can determine the activity of the disease throughout pregnancy. In the third trimester, mechanical back pain becomes concurrent in half of the patients. Functional impairments increase with gestational age, and this is due to both the activity of AS and pregnancy itself in the third trimester. 

scholarly journals Correlation study between increased fetal movement during the third trimester and neonatal outcome

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Cuiqin Huang ◽  
Wei Han ◽  
Yajing Fan
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Gestational Age ◽  
Neonatal Outcome ◽  
Stress Test ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Third Trimester ◽  
The Third ◽  
Fetal Movements

Abstract Background We aimed to analyze the correlation between increased fetal movements in the third trimester and neonatal outcomes. Methods We enrolled pregnant women (n = 219) who reported increased/excessive fetal movements in the third trimester in our hospital. A control group of healthy women (n = 278) who had undergone regular childbirth and delivery in our hospital during the same period and did not report abnormal fetal movements were also recruited. All pregnant women underwent fetal non-stress test. We analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the neck and cord length, and incidence of small for gestational age. In addition, the incidence of preterm delivery, cesarean section rate, postpartum hemorrhage, and other postpartum complications were also analyzed. We then analyzed the correlation between increased/excessive fetal activity and neonatal outcomes. Results Women with complaints of increased/excessive fetal movements exhibited increased fetal movements mainly around 31 and 39 weeks of gestation. Several pregnancy variables, including number of previous delivery, gestational age (less than 34 weeks and more than 37 weeks) and vaginal birth rate, were associated with increased/excessive fetal movements. In addition, women who reported increased/excessive fetal movements had higher odds of large for gestational age (LGA), particularly those with gestational age over 37 weeks. Conclusion Increased/excessive fetal movements may be used to predict adverse neonatal outcome such as LGA.

CORTISOL AND CORTISONE IN SALIVA OF PREGNANCY

1963 ◽  
Vol 26 (2) ◽  
pp. 189-195 ◽  
Author(s):  
M. S. GREAVES ◽  
H. F. WEST
Keyword(s):  
Rheumatoid Arthritis ◽  
Salivary Gland ◽  
Pregnant Women ◽  
Connective Tissues ◽  
Third Trimester ◽  
The Third ◽  
Reasonable Explanation ◽  
The Mean ◽  
Mixed Saliva ◽  
Mean Concentration

SUMMARY The concentration of cortisol and cortisone in mixed saliva has been measured in normal non-pregnant women, normal pregnant women in the third trimester of pregnancy and pregnant ones with mild toxaemia in the third trimester. The ratio of cortisol to cortisone was 1:4 for the non-pregnant and 1:5 for the pregnant women. The mean concentration of cortisol for the pregnant subjects was twice that of the non-pregnant and the mean concentration of cortisone three times that of the non-pregnant women. Filtration studies showed no significant binding of cortisol or cortisone in the saliva. It is concluded that the raised concentration of cortisol and cortisone in saliva indicates a raised concentration in the cells of the salivary gland. If this rise is common to the connective tissues generally it provides a reasonable explanation for the remission of rheumatoid arthritis experienced by some patients in the latter months of pregnancy.

Evaluation of sFlt-1 and PlGF for predicting preeclampsia in pregnant women with diabetes mellitus

2021 ◽  
Vol 70 (4) ◽  
pp. 43-56
Author(s):  
Roman V. Kapustin ◽  
Elizaveta M. Tcybuk ◽  
Sergey V. Chepanov ◽  
Elena N. Alekseenkova ◽  
Ekaterina V. Kopteeva ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
First Trimester ◽  
Diet Therapy ◽  
Third Trimester ◽  
The Third ◽  
Plgf Ratio

AIM: The aim of this study was to evaluate soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels in the blood of women with various types of diabetes mellitus, depending on the correction method applied, and to determine the prognostic significance of the sFlt-1 / PlGF ratio for predicting the development of preeclampsia in this patient population. MATERIALS AND METHODS: We examined 140 pregnant women who were included in six main study groups: type 1 diabetes mellitus (with or without pregravid preparation), type 2 diabetes mellitus (diet therapy or insulin therapy), and gestational diabetes mellitus (diet therapy or insulin therapy). The comparison groups consisted of pregnant women with preeclampsia and patients without complications of pregnancy. Using electrochemiluminescence analysis, PlGF and sFlt-1 levels in the blood serum were determined twice, at 11+013+6 and 30+033+6 weeks of gestation. Statistical data processing was performed using the IBM SPSS Statistics version 23 and GraphPad Prism version 8.0 software packages. RESULTS: In the blood serum of pregnant women with diabetes mellitus in the first and third trimesters of pregnancy, we found an increase in sFlt-1 level and a decrease in PlGF level, as well as an increase in the sFlt-1 / PlGF ratio. These changes were most pronounced in individuals with type 1 diabetes mellitus without pregravid preparation and with type 2 diabetes mellitus on insulin therapy. In patients with pregestational types of diabetes mellitus, the sFlt-1 / PlGF ratio was a predictor of preeclampsia already in the early stages of pregnancy. Analysis of the ROC curve showed that the threshold sFlt-1 / PlGF ratio for predicting preeclampsia in pregnant women with diabetes mellitus in the first trimester was 32.5 (sensitivity 92.9%, specificity 50.0%) and in the third trimester 71.8 (sensitivity 85.7%, specificity 82.3%) with AUC 0.78 (95% CI 0.680.88) and 0.89 (95% CI 0.830.95), respectively. In the first trimester, the positive and negative predictive values of the sFlt-1 / PlGF ratio as a predictor of preeclampsia in pregnant women with diabetes mellitus were 63.3% and 97.6%, respectively; in the third trimester, 38.9% and 93.6%, respectively. CONCLUSIONS: Blood level alterations of PlGF and sFlt-1 are characteristic of patients with diabetes mellitus in the first and third trimesters of pregnancy. An increase in the sFlt-1 / PlGF ratio is associated with a higher incidence of unfavorable perinatal outcomes in women with impaired carbohydrate metabolism. Determination of the sFlt-1 / PlGF ratio is a valid method for predicting the development or absence of preeclampsia in women with diabetes mellitus.

scholarly journals Effectiveness of Prenatal Tdap Immunization in the Prevention of Infant Pertussis in the United States

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S68-S68
Author(s):  
Sylvia Becker-Dreps ◽  
Anne M Butler ◽  
Leah J McGrath ◽  
Kim A Boggess ◽  
David J Weber ◽  
...  
Keyword(s):  
United States ◽  
Pregnant Women ◽  
Gestational Age ◽  
Clinical Effectiveness ◽  
The United States ◽  
Optimal Timing ◽  
Third Trimester ◽  
The Third ◽  
Control And Prevention ◽  
Insurance Claims Data

Abstract Background The Centers for Disease Control and Prevention recommends that all pregnant women in the United States receive tetanus-diphtheria-acellular pertussis (Tdap) immunization to prevent infant pertussis. While the vaccine may be administered at any time during pregnancy, the recommendations define administration at 27 to 36 weeks of gestation as optimal timing to prevent infant pertussis. These recommendations were primarily based on immunogenicity studies. The objective of this study was to examine the clinical effectiveness of prenatal Tdap, and to understand whether effectiveness varies by gestational age at immunization. Methods We performed a nationwide cohort study of pregnant women with deliveries in 2010–2014 and their infants. Commercial insurance claims data were used to identify receipt of Tdap immunization in the pregnant women, and hospitalizations and outpatient visits for pertussis in their infants until 18 months of age. To address the difficulties in diagnosing pertussis, we also employed a “probable pertussis” definition, as an inpatient or outpatient diagnosis of pertussis, plus antibiotic treatment with a macrolide or trimethoprim/sulfamethoxazole within 7 days of diagnosis. Pertussis occurrence was compared between infants of mothers who received prenatal Tdap (overall, and stratified by gestational age at administration) and infants of unvaccinated mothers. Results There were 675,167 mother–infant pairs included in the cohort. Among infants whose mothers received Tdap at any time during pregnancy, the rate of pertussis hospitalization was 50% lower (adjusted hazards ratio (HR) = 0.50, 95% CI: 0.23, 1.09), and the rate of probable pertussis was 42% lower (HR = 0.58, 95% CI: 0.38, 0.89) than infants of unimmunized mothers. Pertussis rates were also lower for infants whose mothers received prenatal Tdap during the third trimester. Infants whose mothers received Tdap before the third trimester also tended to have lower rates of pertussis, but these estimates were imprecise. Conclusion Infants of mothers who received prenatal Tdap experienced half the rate of pertussis as compared with infants of unimmunized mothers. Our results do not provide evidence to support changing the currently recommended timing of Tdap administration in pregnancy. Disclosures S. Becker-Dreps, Pfizer: Consultant and Grant Investigator, Consulting fee and Research grant; A. M. Butler, Astra Zeneca: Consultant, Support to institution; Amgen: Grant Investigator, Investigator initiated grant to institution; &#x2028;D. J. Weber, Merck: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium; Pfizer: Consultant, Consulting fee; J. B. Layton, Merck: Member of Center for Pharmacoepidemiology, Support to institution; GlaxoSmithKline: Member of Center for Pharmacoepidemiology, Support to institution; UCB Biosciences: Member of Center for Pharmacoepidemiology, Support to institution

scholarly journals Preterm and term rupture of the amniotic sac in the third trimester: outcomes for mother and child

2021 ◽  
Vol 12 (4) ◽  
pp. 12-19
Author(s):  
E. V. Enkova ◽  
A. S. Fomina ◽  
V. V. Enkova ◽  
O. V. Khoperskaya
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Neonatal Intensive Care ◽  
Latency Period ◽  
Breech Presentation ◽  
Maternity Hospital ◽  
Third Trimester ◽  
The Third ◽  
Prelabor Rupture Of Membranes

Objective: To evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with preterm prelabor rupture of membranes (PPROM) and preterm rupture of membranes (PROM) in the third trimester of pregnancy.Materials and Methods: The study included pregnant women in the third trimester, at the gestation period of 28-41.6 weeks of pregnancy, divided into groups of PROM and PPROM: 173 (80.8%) and 41 (19.2%) pregnant women, respectively.Results: It was found that PPROM is associated with a significantly lower gestational age, higher levels of C-reactive protein, and higher body temperature upon admission to the maternity hospital (P <0.05). Breech presentation and history of cesarean section were significantly associated with PPROM (P < 0.05), rather than PROM. The PPROM group had a significantly longer latency period compared to the PROM group, in which the latency period increased with a lower gestational age (28–31.6 weeks). A significantly higher rate of admission to the neonatal intensive care unit (NICU) was observed in the PPROM group compared to the PROM group. Also, at the gestational age of 28-31.6 weeks, a significantly higher rate of admission to the NICU was revealed compared to the gestational age of 32-36. 6 weeks (P < 0.05).Conclusions: The purpose of this retrospective study was to evaluate the characteristics of women in labor and pregnancy outcomes at different gestational periods with PPROM and PROM in the third trimester of pregnancy.

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