scholarly journals O14 Paternal acitretin exposure and pregnancy risks

2019 ◽  
Vol 104 (6) ◽  
pp. e6.2-e6 ◽  
Author(s):  
M Nørgaard ◽  
JT Andersen
Keyword(s):  
Exposure Period ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Major Malformation ◽  
Birth Registry ◽  
Exposure Data ◽  
Increased Risk ◽  
One Year ◽  
Hospital Registry ◽  
Fertile Women

BackgroundIn the literature it is well known that acitretin is highly teratogen when used in pregnant women. Therefore, several restrictions to all fertile women prior, during and up to three years after ended treatment are recommended. However, as for paternal acitretin exposure data is very limited leading to worries and anxiety among couples planning or already pregnant.MethodsWe conducted a nationwide cohort study during the period between 1996–2016 investigating paternal acitretin exposure and the risk of spontaneous abortions and the association to major malformation. Data were obtained from the Medical Birth Registry and the National Hospital Registry. All fathers exposed to acitretin were identified by the Danish National Prescription Registry.ResultsWe identified in total 1.477.252 registered pregnancies with known father identity. Of these 244 pregnancies and 205 children were exposed to paternal acitretin treatment between one year prior to conception to the end of first trimester. The adjusted hazard risk (HR) of spontaneous abortion was 0.71 (95% CI: 0.43–1.17). When analysing exposure three months prior to conception and during first trimester only, the adjusted HR was 0.76 (95% CI:0.38–1.51) and 1.06 (95% CI:0.55–2.04), respectively. As for the association between major malformation and paternal acitretin exposure between one year prior to conception to the end of first trimester the adjusted odds ratio (OR) was 1.15 (95% CI: 0.57–2.34). When stratifying for the period of acitretin exposure the same insignificant trend was detected. In addition, both spontaneous abortions and major malformation were independent of dosage.ConclusionWe found no increased risk of spontaneous abortions or major malformation in pregnancies exposed to paternal acitretin one year before to three months after conception. This was persistent when sub-analysing exposure period and dosage. These data are an important contribute to the sparse evidence suggesting that paternal acitretin exposure during fertility is safe.Disclosure(s)Nothing to disclose

First Trimester Hemoglobin A1 and Risk for Major Malformation and Spontaneous Abortion

2021 ◽  
pp. 13-19
Author(s):  
Rachel Blake ◽  
Chloe Zera
Keyword(s):  
Spontaneous Abortion ◽  
Clinical Case ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Major Malformation ◽  
Fetal Malformations ◽  
Study Population ◽  
Hemoglobin A1 ◽  
Location Study

This chapter summarizes a landmark study on the association of first trimester hemoglobin A1 values with risk for spontaneous abortions and major fetal malformations during pregnancy in women with pregestational diabetes. Is there a correlation between glycemic control during the first trimester and risk for spontaneous abortion and major malformations? Starting with this question, it describes the basics of the study, including study location, study population, amount of patients, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Pregnancy outcome in chronic myeloid leukemia patients on imatinib therapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7114-7114
Author(s):  
Swati Dasgupta ◽  
Ashis Mukhopadhyay ◽  
Ujjal Kanti Ray ◽  
Firoj Hossain Gharami ◽  
Chinmay Kumar Basu ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Unplanned Pregnancy ◽  
First Trimester ◽  
Imatinib Therapy ◽  
Spontaneous Abortions ◽  
Male And Female ◽  
Increased Risk ◽  
Male Patients

7114 Background: Now that imatinib is being used to treat thousands of chronic myeloid leukemia (CML) patients for more than 10 year it is highly probable that many patients will get pregnant during its use. Company warns against any such use. But the fact remains that there is need for planned pregnancies in indicated cases. So we selected few cases both male and female for such pregnancies by interrupting treatment and following the pregnancy closely. Their outcome was studied so that we have an idea about what best could be suggested in such instance. Methods: From November 2002 to May 2010, 634 patients with CML in any stage of the disease were treated with imatinib at our tertiary cancer research institute. We selected 22 (12 females and 10 males) cases of pregnancies by interrupting treatment. We reported 9 accidental pregnancies and 13 planned pregnancies involving 22 patients who or their wives conceived while receiving imatinib for the treatment of CML. Results: Among 22 pregnancies there were 3 spontaneous abortions and 4 elective abortions. In case of 7 female patients, 3 and 4 were male and female babies respectably and in case of six male patients 4 and 4 were male and female babies. Two babies were with congenital anomaly such as one Hypospandium and one Mild-Hydrocephalus (in case of unplanned pregnancies and imatinib exposure during the first trimester of organogenesis). Conclusions: In conclusion, exposure to Imatinib during pregnancy might result in an increased risk of serious fetal abnormalities or spontaneous abortions. Women of childbearing potential should use adequate contraception while using Imatinib. We can suggest that planned pregnancy during therapy should be encouraged but imatinib therapy in unplanned pregnancy can cause spontaneous abortion or minor congenital anomaly.

scholarly journals P06 Paternal exposure to methotrexate and the risk of miscarriage – a register based nationwide cohort study

2019 ◽  
Vol 104 (6) ◽  
pp. e19.3-e20
Author(s):  
J Andersen ◽  
B Askaa ◽  
TB Jensen ◽  
H Horwitz ◽  
C Vermehren ◽  
...  
Keyword(s):  
Cohort Study ◽  
First Trimester ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Birth Registry ◽  
Paternal Exposure ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
First Trimester Of Pregnancy ◽  
Cox Proportional Hazard Regression

ObjectiveTo study the association between paternal exposure to methotrexate within three month before conception and during the first trimester of pregnancy and the risk of miscarriage.MethodsWe conducted a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2015. All births were identified using the Medical Birth Registry, and all records of induced abortion and miscarriage were from the National Hospital Register. Data on drug use were from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women with a partner exposed to methotrexate. The study was approved by the Danish Data Protection Agency (2015-41-4309).ResultsWe identified 1,364,063 registered pregnancies with known paternity, of whom 520 fathers were exposure to methotrexate within the three months before conception to the end of the first trimester. Among these, 46 (8.9%) experienced a miscarriage compared to 122,926 (9.0%) among the unexposed.There was no increased risk of experiencing a miscarriage in pregnancies to men exposed to methotrexate before pregnancy compared to unexposed (adjusted hazard ratio 0.99 (CI95% 0.67- 1.46)). Furthermore, we found no increased risk of experiencing a miscarriage in pregnancies to men exposed to methotrexate during first trimester compared to unexposed (adjusted hazard ratio 0.90 (CI95% 0.61–1.32)).ConclusionWe found no association between paternal exposure to methotrexate before and during early pregnancy and miscarriage. Available data suggest that paternal methotrexate exposure should not be of major concern. Multinational recommendations could be changed accordingly.Disclosure(s)Nothing to disclose

Pregnancy outcome following first trimester exposure to sumatriptan

Neurology ◽  
1998 ◽  
Vol 51 (2) ◽  
pp. 581-583 ◽  
Author(s):  
S. Shuhaiber ◽  
A. Pastuszak ◽  
B. Schick ◽  
D. Matsui ◽  
G. Spivey ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Birth Defects ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Live Births ◽  
Increased Risk ◽  
Trimester Exposure

We prospectively compared pregnancy outcome after exposure to sumatriptan with that of disease-matched controls and nonteratogen controls. There were no differences in the rates of live births, spontaneous abortions, therapeutic abortions, or major birth defects among the three groups. This first prospective report suggests that the use of sumatriptan during organogenesis is not associated with an apparent increased risk of major birth defects.

Protein-Z Deficiency and/or Protein Z Polymorphisms in First Trimester Pregnancy Complications

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1221-1221
Author(s):  
Maria Topalidou ◽  
Vassilios K Papadopoulos ◽  
Zoi Mpousiou ◽  
Haris Kartsios ◽  
Kyriaki Kokoviadou ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Fetal Loss ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Protein Z ◽  
Increased Risk ◽  
Significant Difference ◽  
Group B

Abstract Abstract 1221 INTRODUCTION: Protein Z (PZ) is a vitamin K-dependent coagulation factor; it is a glycoprotein that inhibits activated factor Xa, acting as a co-factor to PZ-dependent protease inhibitor, enhancing its action approximately by 1000 times. PZ levels in normal individuals vary greatly, as a result of PZ gene polymorphisms. PZ deficiency has been involved in the pathogenesis of ischemic strokes and pregnancy complications. Gris et al [Blood 2002;99(7):2606–08] first described a possible role of PZ deficiency (PZ <= 1mg/L) in women with fetal loss between the beginning of the 10th and the end of the 15th week of gestation. In a recent meta-analysis [Sofi et al, Thrombosis and Haemostasis 2010;103(4):749–56] PZ deficiency was associated with increased risk of pre-eclampsia and fetal loss, as well as with increased risk of arterial and venous thrombotic events. MATERIALS-METHODS: We studied a total of 314 women, 70 women with three or more consecutive spontaneous abortions (group A), 145 women with less than 3 early spontaneous abortions (group B) and 99 control women with at least one normal pregnancy and negative history of a thrombotic complication (group C). All women were tested for congenital and acquired thrombophilia such as antithrombin, protein C and S levels, homocysteine levels, lupus anticoagulant (PTTLa), factor V Leiden mutation, prothrombin G20210A gene polymorphism and PZ levels. We also investigated protein Z polymorphism F79A in a subgroup of our patients. Measurements were made at least 3 months apart from a thrombotic event. Differences between groups were assessed with ANOVA and chi-squared tests for continuous and categorical variables respectively. RESULTS: Statistically significant difference was found in PZ levels between the three groups. Mean PZ level was 1.23mg/dL, 1.31mg/dL και 1.61mg/dL (p<0.00001) in groups A, B, C respectively. Post-hoc Bonferroni analysis revealed a significant difference between groups A and C (p=0.0003) and between groups B and C (p=0.001). The percentage of PZ deficiency (95% condidence interval) was 40% (28%–52%), 38% (30%–46%) and 18% (11%–26%) respectively (p=0.001). Both group A (OddsRatio[OR]=3) and group B (OR=2.75) have a statistically greater PZ deficiency than control group C. The other parameters did not differ significantly between the three groups. DISCUSSION/CONCLUSIONS: Spontaneous abortions are common in women especially in first trimester. Thrombophilia has a major role in pregnancy complications. In these women that one cannot find some of the well established thrombophilic factors, searching for other possible deficiencies is necessary. The role of PZ deficiency has been investigated thoroughly in the last decade with sometimes conflicting results. To the best of our knowledge, this is the first Greek study investigating the possible role of protein Z deficiency in women with early pregnancy losses. From our study it is evident that PZ deficiency is an independent risk factor for early pregnancy losses. From our study it seems that the other thrombophic factors may play a minor role. A plausible pathophysiologic explanation is the occurrence of microthrombi due to atherosclerotic lesions soon after the development of materno-placental circulation. The role of PZ gene polymorphisms in PZ levels and in thrombotic complications remains to be investigated further. According to preliminary results from a sub-group of our patients (Topalidou et al, Thrombosis Research 2009;124:24–27), the presence of the intron F79A polymorphism was associated with significantly lower PZ levels, but was unrelated to unexplained early pregnancy losses. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Case of Intertwin Membrane Hemorrhage with Spontaneous Resolution

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Lily Criscione ◽  
Kristen Elmezzi ◽  
Saioa Torrealday ◽  
Barton C. Staat ◽  
Kimberly Hickey
Keyword(s):  
Vaginal Bleeding ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Final Diagnosis ◽  
Spontaneous Resolution ◽  
Multiple Gestation ◽  
Spontaneous Abortions ◽  
Third Trimester ◽  
The Third ◽  
Increased Risk

Vaginal bleeding during pregnancy places women at increased risk of spontaneous abortion. Etiologies for threatened and spontaneous abortions have been well studied, but there is little information on intertwin membrane hemorrhage. We present a patient with a multiple gestation pregnancy who experienced first trimester vaginal bleeding with visualization and subsequent rapid resolution of an intertwin membrane hemorrhage. The patient had an otherwise normal pregnancy until the third trimester when she developed preeclampsia with severe features and elected for a primary cesarean section at 35 + 5 weeks. The implications of an intertwin membrane hemorrhage are not well understood, although there could be a possible correlation between the hemorrhage and the ultimate progression to preeclampsia with severe features. Despite the final diagnosis, the patient did not have any noticeable complications due to the hemorrhage both when it was discovered and in the weeks following its discovery.

scholarly journals Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study

BMJ ◽  
2020 ◽  
pp. m331 ◽  
Author(s):  
Heng Fan ◽  
Ruth Gilbert ◽  
Finbar O’Callaghan ◽  
Leah Li
Keyword(s):  
First Trimester ◽  
Population Based ◽  
Autism Spectrum ◽  
Macrolide Antibiotics ◽  
Study Cohort ◽  
Major Malformation ◽  
Cardiovascular Malformations ◽  
Hyperactivity Disorder ◽  
Increased Risk ◽  
The Uk

Abstract Objective To assess the association between macrolide antibiotics prescribing during pregnancy and major malformations, cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder in children. Design Population based cohort study. Setting The UK Clinical Practice Research Datalink. Participants The study cohort included 104 605 children born from 1990 to 2016 whose mothers were prescribed one macrolide monotherapy (erythromycin, clarithromycin, or azithromycin) or one penicillin monotherapy from the fourth gestational week to delivery. Two negative control cohorts consisted of 82 314 children whose mothers were prescribed macrolides or penicillins before conception, and 53 735 children who were siblings of the children in the study cohort. Main outcome measures Risks of any major malformations and system specific major malformations (nervous, cardiovascular, gastrointestinal, genital, and urinary) after macrolide or penicillin prescribing during the first trimester (four to 13 gestational weeks), second to third trimester (14 gestational weeks to birth), or any trimester of pregnancy. Additionally, risks of cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder. Results Major malformations were recorded in 186 of 8632 children (21.55 per 1000) whose mothers were prescribed macrolides and 1666 of 95 973 children (17.36 per 1000) whose mothers were prescribed penicillins during pregnancy. Macrolide prescribing during the first trimester was associated with an increased risk of any major malformation compared with penicillin (27.65 v 17.65 per 1000, adjusted risk ratio 1.55, 95% confidence interval 1.19 to 2.03) and specifically cardiovascular malformations (10.60 v 6.61 per 1000, 1.62, 1.05 to 2.51). Macrolide prescribing in any trimester was associated with an increased risk of genital malformations (4.75 v 3.07 per 1000, 1.58, 1.14 to 2.19, mainly hypospadias). Erythromycin in the first trimester was associated with an increased risk of any major malformation (27.39 v 17.65 per 1000, 1.50, 1.13 to 1.99). No statistically significant associations were found for other system specific malformations or for neurodevelopmental disorders. Findings were robust to sensitivity analyses. Conclusions Prescribing macrolide antibiotics during the first trimester of pregnancy was associated with an increased risk of any major malformation and specifically cardiovascular malformations compared with penicillin antibiotics. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations. These findings show that macrolides should be used with caution during pregnancy and if feasible alternative antibiotics should be prescribed until further research is available. Trial registration ClinicalTrials.gov NCT03948620

Leflunomide use during pregnancy and the risk of adverse pregnancy outcomes

2017 ◽  
Vol 77 (4) ◽  
pp. 500-509 ◽  
Author(s):  
Anick Bérard ◽  
Jin-Ping Zhao ◽  
Irene Shui ◽  
Susan Colilla
Keyword(s):  
Spontaneous Abortion ◽  
First Trimester ◽  
Spontaneous Abortions ◽  
Third Trimester ◽  
Increased Risk ◽  
First Trimester Of Pregnancy ◽  
Exposure During Pregnancy ◽  
Trimester Exposure ◽  
Adverse Pregnancy ◽  
Generalised Estimating Equations

ObjectivesLeflunomide is known to be embryotoxic and teratogenic in rodents. However, there is less evidence in humans. We quantified the risk of major congenital malformation (MCM), prematurity, low birth weight (LBW) and spontaneous abortion associated with leflunomide exposure during pregnancy in humans.MethodsFrom a cohort of 289 688 pregnancies in Montreal, Quebec, Canada, from 1998 to 2015, first-trimester leflunomide exposure and other antirheumatic drug exposures were studied for their association with MCM and spontaneous abortions. Also second or third-trimester leflunomide exposures were examined for associations with prematurity and LBW. Logistic regression model-based generalised estimating equations were used.Results51 pregnancies were exposed to leflunomide during the first trimester, and 21 during the second/third trimesters. Adjusting for potential confounders, use of leflunomide during the first trimester of pregnancy was not associated with the risk of MCM (adjusted OR (aOR) 0.97, 95% CI 0.81 to 1.16; 5 exposed cases). No association was found between second/third-trimester exposure to leflunomide and the risk of prematurity (aOR 4.03, 95% CI 0.91 to 17.85; 7 exposed cases) nor LBW (aOR 1.06, 95%CI 0.90 to 1.25; 8 exposed cases). Pregnancy exposure to leflunomide was also not associated with the risk of spontaneous abortion (aOR 1.09, 95% CI 0.90 to 1.32; 11 exposed cases).ConclusionsMaternal exposure to leflunomide during pregnancy was not associated with statistically significant increased risk of MCMs, prematurity, LBW or spontaneous abortions. However, given that relatively few women were exposed to leflunomide during pregnancy in this cohort, caution remains warranted.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

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