A Population-level Analysis of the Differing Effects of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes

2019 ◽  
Vol 47 (2) ◽  
pp. 197-203 ◽  
Author(s):  
Stephanie O. Keeling ◽  
Samantha L. Bowker ◽  
Anamaria Savu ◽  
Padma Kaul
Keyword(s):  
Rheumatoid Arthritis ◽  
Pregnant Women ◽  
Population Level ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Neonatal Outcomes ◽  
Hypertensive Disorder ◽  
Antiinflammatory Drugs ◽  
Hypertensive Disorders ◽  
Maternal And Neonatal Outcomes ◽  
In Pregnancy

Objective.The effects of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level have not previously been well compared.Methods.A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 3 groups: (1) no inflammatory arthritis (no IA, n = 308,989), (2) RA (n = 631), and (3) SpA (n = 2461). We compared maternal and neonatal outcomes, comorbid conditions, and medication use among the 3 groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy.Results.Pregnant women with RA were significantly more likely to have preterm delivery (13.5%), cesarean delivery (33.9%), hypertensive disorders in pregnancy (10.5%), and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Nonsteroidal antiinflammatory drugs and corticosteroid use were significantly higher in pregnant women with RA compared to the other groups. Women with RA were significantly more likely to have an SGA baby (OR 1.51, 95% CI 1.21–1.88; p < 0.01), and hypertensive disorder in pregnancy (OR 1.51, 95% CI 1.16–1.97; p < 0.01), compared to women with no IA, while no difference was found between women with SpA and those with no IA.Conclusion.Women with RA have a higher risk of worse maternal and neonatal outcomes, whereas the risk of these events is similar between women with and without SpA.

scholarly journals Perinatal outcome in hypertensive disorder of pregnancy in a rural community of Haryana

2019 ◽  
Vol 6 (10) ◽  
pp. 4267
Author(s):  
Bharti . ◽  
Sumit Chawla
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Statistical Tests ◽  
Mode Of Delivery ◽  
Hypertensive Disorder ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
In Pregnancy

Background: Pregnancy in hypertension may complicate pregnancies with variable incidence among different settings. Pregnancies complicated with hypertensive disorders are associated with increased risk of adverse fetal, neonatal and maternal outcome including preterm birth, intrauterine growth retardation (IUGR), perinatal death etc. The present study was undertaken to study the perinatal outcome of hypertension in pregnancy in a rural block of Haryana.Methods: This cross-sectional study was carried out in the all the 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Pregnancy outcome was followed-up by contacting the health worker of respective sub-center or mother. Information regarding stillbirth, abortion, maturity, birth weight, mode of delivery and early neonatal death was collected. Appropriate statistical tests were used for analysis.Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Hypertension in pregnancy is significantly associated with premature births still births (6.7% vs 1.4%; p=0.003), low birth weight (26.7% vs 4.9%; p=0.000) and early neonatal deaths (8.3% vs 2.8%; p=0.017).Conclusions: Perinatal mortality is significantly high in mothers with hypertensive disorders. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

scholarly journals A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcome

2017 ◽  
Vol 6 (10) ◽  
pp. 4302 ◽  
Author(s):  
Neha V. Bhave ◽  
Parmanand K. Shah
Keyword(s):  
Lactate Dehydrogenase ◽  
Pregnant Women ◽  
Vascular Function ◽  
Perinatal Outcome ◽  
Gestational Hypertension ◽  
Hypertensive Disorder ◽  
Severity Of Disease ◽  
Hypertensive Disorders ◽  
Dehydrogenase Enzyme ◽  
In Pregnancy

Background: A spectrum of hypertensive disorders in pregnancy contribute to maternal and perinatal morbidity and mortality. For prediction and early diagnosis of preeclampsia various biochemical markers, vascular function test and renal markers have been developed. The objective of the study is to measure the lactate dehydrogenase enzyme (LDH) levels in pregnant women with pregnancy induced hypertensive disorders and correlate the levels with the severity of condition, maternal and the perinatal outcome.Methods: In this prospective observational study, a total of 150 pregnant women were studied. Out of these 150 women, 30 women had normal blood pressure, 30 women had gestational hypertension, 30 women had mild preeclampsia, 30 women had severe preeclampsia and 30 women had eclampsia. The serum LDH levels were measured in third trimester and patients followed up until early postpartum period and babies were followed up till early neonatal period to assess the maternal and neonatal outcomes.Results: Higher lactate dehydrogenase enzyme (LDH) levels were observed in pregnant women with severe form of hypertensive disorder and those who had a poor maternal and perinatal outcome. This is statistically significant (p<0.001).Conclusions: Lactate dehydrogenase enzyme (LDH) level is a useful biochemical marker to assess and predict the severity of disease, maternal and perinatal outcome as higher levels of the enzyme are associated with worsening severity of disease, a poor maternal and perinatal outcome.

scholarly journals PREVALENCE OF HYPERTENSIVE DISORDERS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN SELECTED PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA

2021 ◽  
Vol 7 (2) ◽  
pp. 19-44
Author(s):  
Weynshet Firisa ◽  
Lister Onsongo ◽  
Judy Mugo
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Addis Ababa ◽  
Public Hospitals ◽  
Hypertensive Disorder ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
In Pregnancy

Purpose: This study sought to assess the prevalence of hypertension in pregnancy and associated risk factors among women attending antenatal care clinics in selected Pubic Hospitals in Addis Ababa, Ethiopia. Materials and Methods: The research employed a cross-sectional descriptive study design. Study population was pregnant women who attended ANC care in selected hospital.  The respondents were randomly selected from Tikur Anbesa specialized, Zewuditu Memorial and St. Paul’s Millennium medical college hospitals. Respondents for interview were selected using systematic random sampling at an interval of nine until a sample size of 297 was reached. The study used an adopting both quantitative and qualitative data collection methods. Quantitative data was collected using structured questionnaires from pregnant women attending antenatal care clinics while qualitative data was collected using key informant interview schedules and Focused Group Discussion guides with Nurses in charge of antenatal care clinics and primary respondents respectively. Key informants and focused group discussants were purposively selected. Descriptive data was analysed using Statistical Package for Social Sciences version 20.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analysed using thematic analysis and results triangulated with quantitative data as direct quotes or narrations. Inferential statistics were calculated using Chi-Square tests done at 95% confidence interval and a margin of error of 0.05 to establish the association between variables. Information generated were presented in the text in the form of tables, bar graphs and pie charts. Results: The study results revealed that the prevalence of pregnancy induced hypertension in Addis Ababa was 21.9%. Socio-demographic factors such as age (p=0.030), occupation (p=0.031), income (p=0.0014), highest level of education (p=0.001) and health insurance (p=0.001) were significantly associated with occurrence of hypertension in pregnancy. Rreproductive and obstetric factors such as age at first pregnancy (p=0.001), gravidity (p=0.046), parity (p=0.001), history of obesity (p=0.001) and occurrence of gestational diabetes (p=0.002) were significantly associated with hypertension in pregnancy. More than a half (51.9%) of respondents had negative attitude towards hypertensive disorder in pregnancy. The level of attitude (p=0.040) was significantly associated with occurrence of hypertension in pregnancy. Unique contribution to theory, practice and policy: The study recommends that the management of the 3 health facilities together with other stakeholders in health empower women to start income generating projects to increase their financial access to antenatal care services consequently reduces hindrances that may lead to pregnancy complications such as hypertensive disorders in pregnancy.

Abstract P164: Blood Pressure During Pregnancy and Risk of Hypertension Later in Life: A Longitudinal Study of POUCHMoms

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Galit Levi Dunietz ◽  
Kelly L Strutz ◽  
Claudia B Holzman ◽  
Yan Tian ◽  
David Todem ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Multinomial Logistic Regression ◽  
Elevated Blood Pressure ◽  
Hypertensive Disorder ◽  
Elevated Blood ◽  
Hypertensive Disorders ◽  
Before And After ◽  
In Pregnancy

Objectives: Hypertensive disorders in pregnancy carry a long-term risk of cardiovascular disease (CVD) for women. However, future hypertension status among pregnant women who have moderately elevated blood pressure (MEBP), that does not meet criteria for hypertensive disorders is unknown. We, therefore, investigated the risk of later hypertension among women with MEBP in pregnancy in addition to those diagnosed with gestational hypertensive disorders. Methods: Data are from the Pregnancy Outcomes and Community Health (POUCH) study, which enrolled pregnant women from 52 clinics in 5 Michigan Communities (1998-2004). We included 667 women with abstracted gestational BP measurements who also participated in the POUCHMoms follow-up 7-15 years later. MEBP was defined as systolic BP (SBP) ≥120mmHg or diastolic BP (DBP) ≥80mmHg among pregnant women who did not have a hypertensive disorder. Hypertensive disorders were defined as at least two SBP measurements ≥140 or DBP measurements ≥90 or regular use of anti-hypertensives, with or without proteinuria. Weighted multinomial logistic regression models were run to estimate the odds of prehypertension or hypertension at follow-up, before and after controlling for maternal prenatal confounders (e.g. age, parity, race) and time between pregnancy and follow-up. Results: The majority of participants (59.6%) met the criteria for MEBP which was significantly associated with hypertension at follow-up before and after adjustment for confounders (AOR=2.76; 95% CI 1.40, 5.46). Significant associations were seen for MEBP first identified prior to 20 weeks, and for MEBP observed due to elevated SBP either alone or in conjunction with elevated DBP. As expected, gestational hypertensive disorders also were associated with increased odds of hypertension at follow-up (AOR=16.99; 95% CI 6.11, 47.24). All of the above relationships held when body mass index (BMI) at follow-up was added into the models. Conclusions: Moderately elevated blood pressure in pregnancy may be a risk factor for hypertensive disorders later in life and may identify a group of women who need closer surveillance for CVD risk in the years following pregnancy. Elevated SBP appears to play a more influential role than DBP in the observed association.

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

2020 ◽  
Vol 16 ◽  
Author(s):  
Reza Omani-Samani ◽  
Saman Maroufizadeh ◽  
Nafise Saedi ◽  
Nasim Shokouhi ◽  
Arezoo Esmailzadeh ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Unwanted Pregnancy ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

scholarly journals Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

2021 ◽  
Vol 38 (05) ◽  
pp. 515-522
Author(s):  
Marissa Berry ◽  
Amanda Wang ◽  
Shannon M. Clark ◽  
Hassan M. Harirah ◽  
Sangeeta Jain ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Disease Severity ◽  
Gestational Age ◽  
Laboratory Data ◽  
Population Characteristics ◽  
Neonatal Outcomes ◽  
P Value ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes

Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. Key Points

Treatment Options for Rheumatoid Arthritis: Celecoxib, Leflunomide, Etanercept, and Infliximab

2000 ◽  
Vol 34 (6) ◽  
pp. 743-760 ◽  
Author(s):  
Brigitte T Luong ◽  
Barbara S Chong ◽  
Dionne M Lowder
Keyword(s):  
Rheumatoid Arthritis ◽  
English Language ◽  
Data Extraction ◽  
Treatment Options ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Safety And Efficacy ◽  
Medline Search ◽  
Pertinent Data

OBJECTIVE: To review new pharmacologic agents approved for use in the management of rheumatoid arthritis (RA). DATA SOURCES: A MEDLINE search (1966–January 2000) was conducted to identify English-language literature available on the pharmacotherapy of RA, focusing on celecoxib, leflunomide, etanercept, and infliximab. These articles, relevant abstracts, and data provided by the manufacturers were used to collect pertinent data. STUDY SELECTION: All controlled and uncontrolled trials were reviewed. DATA EXTRACTION: Agents were reviewed with regard to mechanism of action, efficacy, drug interactions, pharmacokinetics, dosing, precautions/contraindications, adverse effects, and cost. DATA SYNTHESIS: Traditional pharmacologic treatments for RA have been limited by toxicity, loss of efficacy, or both. Increasing discoveries into the mechanisms of inflammation in RA have led to the development of new agents in hopes of addressing these limitations. With the development of celecoxib, a selective cyclooxygenase-2 inhibitor, the potential exists to minimize the gastrotoxicity associated with nonsteroidal antiinflammatory drugs. Leflunomide has been shown to be equal to or less efficacious than methotrexate, and may be beneficial as a second-line disease-modifying antirheumatic drug (DMARD). The biologic response modifiers, etanercept and infliximab, are alternatives that have shown benefit alone or in combination with methotrexate. However, they should be reserved for patients who fail to respond to DMARD therapy. Further studies should be conducted to evaluate the long-term safety and efficacy of these agents as well as their role in combination therapy. CONCLUSIONS: Celecoxib, leflunomide, etanercept, and infliximab are the newest agents approved for RA. Clinical trials have shown that these agents are beneficial in the treatment of RA; however, long-term safety and efficacy data are lacking.

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.

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