scholarly journals Hydroxychloroquine PK and exposure-response in pregnancies with lupus: the importance of adherence for neonatal outcomes

2022 ◽  
Vol 9 (1) ◽  
pp. e000602
Author(s):  
Stephen J Balevic ◽  
Daniel Weiner ◽  
Megan E B Clowse ◽  
Amanda M Eudy ◽  
Anil R Maharaj ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Physiological Changes ◽  
Third Trimester ◽  
Exposure Response ◽  
Multiple Gestations ◽  
Adjusted Logistic Regression ◽  
Using Data ◽  
Poor Outcomes ◽  
The Impact

ObjectiveEvaluate the impact of pregnancy physiology and medication non-adherence on serum hydroxychloroquine (HCQ) pharmacokinetics (PK) and exposure-response in SLE.MethodsWe conducted a PK analysis using data from two observational pregnancy registries. We enrolled pregnant women with SLE taking HCQ at least 3 months prior to, and throughout pregnancy, and excluded those with multiple gestations. Using the PK model, we conducted dosing simulations and imputed 0%/20%/40%/60% non-adherence to evaluate the impact of adherence versus physiological changes on HCQ concentrations. We compared the effect of pregnancy-average non-adherent concentrations (≤100 ng/mL vs >100 ng/mL) on preterm birth using adjusted logistic regression.ResultsWe enrolled 56 women who had 61 pregnancies. By the third trimester, mean apparent HCQ clearance increased by 59.6%. At a dosage of 400 mg/day, fully adherent patients are expected to have HCQ concentrations ≤100 ng/mL only 0.3% of the time, compared with 24.2% when 60% of doses are missed. Persistently low HCQ concentrations throughout pregnancy were associated with a significantly higher odds of preterm birth, controlling for lupus nephritis and race (OR 11.2; 95% CI 2.3 to 54.2; p=0.003).ConclusionsWe observed significant changes in HCQ PK during pregnancy, resulting in a shortening in the drug’s half-life by 10 days; however, medication non-adherence had a more pronounced effect on HCQ exposure compared with physiological changes alone. Moreover, pregnant women with non-adherent HCQ concentrations had significantly higher rates of preterm birth. Accordingly, optimising adherence in pregnancy may be more clinically meaningful than adjusting HCQ dosage to account for physiological changes. PK modelling indicates that serum HCQ concentrations ≤100 ng/mL are suggestive of non-adherence regardless of trimester and may help identify pregnancies at risk for poor outcomes.

RELATIONSHIP OF MATERNAL VITAMIN B12 STATUS IN PREGNANCY WITH PRETERM BIRTH AND MATERNAL HEALTH RISKS

2020 ◽  
pp. 32-38
Author(s):  
VICTORIA LAZAROVA SPASOVA ◽  
LILIA IVANOVA KOLEVA ◽  
MARIETA ANTONOVA POPOVA ◽  
VALENTINA BOYANOVA PETKOVA ◽  
MILEN VENTZISLAVOV DIMITROV
Keyword(s):  
Preterm Birth ◽  
Vitamin B12 ◽  
Pregnant Women ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Inverse Association ◽  
Maternal Vitamin ◽  
B12 Deficiency ◽  
The Impact ◽  
In Pregnancy

Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women. Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.

scholarly journals Vitamin B-12 Supplementation during Pregnancy and Early Lactation Does Not Affect Neurophysiologic Outcomes in Children Aged 6 Years

2020 ◽  
Vol 150 (7) ◽  
pp. 1951-1957 ◽  
Author(s):  
Krishnamachari Srinivasan ◽  
Susan Thomas ◽  
Shilpa Anand ◽  
Mahesh Jayachandra ◽  
Tinku Thomas ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Mismatch Negativity ◽  
Controlled Trial ◽  
Event Related Potentials ◽  
P300 Amplitude ◽  
Vitamin B ◽  
Third Trimester ◽  
Related Potentials ◽  
Vitamin B 12 ◽  
The Impact

ABSTRACT Background Deficiency of vitamin B-12 is common in pregnant Indian women. Assessment of neurophysiological measures using event-related potentials (ERPs) may yield additional information on the effects of maternal B-12 supplementation on child brain function. Objectives The objective of the study was to evaluate the effects of vitamin B-12 supplementation (50 μg daily orally) during pregnancy on the childhood ERP measures of positive waveform ∼300 ms after stimulus (P300) and mismatch negativity. Methods This study was a follow-up of children born to pregnant women who received oral vitamin B-12 supplements (n = 62) compared with children of pregnant women who received placebo (n = 70) from a randomized controlled trial. The mean ± SD child age was 72 ± 1 mo. We used the Enobio system to assess the ERP measures P300 and mismatch negativity. Results There were no significant differences in the primary outcomes, amplitudes, and latencies of the P300 results and the mismatch negativity between children in the supplementation and placebo groups. We combined the intervention and placebo groups for secondary analyses. On multiple variable regression analysis after adjusting for treatment group, intrauterine growth restriction, and home environment, P300 amplitude in children was significantly higher in the lowest tertile of third-trimester maternal methylmalonic acid (MMA) concentrations (β = 3034.04; 95% CI: 923.24, 5144.83) compared with the highest MMA tertile (β = 1612.12; 95% CI: −258.86, 3483.10, P = 0.005). Conclusions While no significant effects of maternal vitamin B-12 supplementation on children's ERP measures were seen at 72 mo, elevated maternal MMA concentrations in the third trimester were negatively associated with P300 amplitude in children. It may be worthwhile to study the impact of maternal and infant vitamin B-12 supplementation on childhood brain structure and function in longer and larger trials. The parent trial was registered at clinicaltrials.gov as NCT00641862.

scholarly journals Clinical Pharmacology Aspects of Some Tocolytic Drugs Used in Pregnant Women at Risk of Preterm Birth

2019 ◽  
Vol 9 (3) ◽  
pp. 162-166
Author(s):  
E. A. Sоkоvа ◽  
R. A. Chilova ◽  
O. A. Demidova ◽  
K. O. Akopov
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Preterm Labour ◽  
Plasma Concentrations ◽  
Cyclooxygenase Inhibitors ◽  
Pharmacokinetic Parameters ◽  
Clinical Effects ◽  
Spontaneous Preterm Birth ◽  
Rational Pharmacotherapy ◽  
The Impact

Spontaneous preterm birth is one of the most pressing issues in obstetrics, as it remains one of the leading causes of newborn morbidity and mortality. Pending issues of aetiology, pathogenesis, and absence of medicinal products indicated for the treatment of spontaneous preterm labour pose a challenge for rational pharmacotherapy. The paper presents the results of a scientific literature review on the problem of rational pharmacotherapy of spontaneous preterm labour using tocolytic drugs — calcium channel blockers, cyclooxygenase inhibitors. The paper summarises specific pharmacokinetic parameters of these drugs during pregnancy. It discusses pharmacogenetic aspects of using tocolytic drugs in pregnant women and their potential clinical effects. It was demonstrated that women with threatened miscarriage had high interindividual variability in nifedipine plasma concentrations depending on CYP3A5 genotype. It was shown that certain genetic polymorphisms of CYP2C9 may lead to an increased metabolic rate and an increase in indomethacin clearance resulting in the reduction of its efficacy. Yet, there is minimal research regarding this issue. Therefore, further research is needed to assess the impact of CYP3A5 and CYP2C9 genotypes on the efficacy and safety of nifedipine and indomethacin used as tocolytic drugs in obstetrics.

scholarly journals Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

2020 ◽  
Author(s):  
Zhihua Wan ◽  
Huan Zhang ◽  
Haigang Xu ◽  
Yang Hu ◽  
Cai Tan ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Jiangxi Province ◽  
Adequate Treatment ◽  
Maternal Treatment ◽  
Syphilis Treatment ◽  
Maternal Syphilis ◽  
The Impact

Abstract Background Studies investigating the associations of maternal syphilis treatment during pregnancy with pregnancy outcomes mainly concentrated in economically developed areas. Limited data are available in economically underdeveloped areas, such as Jiangxi Province. The study aims to investigate the impact of maternal treatment during pregnancy on pregnancy outcomes in Jiangxi Province, China. Methods Data were obtained from the China’s Information System of Prevention of Mother-to-Child Transmission (PMTCT) of syphilis management in Jiangxi Province. All syphilis infected pregnant women who delivered at gestational age of 28 weeks or more and were registered in this system between 1 January 2013 and 31 December 2019 were enrolled. Pregnancy outcomes were evaluated by group-specific analyses according to their treatment status, adequacy and initiation time. Results 4210 pregnant women with syphilis infection were included in the analyses. Infants born to untreated mothers were at significantly higher risk for stillbirth (adjusted odds ratio (aOR) = 1.74, 95% CI, 1.01-3.00, P = 0.045), preterm birth (aOR = 1.27, 95% CI, 1.02–1.59, P = 0.034) and low birth weight (LBW) (aOR = 1.44; 95% CI, 1.11–1.86, P = 0.006) than those born to treated mothers after adjustment for confounding factors. Moreover, a significantly higher risk of stillbirth (aOR = 3.68; 95% CI, 1.62–8.34, P = 0.002), preterm birth (aOR = 2.26; 95% CI, 1.71-3.00, P < 0.001), LBW (aOR = 2.23; 95% CI, 1.59–3.14, P < 0.001) and congenital syphilis (CS) (aOR = 3.63; 95% CI, 1.80–7.31, P < 0.001) was found in infants exposed to mothers treated inadequately than those treated adequately. In addition, no pregnant women who initiated the treatment in the first trimester delivered a neonatal CS case. Compared with mothers who initiated treatment in the first trimester, those initiated in the third trimester suffered an increased risk of stillbirth (aOR = 4.48; 95% CI, 1.31–15.30, P = 0.017), preterm birth (aOR = 2.34; 95% CI, 1.61–3.40, P < 0.001) and LBW (aOR = 3.25; 95% CI, 1.97–5.37, P < 0.001). Conclusions Maternal treatment, especially early and adequate treatment, plays a crucial role in mitigating adverse pregnancy outcomes among syphilis infected women.

scholarly journals Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi Province, China

2020 ◽  
Author(s):  
Zhihua Wan ◽  
Huan Zhang ◽  
Haigang Xu ◽  
Yang Hu ◽  
Cai Tan ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Pregnancy Outcomes ◽  
First Trimester ◽  
Jiangxi Province ◽  
Adequate Treatment ◽  
Syphilis Treatment ◽  
Maternal Syphilis ◽  
The Impact

Abstract BackgroundStudies investigating the associations of maternal syphilis treatment with birth outcomes mainly concentrated in economically developed areas. Limited data are available in economically underdeveloped areas, such as Jiangxi Province. The study aims to investigate the impact of maternal treatment on birth outcomes in Jiangxi Province, China.MethodsData were obtained from the China’s Information System of Prevention of Mother-to-Child Transmission in Jiangxi Province. All syphilis infected pregnant women who delivered ≥28 gestational weeks and were registered in this system between 1 January 2013 and 31 December 2019 were enrolled. Pregnancy outcomes were evaluated by group-specific analyses according to their treatment status, adequacy and initiation time.Results4210 syphilis infected pregnant women were included in the analyses. Infants born to untreated mothers (n = 1364) were at significantly higher risk for stillbirth (adjusted odds ratio (aOR) = 1.74, 95% CI, 1.01-3.00, P = 0.045), preterm birth (aOR = 1.27, 95% CI, 1.02-1.59, P = 0.034) and low birth weight (LBW) (aOR = 1.44; 95% CI, 1.11-1.86, P = 0.006) than those born to treated mothers (n = 2846) after adjustment for confounding factors. A significantly higher risk of stillbirth (aOR = 3.68; 95% CI, 1.62-8.34, P = 0.002), preterm birth (aOR = 2.26; 95% CI, 1.71-3.00, P < 0.001), LBW (aOR = 2.23; 95% CI, 1.59-3.14, P < 0.001) and congenital syphilis (CS) (aOR = 3.63; 95% CI, 1.80-7.31, P < 0.001) was found in infants exposed to mothers treated inadequately (n = 1299) than those treated adequately (n = 1547). No pregnant women who initiated the treatment in the first trimester (n = 682) delivered a neonatal CS case. Compared with mothers who initiated treatment in the first trimester (n = 682), those initiated in the third trimester (n = 1234) suffered an increased risk of stillbirth (aOR = 4.48; 95% CI, 1.31-15.30, P = 0.017), preterm birth (aOR = 2.34; 95% CI, 1.61-3.40, P < 0.001) and LBW (aOR = 3.25; 95% CI, 1.97-5.37, P < 0.001). ConclusionsMaternal treatment, especially early and adequate treatment, plays a crucial role in mitigating adverse pregnancy outcomes among syphilis infected women.

scholarly journals Effleurage Massage for Pain Relief in Pregnant Women

2020 ◽  
Vol 2 (1) ◽  
pp. 185-197
Author(s):  
Mutia Nadra Maulida
Keyword(s):  
Back Pain ◽  
Pregnant Women ◽  
Varicose Veins ◽  
First Trimester ◽  
Maximum Point ◽  
Physiological Changes ◽  
Second Trimester ◽  
Third Trimester ◽  
The Uk ◽  
Spinal Muscles

Pregnancy is an event that begins with conception and ends with the onset of labor. Pregnancy is divided into three trimesters, the first trimester (0-12 weeks), the second trimester (13-27 weeks), and the third trimester (28-40 weeks). During the pregnancy process will cause various changes in all body systems, both physiological changes and psychological changes that can cause discomfort to pregnant women. Physiological changes that often occur in pregnant women such as dyspnea, insomnia, gingivitis, frequent urination, pressure and discomfort in the perineum, back pain, constipation, varicose veins, fatigue, Braxton hicks contractions, leg cramps, ankle edema. Not only physiologically, changes in pregnant women also occur psychologically such as changes in mood and increased anxiety.One of the physiological changes that pregnant women often complain about is back pain. According to Ratih (2016), the results of research on pregnant women in various regions of Indonesia reached 60-80% of people who experience back pain in their pregnancy. The reported prevalence of back pain in pregnancy varies from 50% in the UK and Scandinavia to 70% in Australia. Back pain experienced by pregnant women will peak at week 24 to week 28, just before abdominal growth reaches its maximum point. Most back pain during pregnancy occurs due to changes in the spinal muscles, as much as 70%.Back pain in pregnant women can be treated both pharmacologically and non pharmacologically. One of the non-pharmacological therapies that can be given is Effleurage Massage, which provides a gentle, slow and uninterrupted massage on the back of pregnant women so that it can cause relaxation and reduce pain.

scholarly journals Fetomaternal outcome in COVID-19 infected pregnant women: a preliminary clinical study

2020 ◽  
Vol 9 (9) ◽  
pp. 3704
Author(s):  
Parul T. Shah ◽  
Sapana R. Shah ◽  
Sushma R. Shah ◽  
Pushpa A. Yadava ◽  
Babulal S. Patel ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Clinical Study ◽  
Pregnant Women ◽  
Clinical Characteristics ◽  
Severe Pneumonia ◽  
Third Trimester ◽  
Missed Abortion ◽  
Viral Nucleic Acid ◽  
Live Births ◽  
The Third

Background: WHO has declared COVID-19 infection a health emergency of international concern on 11th March, 2020. It is not clear whether clinical characteristics of pregnant women with COVID-19 differ from those of nonpregnant women and whether it aggravates COVID-19 symptoms and whether antiviral therapy is necessary for COVID-19 infected pregnant women.Methods: This is prospective study of 125 cases based on the compiled clinical data for pregnant women with COVID-19 between 15th April 2020 and 10th June 2020. A laboratory confirmed positive case of COVID-19 infection in pregnant women were included.Results: The most common symptoms at presentation were cough in 61.6% (77/125) and fever in 46.4% (58/125). Other reported symptoms were sore throat in 13.6% (17/125), myalgia in 10.4% (13/125) while 38.4% (48/125) were asymptomatic. There were total 97 deliveries (including 2 twins’ deliveries) among which 3 cases had IUD. Present study reported 96 live births. The incidence of missed abortion was 2.4% (3/125). The incidence of preterm birth before 37 weeks was 8.2% (8/97). Ninety-six (96.9%) of neonates were tested for SARS-CoV-2 viral nucleic acid on nasopharyngeal and pharyngeal samples and 16.67% (16/96) were resulted positive.Conclusions: At present, there is no evidence regarding the greater risk of pregnant women to succumb to COVID-19 infection and experience severe pneumonia. The risks of spontaneous abortion and preterm birth are not increased as reported in this study but shows possibility of vertical transmission when it manifests during the third trimester of pregnancy.

Spousal Relationship (E) Quality and Adjustment to Motherhood in Israel

2019 ◽  
Vol 40 (11) ◽  
pp. 1561-1578
Author(s):  
Miri Kestler-Peleg ◽  
Osnat Lavenda ◽  
Shelli Keren-Leneman ◽  
Karni Ginzburg
Keyword(s):  
Life Satisfaction ◽  
Postpartum Depression ◽  
Positive Affect ◽  
Pregnant Women ◽  
Psychological Adjustment ◽  
Postnatal Period ◽  
Third Trimester ◽  
Spousal Relationship ◽  
The Third ◽  
The Impact

Contemporary families experience the paradox of traditionalism/postmodernism especially in the postnatal period which presents many challenges to couples subsystem. One of them is the change in roles, which often leads to decreased relationships’ equality. This article tests the impact of change in perceived spousal equality after giving birth on relationships’ quality and the implications of the latter for mothers’ psychological adjustment. Participants included 349 Israeli pregnant women who completed self-reported questionnaires at the third trimester of pregnancy (T1) and 5 months postnatal (T2). The questionnaires dealt with perceived spousal equality, relationship’s quality and psychological adjustment (i.e., postpartum depression, negative and positive affect and life satisfaction). Results demonstrated that decrease in perceived equality from T1 to T2 reduced the levels of relationship’s quality, which in turn resulted in a decrease in mothers’ psychological adjustment, 5 months after giving birth. The centrality of spousal relationship for mothers’ psychological adjustment is discussed.

scholarly journals Risk assessment of preterm birth through identification and stratification of pregnancies using a real-time scoring algorithm

2021 ◽  
Vol 9 ◽  
pp. 205031212098672
Author(s):  
Lisa BE Shields ◽  
Clayton Weymouth ◽  
Kevin L Bramer ◽  
Scott Robinson ◽  
Donna McGee ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Real Time ◽  
First Trimester ◽  
Operating Characteristics ◽  
Early Care ◽  
Likelihood Ratios ◽  
Third Trimester ◽  
Predictive Values ◽  
Scoring Algorithm

Introduction: Preterm birth poses a significant challenge. This study evaluated a real-time scoring algorithm to identify and stratify pregnancies to indicate preterm birth. Methods: All claims data of pregnant women were reviewed between 1 January 2014 and 31 October 2018 in Kentucky. Results: A total of 29,166 unique women who were matched to a live newborn were documented, with the pregnancy identified during the first trimester in 54.1% of women. Negative predictive values, sensitivity, and positive likelihood ratios increased from the first to third trimesters as pregnant women who were matched to a live newborn had more visits with their physicians. The area under the receiving-operating characteristics curve on test data classifying preterm birth was 0.59 for pregnancies identified during the first trimester, 0.62 for pregnancies identified in the second trimester, and 0.73 for pregnancies identified in the third trimester. Conclusions: This study presents a real-time scoring algorithm of indicating preterm birth in the first trimester of gestation which permits stratification of pregnancies to provide more efficient early care management.

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