Risk Factors of Drug-Induced Liver Involvement in First Trimester of Pregnancy

Study Objective: to identify the risk factors of drug-induced liver involvement in first trimester of pregnancy. Study Design: prospective randomized comparative clinical research. Materials and Methods. At the Scientific Centre of Obstetrics, Gynaecology and Reproductive Medicine named after D.O. Ott, we selected 113 pregnant women in first trimester of pregnancy. The study group included 81 patients with clinical, anamnestic and biochemical signs of drug-induced liver involvement, while the comparison group included 20 pregnant women who took hormonal drugs to prevent or treat habitual miscarriage and who did not have aminotransferases changed; and the control group of 12 healthy women who did not take any hormonal drugs. Diagnosis of hepatic involvement was based on the RUCAM criteria (Roussel Uclaf Causality Assessment Method). We assessed biochemical blood analysis which demonstrated hepatic functional status; ultrasound results for liver and gall bladder; amount and types of drugs used; incidence of background gynaecological and somatic disorders. Study Results: During pregnancy planning, 71.8% of women from the study group were treated with hormonal agents; 49.4% had their present pregnancy after in vitro fertilisation (IVF) and cryoconservation protocol. In addition to hormonal therapy, in first trimester of pregnancy some patients were prescribed antimicrobials and immunoglobulins, more frequently in the study group (31.3% and 34.3%, respectively). Apart from hormonal agents, women in the study group were prescribed 7.7 ± 0.2 medicines on the average vs. 3.8 ± 0.3 medicines in controls. Pregnant women in the study group were treated with hormones for 35 ± 1.7 days vs. 15.8 ± 0.8 days in controls. Conclusion. The following risk factors of drug-induced hepatic involvement in first trimester of pregnancy were identified: hormonal therapy during pregnancy planning and in first trimester of pregnancy; pregnancy after ovulation stimulation and IVF; long-term use (over 4 weeks) of estrogenic and gestagenic drugs; polypragmasy. No correlation was found between somatic disorders and the risk of hepatic involvement. Hepatocellular hepatic involvement prevailed; the incidence of cholestatic and vessel types made 9% and 5%, respectively. Keywords: drug-induced liver involvement, pregnancy, first trimester, oestrogens, gestagens, risk factors.

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Drug-induced cytolytic syndrome in pregnancy: clinical and biochemical diagnostic criteria

Journal of obstetrics and women s diseases ◽

10.17816/jowd65628-35 ◽

2016 ◽

Vol 65 (6) ◽

pp. 28-35

Author(s):

Irina V Borisova

Keyword(s):

Pregnant Women ◽

Hormone Therapy ◽

Clinical Manifestations ◽

First Trimester ◽

Gamma Glutamyl Transpeptidase ◽

Drug Induced ◽

Planning Stage ◽

Protein Levels ◽

First Trimester Of Pregnancy ◽

In Pregnancy

The aim of the study was evaluation of clinical and laboratory manifestations of drug-induced cytolytic syndrome in pregnancy. In the research group included 62 pregnant women with drug-induced liver injury (DILI) in the first trimester of pregnancy. These pregnant women received hormone therapy at the planning stage and/or during pregnancy for the prevention and treatment of miscarriage and had clinical and biochemical manifestations of cytolytic syndrome. Pregnancy after IVF and ovulation induction was in 60.8% of cases. Hormone therapy for pregnant patients received long-term, 85% of pregnant women used estrogen and progestin drugs. DILI during pregnancy characterized by low-symptom or asymptomatic clinical manifestations. DILI manifested cytolytic biochemical syndrome, in which there is isolated increase of transaminase levels, in some cases accompanied by increased level of gamma glutamyl transpeptidase, liver glutamate dehydrogenase and decreased total protein levels, in the first place due to the albumin fraction.

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Preeclampsia and level of oxidative stress in the first trimester of pregnancy

Vojnosanitetski pregled ◽

10.2298/vsp150517251b ◽

2017 ◽

Vol 74 (7) ◽

pp. 633-638 ◽

Cited By ~ 1

Author(s):

Mirjana Bogavac ◽

Ana Jakovljevic ◽

Zoran Stajic ◽

Aleksandra Nikolic ◽

Mirjana Milosevic-Tosic ◽

...

Keyword(s):

Oxidative Stress ◽

Pregnant Women ◽

Total Antioxidant Status ◽

First Trimester ◽

Normal Pregnancy ◽

Clinical Syndrome ◽

Control Group ◽

Study Group ◽

First Trimester Of Pregnancy ◽

A Prospective Study

Background/Aim. Preeclampsia (PE) is a multisystemic syndrome that complicates 5?8% of all pregnancies. The aim of this study was to evaluate the biochemical parameters of oxidative stress in the first trimester of pregnancy in patients with preeclampsia, with the purpose of comparing the level of oxidative stress with normal pregnancy. Methods. The study was conducted as a prospective study. It included totally 107 pregnant women divided into two groups. In the study group (n = 33) there were women who developed preeclampsia in the current pregnancy. The control group (n = 74) included healthy pregnant women. Blood samples were taken between 11th and 14th weeks of gestation, and the values of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and total antioxidant status (TAS) were determined in serum by enzymatic colorimetric methods. Results. The values of SOD and GHS-Px were statistically higher in the study group, while the values of TAS were statistically higher in the control group. The level of TAS inversely correlated with GSH-Px and SOD, but there is no statistically significant correlation between GSHPx and SOD in the study group. Conclusion. The results of this study suggest a higher level of oxidative stress in the first trimester of pregnancy with preeclampsia, which may indicate that the initiation and development of pathophysiological processes underlying preeclampsia start much earlier than the clinical syndrome exhibit.

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Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10050601 ◽

2021 ◽

Vol 10 (5) ◽

pp. 601

Author(s):

Houyu Zhao ◽

Mei Zhang ◽

Jiaming Bian ◽

Siyan Zhan

Keyword(s):

Pregnant Women ◽

Ambulatory Care ◽

National Level ◽

Mainland China ◽

Antibiotic Use ◽

First Trimester ◽

Cross Sectional Study ◽

Cross Sectional ◽

Fetal Safety ◽

First Trimester Of Pregnancy

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

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Malarial Infection in HIV Infected Pregnant Women Attending a Rural Antenatal Clinic in Nigeria

Advances in Epidemiology ◽

10.1155/2014/694213 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

R. S. Houmsou ◽

B. E. Wama ◽

S. O. Elkanah ◽

L. C. Garba ◽

T. D. Hile ◽

...

Keyword(s):

Risk Factors ◽

Haemoglobin Level ◽

Pregnant Women ◽

Rural Areas ◽

First Trimester ◽

Antenatal Clinic ◽

Severe Anaemia ◽

Sub Saharan Africa ◽

Malarial Infection ◽

Sub Saharan

Malaria still remains a challenging infection affecting the lives of several HIV infected pregnant women in sub-Saharan Africa. This study was undertaken to determine malarial infection in HIV infected pregnant women in relation to sociodemographic and obstetrical factors. The study also assessed relationship between malarial infection and haemoglobin level, CD4+ counts, and ART regimen, as well as predisposing risk factors that influenced occurrence of malarial infection in the women. Thick and thin blood smears were prepared and stained with Giemsa. Haemoglobin level was determined using a hematology analyzer, while the flow cytometry was used to measure CD4+ counts. Sociodemographic and obstetrical parameters were obtained through the administration of questionnaires. Of the 159 HIV infected pregnant women examined, 33.3% (59/159) had malarial infection. Malarial infection was significantly higher in pregnant women who were divorced, 40.24% (33/82) (χ2=5.72; P=0.05), were at their first trimester (4–12 weeks), 54.8% (17/31) (χ2=14.85; P=0.01), had CD4+ = [201–500 cells/μL], 42.42% (42/99) (χ2=10.13; P=0.00), and those that had severe anaemia (<8 dg/L), 100.00% (χ2= 45.75; P=0.00). However, risk factors that influenced the occurrence of malarial infection in the pregnant women were occupation (farming) (AOR=0.226; P=0.03), marital status (divorced) (AOR=2.80; P=0.02), gestation (first trimester) (AOR=0.33; P=0.00), haemoglobin level (Hb < 8 dg/L) (AOR=0.02; P=0.00), and CD4+ counts (low CD4+) (OR=0.40; P=0.05). The study reported endemicity of malaria in HIV infected pregnant women living in rural areas of Benue State, Nigeria. Malarial infection was higher in women that were divorced, and at their first trimester, had low CD4+ count, and had severe anaemia. Farming, divorce, gestation, severe anaemia, and low CD4+ counts were predisposing risk factors that influenced malaria occurrence in the HIV infected pregnant women. It is advocated that HIV infected pregnant women should be properly and thoroughly educated on malaria preventive measures in rural areas so as to avoid unpleasant effect of malaria during their pregnancies.

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Adequacy and Sources of Protein Intake among Pregnant Women in the United States, NHANES 2003–2012

Nutrients ◽

10.3390/nu13030795 ◽

2021 ◽

Vol 13 (3) ◽

pp. 795

Author(s):

Mary M. Murphy ◽

Kelly A. Higgins ◽

Xiaoyu Bi ◽

Leila M. Barraj

Keyword(s):

Pregnant Women ◽

Protein Intake ◽

First Trimester ◽

The United States ◽

Limited Information ◽

Health And Nutrition ◽

Animal Source ◽

Usual Intake ◽

First Trimester Of Pregnancy ◽

Using Data

Limited information is available on protein intake and adequacy of protein intake among pregnant women. Using data from a sample of 528 pregnant women in the National Health and Nutrition Examination Surveys (NHANES) 2003–2012, usual intake of protein (g/day and g/kg body weight (bw)/day) and prevalence of intake below the Estimated Average Requirement (EAR) by trimester of pregnancy were calculated using the National Cancer Institute method. Percent contributions to protein intake by source (i.e., plant and animal, including type of animal source) were also calculated. Mean usual intake of protein was 88 ± 4.3, 82 ± 3.1, and 82 ± 2.9 g/day among women in trimester 1, 2, and 3 of pregnancy, respectively, or 1.30 ± 0.10, 1.35 ± 0.06, and 1.35 ± 0.05 g/kg bw/day, respectively. An estimated 4.5% of women in the first trimester of pregnancy consumed less protein than the EAR of 0.66 g/kg bw/day; among women in the second and third trimesters of pregnancy, 12.1% and 12.8% of women, respectively, consumed less protein than the EAR of 0.88 g/kg bw/day. Animal sources of protein accounted for approximately 66% of total protein. Findings from this study show that one in eight women in the second and third trimesters of pregnancy have inadequate intake of protein. Pregnant women should be encouraged to consume sufficient levels of protein from a variety of sources.

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AYURVEDIC MANAGEMENT OF GARBHINI CHARDI (Emesis Gravidarum) WITH CHATURJATA CHOORNA (CHATURJATA POWDER) - A PILOT STUDY

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj0308072020 ◽

2020 ◽

Vol 8 (9) ◽

pp. 4317-4323

Author(s):

Priyanka 1 ◽

Shreyes. S ◽

Yogitha Bali M.R

Keyword(s):

Pilot Study ◽

Pregnant Women ◽

First Trimester ◽

Nausea And Vomiting ◽

Morning Sickness ◽

Excessive Salivation ◽

First Trimester Of Pregnancy ◽

Rice Water ◽

Single Blind

Background: During pregnancy many demands are made by growing fetus, to meet these requirements maternal system has to undergo certain changes. Garbhinichardi (Emesis Gravidarum) is one among them and this has been termed as Gruhita Garbha Lakshanas (Immediate signs of conception) in Ayurvedic clas-sics. Approximately 80 % of pregnant women experience excessive salivation, nausea and vomiting during pregnancy, commonly known as “morning sickness”, which is seen frequently throughout the day. Design: This is single blind pilot study. 30 patients with complaints of Garbhinichardi (Emesis Gravidarum) in first trimester were included in this study. Patients were given Chaturjatachurna (Chatutjata powder)for a peri-od of 2 weeks in dose of 3gms thrice a day after meal with Anupana (Adjuvant) as Madhu (honey) of 5ml mixed with Tandulodaka (Raw rice water) Results: This pilot study showed statistically significant changes with Chaturjatachurna in reducing the complaints of pregnant women such as nausea (p<0.001), vomiting (p<0.001) and Aruchi (Anorexia) (p<0.001) in their first trimester of pregnancy. Conclusion: Chaturjata-churna was effective in the management of Garbhini Chardi (Emesis Gravidarum) and other symptoms in the first trimester of pregnancy.

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Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District-Malawi

Reproductive Health ◽

10.1186/s12978-018-0605-5 ◽

2018 ◽

Vol 15 (1) ◽

Cited By ~ 7

Author(s):

Chancy S. Chimatiro ◽

Precious Hajison ◽

Effie Chipeta ◽

Adamson S. Muula

Keyword(s):

Pregnant Women ◽

First Trimester ◽

Antenatal Clinic ◽

First Trimester Of Pregnancy

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Obstetrical and Neonatal Outcomes in Pregnant Women with Serum Thyroid-Stimulating Hormone (TSH) Levels >2.0 mU/Lvs.Those with TSH <2.0 in the First Trimester of Pregnancy

10.1210/endo-meetings.2011.part2.or6.or15-4 ◽

2011 ◽

pp. OR15-4-OR15-4

Author(s):

Shweta Achit ◽

Tapasya Dhar ◽

Kumkum Awasthi ◽

Bharti Uppal ◽

Jubbin Jagan Jacob

Keyword(s):

Pregnant Women ◽

First Trimester ◽

Thyroid Stimulating Hormone ◽

Neonatal Outcomes ◽

First Trimester Of Pregnancy ◽

Tsh Levels ◽

Stimulating Hormone

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Adverse pregnancy outcomes are associated with Plasmodium vivax malaria in a prospective cohort of women from the Brazilian Amazon

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009390 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009390

Author(s):

Jamille Gregório Dombrowski ◽

André Barateiro ◽

Erika Paula Machado Peixoto ◽

André Boler Cláudio da Silva Barros ◽

Rodrigo Medeiros de Souza ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Multivariate Logistic Regression Analysis ◽

Brazilian Amazon ◽

First Trimester ◽

Inflammatory Factors ◽

Anthropometric Measures ◽

First Trimester Of Pregnancy ◽

Adverse Pregnancy ◽

Angiopoietin 2

Background Malaria in Brazil represents one of the highest percentages of Latin America cases, where approximately 84% of infections are attributed to Plasmodium (P.) vivax. Despite the high incidence, many aspects of gestational malaria resulting from P. vivax infections remain poorly studied. As such, we aimed to evaluate the consequences of P. vivax infections during gestation on the health of mothers and their neonates in an endemic area of the Amazon. Methods and findings We have conducted an observational cohort study in Brazilian Amazon between January 2013 and April 2015. 600 pregnant women were enrolled and followed until delivery. After applying exclusion criteria, 329 mother-child pairs were included in the analysis. Clinical data regarding maternal infection, newborn’s anthropometric measures, placental histopathological characteristics, and angiogenic and inflammatory factors were evaluated. The presence of plasma IgG against the P. vivax (Pv) MSP119 protein was used as marker of exposure and possible associations with pregnancy outcomes were analyzed. Multivariate logistic regression analysis revealed that P. vivax infections during the first trimester of pregnancy are associated with adverse gestational outcomes such as premature birth (adjusted odds ratio [aOR] 8.12, 95% confidence interval [95%CI] 2.69–24.54, p < 0.0001) and reduced head circumference (aOR 3.58, 95%CI 1.29–9.97, p = 0.01). Histopathology analysis showed marked differences between placentas from P. vivax-infected and non-infected pregnant women, especially regarding placental monocytes infiltrate. Placental levels of vasomodulatory factors such as angiopoietin-2 (ANG-2) and complement proteins such as C5a were also altered at delivery. Plasma levels of anti-PvMSP119 IgG in infected pregnant women were shown to be a reliable exposure marker; yet, with no association with improved pregnancy outcomes. Conclusions This study indicates that P. vivax malaria during the first trimester of pregnancy represents a higher likelihood of subsequent poor pregnancy outcomes associated with marked placental histologic modification and angiogenic/inflammatory imbalance. Additionally, our findings support the idea that antibodies against PvMSP119 are not protective against poor pregnancy outcomes induced by P. vivax infections.

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