Perinatal outcomes in pregnancies complicated by acute pancreatitis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emmy Cai ◽  
Nicholas Czuzoj-Shulman ◽  
Haim A. Abenhaim
Keyword(s):  
Acute Pancreatitis ◽  
Perinatal Outcomes ◽  
Rare Condition ◽  
The United States ◽  
Maternal Characteristics ◽  
International Classification Of Disease ◽  
Newborn Outcomes ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
In Pregnancy

Abstract Objectives Acute pancreatitis is a rare condition that can be associated with significant complications. The objective of this study is to evaluate the maternal and newborn outcomes associated with acute pancreatitis in pregnancy. Methods A retrospective cohort study using the Healthcare Cost and Utilization Project – National Inpatient Sample from the United States was performed. All pregnant patients with acute pancreatitis were identified using International Classification of Disease-9 coding from 1999 to 2015. The effect of acute pancreatitis on maternal and neonatal outcomes in pregnancy was evaluated using multivariate logistic regression, while adjusting for baseline maternal characteristics. Results From 1999 to 2015, there were a total of 13,815,919 women who gave birth. There were a total of 14,258 admissions of women diagnosed with acute pancreatitis, including 1,756 who delivered during their admission and 12,502 women who were admitted in the antepartum period and did not deliver during the same admission. Acute pancreatitis was associated with increased risk of prematurity, OR 3.78 (95% CI 3.38–4.22), preeclampsia, 3.81(3.33–4.36), postpartum hemorrhage, 1.90(1.55–2.33), maternal death, 9.15(6.05–13.85), and fetal demise, 2.60(1.86–3.62) among women diagnosed with acute pancreatitis. Among women with acute pancreatitis, delivery was associated with increased risk of requiring transfusions, 6.06(4.87–7.54), developing venous thromboembolisms, 2.77(1.83–4.18), acute respiratory failure, 3.66(2.73–4.91), and disseminated intravascular coagulation, 8.12(4.12–16.03). Conclusions Acute pancreatitis in pregnancy is associated with severe complications, such as maternal and fetal death. Understanding the risk factors that may lead to these complications can help prevent or minimize them through close fetal and maternal monitoring.

Pregnancy outcomes among women with peptic ulcer disease

2020 ◽  
Vol 48 (3) ◽  
pp. 209-216
Author(s):  
Charlotte Rosen ◽  
Nicholas Czuzoj-Shulman ◽  
Daniel S. Mishkin ◽  
Haim Arie Abenhaim
Keyword(s):  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
The United States ◽  
Neonatal Outcomes ◽  
Intrauterine Fetal Death ◽  
Ulcer Disease ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
The Impact ◽  
In Pregnancy

AbstractBackgroundLittle is known about the impact of peptic ulcer disease (PUD) on pregnancy. Our objective was to evaluate the effect of PUD on pregnancy and newborn outcomes.MethodsA retrospective cohort study was carried out using the Healthcare Cost and Utilization Project (HCUP)-National Inpatient Sample (NIS) from the United States. The cohort consisted of all births that took place from 1999 to 2015. PUD was classified on the basis of the International Classification of Diseases-Ninth Revision (ICD-9) coding. Multivariate logistic regression was used to evaluate the adjusted effect of PUD on maternal and neonatal outcomes.ResultsOf the 13,792,544 births in this cohort, 1005 were to women with PUD (7/100,000 births). Between 1999 and 2015, prevalence of PUD in pregnancy increased from 4/100,000 to 11/100,000, respectively. Women with PUD were more commonly older and more likely to have comorbid illnesses. Women with PUD were at greater risk of preeclampsia [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.67–2.66], preterm premature rupture of membranes (PPROM; OR 2.16, 95% CI 1.30–3.59), cesarean delivery (OR 1.60, 95% CI 1.40–1.82), venous thromboembolism (OR 3.77, 95% CI 2.08–6.85) and maternal death (OR 24.50, 95% CI 10.12–59.32). Births to women with PUD were at increased risk of intrauterine growth restriction (IUGR; OR 1.54, 95% CI 1.11–2.14), preterm birth (OR 1.84, 95% CI 1.54–2.21), intrauterine fetal death (OR 2.18, 95% CI 1.35–3.52) and congenital anomalies (OR 2.69, 95% CI 1.59–4.56).ConclusionThe prevalence of PUD in pregnancy has risen over the last several years. PUD in pregnancy should be considered a high-risk condition associated with important adverse maternal and neonatal outcomes.

COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries

2020 ◽  
Vol 48 (9) ◽  
pp. 900-911 ◽  
Author(s):  
Ernesto Antonio Figueiro-Filho ◽  
Mark Yudin ◽  
Dan Farine
Keyword(s):  
General Population ◽  
Pregnant Women ◽  
Clinical Symptoms ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Outcomes ◽  
Eligibility Criteria ◽  
Maternal Characteristics ◽  
Th2 Immune Response ◽  
Maternal And Neonatal Outcomes

AbstractThe objective of this review was to identify the most significant studies reporting on COVID-19 during pregnancy and to provide an overview of SARS-CoV-2 infection in pregnant women and perinatal outcomes. Eligibility criteria included all reports, reviews; case series with more than 100 individuals and that reported at least three of the following: maternal characteristics, maternal COVID-19 clinical presentation, pregnancy outcomes, maternal outcomes and/or neonatal/perinatal outcomes. We included eight studies that met the inclusion criteria, representing 10,966 cases distributed in 15 countries around the world until July 20, 2020. The results of our review demonstrate that the maternal characteristics, clinical symptoms, maternal and neonatal outcomes almost 11,000 cases of COVID-19 and pregnancy described in 15 different countries are not worse or different from the general population. We suggest that pregnant women are not more affected by the respiratory complications of COVID-19, when compared to the outcomes described in the general population. We also suggest that the important gestational shift Th1-Th2 immune response, known as a potential contributor to the severity in cases of viral infections during pregnancy, are counter-regulated by the enhanced-pregnancy-induced ACE2-Ang-(1–7) axis. Moreover, the relatively small number of reported cases during pregnancy does not allow us to affirm that COVID-19 is more aggressive during pregnancy. Conversely, we also suggest, that down-regulation of ACE2 receptors induced by SARS-CoV-2 cell entry might have been detrimental in subjects with pre-existing ACE2 deficiency associated with pregnancy. This association might explain the worse perinatal outcomes described in the literature.

Adverse Perinatal Outcomes Associated with Stage 1 Hypertension in Pregnancy: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Elizabeth Norton ◽  
Frances Shofer ◽  
Hannah Schwartz ◽  
Lorraine Dugoff
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Hypertensive Disorder ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Hypertensive Disorder Of Pregnancy ◽  
Adverse Perinatal Outcomes ◽  
Stage 1 ◽  
In Pregnancy

Objective To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. Study Design We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP] 130–139/80–89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (<130/80 mm Hg) before 20 weeks of gestation. The primary outcome was any hypertensive disorder of pregnancy; secondary outcomes were indicated preterm birth and small for gestational age. Generalized linear models were used to compare risk of adverse outcomes between the groups. Results Of the 1,630 women included in the analysis, 1,443 women were normotensive prior to 20 weeks of gestation and 187 women (11.5%) identified with stage 1 hypertension. Women with stage 1 hypertension were at significantly increased risk for any hypertensive disorder of pregnancy (adjusted risk ratio [aRR]: 1.86, 95% confidence interval [CI]: 1.12–3.04) and indicated preterm birth (aRR: 1.83, 95% CI: 1.12–3.02). Black women and obese women with stage 1 hypertension were at increased for hypertensive disorder of pregnancy compared with white women and nonobese women, respectively (aRR: 1.32, 95% CI: 1.11–1.57; aRR: 1.69, 95% CI: 1.39–2.06). Conclusion These results provide insight about the prevalence of stage 1 hypertension and inform future guidelines for diagnosis and management of hypertension in pregnancy. Future research is needed to assess potential interventions to mitigate risk. Key Points

scholarly journals Maternal and Neonatal Outcomes Associated with Psychostimulant Use in Pregnancy

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ximena Camacho ◽  
Alys Havard ◽  
Helga Zoega ◽  
Margaret Wilson ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Cohort Analysis ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
The Usa ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionRecent evidence from the USA and Nordic countries suggests a possible association between psychostimulant use during gestation and adverse pregnancy and birth outcomes. Objectives and ApproachWe employed a distributed cohort analysis using linked administrative data for women who gave birth in New South Wales (NSW; Australia) and Ontario (Canada), whereby a common protocol was implemented separately in each jurisdiction. The study population comprised women who were hospitalized for a singleton delivery over an 8 (NSW) and 4 (Ontario) year period, respectively, with the NSW cohort restricted to social security beneficiaries. Psychostimulant exposure was defined as at least one dispensing of methylphenidate, amphetamine, dextroamphetamine or lisdexamfetamine during pregnancy. We examined the risk of maternal and neonatal outcomes among psychostimulant exposed mothers compared with unexposed mothers. ResultsThere were 140,356 eligible deliveries in NSW and 449,499 in Ontario during the respective study periods. Fewer than 1% of these pregnancies were exposed to psychostimulants during gestation, although use was higher in Ontario (0.30% vs 0.11% in NSW). Preliminary unadjusted analyses indicated possible associations between psychostimulant use in pregnancy and higher risks of pre-term birth (relative risk [RR] 1.7, 95% confidence interval [CI] 1.4-2.0 (Ontario); RR 1.8, 95% CI 1.2-2.6 (NSW)) and pre-eclampsia (RR 2.0, 95% CI 1.5-2.6 (Ontario); RR 2.0, 95% CI 1.2-3.5 (NSW)). Similarly, psychostimulant use was associated with higher risks of low birthweight (RR 1.6, 95% CI 1.3-1.9 (Ontario); RR 2.0, 95% CI 1.3-3.0 (NSW)) and admission to neonatal intensive care (RR 2.1, 95% CI 1.9-2.3 (Ontario); RR 1.5, 95% CI 1.1-1.9 (NSW)). Conclusion / ImplicationsUnadjusted analyses indicate an increased risk of adverse maternal and birth outcomes associated with psychostimulant exposure during pregnancy, potentially representing a placental effect. We are currently refining the analyses, employing propensity score methods to adjust for confounding.

Maternal and neonatal characteristics of a Canadian urban cohort receiving treatment for opioid use disorder during pregnancy

2018 ◽  
Vol 10 (1) ◽  
pp. 132-137 ◽  
Author(s):  
C. Miller ◽  
D. Grynspan ◽  
L. Gaudet ◽  
E. Ferretti ◽  
S. Lawrence ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Maternal Characteristics ◽  
Ottawa Hospital ◽  
Increased Risk ◽  
Opioid Replacement Therapy ◽  
In Pregnancy

AbstractThe epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.

scholarly journals H1N1 INFECTION IN PREGNANCY; A RETROSPECTIVE STUDY OF FETO-MATERNAL OUTCOME AND IMPACT OF THE TIMING OF ANTIVIRAL THERAPY

2019 ◽  
Vol 11 (1) ◽  
pp. e2019020 ◽  
Author(s):  
Naser Al-Husban
Keyword(s):  
Antiviral Therapy ◽  
Influenza A ◽  
Public Awareness ◽  
Perinatal Outcomes ◽  
H1n1 Influenza ◽  
Early Initiation ◽  
H1n1 Infection ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
In Pregnancy

Background and Objective: H1N1 infection carries an increased risk in pregnancy. Our aim was to study the fetomaternal outcome and the effect of early initiation of therapy. Methods: This is a retrospective descriptive study. Confirmed infected cases were included. Maternal age, parity, gestational age at diagnosis, presenting symptoms, time between presentation and starting therapy, ICU admission, and maternal and perinatal outcome were evaluated. Results: Nineteen confirmed patients were included. Most patients are 31 years old or more. Multiparous patients were 73.68% and 57.89% were in the third trimester. Most of our patients presented with cough, fever, and chills. Two patients were admitted to the ICU. One of them was a case of maternal mortality. 42.10% of patients were started on therapy only one day after clinical onset of symptoms. 26.31% delivered before 37 completed weeks. 73.68% delivered beyond term. Around one third delivered vaginally. 45% of babies weighed more than 3 kg. Four babies weighed less than 2 kg. Ninety percent had APGAR scores more than 8 at 1 and 5 minutes after delivery. Twenty five percent were admitted to the NICU with no neonatal mortalities. Conclusions: H1N1 influenza A infection in pregnancy is associated with adverse maternal and perinatal outcomes. Medical and public awareness, low threshold for testing suspected pregnant patients, very early initiation of antiviral therapy, and multidisciplinary approach in our series decreased the overall adverse effects of this infection.  

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.

scholarly journals Pregnancy and Delivery with Cardiac Disease in Dr. Soetomo Hospital 2018

2021 ◽  
Vol 2 (2) ◽  
pp. 61-66
Author(s):  
Ana Puji Rahayu ◽  
Khanisyah Erza Gumilar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cardiac Disease ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Number Of Patients ◽  
Pregnancy And Delivery ◽  
Maternal And Neonatal Outcomes ◽  
In Pregnancy

Background: Cardiac disease is one of the non obstetric problems causing mortality both in pregnancy and labor due to the complications. Preventions for the complications have not been implemented, thus the number of patients which have cardiac disease with complications and perinatal outcome with low birth weight is still high. Objective : To identify maternal and neonatal outcome of pregnant women with cardiac disease in dr. Soetomo Surabaya hospital in 2018. Method: Descriptive retrospective study using medical records in dr. Soetomo Surabaya hospital 2018. Result: We found 1433 pregnancy cases with 51 (3,6 %) patients were having cardiac disease and included in this research. The most common maternal complication was pulmonary hypertension 16 cases. A dead case was found 1 case (1,9 %) with eissenmenger syndrome. We found the perinatal outcome of 30 babies (58.8%) born with a weight of 2500 gram and under. There are 7 patients with cardiac disease that have been corrected (13,7%). Among those 7 patients, 6 had a perinatal outcome with a birth weight of more than 2500 gram. Conclusion : Most pregnant patients with cardiac disease in dr. Soetomo Surabaya hospital 2018 are already having some complications with perinatal outcomes of low birth weight. Therefore, management of cardiac disease in pregnancy to prevent complications by means of preconception counseling, good antenatal care, and appropriate referrels are still needed to improve the quality of maternal and neonatal outcomes.

Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a population-based study

2016 ◽  
Vol 44 (8) ◽  
Author(s):  
Andreja Trojner Bregar ◽  
Isaac Blickstein ◽  
Ivan Verdenik ◽  
Miha Lucovnik ◽  
Natasa Tul
Keyword(s):  
Assisted Reproduction ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Monochorionic Twins ◽  
Population Based Study ◽  
Maternal Characteristics ◽  
Assisted Reproduction Technology ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes ◽  
Twin Pregnancies

AbstractObjecive:To evaluate the perinatal outcome of monochorionic-diamniotic twins conceived by assisted reproduction technology (ART).Methods:We compared data from a national population-based perinatal registry on perinatal outcomes of monochorionic-diamniotic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic-diamniotic twins. We compared maternal characteristics, pregnancy complications and perinatal outcomes.Results:Monochorionic-diamniotic twin pregnancies (n=45) comprised 5.5% of all ART twins, and 9.3% of all monochorionic twins in this dataset. ART does not appear to increase the already high risk of monochorionicity compared to spontaneous conception, with the latter having an increased incidence for birth weight <1500 g [odds ratio (OD) 2.6, 95% confidence interval (CI) 1.2–5.4].Conclusion:Our results disagree with hospital-based data and suggest that monochorionic-diamniotic twins following ART are not at increased risk of adverse perinatal outcomes compared to spontaneous monochorionic-diamniotic twins as well as to dichorionc twins conceived by ART.

Maternal and neonatal outcomes among pregnant women with myasthenia gravis

2020 ◽  
Vol 48 (8) ◽  
pp. 793-798
Author(s):  
Laura Nicholls-Dempsey ◽  
Nicholas Czuzoj-Shulman ◽  
Haim Arie Abenhaim
Keyword(s):  
Respiratory Failure ◽  
Myasthenia Gravis ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Neonatal Outcomes ◽  
Chronic Hypertension ◽  
Significant Difference ◽  
Maternal And Neonatal Outcomes ◽  
In Pregnancy

AbstractObjectivesMyasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction marked by weakness and fatiguability of skeletal muscle. MG has an unpredictable course in pregnancy. Our purpose was to evaluate the effect of MG on maternal and neonatal outcomes.MethodsUsing the United States’ Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2005 to 2015, we conducted a retrospective cohort study consisting of women who delivered during that period. Multivariate logistic regression models, adjusted for baseline maternal demographics and comorbidities, were used to compare maternal and neonatal outcomes among pregnancies in women with and without MG.ResultsDuring the study period, 974 deliveries were to women diagnosed with MG. Women with MG were more likely to be older, African American, obese, have Medicare insurance and be discharged from an urban teaching hospital. Women with MG were also more likely to have chronic hypertension, pre-gestational diabetes, hypothyroidism, and chronic steroid use. Women with MG were at greater risk for acute respiratory failure (OR 13.7, 95% CI 8.9–21.2) and increased length of hospital stay (OR 2.5, 95% CI 1.9–3.3). No significant difference was observed in the risk of preterm premature rupture of membranes, caesarean section or instrumental vaginal delivery. Neonates of women with MG were more likely to be premature (OR 1.4, 95% CI 1.2–1.8).ConclusionsMG in pregnancy is a high-risk condition associated with greater risk of maternal respiratory failure and preterm birth. Management in a tertiary care center with obstetrical, neurological, anesthesia and neonatology collaboration is recommended.

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