scholarly journals Comparing Newborn Outcomes After Prenatal Exposure to Individual Antidepressants

2020 ◽  
Vol 3 ◽  
Author(s):  
Claire Marks ◽  
Sara Quinney ◽  
David Haas
Keyword(s):  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Admission Rates ◽  
Newborn Outcomes ◽  
Regenstrief Institute ◽  
Multivariable Regression ◽  
Nicu Admission ◽  
Multiple Drugs ◽  
Maternal And Newborn ◽  
Selection Of

Background:  Up to 1 out of 5 women experience depression during their childbearing years, with 20-33% treating with drugs. However, data are limited on individual drugs’ effects on pregnancy outcomes. The objective of this study was to compare associations between individual antidepressants and pregnancy outcomes.    Study Methods:  Deidentified demographic, medical and obstetric data from women who received at least one antidepressant (SSRI or SNRI) prescription prior to conception through delivery were obtained from Regenstrief Institute. Drugs were were compared using standard statistics and multivariable regression.     Results: A total of 3801 women took bupropion (n=311), citalopram (n=355), fluoxetine (n=520), sertraline (n=1557), duloxetine (n=112), escitalopram (n=534), venlafaxine (n=105), paroxetine (n=45), desvenlafaxine (n=12), or multiple antidepressants (n=250). Most women were white (86.5%), and had either commercial (50.3%) or government (48.1%) insurance.     Race (p=0.002), hospital (p<0.001), and insurance (p<0.001) were associated with selection of drug. Incidence of diabetes (p<0.001), gestational diabetes (p=0.005), hypertension (p=0.015), and gestational hypertension (p=0.006) varied between drugs, with highest rates in women taking duloxetine.  NICU admission (p<0.001), transient tachypnea of newborn (TTN) (p=0.001), and adaptation syndrome (p<0.001) were significantly different between drugs, with duloxetine having highest NICU admission (42.9%) and TTN (20.5%).  Paroxetine was associated with higher rates of adaptation syndrome (13.3%).     After controlling for maternal age, race, hospital, and insurance, adaptation syndrome was increased with citalopram OR[95%CI] = 2.358[1.147-4.849], duloxetine 3.180[1.362-7.424], escitalopram 2.832[1.418], paroxetine 3.347[1.138-9.847], and multiple drugs 2.603[1.222-5.545] compared to bupropion. Adding hypertension and diabetes to the model above, increased NICU admission rates were seen with citalopram 1.498[1.036-2.168], fluoxetine 1.565[1.109-2.208], duloxetine 2.568[1.593-4.139], escitalopram 2.045[1.458-2.869], and multiple drugs 2.009[1.362-2.964] compared to bupropion.    Conclusion: Different antidepressants have associations with individual maternal and newborn outcomes. Duloxetine and paroxetine appear to have the strongest associations with NICU admission and adaptation syndromes, respectively. These outcomes require further investigation by exposure trimester.  

scholarly journals Evaluation of perinatal outcome in women presented with first trimester vaginal bleeding: our experience

2017 ◽  
Vol 6 (3) ◽  
pp. 829
Author(s):  
Priyanka Rai ◽  
Girija Kumari ◽  
Kalpana Kumari ◽  
Deepshikha Jaiswal
Keyword(s):  
Pregnancy Outcomes ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Vaginal Bleeding ◽  
Placental Abruption ◽  
Gestational Hypertension ◽  
Late Pregnancy ◽  
First Trimester ◽  
High Risk Group ◽  
Nicu Admission

Background: First trimester vaginal bleeding (FTVB) plays a role in occurrence of late pregnancy complications in both mother and infant. Late pregnancy outcomes in mothers and infants are the main concerns for the obstetricians. The purpose of this study was to assess the perinatal outcome of pregnancies complicated by first trimester vaginal bleeding.Methods: The present study included total 100 singleton pregnant women with history of FTVB whose pregnancy was confirmed chemically. Patients were closely observed and follow up done 2 weekly upto 36 weeks and weekly after that. Late pregnancy outcomes such as gestational hypertension, pre eclampsia, placental abruption, preterm delivery and pre mature rupture of membranes in the mothers and  low birth weight, intrauterine growth ristriction, apgar score after 1 and 5 minutes,  and  NICU admission in new born were calculated.Results: Incidence of PROM, gestational hypertension and placental abruption is more in women with FTVB. However there infant had higher rate of IUGR and LBW. Apgar score after 1 and 5 minutes were less than 5 and admission to NICU too.Conclusions: FTVB is an important factor to predict both the maternal and fetal outcomes in late pregnancy. It is therefore important to evaluate and consider these pregnancies as high risk group and provide careful antenatal care.

scholarly journals Impact of metformin treatment during pregnancy on maternal outcomes: a systematic review/meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jane L. Tarry-Adkins ◽  
Susan E. Ozanne ◽  
Catherine E. Aiken
Keyword(s):  
Side Effects ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Risk Of Bias ◽  
Maternal Outcomes ◽  
Metformin Treatment ◽  
Eligibility Criteria ◽  
Treatment Groups ◽  
Gastrointestinal Side Effects ◽  
The Impact

AbstractWe systematically assessed the impact of metformin treatment on maternal pregnancy outcomes. PubMed, Ovid Embase, Medline, Web of Science, ClinicalTrials.gov and Cochrane databases were systematically searched (inception-1st February 2021). Randomised controlled trials reporting pregnancy outcomes in women randomised to metformin versus any other treatment for any indication were included. Outcomes included gestational weight gain (GWG), pre-eclampsia, gestational hypertension, preterm birth, gestational age at delivery, caesarean section, gestational diabetes, glycaemic control, and gastrointestinal side-effects. Two independent reviewers conducted screening, with a third available to evaluate disagreements. Risk-of-bias and GRADE assessments were conducted using Cochrane Risk-of-Bias and GRADE-pro software. Thirty-five studies (n = 8033 pregnancies) met eligibility criteria. GWG was lower in pregnancies randomised to metformin versus other treatments (1.57 kg ± 0.60 kg; I2 = 86%, p < 0.0001), as was likelihood of pre-eclampsia (OR 0.69, 95% CI 0.50–0.95; I2 = 55%, p = 0.02). The risk of gastrointestinal side-effects was greater in metformin-exposed versus other treatment groups (OR 2.43, 95% CI 1.53–3.84; I2 = 76%, p = 0.0002). The risk of other maternal outcomes assessed was not significantly different between metformin-exposed versus other treatment groups. Metformin for any indication during pregnancy is associated with lower GWG and a modest reduced risk of pre-eclampsia, but increased gastrointestinal side-effects compared to other treatments.

scholarly journals Electronic data collection for multi-country, hospital-based, clinical observation of maternal and newborn care: EN-BIRTH study experiences

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Harriet Ruysen ◽  
◽  
Ahmed Ehsanur Rahman ◽  
Vladimir Sergeevich Gordeev ◽  
Tanvir Hossain ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Data Collection ◽  
Data Quality ◽  
Clinical Observation ◽  
Data Extraction ◽  
Observation Data ◽  
Electronic Data ◽  
Concurrent Events ◽  
Maternal And Newborn ◽  
Selection Of

Abstract Background Observation of care at birth is challenging with multiple, rapid and potentially concurrent events occurring for mother, newborn and placenta. Design of electronic data (E-data) collection needs to account for these challenges. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study to assess measurement of indicators for priority maternal and newborn interventions and took place in five hospitals in Bangladesh, Nepal and Tanzania (July 2017–July 2018). E-data tools were required to capture individually-linked, timed observation of care, data extraction from hospital register-records or case-notes, and exit-survey data from women. Methods To evaluate this process for EN-BIRTH, we employed a framework organised around five steps for E-data design, data collection and implementation. Using this framework, a mixed methods evaluation synthesised evidence from study documentation, standard operating procedures, stakeholder meetings and design workshops. We undertook focus group discussions with EN-BIRTH researchers to explore experiences from the three different country teams (November–December 2019). Results were organised according to the five a priori steps. Results In accordance with the five-step framework, we found: 1) Selection of data collection approach and software: user-centred design principles were applied to meet the challenges for observation of rapid, concurrent events around the time of birth with time-stamping. 2) Design of data collection tools and programming: required extensive pilot testing of tools to be user-focused and to include in-built error messages and data quality alerts. 3) Recruitment and training of data collectors: standardised with an interactive training package including pre/post-course assessment. 4) Data collection, quality assurance, and management: real-time quality assessments with a tracking dashboard and double observation/data extraction for a 5% case subset, were incorporated as part of quality assurance. Internet-based synchronisation during data collection posed intermittent challenges. 5) Data management, cleaning and analysis: E-data collection was perceived to improve data quality and reduce time cleaning. Conclusions The E-Data system, custom-built for EN-BIRTH, was valued by the site teams, particularly for time-stamped clinical observation of complex multiple simultaneous events at birth, without which the study objectives could not have been met. However before selection of a custom-built E-data tool, the development time, higher training and IT support needs, and connectivity challenges need to be considered against the proposed study or programme’s purpose, and currently available E-data tool options.

Pharmacogenomics of Antihypertensive Drugs in Brazil: recent progress and clinical implications

2021 ◽  
Vol 22 ◽  
Author(s):  
Fabiana Dalla Vecchia Genvigir ◽  
Carolina Dagli Hernandez ◽  
Thiago Dominguez Crespo Hirata ◽  
Yitian Zhou ◽  
Volker M Lauschke ◽  
...  
Keyword(s):  
Genetic Factors ◽  
Antihypertensive Drugs ◽  
Gestational Hypertension ◽  
Pressure Control ◽  
Response To Therapy ◽  
Clinical Implications ◽  
Genetic Predictors ◽  
Antihypertensive Response ◽  
Drug Responsiveness ◽  
Multiple Drugs

Background: The available antihypertensive drugs are effective and well tolerated agents. However, only about half of patients with treated hypertension achieve appropriate blood pressure control. Genetic and non-genetic factors contribute to the interindividual variability of the therapeutic response Objective: This review constitutes a comprehensive update of the pharmacogenomics of antihypertensive drugs and their clinical implications in Brazil. Results: Twenty-five studies explored the influence of gene variants on drug response in patients with primary, resistant, or gestational hypertension. Variants in BDKRB2, NOS3, PRKCA, and VEGFA influenced the response to enalapril in patients with primary hypertension. AGT and MMP2 variants were associated with high risk of resistance to antihypertensive treatment, whereas NOS2 variants were related to low risk. Moreover, NAT2 slow acetylators showed an increased response to hydralazine in patients with resistant hypertension. HMOX1, NAMPT, MMP9, NOS3 and TIMP1 variants might be markers of drug responsiveness in hypertensive or preeclamptic pregnant women. Power and replication of studies, polygenic nature of response to therapy, and treatment with multiple drugs were important challenges to be overcome for identifying genetic predictors of antihypertensive response in Brazil. Conclusion: Pharmacogenomic studies in Brazilian cohorts provide some evidences of variants, mainly in pharmacodynamics genes, which influence the response to antihypertensive drugs. However, some findings are limited by cohort size or therapeutic scheme and may be influenced by interactions with other genetic and non-genetic factors. Therefore, further investigations are needed to elucidate the contribution of pharmacogenomics to the efficacy and safety of antihypertensive therapy.

scholarly journals Prediction of Healthy Pregnancy Outcomes in Women with Overweight and Obesity: The Role of Maternal Early-Pregnancy Metabolites

Metabolites ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 13
Author(s):  
Rama J. Wahab ◽  
Vincent W. V. Jaddoe ◽  
Romy Gaillard
Keyword(s):  
Pregnancy Outcome ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Characteristic Curve ◽  
Overweight And Obesity ◽  
Large For Gestational Age ◽  
Maternal Characteristics ◽  
Healthy Pregnancy ◽  
Increased Risk

Women with obesity receive intensified antenatal care due to their increased risk of pregnancy complications, even though not all of these women develop complications. We developed a model based on maternal characteristics for prediction of healthy pregnancy outcomes in women with obesity or who are overweight. We assessed whether early-pregnancy metabolites improved prediction. In a population-based cohort study among a subsample of 1180 Dutch pregnant women with obesity or who are overweight, we developed a prediction model using 32 maternal socio-demographic, lifestyle, physical and pregnancy-related characteristics. We determined early-pregnancy amino acids, nonesterifed fatty acids, phospholipids and carnitines in blood serum using liquid chromatography-tandem mass spectrometry. A healthy pregnancy outcome was the absence of fetal death, gestational hypertension, preeclampsia, gestational diabetes, caesarian section, preterm birth, large-for-gestational-age at birth, macrosomia, postpartum weight retention and offspring overweight/obesity at 5 years. Maternal age, relationship status, parity, early-pregnancy body mass index, mid-pregnancy gestational weight gain, systolic blood pressure and estimated fetal weight were selected into the model using backward selection (area under the receiver operating characteristic curve: 0.65 (95% confidence interval 0.61 to 0.68)). Early-pregnancy metabolites did not improve model performance. Thus, in women with obesity or who are overweight, maternal characteristics can moderately predict a healthy pregnancy outcome. Maternal early-pregnancy metabolites have no incremental value in the prediction of a healthy pregnancy outcome.

scholarly journals The implications for advanced maternal age on pregnancy complications and adverse neonatal outcomes

2021 ◽  
Vol 29 (3) ◽  
pp. 200-209
Author(s):  
Zeynep Gedik Özköse ◽  
Süleyman Cemil Oğlak
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Apgar Scores ◽  
Adverse Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
Nicu Admission

Objective This study aimed to determine the effect of advanced maternal age (AMA) on maternal and neonatal outcomes in pregnant women aged ≥35 years compared with patients aged 30–34 years. Also, we aimed to analyze the risk estimates of potential confounders to identify whether these variables contributed to the development of adverse pregnancy outcomes or not. Methods This retrospective cohort study included 2284 pregnant women aged ≥35 years at the time of delivery who was delivered in a tertiary referral hospital from January 1, 2016, to December 31, 2020. We further classified these women into two subgroups: 35–39 years as early AMA (EAMA), and ≥40 years as very AMA (VAMA). Pregnancy complications and adverse neonatal outcomes were recorded. Results Compared to younger women, pregnant AMA women had significantly higher risks of complicated pregnancies, including a higher risk of gestational diabetes mellitus (GDM, p<0.001), polyhydramnios (p<0.001), cesarean section (p<0.001), stillbirths (p<0.001), major fetal abnormality (p<0.001), preterm delivery (p<0.001), lower birth weight (p<0.001), lower 5-minute Apgar scores (p<0.001), lower umbilical artery blood pH values (p<0.001), neonatal intensive care unit (NICU) admission (p<0.001), and length of NICU stay (p<0.001). Conclusion We found a strong and significant association between VAMA and adverse pregnancy outcomes, including an increased risk of GDM, polyhydramnios, cesarean section, and adverse neonatal outcomes, including a higher risk of stillbirths, preterm delivery, lower birth weight, lower 5-minute Apgar scores, and NICU admission.

Implementation of a conservative checklist-based protocol for oxytocin administration: Maternal and newborn outcomes

2006 ◽  
Vol 195 (6) ◽  
pp. S118
Author(s):  
Steven Clark ◽  
Michael Belfort ◽  
George Saade ◽  
Darla Miller ◽  
Janet Meyers ◽  
...  
Keyword(s):  
Newborn Outcomes ◽  
Maternal And Newborn

Placental massive perivillous fibrinoid deposition is associated with adverse pregnancy outcomes: a clinicopathological study of 12 cases

2016 ◽  
Vol 5 (1) ◽  
pp. 35-39
Author(s):  
Maili Qi ◽  
Kenneth Tou En Chang ◽  
Derrick Wen Quan Lian ◽  
Chong Kiat Khoo ◽  
Kok Hian Tan
Keyword(s):  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Local Population ◽  
Fetal Loss ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Special Focus ◽  
Adverse Perinatal Outcomes ◽  
Adverse Pregnancy

Abstract Introduction: Massive perivillous fibrinoid deposition (MPFD) is a very rare placental condition characterized by abnormally extensive fibrinoid deposition in the placental villous parenchyma. The aim of this study is to document clinical and pathological features with special focus on pregnancy outcomes of this condition in consecutive cases of MPFD in our local population. Methods: This is a retrospective clinico-pathological study of cases affected by MPFD over the period January 2010–July 2014 in our hospital. We document clinical features (including perinatal outcome and subsequent pregnancies) and placental pathological characteristics. Results: Twelve cases of MPFD were identified among 3640 placentas (0.33%). There was no identified recurrence. The affected infants had adverse outcomes, including intrauterine growth restriction (IUGR) (75%), preterm birth (58.3%), and fetal loss (25%). A high frequency of reduced PAPP-A in the first trimester (25%), and concurrent gestational hypertension or pre-eclampsia (25%) was noted. Conclusion: MPFD is associated with adverse perinatal outcomes. Further research to better understand its pathogenesis and to improve clinical diagnosis and management is warranted.

scholarly journals Impact of Wildfire Smoke on Adverse Pregnancy Outcomes in Colorado, 2007–2015

2019 ◽  
Vol 16 (19) ◽  
pp. 3720 ◽  
Author(s):  
Mona Abdo ◽  
Isabella Ward ◽  
Katelyn O’Dell ◽  
Bonne Ford ◽  
Jeffrey Pierce ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Wildfire Smoke ◽  
Secondary Outcomes ◽  
Adverse Pregnancy ◽  
The Impact ◽  
Zip Code

Colorado is regularly impacted by long-range transport of wildfire smoke from upwind regions. This smoke is a major source of ambient PM2.5. Maternal exposure to total PM2.5 during pregnancy has been linked to decreased birth weight and other adverse outcomes, although the impact of wildfire smoke contribution has only recently been investigated. The objective of this study was to estimate associations between adverse pregnancy outcomes and ambient wildfire smoke PM2.5. Wildfire smoke PM2.5 exposures were estimated using a previously published method incorporating ground-based monitors and remote sensing data. Logistic regression models stratified by ZIP code and mixed models with random intercept by ZIP code were used to test for associations. The primary outcomes of interest were preterm birth and birth weight. Secondary outcomes included gestational hypertension, gestational diabetes, neonatal intensive care unit admission, assisted ventilation, small for gestational age, and low birth weight. Exposure to wildfire smoke PM2.5 over the full gestation and during the second trimester were positively associated with pre-term birth (OR = 1.076 (μg/m3)−1 [95% CI = 1.016, 1.139; p = 0.013] and 1.132 (μg/m3)−1 [95% CI = 1.088, 1.178]; p < 0.0001, respectively), while exposure during the first trimester was associated with decreased birth weight (−5.7 g/(μg/m3) [95% CI: −11.1, −0.4; p = 0.036]). Secondary outcomes were mixed.

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