scholarly journals High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

2019 ◽  
Vol 3 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Johanna Gebhart ◽  
Florian Posch ◽  
Silvia Koder ◽  
Peter Quehenberger ◽  
Thomas Perkmann ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Lupus Anticoagulant ◽  
Adverse Pregnancy Outcomes ◽  
Antiphospholipid Antibody ◽  
Childbearing Age ◽  
Elevated Liver Enzymes ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Lupus anticoagulant (LA) has been associated with pregnancy complications and pregnancy loss. Identification of predictive factors could aid in deciding on therapeutic management. To identify risk factors for adverse pregnancy outcomes in high-risk women with persistently positive LA, we prospectively followed 82 women of childbearing age, of whom 23 had 40 pregnancies within the Vienna Lupus Anticoagulant and Thrombosis Study. Pregnancy complications occurred in 28/40 (70%) pregnancies, including 22 (55%) spontaneous abortions (<10th week of gestation [WOG]: n = 12, 10th to 24th WOG: n = 10) and 6 deliveries <34th WOG (15%, 3 due to severe preeclampsia/HELLP [hemolysis, elevated liver enzymes, and a low platelet count] syndrome, 3 due to placental insufficiency). One abortion was followed by catastrophic antiphospholipid syndrome. Neither a history of pregnancy complications nor of thrombosis, or prepregnancy antiphospholipid antibody levels were associated with adverse pregnancy outcomes. In logistic regression analysis, higher age was associated with a lower risk of adverse pregnancy outcome (per 5 years’ increase: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.19-0.87), a high Rosner index (index of circulating anticoagulant) predicted an increased risk (OR = 4.51, 95% CI: 1.08-18.93). Live birth rate was 15/28 (54%) in women on the combination of low-molecular-weight heparin and low-dose aspirin and 3/12 (25%) in those with no treatment or a single agent. We conclude that the risk of severe, even life-threatening pregnancy complications and adverse pregnancy outcomes is very high in women with persistent LA. A high Rosner index indicates an increased risk. Improved treatment options for women with persistently positive LA are urgently needed.

Adverse Pregnancy Outcomes In High Risk Sickle Cell Women

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2218-2218
Author(s):  
Pankhoori Saraf ◽  
Sari H Jacoby ◽  
Shailja Shah ◽  
Habib Nazir ◽  
Martin Gimovsky ◽  
...  
Keyword(s):  
High Risk ◽  
Sickle Cell ◽  
Pregnancy Outcomes ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Adverse Pregnancy Outcomes ◽  
Acute Chest Syndrome ◽  
Childbearing Age ◽  
Fetal Outcomes ◽  
Adverse Pregnancy

Abstract Background Life expectancy in patients with sickle cell disease (SCD) has increased with the institution of newborn screening, antibiotics and Hydroxyurea (HU). Prior studies have reported maternal mortality rate to be 2.2 times that of normal pregnancies. With improved high risk obstetrical services and hematological care, more women with SCD are choosing to carry a pregnancy (P). In order to see if outcomes have improved, we performed a review of women with SCD who had recent P at our hospital with a focus on maternal and fetal outcomes. Methods Patients (pts) were identified by a chart review of all women of childbearing age followed at both the Comprehensive Sickle Cell Center and the high risk obstetrics clinic. Data included: genotypes of SCD, fetal complications, P outcomes, transfusions (T), hospital admissions, previous HU use. Results 71 pregnancies were identified in 53 women from 2008 to 2013. Pregnancy outcomes See Table 1. Live births rates were equal in both GR I and GR II. The mean gestational age (weeks) in GR I was 35.13 and GR II 38.28 (p=0.0077) with more preterm births in GR I 16/36 (44%) compared to GR II 2/18 (11%). The most common mode of delivery was C-section in both GR I and II. Reasons for C- section were fetal distress 60% (20), repeat C-section 27% (9), other (5% or less) for breech, elective, preeclampsia, placenta previa. There were equal numbers of induced and spontaneous labor in each group. Complications in GR I 8/36 (22%) and GR II 2/18(11%) included PIH, Chorioamniotis, placenta previa, death (cardiac arrest). Fetal outcomes Low birth weight occurred in 20/33(61%) of GR I and 3/18(17%) of GR II (p= 0.0016) births. Other complications (41 % of births) including IUGR, meconium aspiration, oligohydramnios and Apgar scores <7 @ 1 min occurred equally in both GRs. Maternal outcomes: During P mean values for events in GR I and GR II respectively were: transfusions 5.56 units (U) and 1.22 U (p=0.0022), admission for vasoocclusive crisis (VOC) 3.33/pt and 1.44/pt (p=0.0173). Other complications were urinary tract infection (7), pneumonia (4), acute chest syndrome (4), cardiomyopathy (1), renal failure (1), hepatic crisis (2), DVT (1). Six patients were on HU pre- pregnancy (PP). In these patients 13 simple blood T were required PP and 56 during P (p=0.0297). VOC events increased from 13 PP to 35 during P (p=0.1011). 2 patient required exchange T during P. Conclusion Despite improved antenatal care for SCD women, P remains a high risk event for mother and fetus, with lower birth weights and more preterm deliveries in SS/SB 0 thal pts compared to SC/SB+ thal. Prior use of HU PP was not protective. New insights and studies are warranted to understand the pathophysiology of SCD causing adverse pregnancy outcomes and possible effects of HU withdrawal. Disclosures: No relevant conflicts of interest to declare.

The Association Between Antiphospholipid Antibodies and Adverse Pregnancy Outcomes: A Metaanalysis.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1819-1819
Author(s):  
Karim Abou-Nassar ◽  
Marc Carrier ◽  
Marc Rodger
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Placental Abruption ◽  
Fetal Loss ◽  
Anticardiolipin Antibodies ◽  
Adverse Pregnancy Outcomes ◽  
Clinical Criteria ◽  
Adverse Pregnancy

Abstract BACKGROUND: The Sapporo criteria for the diagnosis of the antiphospholipid syndrome (APS) are based on the presence of antiphospholipid antibodies (APLA) and clinical criteria. Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, their association with APLA remains controversial. OBJECTIVE: This review was conducted to evaluate the association between APLA (anticardiolipin antibodies, lupus anticoagulant, anti B2 glycoprotein 1 antibodies) and placenta mediated complications in untreated women without autoimmune diseases. METHODS: We performed a systematic review of published case-control, cohort and cross sectional studies using MEDLINE (1975 to October week 2 2007), EMBASE 16 (1980 to 2007 week 42) and all EBM Reviews (3rd quarter of 2007). For eligible studies, the rates of adverse pregnancy outcomes were compared between patients with and without specific APLA. Pooled odds ratios with 95% CI were generated using random-effects models. RESULTS: Our search strategy identified 1204 potentially relevant studies. Twenty five were included in the final analysis. Results are outlined in table 1. CONCLUSION: The association between various APLA and pregnancy complications is for the most part weak and inconsistent. There is currently insufficient data to support a significant link between anti-B2 glycoprotein 1 antibodies and pregnancy morbidity. Caution should be used when establishing a diagnosis of APS based on the presence of any APLA, particularly anti-B2 glycoprotein 1 antibodies, in the setting of late pregnancy complications. Table 1 Association Between APLA and Adverse Pregnancy Outcomes Pre-eclampsia OR (95%CI) # studies / participants IUGR OR (95%CI) # studies / participants Placental abruption OR (95%CI) # studies / participants Late fetal loss OR (95%CI) # studies / participants LA: Lupus anticoagulant; aCL: Anticardiolipin antibodies; Anti-B2 GP1 antibodies: Anti-B2 glycoprotein 1 antibodies italic characters indicate statistically significant associations LA 2.88 (1.42, 5.87)&#x2028; 11 / 6085 3.51 (1.38, 8.93)&#x2028; 4 / 3232 0.78 (0.13, 4.80)&#x2028; 2 / 226 3.56 (0.12, 106.05)&#x2028; 3 / 3870 aCL (IgG/IgM) 1.71 (1.09, 2.70)&#x2028; 21 / 9722 2.31 (0.74, 7.17)&#x2028; 6 / 5753 1.35 (0.45, 4.02)&#x2028; 4 / 1274 3.86 (1.14, 13.07)&#x2028; 7 / 5963 aCL IgG 1.65 (0.84, 3.22)&#x2028; 15 / 3627 6.16 (2.50, 15.18)&#x2028; 2 / 1006 1.87 (0.21, 16.83)&#x2028; 2 / 500 10.06 (0.88, 114.96)&#x2028; 2 / 1006 aCL IgM 1.36 (0.93, 1.97)&#x2028; 13 / 5397 0.75 (0.19, 2.93)&#x2028; 2 / 3002 0.96 (0.24, 3.85)&#x2028; 2 / 500 1.37 (0.42, 4.46)&#x2028; 3 / 3212 anti- B2GP1 (IgG/IgM) 2.97 (0.47, 18.69)&#x2028; 4 / 2225 20.03 (4.59, 87.43)&#x2028; 1 / 1108 2.64 (0.14, 50.63)&#x2028; 1 / 510 6.74 (0.24, 191.23)&#x2028; 3 / 1828 anti- B2GP1 IgG 0.87 (0.38, 2.01)&#x2028; 2 / 607 N/A&#x2028; 0 / 0 N/A&#x2028; 0 / 0 0.52 (0.02, 11.02)&#x2028; 1 / 212 anti- B2GP1 IgM 0.37 (0.16, 0.85)&#x2028; 1 / 400 N/A&#x2028; 0 / 0 N/A&#x2028; 0 / 0 1.32 (0.24, 7.42)&#x2028; 1 / 210

scholarly journals Pregnancy Outcomes of Women Conceiving on Antiretroviral Therapy (ART) Compared to Those Commenced on ART During Pregnancy

2020 ◽  
Author(s):  
Gerhard Theron ◽  
Sean Brummel ◽  
Lee Fairlie ◽  
Mauricio Pinilla ◽  
Katie McCarthy ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Childbearing Age ◽  
Intention To Treat ◽  
Increased Risk ◽  
Breastfeeding Cessation ◽  
Adverse Pregnancy ◽  
The Impact

Abstract Background Globally, the number of infected women of childbearing age living with human immunodeficiency virus (HIV) and conceiving on antiretroviral therapy (ART) is increasing. Evidence of ART safety at conception and during pregnancy and adverse pregnancy outcomes remains conflicting. The Promoting Maternal and Infant Survival Everywhere (PROMISE) 1077 breastfeeding (BF) and formula feeding (FF) international multisite trials provide an opportunity to examine the impact of ART at conception on pregnancy outcomes with subsequent pregnancies. Methods The PROMISE 1077BF/1077FF trials were designed to address key questions in the management of HIV-infected women who did not meet clinical guidelines for ART treatment during the time of the trials. After the period of risk of mother-to-child transmission was over, women were randomized to either continue or discontinue ART. We compared subsequent pregnancy outcomes of nonbreastfeeding women randomized to continue ART following delivery, or breastfeeding women randomized to continue ART following breastfeeding cessation who conceived while on ART to women randomized to discontinue ART, who restarted ART after pregnancy was diagnosed. Results Pregnancy outcomes of 939 subsequent pregnancies of 826 mothers were recorded. The intention-to-treat analyses showed increased incidence of low birth weight (&lt;2500 g) for women who conceived while on ART (relative risk, 2.65 [95% confidence interval {CI}, 1.20–5.81]), and also a higher risk of spontaneous abortion, stillbirth, or neonatal death (hazard ratio, 1.40 [95% CI, .99–1.98]) compared to women who restarted ART after they were found to be pregnant during trial follow-up. Conclusions We found an increased risk for adverse pregnancy outcomes in women conceiving on ART, emphasizing the need for improved obstetric and neonatal care for this group. Clinical Trials Registration NCT01061151.

The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

2021 ◽  
Author(s):  
Shamil D. Cooray ◽  
Jacqueline A. Boyle ◽  
Georgia Soldatos ◽  
Shakila Thangaratinam ◽  
Helena J. Teede
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Adverse Pregnancy Outcomes ◽  
Therapeutic Interventions ◽  
Clinical Prediction Model ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Individual ◽  
Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

2022 ◽  
pp. jech-2021-217754
Author(s):  
Lixin Li ◽  
Yanpeng Wu ◽  
Yao Yang ◽  
Ying Wu ◽  
Yan Zhuang ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Maternal Education ◽  
Rural China ◽  
Education Level ◽  
Adverse Pregnancy Outcomes ◽  
Secondary Outcome ◽  
Health Examination ◽  
Educational Inequalities ◽  
Increased Risk ◽  
Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

scholarly journals Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

2020 ◽  
Vol 9 (4) ◽  
pp. 1487
Author(s):  
Shaina Chamotra ◽  
Kushla Pathania ◽  
S. K. Verma ◽  
Ankit Chaudhary
Keyword(s):  
Pregnancy Outcomes ◽  
Homocysteine Level ◽  
Perinatal Outcomes ◽  
Normal Subjects ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Causal Pathway ◽  
Mother And Child ◽  
Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

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