scholarly journals Steroid use in Pregnancy with Severe COVID-19      

2021 ◽  
Author(s):  
Aaron Corp ◽  
Tom Lawton ◽  
Adam Young ◽  
Nada Sabir ◽  
Michael McCooe ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Expert Opinion ◽  
Class Effect ◽  
Steroid Use ◽  
Class Differences ◽  
Current Guidance ◽  
The Uk ◽  
In Pregnancy

Managing women who are pregnant with severe COVID-19 is complex. This paper focuses on the debate surrounding steroid use in this group. Unfortunately, despite international efforts to identify treatments for COVID-19, there is very little research which has focussed specifically on pregnant women. Therefore current guidance is based on consensus and expert opinion, with variation in these guidelines worldwide, and reports that 73% of pregnant women do not receive steroids at all. There is an assumption of a steroid class-effect implicit within the UK guidelines for the mother with COVID-19 which is at odds with established within-class differences for effects on the foetus. This now warrants further discussion given the increasing numbers of pregnant women being admitted to hospital with COVID-19.

scholarly journals Steroid use in Pregnancy with Severe COVID-19      

2021 ◽  
Author(s):  
Aaron Corp ◽  
Tom Lawton ◽  
Adam Young ◽  
Nada Sabir ◽  
Michael McCooe ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Expert Opinion ◽  
Class Effect ◽  
Steroid Use ◽  
Class Differences ◽  
Current Guidance ◽  
The Uk ◽  
In Pregnancy

Managing women who are pregnant with severe COVID-19 is complex. This paper focuses on the debate surrounding steroid use in this group. Unfortunately, despite international efforts to identify treatments for COVID-19, there is very little research which has focussed specifically on pregnant women. Therefore current guidance is based on consensus and expert opinion, with variation in these guidelines worldwide, and reports that 73% of pregnant women do not receive steroids at all. There is an assumption of a steroid class-effect implicit within the UK guidelines for the mother with COVID-19 which is at odds with established within-class differences for effects on the foetus. This now warrants further discussion given the increasing numbers of pregnant women being admitted to hospital with COVID-19.

scholarly journals Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019

2020 ◽  
pp. 1753495X2092950
Author(s):  
Catherine Atkin ◽  
Paarul Prinja ◽  
Anita Banerjee ◽  
Mark Holland ◽  
Dan Lasserson
Keyword(s):  
Pregnant Women ◽  
Medical Problems ◽  
Acute Medicine ◽  
Hospital Size ◽  
Obstetric Medicine ◽  
Provision Of Services ◽  
Timely Access ◽  
The Uk ◽  
Local Guideline ◽  
In Pregnancy

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

scholarly journals Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038505
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Farah Seedat ◽  
John Marshall ◽  
Heather Bailey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pregnant Women ◽  
Neonatal Death ◽  
Cost Effective ◽  
Screening Strategy ◽  
Base Case ◽  
Scenario Analyses ◽  
The Uk ◽  
The Cost ◽  
In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

scholarly journals The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

2021 ◽  
Author(s):  
◽  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Surveillance System ◽  
Absolute Risk ◽  
Preterm Births ◽  
Incidence Rates ◽  
Minority Ethnic Group ◽  
Symptom Status ◽  
The Uk ◽  
In Pregnancy

ABSTRACTBackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

scholarly journals A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III)

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038827
Author(s):  
Nicola McMeekin ◽  
Lesley Sinclair ◽  
Linda Bauld ◽  
David Michael Tappin ◽  
Alex Mitchell ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Usual Care ◽  
Pregnant Women ◽  
Financial Incentives ◽  
Cost Effective ◽  
Good Opportunity ◽  
Link Type ◽  
The Uk ◽  
In Pregnancy

IntroductionSmoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%–23% in the UK. Smoking during pregnancy causes low birth weight and increases the risk of premature birth. After birth, passive smoking is linked to sudden infant death syndrome, respiratory diseases and increased likelihood of taking up smoking. These risks impact the long-term health of the child with associated increase in health costs. Emerging evidence suggests that offering financial incentives to pregnant women to quit is highly cost effective.This protocol describes the economic evaluation of a multi-centre randomised controlled trial (Cessation in Pregnancy Incentives Trial III, CPIT III) designed to establish whether offering financial incentives, in addition to usual care, is effective and cost effective in helping pregnant women to quit.Methods and analysisThe economic evaluation will identify, measure and value resource use and outcomes from CPIT III, comparing participants randomised to either usual care or usual care plus up to £400 financial incentives. Within-trial and long-term analyses will be conducted from a National Health Service and Personal Social Services perspective; the outcome for both analyses will be quality adjusted life-years measured using EQ-5D-5L. Patient level data collected during the trial will be used for the within-trial analysis, with an additional outcome of cotinine validated quit rates at 34–38 weeks gestation and 6 months postpartum. The long-term model will be informed by data from the trial and published literature.Ethics and disseminationTrial registration numberISRCTN15236311; Pre-results (https://doi.org/10.1186/ISRCTN15236311).

scholarly journals Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study

2019 ◽  
Vol 16 (1) ◽  
pp. 110 ◽  
Author(s):  
Sue Cooper ◽  
Sophie Orton ◽  
Katarzyna A. Campbell ◽  
Michael Ussher ◽  
Naomi Coleman-Haynes ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Mixed Methods Study ◽  
Cigarette Use ◽  
Smoking In Pregnancy ◽  
Stop Smoking ◽  
Quitting Smoking ◽  
Stop Smoking Services ◽  
The Uk ◽  
In Pregnancy

Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don’t know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS’ position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4–4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support.

scholarly journals Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

BMJ ◽  
2020 ◽  
pp. m2107 ◽  
Author(s):  
Marian Knight ◽  
Kathryn Bunch ◽  
Nicola Vousden ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Minority Groups ◽  
Fetal Loss ◽  
Population Based ◽  
National Population ◽  
Minority Ethnic Groups ◽  
National Cohort ◽  
The Uk ◽  
In Pregnancy

AbstractObjectivesTo describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.DesignProspective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll 194 obstetric units in the UK.Participants427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.Main outcome measuresIncidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.ResultsThe estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.ConclusionsMost pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.Study registrationISRCTN 40092247.

TO REVIEW THE TIMING OF INTERVENTION WHICH WILL PROVIDE THE BEST OUTCOME IN HYPOTHYROIDISM IN PREGNANCY

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr. Archana Mohana ◽  
Dr. Sujata Badoniya
Keyword(s):  
Pregnant Women ◽  
Thyroid Disease ◽  
Fetal Outcome ◽  
Thyroxine Therapy ◽  
In Pregnancy

The Aim of this study is to Review the timing of intervention which will provide the Best Outcome in Hypothyroidism in Pregnancy. Hypothyroid pregnant women are appropriately managed with regular antenatal checkup and thyroxine therapy during pregnancy, a good maternal and fetal outcome can be achieved and congenital cretinism and other neuro developmental sequele in the offspring can be averted. Keywords: Intervention, Hyperthyroidism, Pregnancy & Thyroid disease.

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