Pregnancy outcomes in DMARD-exposed patients with juvenile idiopathic arthritis—results from a JIA biologic registry

Rheumatology ◽  
2019 ◽  
Author(s):  
Paula Drechsel ◽  
Katrin Stüdemann ◽  
Martina Niewerth ◽  
Gerd Horneff ◽  
Rebecca Fischer-Betz ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Observation Study ◽  
Patient Interviews ◽  
Increased Risk ◽  
Patient Reported ◽  
Male Patients ◽  
Adverse Pregnancy ◽  
Reported Data ◽  
Long Term Observation ◽  
In Pregnancy

Abstract Objectives To investigate the courses and outcomes of pregnancies involving JIA patients who were exposed to DMARDs. Methods In the Juvenile arthritis MTX/Biologics long-term Observation study, pregnant patients or male patients with pregnant partners were identified. Standardized patient interviews were conducted, and the course and outcome of pregnancy were assessed. Prospectively collected physician- and patient-reported data were also considered in the analysis. Results The study sample included 152 pregnancies in 98 women with JIA and 39 pregnancies involving 21 male patients as partners. The majority of patients had polyarticular-onset/-course JIA (61%). The average age of patients at first pregnancy was 24.1 (4.5) years, and their mean disease duration was 13.8 (5.9) years. Patients had been exposed to DMARDs for 9.5 (5.6) years, and 90% of these patients had received biologics before. Half of the pregnancies occurred during DMARD exposure, mostly with etanercept. Significant differences in pregnancy outcomes between DMARD-exposed and -unexposed pregnancies were not observed. Spontaneous abortion (13.1%) and congenital anomaly (3.6%) rates were not suggestive of increased risk compared with expected background rates. However, the rates of premature birth (12.3%) and caesarean section (37.7%) were slightly above those in the German birthing population. The disease activity of female patients remained relatively stable in pregnancy, with mean cJADAS-10 scores of 5.3, 7.1 and 5.6 in each trimester, respectively. Conclusion Young adults with JIA often become pregnant or become fathers of children while still being treated with DMARDs. Data suggest no increased risk of major adverse pregnancy outcomes.

scholarly journals Coeliac disease and pregnancy outcomes

2011 ◽  
Vol 4 (3) ◽  
pp. 95-98 ◽  
Author(s):  
M M Butler ◽  
L C Kenny ◽  
F P McCarthy
Keyword(s):  
Coeliac Disease ◽  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Reproductive Medicine ◽  
Risk Groups ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Gluten Sensitive Enteropathy ◽  
Adverse Pregnancy ◽  
In Pregnancy

Coeliac disease is a gluten-sensitive enteropathy affecting up to 1% of the population. An accumulating body of evidence supports the association of coeliac disease with adverse pregnancy outcomes, including increased risk of miscarriage and intrauterine growth restriction. Reports differ regarding the extent and severity of these associations, in addition to the exact pathophysiology underlying these associations. Overall, coeliac disease is believed to be a significant condition in pregnancy and reproductive medicine with some advocating the screening of coeliac disease in all pregnant women or some specific high-risk groups.

The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

2021 ◽  
Author(s):  
Shamil D. Cooray ◽  
Jacqueline A. Boyle ◽  
Georgia Soldatos ◽  
Shakila Thangaratinam ◽  
Helena J. Teede
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Adverse Pregnancy Outcomes ◽  
Therapeutic Interventions ◽  
Clinical Prediction Model ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Individual ◽  
Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Tanapak Wisetmongkolchai ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Loss Rate ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Expert Group ◽  
Second Trimester ◽  
Single Institution ◽  
Adverse Pregnancy ◽  
In Pregnancy ◽  
Singleton Pregnancies

AbstractObjectivesTo compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.MethodsA retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.ResultsIn total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.ConclusionsThe amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

Pregnancy outcomes of women with and without a history of anorexia nervosa

2012 ◽  
Vol 42 (12) ◽  
pp. 2651-2660 ◽  
Author(s):  
J. M. Eagles ◽  
A. J. Lee ◽  
E. Amalraj Raja ◽  
H. R. Millar ◽  
S. Bhattacharya
Keyword(s):  
Anorexia Nervosa ◽  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Maternal Body Mass Index ◽  
Intrauterine Growth ◽  
North East ◽  
Increased Risk ◽  
History Of ◽  
Obstetric Services ◽  
Adverse Pregnancy

BackgroundWhen women have a history of anorexia nervosa (AN), the advice given about becoming pregnant, and about the management of pregnancies, has usually been cautious. This study compared the pregnancy outcomes of women with and without a history of AN.MethodWomen with a confirmed diagnosis of AN who had presented to psychiatric services in North East Scotland from 1965 to 2007 were identified. Those women with a pregnancy recorded in the Aberdeen Maternal and Neonatal Databank (AMND) were each matched by age, parity and year of delivery of their first baby with five women with no history of AN. Maternal and foetal outcomes were compared between these two groups of women. Comparisons were also made between the mothers with a history of AN and all other women in the AMND.ResultsA total of 134 women with a history of AN delivered 230 babies and the 670 matched women delivered 1144 babies. Mothers with AN delivered lighter babies but this difference did not persist after adjusting for maternal body mass index (BMI) in early pregnancy. Standardized birthweight (SBW) scores suggested that the AN mothers were more likely to produce babies with intrauterine growth restriction (IUGR) [relative risk (RR) 1.54, 95% confidence interval (CI) 1.11–2.13]. AN mothers were more likely to experience antepartum haemorrhage (RR 1.70, 95% CI 1.09–2.65).ConclusionsMothers with a history of AN are at increased risk of adverse pregnancy outcomes. The magnitude of these risks is relatively small and should be appraised holistically by psychiatric and obstetric services.

Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

2022 ◽  
pp. jech-2021-217754
Author(s):  
Lixin Li ◽  
Yanpeng Wu ◽  
Yao Yang ◽  
Ying Wu ◽  
Yan Zhuang ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Maternal Education ◽  
Rural China ◽  
Education Level ◽  
Adverse Pregnancy Outcomes ◽  
Secondary Outcome ◽  
Health Examination ◽  
Educational Inequalities ◽  
Increased Risk ◽  
Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

scholarly journals Dengue in Pregnancy

2019 ◽  
Vol 34 (1) ◽  
pp. 36-42
Author(s):  
Sameena Chowdhury ◽  
Sharmin Abbasi
Keyword(s):  
Adverse Effects ◽  
Dengue Fever ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Severe Dengue ◽  
Management Guideline ◽  
Serious Infection ◽  
Adverse Pregnancy ◽  
Day By Day ◽  
In Pregnancy

Dengue fever during pregnancy is increasing day by day in Bangladesh. The knowledge of adverse effects on mother and neonate remains limited and there are also lack of management guideline in this regard. Mortality rate for severe dengue fever is 0.8–2.5%, and pregnancy should be considered as a coexisting risk factor for serious infection. However, the maternal and fetal outcomes not fully understood. Some review articles on outcomes of neonates born to mother with dengue fever was reported, and demonstrated that preterm birth and low birth weight were the most common adverse pregnancy outcomes; however, dengue fever was not significantly associated with these adverse outcomes, suggesting that symptomatic dengue fever may indicate risk. Other adverse effects such as stillbirth or postpartum hemorrhage (PPH) remain unclear. Therefore, we aimed to brief review of recent management guideline of OGSB about dengue fever in pregnancy. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 36-42

scholarly journals Maternal Prepregnancy Weight and Pregnancy Outcomes in Saudi Women: Subgroup Analysis from Riyadh Mother and Baby Cohort Study (RAHMA)

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Hayfaa Wahabi ◽  
Samia Esmaeil ◽  
Amel Fayed
Keyword(s):  
Cohort Study ◽  
Subgroup Analysis ◽  
Pregnancy Outcomes ◽  
Reference Group ◽  
Overweight And Obesity ◽  
Obese Women ◽  
Saudi Women ◽  
Prepregnancy Weight ◽  
Increased Risk ◽  
Adverse Pregnancy

The objectives of this study were to estimate the prevalence of prepregnancy overweight/obesity and underweight among Saudi mothers and to determine the adverse pregnancy outcomes associated with them. Methods. This is a subgroup analysis from a Riyadh mother and baby cohort study. Participants were divided into four groups according to prepregnancy BMI. Participants with normal BMI were the reference group. Groups were compared in relation to pregnancy-related obstetric, as well as fetal and neonatal complications. A regression model was used to control for covariates, and adjusted odds ratios (AOR) with 95% Confidence Intervals (95% CI) were calculated. Results. A total of 7,029 women were included, 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Obesity was associated with increased odds of gestational diabetes (AOR 2.07, 95% CI 1.73-2.47), hypertensive events in pregnancy (AOR 2.33, 95% CI 1.19-3.91), induction of labour (IOL) (AOR 1.40, 95% CI, 1.19-1.65), failed IOL (AOR 2.13, 95% CI 1.40-3.25), and delivery by emergency caesarean section (CS) (AOR 1.67, 95% CI 1.39-2.01). Infants of obese women had increased odds of macrosomia (AOR 3.73, 95% CI 2.33-5.98). Overweight women had increased odds of CS delivery (AOR 1.25, 95% CI 1.03-1.5) and failed IOL (AOR 1.69, 95% CI 1.09-2.60). Underweight women had increased odds of delivering a low birth weight (LBW) infant (AOR 2.49, 95% CI, 1.58-3.92). Conclusion. The prevalence of prepregnancy overweight and obesity is very high in Saudi Arabia. Prepregnancy obesity is associated with GDM and hypertensive events inpregnancy, IOL, failed IOL, and CS delivery. Infants of obese mothers were at higher risk of macrosomia, while underweight women were at increased risk of delivering LBW infants.

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

scholarly journals Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

2020 ◽  
Vol 9 (4) ◽  
pp. 1487
Author(s):  
Shaina Chamotra ◽  
Kushla Pathania ◽  
S. K. Verma ◽  
Ankit Chaudhary
Keyword(s):  
Pregnancy Outcomes ◽  
Homocysteine Level ◽  
Perinatal Outcomes ◽  
Normal Subjects ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Causal Pathway ◽  
Mother And Child ◽  
Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

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