scholarly journals Topiramate use early in pregnancy and the risk of oral clefts

Neurology ◽  
2017 ◽  
Vol 90 (4) ◽  
pp. e342-e351 ◽  
Author(s):  
Sonia Hernandez-Diaz ◽  
Krista F. Huybrechts ◽  
Rishi J. Desai ◽  
Jacqueline M. Cohen ◽  
Helen Mogun ◽  
...  
Keyword(s):  
Linear Models ◽  
Reference Group ◽  
First Trimester ◽  
Population Based ◽  
Oral Clefts ◽  
Born Infant ◽  
Increased Risk ◽  
The Us ◽  
Median Daily Dose ◽  
In Pregnancy

ObjectiveTo assess the relative risk of oral clefts associated with maternal use of high and low doses of topiramate during the first trimester for epilepsy and nonepilepsy indications.MethodsThis population-based study nested in the US 2000–2010 Medicaid Analytic eXtract included a cohort of 1,360,101 pregnant women with a live-born infant enrolled in Medicaid from 3 months before conception through 1 month after delivery. Oral clefts were defined as the presence of a recorded diagnosis in claims during the first 90 days after birth. Women with a topiramate dispensing during the first trimester were compared with those without any dispensing and with an active reference group of women with a lamotrigine dispensing during the first trimester. Risk ratios (RRs) were estimated with generalized linear models with fine stratification on the propensity score of treatment to control for potential confounders. Stratified analyses by indication of use and dose were conducted.ResultsThe risk of oral clefts at birth was 4.1 per 1,000 in the 2,425 infants born to women exposed to topiramate compared with 1.1 per 1,000 in the unexposed group (RR 2.90, 95% confidence interval [CI] 1.56–5.40). The RR among women with epilepsy was 8.30 (95% CI 2.65–26.07); among women with other indications such as bipolar disorder, it was 1.45 (95% CI 0.54–3.86). The median daily dose for the first prescription filled during the first trimester was 200 mg for women with epilepsy and 100 mg for women without epilepsy. For topiramate monotherapy, the RR for oral clefts associated with doses ≤100 mg was 1.64 (95% CI 0.53–5.07) and for doses >100 mg it was 5.16 (95% CI 1.94–13.73). Results were similar when lamotrigine was used as a reference group.ConclusionThe increased risk of oral clefts associated with use of topiramate early in pregnancy was more pronounced in women with epilepsy, who used higher doses.

scholarly journals Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

2021 ◽  
pp. 1753495X2110125
Author(s):  
Jonathan S Zipursky ◽  
Deva Thiruchelvam ◽  
Donald A Redelmeier
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Pregnant Women ◽  
Odds Ratio ◽  
Population Based ◽  
Relative Increase ◽  
Organic Disease ◽  
Increased Risk ◽  
Clinical Clue ◽  
In Pregnancy

Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

scholarly journals Effect of IBD medications on COVID-19 outcomes: results from an international registry

Gut ◽  
2020 ◽  
pp. gutjnl-2020-322539 ◽  
Author(s):  
Ryan C Ungaro ◽  
Erica J Brenner ◽  
Richard B Gearry ◽  
Gilaad G Kaplan ◽  
Michele Kissous-Hunt ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Reference Group ◽  
Large Population ◽  
Random Effect ◽  
Estimating Equation ◽  
Population Based ◽  
Interleukin 12 ◽  
International Registry ◽  
Increased Risk ◽  
Tnf Antagonist

ObjectiveWe sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.DesignSurveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.Results1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively).ConclusionCombination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line

Behcet’s disease and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 12 million births

2019 ◽  
Vol 47 (4) ◽  
pp. 381-387 ◽  
Author(s):  
Seohyuk Lee ◽  
Nicholas Czuzoj-Shulman ◽  
Haim Arie Abenhaim
Keyword(s):  
Venous Thromboembolism ◽  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
The United States ◽  
Population Based ◽  
Fetal Outcomes ◽  
Behcet's Disease ◽  
Increased Risk ◽  
In Pregnancy

AbstractBackgroundBehcet’s disease (BD) is a rare, multi-systemic inflammatory disorder for which only limited and contradictory data exists in the context of pregnancy. Our objective was to estimate the prevalence of BD in pregnancy and to evaluate maternal and fetal outcomes associated with pregnant women living with BD.MethodsUsing the 1999–2013 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States, we performed a population-based retrospective cohort study consisting of pregnancies that occurred during this time period. ICD-9 codes were used to identify delivery admissions to women with or without BD. Multivariate logistic regression was used to estimate the adjusted effects of BD on maternal and fetal outcomes.ResultsAmong the 12,592,676 pregnancies in our cohort, 144 were to women with BD, for an overall prevalence of 1.14 cases/100,000 births between 1999 and 2013. Over the study period, the prevalence of BD rose from 0.5 to 2.4/100,000 births. Women with BD demonstrated a two-fold greater frequency of non-delivery hospital admissions during pregnancy, and were more likely to be Caucasian, have private medical insurance, be of the upper income quartiles, and deliver at an urban teaching hospital. Women with BD were at greater risk for preterm labor and postpartum venous thromboembolism, while their newborns were more likely to be born premature.ConclusionBD-associated pregnancies are increasing in prevalence and are associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism.

Smoking during Pregnancy and Adverse Birth and Maternal Outcomes in California, 2007 to 2016

2019 ◽  
Vol 37 (13) ◽  
pp. 1364-1376
Author(s):  
Anura W.G. Ratnasiri ◽  
Lauren Gordon ◽  
Ronald A. Dieckmann ◽  
Henry C. Lee ◽  
Steven S. Parry ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
First Trimester ◽  
Population Based ◽  
Maternal Outcomes ◽  
Smoking During Pregnancy ◽  
Maternal Risk ◽  
Maternal Cigarette Smoking ◽  
Increased Risk

Abstract Objective This study aimed to determine associations between maternal cigarette smoking and adverse birth and maternal outcomes. Study Design This is a 10-year population-based retrospective cohort study including 4,971,896 resident births in California. Pregnancy outcomes of maternal smokers were compared with those of nonsmokers. The outcomes of women who stopped smoking before or during various stages of pregnancy were also investigated. Results Infants of women who smoked during pregnancy were twice as likely to have low birth weight (LBW) and be small for gestational age (SGA), 57% more likely to have very LBW (VLBW) or be a preterm birth (PTB), and 59% more likely to have a very PTB compared with infants of nonsmokers. During the study period, a significant widening of gaps developed in both rates of LBW and PTB and the percentage of SGA between infants of maternal smokers and nonsmokers. Conclusion Smoking during pregnancy is associated with a significantly increased risk of adverse birth and maternal outcomes, and differences in rates of LBW, PTB, and SGA between infants of maternal smokers and nonsmokers increased during this period. Stopping smoking before pregnancy or even during the first trimester significantly decreased the infant risks of LBW, PTB, SGA, and the maternal risk for cesarean delivery.

scholarly journals Acquisition and Elimination of Bacterial Vaginosis During Pregnancy: A Danish Population-Based Study

2006 ◽  
Vol 2006 ◽  
pp. 1-6 ◽  
Author(s):  
Ida Vogel ◽  
Poul Thorsen ◽  
Bernard Jeune ◽  
Bo Jacobsson ◽  
Niels Ebbesen ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Early Pregnancy ◽  
Elimination Rate ◽  
Population Based ◽  
Gradual Change ◽  
Third Trimester ◽  
Clinical Criteria ◽  
Vaginal Ph ◽  
Increased Risk ◽  
In Pregnancy

Objectives: the aim was to examine factors associated with acquisition and elimination of bacterial vaginosis in pregnancy.Methods: a group of 229 pregnant women were randomly selected from a population-based prospective cohort study of 2927. They were examined at enrollment (mean gestational weeks16w+0d) and again in mid-third trimester (mean gestational age32w+3d).Measures: BV (Amsel's clinical criteria), microbiological cultures of the genital tract and questionnaire data.Results: BV prevalence decreased from 17% in early second trimester to 14% in mid-third trimester due to a tenfold higher elimination rate (39%) than incidence rate (4%). Heavy smokers(>10/d)in early pregnancy were at increased risk(5.3 [1.1−25])for the acquisition of BV during pregnancy, as were women receiving public benefits(4.8 [1.0−22]), having a vaginal pH above4.5 (6.3 [1.4−29])or vaginal anaerobe bacteria(18 [2.7−122])at enrollment. A previous use of combined oral contraceptives was preventive for the acquisition of BV(0.2 [0.03−0.96]). Elimination of BV in pregnancy tended to be associated with a heavy growth ofLactobacillus (3.2 [0.8−13])at enrollment.Conclusions: acquisition of BV during pregnancy is rare and is associated with smoking, while the presence of anaerobe bacteria and a vaginal pH> 4.5are interpreted as steps on a gradual change towards BV. In the same way heavy growth ofLactobacillusspp in early pregnancy may be an indicator of women on the way to eliminate BV.

scholarly journals Maternal intake of sugar during pregnancy and childhood respiratory and atopic outcomes

2017 ◽  
Vol 50 (1) ◽  
pp. 1700073 ◽  
Author(s):  
Annabelle Bédard ◽  
Kate Northstone ◽  
A. John Henderson ◽  
Seif O. Shaheen
Keyword(s):  
Early Childhood ◽  
Maternal Diet ◽  
Population Based ◽  
Atopic Asthma ◽  
Free Sugar ◽  
Sugar Intake ◽  
Parents And Children ◽  
Increased Risk ◽  
Serum Total Ige ◽  
In Pregnancy

The possible role of maternal consumption of free sugar during pregnancy in the inception of respiratory and atopic diseases has not been studied. We aimed to study the relationship between maternal intake of free sugar during pregnancy and respiratory and atopic outcomes in the offspring in a population-based birth cohort, the Avon Longitudinal Study of Parents and Children.We analysed associations between maternal intake of free sugar in pregnancy (estimated by a food frequency questionnaire), and current doctor-diagnosed asthma, wheezing, hay fever, eczema, atopy, serum total IgE and lung function in children aged 7–9 years (n=8956 with information on maternal diet in pregnancy and at least one outcome of interest).After controlling for potential confounders, maternal intake of free sugar was positively associated with atopy (OR for highest versus lowest quintile of sugar intake 1.38, 95% CI 1.06–1.78; per quintile p-trend=0.006) and atopic asthma (OR 2.01, 95% CI 1.23–3.29; per quintile p-trend=0.004). These associations were not confounded by intake of sugar in early childhood, which was unrelated to these outcomes.Our results suggest that a higher maternal intake of free sugar during pregnancy is associated with an increased risk of atopy and atopic asthma in the offspring, independently of sugar intake in early childhood.

scholarly journals Acute HIV Infection in Pregnancy: The Case for Third Trimester Rescreening

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Jocelyn Wertz ◽  
Jason Cesario ◽  
Jennifer Sackrison ◽  
Sean Kim ◽  
Chi Dola
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Late Pregnancy ◽  
First Trimester ◽  
Acute Hiv Infection ◽  
Hiv Rna ◽  
Increased Risk ◽  
Acute Hiv ◽  
Anti Hiv ◽  
In Pregnancy

Combination testing with anti-HIV Elisa and Western blot is both sensitive and specific for diagnosis of established HIV-1 infection but could not detect acute HIV infection (AHI). AHI is a time of extremely high viral load, which may correlate to increased risk of horizontal or vertical transmission. Thus, early identification of AHI could allow for interventions to decrease transmission. However, recognition of AHI can be challenging as symptoms could be absent or nonspecific, therefore, AHI is often not detected, particularly in pregnancy. We present a case report of AHI in a pregnant woman who presented with headache and fever. She tested negative for HIV in the first trimester and at time of AHI at 26 3/7 weeks by anti-HIV Elisa, but was diagnosed with AHI based on an HIV RNA viral load of 434,000 copies/mL. This report presents a case for improved awareness of AHI in pregnancy, and the need for repeat HIV testing in late pregnancy, and highlighted that early detection of AHI might be possible with adding HIV RNA testing at time of standard anti-HIV Elisa screening test in pregnancy. Novel laboratory approaches including pooling of sera for HIV RNA could reduce the cost of HIV RNA testing.

scholarly journals Cancer risk in individuals with intellectual disability in Sweden: A population-based cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003840
Author(s):  
Qianwei Liu ◽  
Hans-Olov Adami ◽  
Abraham Reichenberg ◽  
Alexander Kolevzon ◽  
Fang Fang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intellectual Disability ◽  
Cancer Risk ◽  
Reference Group ◽  
Population Based ◽  
Sibling Comparison ◽  
Increased Risk ◽  
Specific Cancer ◽  
Cancer Types ◽  
Risk Of Cancer

Background A knowledge gap exists about the risk of cancer in individuals with intellectual disability (ID). The primary aim of this study was to estimate the cancer risk among individuals with ID compared to individuals without ID. Methods and findings We conducted a population-based cohort study of all children live-born in Sweden between 1974 and 2013 and whose mothers were born in a Nordic country. All individuals were followed from birth until cancer diagnosis, emigration, death, or 31 December 2016 (up to age 43 years), whichever came first. Incident cancers were identified from the Swedish Cancer Register. We fitted Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of cancer risk in relation to ID after adjusting for several potential confounders. We analyzed ID by severity, as well as idiopathic ID and syndromic ID separately. We performed a sibling comparison to investigate familial confounding. The study cohort included a total of 3,531,305 individuals, including 27,956 (0.8%) individuals diagnosed with ID. Compared with the reference group (individuals without ID and without a full sibling with ID), individuals with ID were in general more likely to be male. The median follow-up time was 8.9 and 23.0 years for individuals with ID and individuals without ID, respectively. A total of 188 cancer cases were identified among individuals with ID (incidence rate [IR], 62 per 1,000 person-years), and 24,960 among individuals in the reference group (IR, 31 per 1,000 person-years). A statistically significantly increased risk was observed for any cancer (HR 1.57, 95% CI 1.35–1.82; P < 0.001), as well as for several cancer types, including cancers of the esophagus (HR 28.4, 95% CI 6.2–130.6; P < 0.001), stomach (HR 6.1, 95% CI 1.5–24.9; P = 0.013), small intestine (HR 12.0, 95% CI 2.9–50.1; P < 0.001), colon (HR 2.0, 95% CI 1.0–4.1; P = 0.045), pancreas (HR 6.0, 95% CI 1.5–24.8; P = 0.013), uterus (HR 11.7, 95% CI 1.5–90.7; P = 0.019), kidney (HR 4.4, 95% CI 2.0–9.8; P < 0.001), central nervous system (HR 2.7, 95% CI 2.0–3.7; P < 0.001), and other or unspecified sites (HR 4.8, 95% CI 1.8–12.9; P = 0.002), as well as acute lymphoid leukemia (HR 2.4, 95% CI 1.3–4.4; P = 0.003) and acute myeloid leukemia (HR 3.0, 95% CI 1.4–6.4; P = 0.004). Cancer risk was not modified by ID severity or sex but was higher for syndromic ID. The sibling comparison showed little support for familial confounding. The main study limitations were the limited statistical power for the analyses of specific cancer types, and the potential for underestimation of the studied associations (e.g., due to potential underdetection or delayed diagnosis of cancer among individuals with ID). Conclusions In this study, we found that individuals with ID showed an increased risk of any cancer, as well as of several specific cancer types. These findings suggest that extended surveillance and early intervention for cancer among individuals with ID are warranted.

scholarly journals Does thyroid function influence fracture risk? Prospective data from the HUNT2 study, Norway

2013 ◽  
Vol 169 (6) ◽  
pp. 845-852 ◽  
Author(s):  
Anders Svare ◽  
Tom Ivar Lund Nilsen ◽  
Bjørn Olav Åsvold ◽  
Siri Forsmo ◽  
Berit Schei ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Fracture Risk ◽  
Reference Group ◽  
Positive Association ◽  
Population Based ◽  
Health Study ◽  
Thyroid Peroxidase ◽  
Forearm Fractures ◽  
Hip Fracture Risk ◽  
Increased Risk

ObjectiveTo prospectively study the relation between TSH and risk of hip and forearm fractures.DesignA population-based cohort study.MethodsIn a substudy of the second survey of the Nord Trøndelag Health Study, Norway (HUNT2, 1995–97), linked with a hospital-based fracture registry, we investigated the relation between baseline TSH and risk of hip and/or forearm fractures.PopulationA total of 16 610 women and 8595 men aged 40 years or more, without previous self-reported thyroid disease and hip or forearm fractures.ResultsDuring 12.5 years follow-up, a total of 1870 women and 342 men experienced hip or forearm fractures. Overall, there was no relation between baseline TSH and fracture risk. However, there was weak evidence that women with TSH <0.5 and >3.5 mU/l had a slightly increased risk of hip fractures (hazard ratio (HR) 1.30, 95% CI 0.97–1.94 and HR 1.19, 95% CI 0.93–1.52) compared with the reference group with TSH of 1.5–2.4 mU/l. Supplementary analyses showed higher hip fracture risk in women with TSH >4.0 mU/l and negative thyroid peroxidase antibodies (TPOAb) compared with the reference group (HR 1.75, 95% CI 1.24–2.46).ConclusionWe found no statistically significant relation between baseline TSH and subsequent fracture risk, but the data suggest a weak positive association with hip fracture risk among women with both low and high TSH. The latter association was confined to women with negative TPOAb status.

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