scholarly journals FRI0061 THE ADVERSE OBSTETRIC OUTCOMES WHEN RHEUMATOID ARTHRITIS IS CONTROLLED DURING PREGNANCY: IS THE DISEASE ITSELF A PROBLEM? DATA FROM A CASE-CONTROL COHORT OF 190 PREGNANCIES AT A MULTI-NATIONALITY SPECIALIZED CENTER IN QATAR

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 607.2-607
Author(s):  
E. Elsayed ◽  
S. Abuyaqoub ◽  
N. Almallahi ◽  
F. Alam ◽  
R. Saleh ◽  
...  

Background:Rheumatoid arthritis is implicated in causing adverse pregnancy outcomes including high rates of prematurity and low birth weight. But little is known about the impact of the disease when it’s controlled as most of the information is extracted from retrospective data.Objectives:To examine the adverse obstetric outcomes after controlling disease during pregnancy. We also took into account many confounders that might affect the outcome.Methods:This is an ongoing Case-Control Prospective Cohort. It is implemented in a tertiary center where cases are recruited from a single specialized pregnancy and rheumatic disease clinic to ensure standardized management. These cases were fulfilling the ACR 2010 classification criteria for rheumatoid arthritis. Disease activity was measured using CDAI once before pregnancy and once in each trimester. We excluded subjects with chronic morbidities or twin pregnancy. Data were collected in pre-specified data sheets. Routine blood tests in addition to C-reactive protein were obtained. Cases were recruited at different disease activity stages, but treatment was escalated to reach remission as possible by the third trimester. Data were analyzed using SPSS software for descriptive and comparative analyses.Results:Since 2017 we have recruited 215 subjects. A total of 190 completed pregnancies were analyzed in this report (114 controls and 76 cases). Five subjects were excluded as their disease was not controlled by 27 weeks of gestation. Baseline characteristics of age, baseline BMI and anemia were similar. Exposure to passive smoking was significantly higher in the control group. There was no statistical difference in the incidence of gestational diabetes, pre-eclampsia and infections. Rates of abortions and cesarean sections were significantly higher in the cases group. The incidence of PROM & low birth weight was not statistically different. Three cases of IUFD were reported among controls versus none in the cases (Table 1). Prematurity rate was numerically higher in the control group but did not reach a statistical difference. Congenital anomalies and NICU admission rates were comparable between the groups. But the incidence of neonatal morbidities was significantly higher in the control group (p. value 0.006), but the majority of morbidities were due to jaundice that resolved with phototherapy. we have evaluated the incidence of group B streptococcal Agalactae as a possible contributor to morbidities but it was similar between the groups. All cases were on DMARDs during pregnancy. Hydroxychloroquine was the most commonly used (55%) followed by sulfasalazine (40%). Steroid was used for variable duration in pregnancy in 23 cases. In most of them, it was tapered and stopped by the end of pregnancy. Biologics were used in 15 cases with few adverse outcomes including: abortion (1 case), PROM (1), maternal UTI (1), repeated URT infection (1) and neonatal bronchiolitis (1).Table 1.Birth OutcomesBirth OutcomeCases (n)Controls (n)P.valueAbortion910.001IUFD030.18PROM180.09Cesarean20170.02LBW680.68Premature8250.74Conclusion:From this ongoing cohort we conclude that controlled RA during pregnancy carries low risk of adverse obstetric outcomes in spite the regular use of DMARDs. Although these results are reassuring, further regression models are required after recruiting more subjects.References:[1]Johanna M. W. Hazes. (2011). Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.Rheumatology, 50:1955-1968Disclosure of Interests:None declared

Author(s):  
Annibal Sabino ◽  
Eduardo de Souza ◽  
Ana Goulart ◽  
Adriana Lima ◽  
Nelson Sass

Objective To evaluate whether the presence of maternal blood pressure reduces the risks of morbidity, perinatal mortality and morbidity at 24 months of age in very low birth weight infants (VLBWIs) compared with a control group. Methods A retrospective, observational, case-control study. Total 49 VLBWIs were allocated to the study group, called the maternal arterial hypertension group (AHG), and matched with 44 in the control group (CG). The infants were assessed during hospitalization and at 12 and 24 months corrected age at a specialized clinic. For the assessment of growth, the World Health Organization (WHO) Anthro software (Geneva, 2006) was used, and for the psychomotor assessment, the Denver II test was used. Results In relation to the antenatal variables, the infants of the AHG had more centralized circulation assessed by Doppler, received more corticosteroids and magnesium sulfate, and were born by cesarean section more frequently. In terms of the postnatal and in-hospital outcomes, the AHG had a higher gestational age at birth (30.7 versus 29.6 weeks) and a lower frequency of 5-minute Apgar scores of less than 7 (26.5% versus 52.3%). The CG had a higher rate of pulmonary dysplasia (30.2% versus 8.3%). There were no differences in terms of hospital mortality, complications, somatic growth and functional problems at 24 months of corrected age. Conclusion The presence of maternal hypertension, especially preeclampsia, was not a protective factor against morbidity, mortality and evolution in VLBWIs aged up to 24 months. Therefore, the clinical practice should be focused on prolonging the pregnancy for as long as possible in these conditions as well.


2020 ◽  
Author(s):  
Romana Koberova ◽  
Vladimira Radochova ◽  
Jana Zemankova ◽  
Lenka Ryskova ◽  
Zdeněk Broukal ◽  
...  

Abstract Background Health problems of premature infants can affect both general and oral health. The enamel defects, poor dietary and oral hygiene habits may predispose these children to dental caries. This study was conducted to assess the impact of very low birth weight and prematurity on caries risk in early childhood.Methods The study cohort consists of 189 of one year old infants. Anamnestic data were obtained from hospital records, feeding practice, bed-time sugar drinks and oral hygiene onset from questionnaires. Saliva samples of children and their mothers were collected for the detection of cariogenic pathogens.Results VLBW newborns had significantly shorter gestation age (29.6 vs. 38.8)) and lower mean birthweight (1124g vs 3315g) compared to NBW ones (p<0.0001). Statistical significance has been found in the presence of early morbidity (p<0.0001) and regular medication intake (p=0.007). VLBW children got more frequently sweetened drinks during the day and night (p=0.007). Regular oral hygiene practice was more frequent in full term group (p=0.002). There was statistical difference in the presence of enamel hypoplasia in VLBW children (p=0.033) but no statistical difference in the presence of hypomineralization (p=0.0736) in comparison to NBW individuals. Proportional representation and count of S. mutans did not reveal statistical difference neither in both groups of children (p=0.484) nor in both groups of mothers (p=0.385).Conclusions The study confirmed anamnestic and medical differences between both groups. The proportional representation and count of S. mutans did not reveal statistical difference neither in VLBW and NBW children, nor in their mothers.


Author(s):  
Faezeh Jamali ◽  
Arman Ahmadzadeh ◽  
Zahra Sahraei ◽  
Jamshid Salamzadeh

Rheumatoid arthritis (RA) is considered as an autoimmune-related condition in which the overproduction of pro-inflammatory cytokines leads to an inflammatory cascade. N-acetylcysteine (NAC) is a potent anti-inflammatory and anti-oxidant agent. We aimed to explore the impact of oral NAC on cytokines activities and clinical indicators in RA patients. In this placebo-controlled randomized double-blind clinical trial, 41 active RA patients were allocated in either NAC (600 mg, twice a day) or placebo group, as add-on therapy to the routine regimen, for 8 weeks. Disease activity score with an erythrocyte sedimentation rate (DAS28-ESR), and serum concentrations of interleukin (IL)-1β and IL-17 were assessed at baseline and end of the trial for all participants in the test and control groups. The reduction of the DAS28-ESR was higher considerably in the NAC group compared to that of the control group. No statistically significant differences were seen in the reduction of IL- 1β and IL-17 cytokines between the NAC and control groups. In addition, improvements in the patient global assessment, number of tender joints, number of swollen joints, and the ESR rates were in favor of the NAC group. Our findings reveal that NAC may have a beneficial effect on all of the clinical features of RA. However, non-significant variations in the IL-1β and IL-17 levels suggest an alternative way of NAC effectiveness without influencing the measured cytokines. Nevertheless, these results need to be confirmed by further investigations.


2018 ◽  
Vol 66 (6) ◽  
pp. 1004-1007 ◽  
Author(s):  
Tien-Tsai Cheng ◽  
Han-Ming Lai ◽  
Shan-Fu Yu ◽  
Wen-Chan Chiu ◽  
Chung-Yuan Hsu ◽  
...  

This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5–7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1–4) (g/cm2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1–4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment.


2015 ◽  
Vol 8 (5) ◽  
pp. 184 ◽  
Author(s):  
Mohammad Reza Karimi ◽  
Jalaleddin H Hamissi ◽  
Simin Rafieyan Naeini ◽  
Mojgan Karimi

<p><strong>AIM &amp; BACKGROUND: </strong>It has been suggested that periodontitis is associated with systemic alterations such as adverse pregnancy outcomes. However, some conflicting results have been reported. This study was conducted to determine the association between periodontitis and preterm birth (PTB), low birth weight (LBW) to obtain information which is necessary for the planning of preventive programs of periodontal disease for pregnant women in this area.</p> <p><strong>MATERIALS &amp; METHODS: </strong>This case-control study was performed on 264 mothers. The index used to determine oral hygiene and periodontal diseases is Community Periodontal Index Treatment Needs (CPITN).</p> <p><strong>RESULTS: </strong>The mothers in the sample group with single delivery delivered 8 times low birth weight infants more than the mothers in the control group with single delivery. And also the mothers in the sample group with multiple deliveries; delivered 10 times low birth weight infants and 8 times premature infant more than the mothers in the control group.</p> <p><strong>CONCLUSION: </strong>More studies should be carried out in through preventing and treating periodontal diseases, expenses incurred due to preterm labor and low birth weight decrease and the society will witness fewer mental problems suffered by such children as they grow up. So we can emphasize the importance of periodontal care in prenatal health programs. And we may suggest that a special program of periodontal disease prevention for pregnant women is very necessary.</p>


2018 ◽  
Vol 2 (4) ◽  
pp. 373
Author(s):  
Novianti Tysmala Dewi ◽  
Dhenok Widari

Background: Stunting is a nutritional problem that has a high prevalence in Indonesia. Stunting among children under two years of age has a higher risk compared to other age groups because it will permanently affect the physical and cognitive development of children in the future. Factors that can cause stunting include low birth weight and infectious diseases.Objectives: The aim of this study was to determine the relationship between low birth weight and infection disease with incident of stunting among children under two years of age in Maron sub district, District of Probolinggo, East Java. Methods: This research was an observational research with case-control design. Sampling technique using multistage random sampling. the study was conducted in June until July 2018. The samples of study were 52 children (26 stunted children in case group and 26 normal growth children in control group. Data collection of infectious diseases was carried out by structured questionnaire interviews and medical records while low birth weight was obtained by looking at KIA book. Stunting was determined from measurement of children's recumbent length by metline. Data were analyzed by using chi square test for determining odds ratio. Results: The results showed that low birth weight (p=0.042; OR=0.157; 95% CI: 0.030-0.822) and infection disease (p=0.049; OR=3.071; 95% CI: 1.155-11.861) had significant relation with stunting among children under two years of age. Conclusions: Low birth weight and infection disease in the last 3 months increased the risk of 0.157 and 3.017 times stunting among children under two years of age. It is recommended for children under two years of age who have low birth weight and infectious disease should be given special attention by Integrated Health Post and there should be a monitoring related development routinely so developmental disruptions can be identified and immediately get the treatment. ABSTRAKLatar Belakang:Stunting merupakan masalah gizi yang memiliki prevalensi tinggi di Indonesia. Stunting pada baduta memiliki risiko lebih tinggi jika dibanding dengan kelompok usia lain karena akan berdampak secara permanen terhadap perkembangan fisik dan kognitif anak dimasa depan. Faktor penyebab stunting diantaranya adalah berat badan lahir rendah dan penyakit infeksi.Tujuan: Penelitian ini bertujuan untuk untuk menganalisis hubungan antara berat badan lahir rendah dan penyakit infeksi dengan kejadian stunting pada baduta di Desa Maron Kidul Kecamatan Maron, Kabupaten Probolinggo.Metode: Jenis penelitian menggunakan desain case-control. Sampel diambil dengan teknik sampel acak bertahap. Penelitian dilakukan pada bulan Juni hingga Juli 2018. Besar sampel sebanyak 52 baduta (26 anak stunting dan 26 anak non-stunting). Pengumpulan data penyakit infeksi dilakukan dengan wawancara kuisioner terstruktur dan rekam medik sedangkan berat badan lahir rendah diperoleh dengan melihat buku KIA. Penentuan stunting baduta diperoleh melalui pengukuran panjang badan dengan metline. Data dianalisis menggunakan chi-square untuk menentukan odds ratio.Hasil:  Hasil penelitian menunjukkan ada hubungan berat badan lahir rendah (p=0.042; OR=0,157; 95% CI: 0,030-0,822), dan penyakit infeksi (p=0,049; OR=3,071; 95% CI: 1,155-11,861) dengan kejadian stunting pada baduta.  Kesimpulan:Berat badan lahir rendah dan Rerat badan lahir rendah dan dutdah diperoleh dengan melihat buku KIA. of alcohol penyakit infeksi dalam 3 bulan terakhir meningkatkan risiko sebesar 0,157 dan 3,017 kali terhadap kejadian stunting pada baduta. Disarankan untuk baduta yang memiliki masalah BBLR dan penyakit infeksi diberikan perhatian khusus oleh posyandu serta perlu dilakukan peninjauan terkait perkembangan secara rutin agar gangguan perkembangan yang mungkin terjadi dapat segera dikenali dan diatasi.


2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Umriaty Umriaty ◽  
Juhrotun Nisa

AbstrakMenurut data WHO tahun 2015 jumlah BBLR di Indonesia berada di peringkat sembilan dunia dengan persentase BBLR lebih dari 15,5 % dari kelahiran bayi. Bayi yang lahir dengan berat badan kurang dari 2500 gram mempunyai resiko mengalami komplikasi. Keberlanjutan kehidupan bayi yang lahir dengan berat rendah juga sangat tergantung dari keadaan ekonomi, Pendidikan orang tua  dan perawatan pasca bayi lahir. Penelitian ini adalah penelitian survey analitik. Rancangan penelitian yang digunakan adalah  case control yaitu penelitian melibatkan kelompok kasus yaitu bayi BBLR yang berjumlah 32 dan bayi yang lahir dengan berat lahir normal sebagai kelompok kontrol yang berjumlah 32. Variabel faktor ibu yang diteliti pada penelitian ini adalah umur ibu, paritas, jarak kehamilan, status gizi ibu, anemia dalam kehamilan, pre eklampsi, dan riwayat berat lahir rendah pada kehamilan sebelumnya. Penelitian ini dilakukan pada bulan Oktober sampai dengan Desember 2017. Hasil penelitian menunjukkan bahwa sebagian besar bayi lahir  pada  umur ibu usia tidak beresiko 68, 8 %, paritas Pirmi/multigravida 90,6 %, jarak kehamilan ≥ 2 tahun 84,6 %, ibu hamil tidak KEK 68,8, anemia dalam kehamilan 50 %. Hasil analisis uji hubungan dengan Chi Square dan alpha 0,05 didapatkan 2 variabel mempunyai hubungan yang bermakna yaitu status gizi (p value 0,023), dan Anemia dalam kehamilan (p value 0,012). Kata kunci : faktor maternal, Bayi Berat Lahir Rendah AbstractAccording to WHO data in 201, the number of Low Birth Weight (LBW) of Indonesia is ranked ninth in the world with the percentage of LBW more than 15.5% of babies born. Babies born with weight less than 2500 grams have a risk of complications. The sustainability of a low birth weight baby's life is also highly based on the state of the economy, parental education and post-natal care.This research is an analytic survey research. The design of the research used was case control, the study involved case groups of 32 LBW infants and babies born with normal birth weight as a control group of 32. Maternal factor variables studied in this study were maternal age, parity, gestational distance, maternal nutritional status, anemia in pregnancy, pre-eclampsia, and a history of low birth weight in previous pregnancies. This study was conducted during October to December 2017. The results showed that most of the babies born at the age of the mother were not at risk 68,8%, Primi / multigravida 90.6%, the distance of pregnancy ≥ 2 years 84.6%, pregnant women not KEK 68.8, anemia in pregnancy 50%. Result of analysis of test of correlation with Chi Square and alpha 0,05 got 2 variables have significant relationship that is nutrition status (p value 0,023), and Anemia in pregnancy (p value 0,012). Keyword : maternal factor, Low Birth Weight


2021 ◽  
Vol 10 (s1) ◽  
Author(s):  
Kurniati Puji Lestari ◽  
Firdha Rahma Nurbadlina ◽  
Wagiyo Wagiyo ◽  
Muhammad Jauhar

Background: The low birth weight (LBW) problem is found in various developing countries with an increasing trend of cases every year. This is caused by nutritional status and a history of maternal health. The impact of LBW in children is they are more likely to experience delayed growth and development. This study aims to identify the effect of baby massage on infants’ body weight.Design and Methods: The research design used was quasi-experimental pre and post-test type with control group. There were 16 infants for each group selected by purposive sampling. Baby massage was given to the infants twice a week within four weeks, 10 to 15 min per session. Data analysis was used paired t-test and independent t-test.Results: The mean age of infants was 3.69 months for both group, the mean age at birth was 37.8 weeks (intervention) and 38 weeks (control), the mean birth weight of infants was 2,295 grams (intervention) and 2,288 grams (control). Most of the infants was male for both group. There was an effect of baby massage on the increase in infants’ weight gain with a history of low birth weight significantly with a p value <0.05.Conclusions: Baby massage can increase infants’ weight with a history of low birth weight aged 1-6 months. The role of health workers is to provide education and practice baby massage for mothers in order to stimulate the growth and development of infants. This intervention can be integrated with maternal and child health programs in primary health care facilities.


2020 ◽  
Author(s):  
Romana Koberova ◽  
Vladimira Radochova ◽  
Jana Zemankova ◽  
Lenka Ryskova ◽  
Zdeněk Broukal ◽  
...  

Abstract Background Health problems of premature infants can affect both general and oral health. The enamel defects, poor dietary and oral hygiene habits may predispose these children to dental caries.Aim To assess the impact of very low birth weight and prematurity on caries risk in early childhood.Design The study cohort consists from 189 of one year old infants. Anamnestic data were obtained from hospital records, feeding practice, bed-time sugar drinks and oral hygiene onset from questionnaires. Saliva samples of children and their mothers were collected for the detection of cariogenic pathogens. Results VLBW newborns had significantly shorter gestation age (29.6 vs. 38.8)) and lower mean birthweight (1124g vs 3315g) compared to NBW ones (p<0.0001). Statistical significance has been found in the presence of early morbidity (p<0.0001) and regular medication intake (p=0.007). VLBW children got more frequently sweetened drinks during the day and night (p=0.007). Regular oral hygiene practice was more frequent in full term group (p=0.002). There was statistical difference in the presence of enamel hypoplasia in VLBW children (p=0.033) but no statistical difference in the presence of hypomineralization (p=0.0736) in comparison to NBW individuals. Proportional representation and count of S. mutans did not reveal statistical difference neither in both groups of children (p=0.484) nor in both groups of mothers (p=0.385). Conclusions The study confirmed anamnestic and medical differences between both groups. The proportional representation and count of S. mutans did not reveal statistical difference neither in VLBW and NBW children, nor in their mothers.


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