Management of pregnancy with diffuse cutaneous systemic sclerosis: a case report and literature review

Diffuse cutaneous systemic sclerosis may occur in women of childbearing age. Pregnancies in this population are associated with a markedly increased risk of adverse obstetric and maternal outcomes even before the onset of symptoms related to sclerosis. We report a case involving the management and outcome of pregnancy in a 30-year-old woman with diffuse cutaneous systemic sclerosis. The course of her pregnancy was good and was assisted by a group consultation including obstetricians and rheumatologists. Vaginal delivery was the patient’s preferred choice because she had irregular skin tightness in her lower abdominal skin. She underwent induction of labor and combined spinal-epidural analgesia, and successfully delivered. Importantly, these pregnancies need to be planned, where possible, to allow the opportunity to counsel women and their partners in advance and to decrease any risks. These pregnancies should be considered high risk, and they require close antenatal monitoring and good supervision from an expert multidisciplinary team experienced in high-risk pregnancies. The management of delivery for patients with cutaneous systemic sclerosis is challenging, and vaginal delivery with labor analgesia is an alternative option to cesarean section.

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An observational study of the reactogenicity and immunogenicity of 13-valent pneumococcal conjugate vaccine in women of childbearing age in Papua New Guinea

Pneumonia ◽

10.1186/s41479-020-00076-1 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Sarah Javati ◽

Geraldine Masiria ◽

Arthur Elizah ◽

John-Paul Matlam ◽

Rebecca Ford ◽

...

Keyword(s):

High Risk ◽

Observational Study ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Early Life ◽

Women Of Childbearing Age ◽

Pneumococcal Infections ◽

Childbearing Age ◽

Igg Antibody ◽

Young Infants

Abstract Background Maternal immunization with pneumococcal conjugate vaccine (PCV) may protect young infants in high-risk settings against the high risk of pneumococcal infections in early life. The aim of this study was to determine the safety and immunogenicity of 13-valent PCV (PCV13) in healthy women of childbearing age in PNG. Methods As part of this observational study, 50 non-pregnant women of childbearing age (18-45 yrs. old) living in the highlands of PNG were vaccinated with a single dose of PCV13. Local and systemic reactogenicity were assessed 24–48 h after vaccination. Venous blood samples were collected before and 1 month after vaccination to measure PCV13 serotype-specific IgG antibody concentrations. Results No severe adverse effects were reported during the 1-month follow-up period. IgG antibody concentrations significantly increased after vaccination for all PCV13 serotypes. One month after vaccination IgG antibody levels ≥2.5 μg/mL were reached in at least 75% of women for all PCV13 serotypes, except serotype 3, and ≥ 5 μg/mL in at least 75% of women for 7 serotypes (serotypes 6B, 9 V, 14, 18C, 19A, 19F and 23F). Conclusion PCV13 is safe and immunogenic in women of childbearing age living in a high-risk setting in PNG. This supports the implementation of studies to investigate the safety and immunogenicity of maternal PCV vaccination in high-risk settings as a strategy to protect infants in these settings against the high risk of pneumococcal infections in early life. Trial registration NCT04183322. Registered 3 December 2019 - Retrospectively registered

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P152 Skin score trajectory associates with survival and pulmonary outcome in diffuse cutaneous systemic sclerosis

Rheumatology ◽

10.1093/rheumatology/keaa111.147 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Svetlana I Nihtyanova ◽

Emma C Derrett-Smith ◽

Carmen Fonseca ◽

Voon H Ong ◽

Christopher P Denton

Keyword(s):

Systemic Sclerosis ◽

Pulmonary Complications ◽

Rate Of Change ◽

Skin Thickness ◽

Group Level ◽

Skin Score ◽

Risk Of Death ◽

Increased Risk ◽

Diffuse Cutaneous Systemic Sclerosis ◽

Over Time

Abstract Background Skin thickness improves over time in most diffuse cutaneous systemic sclerosis (dcSSc) patients and the use of group level skin score (mRss) as an endpoint is clinical trials can be challenging. We explore the association between individual mRss trajectories and outcome in early dcSSc patients. Methods Subjects with at least one mRss assessment within the first 5 years from onset were included. Random effects models were fitted to evaluate changes in mRss over time and model-predicted individual patient intercepts and slopes were included in Cox regression to assess associations with outcome. Results Of the 467 patients, 22.7% were male and mean age of disease onset was 45.5 years. Most frequent autoantibodies were anti-Scl70 in 30.2% and anti-RNA polymerase (ARA) in 30.0% of subjects. Average mRss at 12 months from onset was 25 and this declined over time, slowing down with longer disease duration (3.4, 2.7, 1.9 and 1.2 units at years 2, 3, 4 and 5). Higher initial mRss associated with greater subsequent decline (correlation coefficient -0.3). Both higher baseline mRSS (intercept) and slower decline (higher slope) predicted increased risk of death with 8% increase in hazard for every unit higher baseline mRss and 4% increase for every unit higher slope (Table 1). Adjusting for autoantibodies did not change the estimates. ANA+ENA- subjects had the highest risk of death, followed by ATA + (HR 0.91, p = 0.677 v ANA+ENA-), while risk was lowest among ARA+ subjects (HR 0.47, p = 0.002 v ANA+ENA-). Risk of pulmonary complications was associated with rate of change in mRss but not with baseline absolute value. A unit slower yearly decline in mRss increased the hazard of pulmonary fibrosis (PF) by 3.5% and pulmonary hypertension (PH) by 7% (Table 1). The association between mRss and PF disappeared after adjusting for antibody specificities, while the association between skin and PH did not change. Autoantibodies did not show significant association with PH development within this dcSSc cohort. Conclusion Although at a group level there is an improvement in skin over the initial 5 years, for individual patients, poor outcome for skin predicts increased risk of pulmonary complications and higher mortality. Disclosures S.I. Nihtyanova None. E.C. Derrett-Smith None. C. Fonseca None. V.H. Ong None. C.P. Denton None.

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Challenges of Takayasu Arteritis in Pregnancy: A Case Report

Vascular and Endovascular Surgery ◽

10.1177/1538574417698904 ◽

2017 ◽

Vol 51 (4) ◽

pp. 195-198 ◽

Cited By ~ 5

Author(s):

Sarah Soo-Hoo ◽

Jenny Seong ◽

Brandon R. Porten ◽

Nedaa Skeik

Keyword(s):

Heart Failure ◽

Takayasu Arteritis ◽

Cardiovascular Complications ◽

Unknown Etiology ◽

Optimal Management ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Clinical Challenge ◽

Increased Risk ◽

In Pregnancy

Takayasu arteritis is a rare, chronic vasculitis of unknown etiology characterized by inflammation of the aorta and its main branches. Although Takayasu arteritis mostly affects women of childbearing age, there is a paucity in the literature on pregnancy associated with Takayasu arteritis. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes. Furthermore, optimal management has not yet been established for pregnant patients with Takayasu arteritis, posing a clinical challenge. We present a case of a young woman with Takayasu arteritis whose symptoms and disease activity improved during 2 pregnancies. Although her first pregnancy was complicated with preeclampsia, gestational diabetes, and preterm vaginal delivery, her second pregnancy was uneventful. This case provides a rare glimpse of Takayasu arteritis in pregnancy and highlights the challenges of medical management in gravid patients.

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Socioeconomic status and vitamin D deficiency among women of childbearing age: a population-based, case–control study in rural northern China

BMJ Open ◽

10.1136/bmjopen-2020-042227 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042227

Author(s):

Shiqi Lin ◽

Lifang Jiang ◽

Yuan Zhang ◽

Jian Chai ◽

Jiajia Li ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Northern China ◽

Population Based ◽

Vitamin D Insufficiency ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Severe Deficiency ◽

Increased Risk ◽

Control Study

ObjectiveTo explore the association between socioeconomic status (SES) and vitamin D deficiency/insufficiency of women of childbearing age in rural northern China.DesignA population-based, case–control study was conducted.SettingFour counties of Henan Province, China from 2009 to 2010.Participants1151 non-pregnant healthy women between 18 and 40 years old.Primary and secondary outcome measuresSerum 25-hydroxyvitamin D (25(OH)D) levels were measured using high-performance liquid chromatography-tandem mass spectrometry. Vitamin D insufficiency was defined as serum 25(OH)D ≥20 ng/mL and <30 ng/mL, deficiency as ≥10 ng/mL and <20 ng/mL, and severe deficiency as <10 ng/mL. SES was measured separately by women’s and their husbands’ education level and occupation, household income and expenditure, as well as aggregately by SES index constructed with principal component analysis.ResultsThe median serum 25(OH)D level was 20.90 (13.60–34.60) ng/mL, and the prevalence of vitamin D insufficiency, deficiency and severe deficiency was 20.16%, 31.80% and 15.99%, respectively. After adjustment, household annual income <¥10 000 was associated with increased risk of vitamin D insufficiency (adjusted OR (aOR): 2.10, 95% CI 1.41 to 3.14), deficiency (aOR: 1.58, 95% CI 1.09 to 2.29) and severe deficiency (aOR: 2.79, 95% CI 1.78 to 4.38); inadequate household income for expenditure was associated with elevated risk of vitamin D insufficiency (aOR: 1.66, 95% CI 1.08 to 2.54) and deficiency (aOR: 1.81, 95% CI 1.26 to 2.62); low SES index was associated with elevated risk of vitamin D insufficiency (aOR: 2.40, 95% CI 1.52 to 3.80) and deficiency (aOR: 1.64, 95% CI 1.08 to 2.50); and both middle and low SES index were associated with increased risk of vitamin D severe deficiency (aOR: 1.70, 95% CI 1.02 to 2.84; aOR: 2.45, 95% CI 1.45 to 4.14).ConclusionsLower SES was associated with higher risk of vitamin D deficiency/insufficiency in women of childbearing age in rural northern China. More should be done to explore potential mechanisms and to narrow down SES inequalities in vitamin D status.

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The Influence Of Nutrition Counseling On The Knowledge And Intake Of Macro Nutrient Wus Kek In Region Work Puskesmas Sawah Lebar Bengkulu

SANITAS : Jurnal Teknologi dan Seni Kesehatan ◽

10.36525/sanitas.2019.4 ◽

2019 ◽

Vol 10 (1) ◽

pp. 35-45

Author(s):

Meili Dwi Ananda ◽

Jumiyati Jumiyati ◽

Emy Yuliantini

Keyword(s):

Statistical Analysis ◽

Health Center ◽

Post Partum ◽

Wilcoxon Test ◽

Nutrition Counseling ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Increased Risk ◽

Low Birth Weight Babies ◽

The City

Women of Childbearing Age (WUS) are a population that are of particular interest inthe prevention of nutritional problems, especially in addressing their Lack of Chronic Energy (KEK). KEK in WUS is very likely to result in a difficult childbirth and post partum hemorrhage as well as an increased risk death of the mother and of low birth weight babies. Data WUS SEZ in Indonesia in 2010 (30,9%) increased in 2013 (46,4%). Sixteen provinces with the prevalence of the risk of SEZ above the national province, namely the Bengkulu Province (15%). The purpose of this study is to determine the effect of nutrition counseling on the knowledge and intake of macro nutrient on WUS SEZ in the working area of Health Center of Sawah Lebar the Width of the City of Bengkulu the Year 2018. The results of this study there was significant influence of nutritional counseling (p = 0.000) on the intake of macro nutrient (p = 0.000). On WUS KEK in the working area of Health Center of Sawah Lebar the width of the city of bengkulu the year 2018.The Design of this Research is Pre Experimental Design with design One Group Pretest-Posttest. Nutrition counseling on WUS KEK performed 3 times during 3 weeks. The number of samples as many as 23 people. Statistical analysis using dependent t-test and wilcoxon test

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Upaya Pencegahan Kehamilan Resiko Tinggi yang Disebabkan "4 Terlalu" pada Wanita Usia Subur (WUS) di Desa Juntiweden Kabupaten Indramayu

PengabdianMu Jurnal Ilmiah Pengabdian kepada Masyarakat ◽

10.33084/pengabdianmu.v5i1.903 ◽

2019 ◽

Vol 5 (1) ◽

pp. 1-5

Author(s):

Dartiwen Dartiwen ◽

Cucu Nurmala

Keyword(s):

High Risk ◽

Adult Learning ◽

Community Service ◽

Health Workers ◽

Reproductive Organs ◽

Practical Skills ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Infant Deaths ◽

Discussion Question

Fertile Age Women (WUS) are women whose reproductive organs function well between the ages of 20 and 45 years. In Juntiweden Village, there are still many pregnant women who have a high risk so that health workers need to develop practical skills to improve maternal health. One of our approaches is through community service activities by counseling women of childbearing age who aim to increase knowledge to prevent high-risk pregnancies caused by "4 Terlalu" as an effort to improve women's reproductive health. The counseling method uses adult learning methods, including discussion, question and answer, and video screenings. The description of the activity is carried out pretest in advance by using a questionnaire, giving material then carried out posttest. The results of the 50 people the number of participants found that before counseling (pretest) there were 44 people (88%) with less knowledge and six people (12%) with enough knowledge, whereas after being given counseling (posttest) results obtained 50 people (100%) good knowledge. This means that there is an increase in WUS knowledge about preventing high-risk pregnancies after getting counseling. This dedication activity can increase the knowledge of WUS in efforts to prevent high-risk pregnancies from reducing the number of maternal and infant deaths caused by 4 Terlalu.

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Factors Associated with Vitamin D Deficiency and Inadequacy among Women of Childbearing Age in the United States

ISRN Obstetrics and Gynecology ◽

10.5402/2012/691486 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 16

Author(s):

Guixiang Zhao ◽

Earl S. Ford ◽

James Tsai ◽

Chaoyang Li ◽

Janet B. Croft

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

The United States ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Hydroxyvitamin D ◽

Supplement Use ◽

Increased Risk ◽

25 Hydroxyvitamin D ◽

Dietary Supplement Use

Objective. To examine the prevalence and correlates of vitamin D deficiency and inadequacy among US women of childbearing age. Methods. Data from 1,814 female participants (20–44 y) in the 2003–2006 NHANES were analyzed to estimate the age-adjusted prevalence and prevalence ratios with 95% confidence intervals (CIs) for vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] <12.0 ng/mL) and inadequacy (defined as 25(OH)D: 12.0–<20.0 ng/mL). Results. The age-adjusted prevalence was 11.1% (95% CI: 8.8–14.0%) for vitamin D deficiency and 25.7% (95% CI: 22.3–29.5%) for vitamin D inadequacy. Race/ethnicity other than non-Hispanic white and obesity were associated with increased risks, whereas dietary supplement use, milk consumption of ≥1 time/day, and potential sunlight exposure during May-October were associated with decreased risks for both vitamin D deficiency and inadequacy (). Current smoking and having histories of diabetes and cardiovascular disease were also associated with an increased risk for vitamin D deficiency (). Conclusions. Among women of childbearing age, periconceptional intervention programs may focus on multiple risk factors for vitamin D deficiency and inadequacy to ultimately improve their vitamin D nutrition.

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Thoughts and Considerations of Women With Bipolar Disorder About Family Planning and Pregnancy: A Qualitative Study

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390317711251 ◽

2017 ◽

Vol 24 (2) ◽

pp. 118-126 ◽

Cited By ~ 3

Author(s):

Anja Wilhelmina Margaretha Maria Stevens ◽

Thea Henrica Daggenvoorde ◽

Samuel Martinus Dianshah van der Klis ◽

Ralph Werner Kupka ◽

Peter Jan Joseph Goossens

Keyword(s):

Bipolar Disorder ◽

Content Analysis ◽

Family Planning ◽

Qualitative Study ◽

Specific Information ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Increased Risk ◽

Planning Objective ◽

Risk Of Relapse

BACKGROUND: Women with bipolar disorder have an increased risk of relapse during pregnancy and the postpartum period, and they often express broad concerns about family planning. OBJECTIVE: To explore the thoughts and considerations of women of childbearing age with bipolar disorder, about family planning and pregnancy. DESIGN: A qualitative study was conducted: 15 women with bipolar I disorder were individually interviewed. Content analysis was applied. RESULTS: Women worried about heritability of bipolar disorder, medication issues, and risk of relapse during pregnancy. They mentioned their fear to be incompetent as a mother during future mood episodes. Support of partner, family/friends, and professionals was mentioned as essential. CONCLUSIONS: Family planning is an essential topic in the treatment of every woman with bipolar disorder of childbearing age. These women expect early consultation with professionals for support, and specific information about heritability of the illness and use of medication during and after pregnancy.

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High prevalence of high-risk oncogenic human papillomaviruses harboring atypical distribution in women of childbearing age living in Libreville, Gabon

Journal of Medical Virology ◽

10.1002/jmv.20472 ◽

2005 ◽

Vol 77 (3) ◽

pp. 430-438 ◽

Cited By ~ 17

Author(s):

Ali Si-Mohamed ◽

Angélique Ndjoyi-Mbiguino ◽

Kate Cuschieri ◽

Isabelle Ndombi Onas ◽

Isabelle Colombet ◽

...

Keyword(s):

High Risk ◽

Human Papillomaviruses ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

High Prevalence

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Joint effect of 25-hydroxyvitamin D and secondhand smoke exposure on hypertension in non-smoking women of childbearing age: NHANES 2007-2014

Environmental Health ◽

10.1186/s12940-021-00803-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Qianqian Shen ◽

Qian Xu ◽

Guoju Li ◽

Lisheng Ren ◽

Zhenhong Zhang ◽

...

Keyword(s):

Blood Pressure ◽

Synergistic Effect ◽

Secondhand Smoke ◽

Molecular Mechanisms ◽

Interactive Effect ◽

Joint Effect ◽

Directed Acyclic Graphs ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Increased Risk

Abstract Background Vitamin D deficiency (VDD) may increase the risk of hypertension in women of childbearing age, who may be exposed to secondhand smoke (SHS) simultaneously. Till now, few studies have investigated the joint effects of VDD and SHS on hypertension in this population. We evaluated whether exposure to SHS modified the association between VDD and hypertension. Methods Data from National Health and Nutrition Examination Surveys (NHANES) 2007-2014 were analyzed. Our research subjects were 2826 nonsmoking and nonpregnant women of childbearing age (20-44 years old). Hypertension was defined based either on systolic blood pressure (SBP) ≥ 130 mmHg and/or diastolic blood pressure (DBP) ≥ 80 mmHg or on now taking prescribed medicine for hypertension. The directed acyclic graphs (DAG) and the back-door criterion were used to select a minimal sufficient adjustment set of variables (MSAs) that would identify the unconfounded effect of 25(OH)D and hypertension. The interactive effect of VDD and SHS on hypertension was evaluated by using logistic regression models, followed by strata-specific analyses. Results The prevalence of VDD in the hypertension group was significantly higher than that in the non-hypertension group (48.2% vs 41.0%, P = 0.008), as well as the exposure rate of SHS (39.1% vs 33.8%, P = 0.017). VDD was independently associated with nearly 50% increased risk of hypertension [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI): 1.01, 2.04], while no significant association was observed between SHS and hypertension. However, SHS showed a significant synergistic effect on VDD with a higher aOR of 1.79 (95% CI: 1.14, 2.80) (Pinteraction = 0.011). This synergistic effect was more obvious when stratified by BMI (in overweight women, aOR, 95% CI =4.74, 1.65-13.60 for interaction vs 2.33, 1.01-5.38 for VDD only) and race (in Non-Hispanic Black women, aOR, 95% CI =5.11, 1.58-16.54 for interaction vs 2.69, 1.10-6.62 for VDD only). Conclusion There exist synergistic effects of SHS and VDD on the prevalence of hypertension in American women of childbearing age, with more significant effects in women who were overweight or Non-Hispanic Black. Further studies are warranted to verify this finding in other populations, and the molecular mechanisms underlying the joint effect of SHS and VDD need to be elucidated.

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