Evaluation of Anticoagulant Use during Pregnancy in Mothers with Antiphospholipid Syndrome: An Observational Cross-Sectional Study

Abstract Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity with persistent elevated concentration of antiphospholipid antibody. The use of anticoagulant in pregnant women with APS has reduced implantation failure, reduced rate of placental insufficiency, increased rate of delivery of live infant, and reduced rate of abortion. However, compared to its beneficial effects, anticoagulant therapy during pregnancy can be challenging because of the burden of the treatment (self-injecting anticoagulant for 9 months, cost of the treatment) and potential anticoagulant side effects. The purpose of this study was to evaluate the outcome of pregnant women with APS with anticoagulant. Method: We searched through medical records of pregnant women who visited hematology oncology clinic of Cikini CCI Hospital from year 2000 to 2017. Pregnant women with positive antiphospholipid antibodies who were treated with anticoagulant and followed up until presence of outcome were included in the study. Main outcome was any delivery of live infant above 22 weeks gestational age. Activated partial thromboplastin time (aPTT), d dimer level, birth weight and length were also documented. Results: We identified 92 pregnancies in 88 mothers diagnosed with antiphospholipid syndrome who were prescribed anticoagulant. From 92 pregnancies, 67 (73%) and 25 (27%) patients were prescribed low molecular weight heparin (LMWH) and unfractionated heparin (UFH), respectively, with combination of low dose antiplatelet agent. APTT and d dimer level of every patients were monitored monthly. 80% of the pregnancies successfully resulted in live births. The proportion of successful delivery of healthy infant in patients treated with UFH (21 out of 25; 84%) was greater than LMWH (53 out of 67; 79%) but not statistically different (p = 0,708) (Figure 1). Birth weight and length between groups were similar. Conclusion: UFH may be used as safe and cost-effective alternative treatment to LMWH in pregnant women with APS. Despite the use of anticoagulant and antiplatelet agents, 20% of patients still had adverse pregnancy outcome. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Serial D-dimer in Pregnant Women Compared to Antiphospholipid-antibodies Level, a History of Fetal Loss Syndrome and Invitro Fertilization

Blood ◽

10.1182/blood.v118.21.4364.4364 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4364-4364

Author(s):

Tubagus Djumhana Atmakusuma

Keyword(s):

Pregnant Women ◽

Conflicts Of Interest ◽

Post Partum ◽

Fetal Loss ◽

Assay Method ◽

Chromogenic Assay ◽

Group 2 ◽

High Level ◽

D Dimer ◽

Group 1

Abstract 4364 Background We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level. The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level?. Methods. A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method Results Of 83 pregnant women,19 women with high level of APAs (group 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (group 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (group 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml Conclusion Either in group 1, 2, and 3 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in group 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Does Adjusted Global Antiphospholipid Syndrome Score (aGAPSS) Predict the Obstetric Outcome in Antiphospholipid Antibody Carriers? A Single-Center Study

Clinical Reviews in Allergy & Immunology ◽

10.1007/s12016-021-08915-9 ◽

2021 ◽

Author(s):

Sara Del Barrio-Longarela ◽

Víctor M. Martínez-Taboada ◽

Pedro Blanco-Olavarri ◽

Ana Merino ◽

Leyre Riancho-Zarrabeitia ◽

...

Keyword(s):

Autoimmune Diseases ◽

Antiphospholipid Syndrome ◽

Adverse Pregnancy Outcome ◽

Clinical Manifestations ◽

Live Birth Rate ◽

Response To Treatment ◽

Antiphospholipid Antibody ◽

Single Center Study ◽

Patients At Risk ◽

Adverse Pregnancy

AbstractThe adjusted Global Antiphospholipid Syndrome (APS) Score (aGAPSS) is a tool proposed to quantify the risk for antiphospholipid antibody (aPL)-related clinical manifestations. However, aGAPSS has been validated mainly for thrombotic events and studies on APS-related obstetric manifestations are scarce. Furthermore, the majority of them included patients with positive aPL and different autoimmune diseases. Here, we assess the utility of aGAPSS to predict the response to treatment in aPL carriers without other autoimmune disorders. One-hundred and thirty-seven women with aPL ever pregnant were included. Sixty-five meet the APS classification criteria, 61 had APS-related obstetric manifestations, and 11 were asymptomatic carriers. The patients’ aGAPSS risk was grouped as low (< 6, N = 73), medium (6–11, N = 40), and high risk (≥ 12, N = 24). Since vascular risk factors included in the aGAPSS were infrequent in this population (< 10%), the aGAPSS score was mainly determined by the aPL profile. Overall, the live birth rate was 75%, and 37.2% of the patients had at least one adverse pregnancy outcome (APO). When considering patients according to the aGAPSS (high, medium, and low risk), no significant differences were found for pregnancy loss (29.2%, 25%, and 21.9%) or APO (33.3%, 47.5%, and 32.9%). In the present study, including aPL carriers without other autoimmune diseases, aGAPSS is not a valuable tool to identify patients at risk for obstetric complications despite treatment. In these patients with gestational desire, in addition to the aPL profile, other pregnancy-specific factors, such as age or previous obstetric history, should be considered.

Download Full-text

Features of laboratory markers in pregnant women with antiphospholipid syndrome and retrochorial hematoma

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001973 ◽

2021 ◽

pp. 12-19

Author(s):

Oleh Tomniuk

Keyword(s):

Platelet Aggregation ◽

T Lymphocytes ◽

Pregnant Women ◽

Nk Cells ◽

Antiphospholipid Syndrome ◽

Annexin V ◽

Main Group ◽

Control Group ◽

Antiphospholipid Antibody ◽

Willebrand Factor

The aim. Study of hemostasis, antiphospholipid antibody levels and immunological parameters in pregnant women with antiphospholipid syndrome (APS), in particular with retrochorial hematoma (RCH). Materials and methods. 90 women were selected and divided into two groups: the control group – 30 pregnant women with a normal pregnancy (without APS) and the main group – 60 pregnant women with APS. Women in the main group were diagnosed with APS before pregnancy. In turn, the main group was divided into two subgroups: 1 subgroup – 41 pregnant women without RCH and 2 subgroup – 19 pregnant women with RCH. The main indicators of hemostasis were determined in all pregnant women, namely: the degree and rate of platelet aggregation, Willebrand factor, D-dimers. In addition, the level of antiphospholipid antibodies (APLA), antibodies to β2-glycoprotein, to annexin V, to prothrombin was examined, and the level of annexin V was also determined. The absolute and relative content of Treg, CD3+, T-lymphocytes, CD4+ (T-helpers), CD8+ (cytotoxic T-lymphocytes), CD19+ (B-lymphocytes), CD16+CD56+ (NK cells), CD16+CD56+CD107a+ (activated NK cells). Results. The obtained results showed that in pregnant women with APS compared to pregnant women without APS there are statistically significantly higher values of the degree and rate of platelet aggregation (90.6±6.3% and 106.3±6.7% vs. 65.3±5.3 % and 73.4±5.6%, respectively). There were also higher values of Willebrand factor and D-dimers (2.5±0.3 IU/ml and 378.1±34.3 ng/ml against 1.7±0.2 IU/ml and 268.1±27, 3 ng/ml, respectively). APLAs were significantly higher in pregnant women with APS compared with pregnant women in the control group, namely: 16.1±1.5 vs. 3.8±0.4 U/ml. With regard to antibodies to β2-glycoprotein, to annexin V, to prothrombin and to the level of annexin V, their values were also statistically significantly higher in the group of pregnant women with APS. In addition, the results of the study showed that pregnant women with APS showed changes in subpopulations of immunocompetent cells. However, examining the difference in hemostasis, antibody content, and level of lymphocyte subpopulations between pregnant women with APS with and without RCH, it was found that their shifts in pregnant women with RCH were more pronounced than in women without RCH. Conclusions. Pregnant women with APS are characterized by significantly more significant changes in hemostasis, manifested by activation of intravascular thrombosis. In addition, such pregnant women had a significantly higher concentration of autoantibodies. There are also changes in the immune system, in particular, a decrease in Treg-cells, which have the ability to reduce the specific proliferation and effector functions of lymphocytes, thereby participating in the pathogenesis of APS.

Download Full-text

Acute Myeloid Leukemia Diagnosed During Pregnancy: Facing Challenges. Systematic Review and Analysis Of 174 Reported Cases

Blood ◽

10.1182/blood.v122.21.1421.1421 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1421-1421

Author(s):

Israel Henig ◽

Liat Vidal ◽

Oryan Henig ◽

Noam Benyamini ◽

Irit Avivi

Keyword(s):

Acute Myeloid Leukemia ◽

Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Myeloid Leukemia ◽

Conflicts Of Interest ◽

Fetal Outcome ◽

Available N ◽

Live Baby ◽

Acute Myeloid

Abstract Introduction Data on pregnancy-associated acute myeloid leukemia (PA-AML) are scanty, coming from case reports and very small retrospective case series. The aim of the current study was to analyze reported maternal and fetal clinical characteristics and treatment decisions and provide a comprehensive basis for the development of guidelines for the management of women with PA-AML. Methods A systematic search of articles on PA-AML diagnosed during pregnancy or immediately after delivery, published between January 1967 and June 2013 in journals indexed in PubMed, was performed. Search terms of “acute leukemia”, “acute myeloid leukemia” and “acute promyelocytic leukemia” (APL) were crossed with terms “pregnancy”, “gestation” and “partum”. Additional potentially relevant reports referenced in reviewed articles were evaluated. Data on women's age, gestational stage, AML subtype, therapy, timing of its application, achieving complete remission (CR), survival status and fetal outcome (malformations, survival, birth weight) were recorded. Results One hundred and seventy three PA-AML cases, reported in 88 papers, were analyzed. AML was reported in 120 cases (69%) and APL in 53 cases (31%). The French-American-British (FAB) AML categorization, available for 59 non-M3 AML cases, showed the distribution of AML subtypes similar to that reported in non-pregnant women (M1 - 3%, M2 - 12%, M4 - 30%, M5 - 27%, M6 - 5%, M7 - 1%). Median age at diagnosis was 28 years (range 15-45). Thirty seven women (22%) were diagnosed during 1st trimester, 85 (50%) in 2nd and 47 (28%) in 3rd trimester. The trimester was not reported in 4 cases. One hundred and twenty five women received chemotherapy during pregnancy: 18 in whom therapy was started in 1st trimester, 81- in 2nd and 26 - in 3rd trimester. In 46 patients, treatment was administered either after elective abortion (n = 26), or after delivery of a live baby (n =20). Data on therapy were unavailable in 2 cases. Delay in therapy beyond 1 week (range 2-20) from diagnosis (n = 21) did not affect the overall survival (OS) compared to that obtained in women treated promptly (median 11.5 vs 10.5 months, respectively; p=0.572). Among patients for whom remission data were available (n=151), 82 (73%) treated during pregnancy, and 27 (70%) treated after delivery, achieved CR. Within a median follow-up of 9 months (range 0-300), median OS for the entire cohort was 10.5 months (9 for AML vs 15.5 for APL; p=0.001). A multivariate analysis showed APL to be the only independent predictive factor for an improved OS (p=0.037), while maternal age and treatment delay had no statistically significant impact on OS (p= 0.83 and 0.889, respectively). Notably, the OS of women with PA-AML tended to improve over time (19 months for women treated over the last 30 years vs 8 months for those treated earlier; p = 0.09) (Figure 1); however, it is still less than the median OS of 3 years reported in age-matched non-pregnant women (http://seer.cancer.gov). One hundred and forty seven pregnancies were evaluable for the fetal outcome (excluding elective abortions); 117 (80%) pregnancies ended in delivery of a live baby. Six pregnancies where fetuses were exposed to chemotherapy during the 1st (n=1) or 2nd (n=5) trimester resulted in delivery of malformed newborns; 28 pregnancies ended in fetal death (5 stillbirths, 13 intrauterine fetal deaths, 4 post-delivery deaths, 5 unplanned abortions, 1 cause unavailable). Fetal outcome was unavailable for 2 babies. The median birth weight was 2.3 Kg for the 89 babies with reported weight (range 1.7-5 Kg). Among the 83 babies for whom data about birth weight and pregnancy week were available, 59% had a weight appropriate for the gestational age, 30% were small for gestational age and 11% were large for gestational age. In 89% of cases where information was available, the delivery was pre-term. No case of fetal leukemia was reported. Conclusions Based on our retrospective analysis, the outcome of women diagnosed with AML during pregnancy appears to be worse than that reported in age-matched non-pregnant women. The survival rate of the fetuses exposed to chemotherapy is encouraging. The incidence of malformations is low and the birth weight of most newborns is appropriate for the gestational age. Therapy delay could be considered in some of these patients, but large registry-based studies are warranted to establish treatment recommendations for the management of PA-AML. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Assessment of D-Dimer Levels in Southwestern Nigerian Pregnant Women

Advances in Research ◽

10.9734/air/2020/v21i930233 ◽

2020 ◽

pp. 60-68

Author(s):

E. O. Bamisaye ◽

M. A. Okungbowa ◽

D. T. Alade ◽

O. Brown- West ◽

G. T. Oluwasuji

Keyword(s):

Pregnant Women ◽

Teaching Hospital ◽

First Trimester ◽

Elevated Concentration ◽

Third Trimester ◽

Southwestern Nigeria ◽

Blood Samples ◽

The Third ◽

The Mean ◽

D Dimer

Aim: This study evaluated D-dimer level in pregnant and non-pregnant women in Southwestern Nigeria in order to provide more information on the concentration and liable risks in this region. Study Design: This is a cross sectional study where convenience sampling method was applied in sample collection. Place and Duration of Study: Blood samples were collected from pregnant women attending the antenatal clinics of Federal Teaching Hospital Ido-Ekiti (FETHI), Ekiti; Federal Medical Centre (FMC), Owo; and LAUTECH Teaching Hospital (LTH), Osogbo in Southwestern Nigeria. Methodology: Exactly three hundred pregnant (300) and one hundred and fifty (150) apparently healthy non pregnant women were recruited for this study. The blood samples were analysed for haematocrit (HCT) and platelet count using Sysmex KX-2IN (Japan); prothrombin time (PT) and activated partial thromboplastin time (APTT) by Diagen reagents (Diagnostic Ltd., UK); the international normalized ratio (INR) was calculated from the PT results; and D-dimer quantitative assay using Tina Quant Gen 2 on Cobas C111 (Roche). Data analysis was performed using IBM-SPSS version 25.0; mean and standard deviation was used to summarize continuous variables and descriptive and Inferential statistical tests were employed with level of statistical significance was determined at p<0.05. Results: The mean D-dimer levels were significantly higher in the pregnant women (0.87 ± 1.00 ugFEU/ml) than in controls (0.31 ± 0.22 ugFEU/ml) with 42% of the pregnant population having elevated concentration while the mean PT, INR and HCT were significantly higher in controls than the subjects (p<0.05).Furthermore, the HCT, platelet, PT and INR were observed to be highest at first trimester; 36.04±5.09 (L/L), 182.72±35.11 (x109/L), 11.80±1.86 (seconds) and 0.35±0.15 respectively, decreasing across the second and the third trimester. On the other hand, the D-dimer and APTT increased exponentially from the first trimester; 0.42±0.18 (ugFEU/ml) and 30.80±3.30 (seconds), through the second and third trimesters respectively (p>0.05). Conclusion: This study shows a significant increase in D-dimer in the pregnant subjects when compared with the control and an exponential increase in the third trimester, also a significant reduction in some other baseline coagulation profile hence depicting D-dimer as a notable significant marker of coagulation and fibrinolysis. This therefore emphasizes the hypercoagulable state of pregnancy and a need for adequate monitoring.

Download Full-text

Serial D-Dimer in Pregnancy Women with a History of Fetal Loss Syndrome and Invitro Fertilization

Blood ◽

10.1182/blood.v118.21.4366.4366 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4366-4366

Author(s):

Tubagus Djumhana Atmakusuma ◽

Raden Muharam

Keyword(s):

Pregnant Women ◽

Umbilical Artery ◽

Conflicts Of Interest ◽

Post Partum ◽

Fetal Loss ◽

Assay Method ◽

Chromogenic Assay ◽

History Of ◽

High Level ◽

D Dimer

Abstract Abstract 4366 Background We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level, history of fetal loss syndrome or invitro fertilization (IVF). The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level, history of fetal loss syndrome and IVF?. Methods. A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method, a history of fetal loss syndrome and IVF conception Results Of 83 pregnant women,19 women with high level of APAs (subgroup 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (subgroup 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (subgroup 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml Of 83 pregnant women, 47 women who have experienced 1 or ≥ 1 abortion or IUFD (subgroup 4) showed D-dimer level as follows: Trimester I:493.09 ± 385.89 ng/ml, trimester II: 740.23 ± 564.99 ng/ml, trimester III: 859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Meanwhile, 36 women who have no history of fetal loss (subgroup 5) showed: Trimester I: 892.17± 593.47 ng/ml, trimester II: 930.57± 807.02 ng/ml, trimester III: 1439.71 ± 932.12 ng/ml, post partum 1695.16 ± 1131.56 ng/ml. Of 83 pregnant women, 10 women who became pregnant after embryo transfer of IVF (subgroup 6) showed: Trimester I: 493.09± 385.895 ng/ml, trimester II: 740.23± 564.99 ng/ml, trimester III:859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Conclusion Either in subgroup 1, 2, 3,4,5 and 6 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in subgroup 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Obstetric outcomes in patients with primary thrombotic and obstetric antiphospholipid syndrome and its relation to the antiphospholipid antibody profile

Lupus ◽

10.1177/0961203319852155 ◽

2019 ◽

Vol 28 (7) ◽

pp. 868-877 ◽

Cited By ~ 2

Author(s):

A Högdén ◽

A Antovic ◽

E Berg ◽

K Bremme ◽

R Chaireti

Keyword(s):

Birth Weight ◽

Antiphospholipid Syndrome ◽

Pregnancy Outcomes ◽

University Hospital ◽

Obstetric Outcomes ◽

Antiphospholipid Antibody ◽

Primary Antiphospholipid Syndrome ◽

Antibody Positivity ◽

Obstetric Antiphospholipid Syndrome ◽

Antibody Profile

Introduction: Previous studies suggested different obstetric outcomes between patients with thrombotic or obstetric antiphospholipid syndrome, but the data are inconclusive. Aims: To investigate obstetric outcomes and their relation to the antiphospholipid antibody profile in primary thrombotic or obstetric antiphospholipid syndrome patients and compare those to a control population. Materials and methods: A retrospective single-centre study on a cohort of 30 pregnant women with primary antiphospholipid syndrome treated at Karolinska University Hospital Solna, Sweden between 2000 and 2016. The pregnancy outcomes were compared to the outcomes of all pregnancies in Stockholm County during the same period. Results: Preeclampsia ( p < 0.001), low birth weight at delivery ( p = 0.001), Apgar < 7 at 5 minutes ( p < 0.001) and small infants ( p < 0.001) were more common in antiphospholipid syndrome patients compared to controls. Obstetric antiphospholipid syndrome patients had a higher incidence of small infants ( p = 0.023), lower birth weight ( p = 0.013) and infants born with complications ( p=0.004) compared to thrombotic antiphospholipid syndrome. Mothers with triple antibody positivity had a higher incidence of preeclampsia ( p = 0.03), preterm delivery ( p = 0.011), small infants ( p=0.002) and infants born with complications ( p = 0.012). Conclusions: Patients with primary antiphospholipid syndrome, especially those with obstetric antiphospholipid syndrome and triple antibody positivity, are at higher risk for adverse pregnancy outcomes, even under antithrombotic treatment. More frequent antenatal controls in high-risk patients can further improve outcomes.

Download Full-text

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

Current Women s Health Reviews ◽

10.2174/1573404816999201009160848 ◽

2020 ◽

Vol 16 ◽

Author(s):

Reza Omani-Samani ◽

Saman Maroufizadeh ◽

Nafise Saedi ◽

Nasim Shokouhi ◽

Arezoo Esmailzadeh ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Maternal Age ◽

Unwanted Pregnancy ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

Download Full-text

HPV Prevalence and its Association with Perinatal Outcomes among Singleton Mothers: Analysis of Pregnancy Risk Assessment and Monitoring System (PRAMS) Data, 2004-2011

Current Women s Health Reviews ◽

10.2174/1573404814666180517085022 ◽

2019 ◽

Vol 15 (2) ◽

pp. 143-149 ◽

Cited By ~ 1

Author(s):

Harpriya Kaur ◽

Delf Schmidt-Grimminger ◽

Baojiang Chen ◽

K.M. Monirul Islam ◽

Steven W. Remmenga ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Monitoring System ◽

Large Population ◽

Perinatal Outcomes ◽

Hpv Infection ◽

Adverse Outcomes ◽

P Value ◽

Pregnancy Risk

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

Download Full-text

Influence of vitamin D serum concentration, prenatal care and social determinants on birth weight: a northeastern Brazilian cohort study

British Journal Of Nutrition ◽

10.1017/s0007114519001004 ◽

2019 ◽

Vol 122 (03) ◽

pp. 284-292 ◽

Cited By ~ 2

Author(s):

Marcos Pereira-Santos ◽

Gisele Queiroz Carvalho ◽

Djanilson Barbosa dos Santos ◽

Ana Marlucia Oliveira

Keyword(s):

Vitamin D ◽

Birth Weight ◽

Prenatal Care ◽

Serum Concentration ◽

Pregnant Women ◽

Social Determinants ◽

Maternal Education ◽

Late Onset ◽

High Birth Weight ◽

Maternal Vitamin

AbstractThe relationship among social determinants, vitamin D serum concentration and the health and nutrition conditions is an important issue in the healthcare of pregnant women and newborns. Thus, the present study analyses how vitamin D, prenatal monitoring and social determinants are associated with birth weight. The cohort comprised 329 pregnant women, up to 34 weeks gestational age at the time of admission, who were receiving care through the prenatal services of Family Health Units. Structural equation modelling was used in the statistical analysis. The mean birth weight was 3340 (sd 0·545) g. Each nmol increase in maternal vitamin D serum concentration was associated with an increase in birth weight of 3·06 g. Prenatal healthcare with fewer appointments (β −41·49 g, 95 % CI −79·27, −3·71) and late onset of care in the second trimester or third trimester (β −39·24 g, 95 % CI −73·31, −5·16) favoured decreased birth weight. In addition, low socio-economic class and the practice of Afro-Brazilian religions showed a direct association with high vitamin D serum concentrations and an indirect association with high birth weight, respectively. High gestational BMI (β 23·84, 95 % CI 4·37, 43·31), maternal education level (β 24·52 g, 95 % CI 1·82, 47·23) and length of gestation (β 79·71, 95 % CI 52·81; 106·6) resulted in high birth weight. In conclusion, maternal vitamin D serum concentration, social determinants and prenatal care, evaluated in the context of primary healthcare, directly determined birth weight.

Download Full-text