Disease In Pregnant Women Research Articles

Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study

Objectives: The diagnosis and treatment of thyroid diseases in pregnant women remains a challenge. Various medical associations recommend establishing the reference intervals for thyroid hormones by a local laboratory. Considering differences within geophysical, socioeconomic conditions, and iodine prophylaxis in various populations, it is advisable to assess reference intervals for thyroid hormones specific to a region of residence. The objective was to assess trimester-specific reference intervals for TSH, fT₃, and fT₄ for pregnant women in the Polish population. Methods and Results: We conducted a prospective study in 4 centers representing different regions of Poland (Krakow, Warsaw, Poznan, and Bialystok). Our study included consecutive, healthy pregnant women (172 patients), with an age range of 27-47 years. All women had a negative history for thyroid diseases, normal thyroid peroxidase antibody levels, and proper iodine prophylaxis. All newborns had TSH levels in the appropriate reference range. Serum TSH, fT₃, fT₄, and thyroid-peroxidase antibodies were measured in each trimester. The reference intervals were calculated using the percentile method, as recommended by the International Federation of Clinical Chemistry. The reference values calculated were 0.009-3.177, 0.05-3.442, and 0.11-3.53 mIU/L for TSH; 3.63-6.55, 3.29-5.45, and 3.1-5.37 pmol/L for fT₃; and 11.99-21.89, 10.46-16.67, and 8.96-17.23 pmol/L for fT₄ in consecutive trimesters of pregnancy. Reference intervals for pregnant women when compared to the general population showed a lower concentration of TSH in every trimester of pregnancy and lower fT₄ in the 2nd and 3rd trimesters. Conclusions: Using appropriate trimester-specific reference intervals may improve care of pregnant women by preventing misdiagnosis and inadequate treatment.

The relationship of digestive system diseases in pregnant women with stillbirth and neonatal death in Iran: A population-based case–control study

Background: The most important digestive system diseases implicated in pregnant mothers' stillbirth and neonatal death include large intestine diseases, Crohn's disease, ulcerative colitis, and stomach problems. This study aimed to determine the relationship between digestive system diseases in pregnant women and stillbirth and neonatal death. Methods: This population-based case-control study was conducted on 3573 mothers (1223 mothers experiencing stillbirth, 1091 mothers with neonatal death, and 1259 mothers with live births) in 10 provinces of Iran. The study data were analyzed using logistic regression analysis. Results: A total of 461 pregnant women (12.9%) suffered from digestive system diseases before the last pregnancy among whom 171 women (14.1%) experienced stillbirth, 149 (13.7%) reported neonatal deaths, and 141 women (11.2%) were in the control group. The results showed that the women with digestive system diseases were more likely (32%) to experience stillbirth when compared to those with no digestive system diseases (odds ratio [OR]: 1.32; 95% confidence interval [CI] [1.008 − 1.74]). Neonatal mortality was also higher (58%) among the mothers with digestive system diseases as compared to the control group (OR: 1.58, 95% CI [1.19 − 2.09]). Conclusion: Pregnant mothers with digestive system diseases were exposed to higher risks of severe prenatal consequences. The odds of stillbirth and neonatal death, were, respectively, 0.32 and 0.58 times higher in the pregnant mothers affected by digestive system diseases than those without such problems. This shows the undesirable effects of digestive system diseases on the fetus. Mothers' knowledge of appropriate nutrition and digestive system diseases has to be improved to prevent these consequences.

Clinical Updates in Women's Health Care Summary: Liver Disease: Reproductive Considerations.

All women are at risk of acute and chronic liver diseases. Of particular importance are those diseases that exclusively affect pregnant women and have adverse effects on maternal, fetal, or neonatal outcomes. Acute viral hepatitis is an important cause of liver disease in pregnant women, and hepatitis E infection is associated with substantial mortality. An increasing number of women have chronic liver diseases caused by viral hepatitis, alcoholic liver disease and nonalcoholic fatty liver disease, autoimmune liver diseases, and genetic liver diseases. The presence of chronic liver diseases or cirrhosis in pregnant or nonpregnant women requires alterations in gynecologic care, including contraception, pregnancy planning, cervical cancer screening, human papillomavirus vaccination, and postmenopausal hormone therapy. Women who have had liver and other solid organ transplantation require gynecologic care tailored to their immunosuppressed status. Collaboration between obstetrician-gynecologists and hepatologists is essential to provide optimal care to women with acute or chronic liver diseases. Timely referral for evaluation for liver transplantation is mandatory for all women with acute liver failure.

Pattern, Clinical Presentation and Pregnancy Outcome of Thyroid Diseases in Pregnant Women at National Endocrine Referral Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from June 2010 to June 2015

Background: The major disorders of thyroid gland are hypothyroidism and hyperthyroidism and thyroid disorders are predominantly of autoimmune etiology in pregnant women. To date there is no study done in Ethiopia to show pattern and pregnancy outcomes of pregnant women with thyroid disorders. Objectives: To assess pattern of thyroid diseases, thyroid function test profiles, clinical presentations and pregnancy outcomes in pregnant women at National Endocrine Referral Clinics of Tikur Anbessa Specialized Hospital. Methods: A retrospective study was conducted at National Referral Endocrine Clinics of TASH from June 2010 to June 2015. All pregnant women with thyroid disorders were included in the study and patients’ charts were retrieved from follow up clinics and hospital archive by two trained residents of Internal medicine using pre-structured data collection tools. Results: Among a total of 1124 patients with endocrine disorders, 670 (59.6%) were patients with thyroid disorders and 9.25% (62) were pregnant women. Among pregnant women with thyroid disorders, majority, 51 (82.2%) were pregnant women with hyperthyroidism with mean (SD) age of 30 ± (6.45) years. Majority of patients with hyperthyroidism, 43(84.3%) were diagnosed to have TMNG followed by Graves’ disease. Among pregnant women with hypothyroidism, six were cases of iodine deficiency. The commonly seen symptoms of hyperthyroidism were, anterior neck swelling (94.1%), palpitation (47.1%) and heat intolerance (31.4%). Patients with hypothyroidism, accounted for 17.74% of thyroid diseases in pregnancy and the common symptoms were fatigue and cold intolerance each accounting for 9 (81.8%) of the cases. Most of pregnant women with hyperthyroidism, 37 (72.5%) gave birth to an alive neonate, 11 (21.6%) had abortion and the remaining 3 (5.9%) had IUFD. Conclusion: From our study, most of pregnant women with thyroid disorders were patients with hyperthyroidism. The pregnancy outcome of these patients was generally good. Recommendation: We recommend proper documentation and electronic medical recording to be practiced in the hospital and to have pre-pregnancy counseling for all reproductive age women who have follow up at endocrine referral clinics. We also recommend doing more comprehensive research on pregnancy outcomes of pregnant women with thyroid disorders and neonatal screening for congenital hypothyroidism.

MRI for Suspected Appendicitis in Pregnancy

Aim: Acute appendicitis is the most common disease in pregnant women. Based on the premise of the protection of fetus, diagnosis sometimes would be difficult. The purpose of this study is to evaluate the risk and benefit of magnetic resonance imaging for suspected acute appendicitis in Pregnancy. Method: From Oct 2015 to Apr 2017, 10 pregnant women came to our emergency department because of suspected acute appendicitis. We bring MRI to participate the diagnosis in case ultrasound is insufficient to make accurate detection. Result: 5 cases with nonvisualization of appendicitis and 5 cases were confirmed acute appendicitis. Ultrasound of these women couldn't clearly show the abnormal anatomy. But with non-radiation MRI acute appendicitis with presence of appendicoliths were identified. Conclusion: The use of MRI in pregnant women with suspected acute appendicitis is meaningful, not only in confirmation or exclusion of appendicitis but also alternative non-radiation diagnosis tool for further treatment.

Intrahepatic cholestasis of pregnancy and fetal outcomes. Mini review

Intrahepatic cholestasis of pregnancy (ICP), a pregnancy-related liver disease, leads to complications for both mother and fetus. It is the most common liver disease in pregnant women. The incidence of ICP has varied widely in different reports (ranging from 0.1 to 15.6%), for reasons that are incompletely understood. Hormonal, immunologic, genetic, environmental and alimentary factors have been implicated in the etiology of ICP. Although a clear correlation between elevated levels of maternal serum bile acids and deficient fetal outcome has been established in clinical practice, the underlying mechanisms remain elusive. Here we present a mini literature review about intrahepatic cholestasis of pregnancy and fetal outcomes.

Characteristics of cervical diseases in pregnant women with a history of recurrent miscarriage

Characteristics of cervical diseases in pregnant women with a history of recurrent miscarriage

Review of toxoplasmosis in Morocco: seroprevalence and risk factors for toxoplasma infection among pregnant women and HIV- infected patients.

Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii. This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level. For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco.

EXPERIENCE OF TREATMENT OF PREGNANT WOMEN WITH ACUTE ABDOMEN

Aim. To summarize the current experience of diagnosis and treatment of pregnant women with acute abdomen. Materials and methods . Analysis of treatment results of 183 pregnant women with acute abdomen in the conditions of two multidisciplinary hospitals in Krasnodar. The most common urgent surgical diseases in pregnant women are acute appendicitis, cholecystitis and its complications, acute pancreatitis, acute intestinal obstruction. Results. Diagnosis of diseases, providing the contingent of patients, is quite difficult, and often takes a long time, significantly worsening the prognosis for both the mother and the fetus. The ultrasound examination of the abdominal cavity in all patients makes it possible to clarify the diagnosis and adjust the treatment tactics. When doubting the diagnosis, it is necessary to perform diagnostic laparoscopy. Conclusion. The use of minimally invasive technologies in the treatment of pregnant women can reduce the frequency of surgical and associated perinatal complications, promote the prolongation of pregnancy, and reduce maternal and perinatal mortality.

Oral Health And Dental Care In Pregnant Women: Bibliometric Study, Systematic Review, And Content Analysis

Introduction: the oral condition of pregnant women and the attention it needs affect the overall health of these women and their children. A variety of perspectives have been used to understand and approach research on this field. The objectives of this study were: conduct a bibliometric analysis, assess the quality of the available evidence, and conduct content analysis of articles related to the topics. Methodology : publications related to the topics were identified through a systematic search of the literature, identifying authors, years, and countries with the most publications; in addition, quality of the reports was assessed through the STROBE Guide on the studies that were retrieved in full text, conducting content analysis on thematic, methodological, and epistemological aspects. Results: the systematic review was conducted in three databases (PubMed, Scopus, and Web of Science). Institutions, authors, institutional affiliation, and co-authorship networks were identified with the bibliometric analysis. The systematic review showed predominance of cross-sectional observational studies; there were few controlled clinical trials and they generally emphasized treatments for periodontal disease in pregnant women. The evidence on this subject tends to be low. Content analysis showed that, in ontological terms, research focuses on three main areas: a) biological differences between men and women; b) impact of pregnant women’s oral health on the oral and overall health of their babies, c) relationship between pregnancy, oral health, and its impact on the oral and overall health of women. Few studies explore social determinants. In epistemological terms, studies from positivist perspectives were predominant. In methodological terms, the emphasis is placed on research with quantitative approaches. Conclusion: it is necessary to strengthen the relationship between biological and social aspects of pregnant women’s oral health and dental care from different epistemological perspectives, seeking a comprehensive view of these aspects and improving dental care in pregnant women

A Case of Idiopathic Acute Hepatitis with Complications in Mid-Trimester Pregnancy

Although liver diseases in pregnancy are rare, they can seriously affect mother and fetus. Although any type of liver disease can develop during pregnancy, it is difficult to identify features of liver disease in pregnant women because of physiological changes. Physiologic changes of pregnancy can be confounding with the symptoms of liver diseases. It can not only complicate mother’s life but also burden life of fetus to growth restriction. We describe an uncommon case of acute hepatitis with disseminated intravascular coagulation and clinical chorioamnionitis coincidentally in mid-trimester pregnancy. She experienced the development of acute hepatitis of unknown causes. She presented with fever, maternal tachycardia, and fetal tachycardia. We decided termination of pregnancy because of 16 weeks’ gestation. After termination, she was managed about acute hepatitis. So we report our case with a brief reviews of the literature. Key words: Hepatitis; Mid-trimester pregnancy; Chorioamnionitis

Zika Virus Infection in Pregnant Women in Rio de Janeiro

BackgroundZika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants.MethodsWe enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase–polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes.ResultsA total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester).ConclusionsDespite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministério da Saúde do Brasil and others.)

DETECÇÃO DE DOENÇAS TRANSMISSÍVEIS EM GESTANTES NO ESTADO DE GOIÁS: O TESTE DA MAMÃE

Neste trabalho é descrita a triagem de doenças infecciosas em gestantes do estado de Goiás para detecção de agravos que podem ser transmitidos durante a gravidez e causar sequelas na criança.A triagem é realizada por meio de programa da Secretaria Estadual da Saúde em parceria com a Associação de Pais e Amigos dos Excepcionais (APAE) e as Secretarias Municipais de Saúde.A experiência da APAE na detecção de algumas doenças congênitas por teste simples em papel filtro foi aproveitada e seu uso expandido para a detecção de doenças infecciosas/transmissíveis.De setembro de 2003 até junho de 2009 foram examinadas amostras de 348.037 gestantes.Implantada progressivamente a partir de dois municípios, a triagem para doenças infecciosas está disponível em 245 dos 246 municípios do estado de Goiás. Os agravos triados foram: sífilis, HIV/Aids, toxoplasmose, rubéola, hepatites B e C, infecção pelo Trypanosoma cruzi, HTLV e citomegalovirose. A triagem foi realizada em papel filtro por testes imunoenzimáticos ELISA) para cada marcador e os resultados positivos foram confirmados por coleta de sangue venoso, cujo soro foi encaminhado a diferentes centros de referência. Foram identificadas 11.061 gestantes com resultados positivos. A confirmação após os testes com soro foi obtida em 10.496 (94,9%) amostras com as seguintes prevalências: sífilis: 4.028 (1,2%); toxoplasmose: 2.320 (0,7%), anticorpos anti-T. cruzi: 1.768 (0,5%); hepatite B: 956 (0,3%); HIV: 469 (0,1%), hepatite C: 334 (0,1%), HTLV: 312 (0,1%), rubéola: 181(0,05%) e fase aguda de citomegalovirose: 128 (0,04%). Os resultados foram encaminhados ao pré-natalista e ao núcleo de vigilância epidemiológica municipal.

Food Insecurity and Cardiovascular Health in Pregnant Women: Results From the Food for Families Program, Chelsea, Massachusetts, 2013-2015.

BackgroundFood insecurity, uncertainty about the ability to acquire adequate food, is associated with cardiometabolic disease in pregnant women. Whether food insecurity interventions improve cardiometabolic health is unknown.MethodsWe conducted a retrospective analysis of women who visited the obstetrics clinic in a community health center from 2013 through 2015. Patients could be referred to the Food for Families (Food for Families) program, which connects food insecure women to food resources. We hypothesized that participation in Food for Families would be associated with better blood pressure and blood glucose trends during pregnancy. We used a propensity score–matched design to reduce bias from differential entry into Food for Families.ResultsEleven percent of women who visited the obstetrics clinic were referred to Food for Families. In propensity score–matched analyses, we found no difference in baseline systolic blood pressure (SBP) between those who were referred and enrolled in Food for Families (113.5 mm Hg), those who were referred and did not enroll in Food for Families (113.9 mm Hg), and those who were not referred to Food for Families (114 mm Hg) (P = .79). However, during pregnancy, women who were referred to and enrolled in Food for Families had a better SBP trend (0.2015 mm Hg/wk lower, P = .006). SBP trends did not differ between women who were referred and did not enroll in Food for Families and those who were not referred. We observed no differences in blood glucose trends between groups (P = .40).ConclusionsFood for Families participation was associated with better blood pressure trends in pregnant women but no differences in blood glucose trends. Food insecurity reduction programs may improve cardiovascular health for vulnerable pregnant women, and this topic deserves further study incorporating randomized program entry.

Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: A prospective study from Western India.

The aim of this study is to study the etiology, clinical profile, and prognostic factors related to maternal and fetal health in pregnant patients with liver disease in Western India. This study included 103 consecutive pregnant patients with liver dysfunction from August 2013 to July 2015, who underwent regular biochemical tests, viral markers, ultrasound of abdomen, etc. and were followed up for 6weeks postpartum or until death. Pregnancy-specific causes of liver dysfunction were found in 39% (40/103) patients. Liver diseases were most frequent in third trimester 69.9% (72/103). Etiologies in third trimester were viral hepatitis 36.1% (26/72), pregnancy induced hypertension (PIH) 30.5% (22/72), intrahepatic cholestasis of pregnancy 11.1% (8/72), acute fatty liver of pregnancy (2/72), etc. Hepatitis E was the commonest agent among viral hepatitis 71.8% (28/39). Causes of maternal mortality (n = 25) were hepatitis E 40% (10/25), PIH 32% (8/25), and tropical diseases 20% (5/25). Fetal mortality (n = 31) was 38.7% (12/31) in hepatitis E. Maternal mortality was significantly associated with presence of jaundice, fever, abdominal pain, oliguria, anemia, leukocytosis, and coagulopathy. Model for end-stage liver disease (MELD) score >21 predicted maternal mortality with 80% sensitivity and 91% specificity (area under the receiver operating characteristic curve = 0.878 and p < 0.001). Liver disease was most common in the third trimester of pregnancy. Hepatitis E was the most common cause of liver disease in pregnant women in western India with significant maternal mortality, predicted by high MELD score.

Chagas disease prevalence in pregnant women: migration and risk of congenital transmission.

Argentina has been a preferential target for Bolivian immigrants for decades. The relatively recent migratory flux includes Germany, France, the United States, Australia, Japan, and some Latin American countries. The aim of this cross-sectional study was to describe the prevalence of Chagas disease in pregnant women, analyzing the Bolivian-specific Chagas prevalence as the main contributor of migratory populations from Chagas disease-endemic areas to Buenos Aires city, Argentina, and to evaluate the impact of these migrant influxes on the process of the "urbanization" of the disease in reference hospital José Maria Ramos Mejia (JMRM). Overall, 21,332 pregnant women (100%) between 15 and 49 years of age derived from the public maternity service of JMRMH were studied. Serology data was obtained from registered serological diagnosis data, consisting of three different serological tests performed at the Public Parasitology Unit. Although general prevalence decreased during the analyzed period, the specific prevalence of pregnant women from Bolivian origin showed a sustained growth during 1983-2013. Solely 5% of the total pregnant women population from Bolivia contributed to one third of the total Chagas prevalence. This study showed that a cohort of pregnant women from Bolivia who attended JMRMH during the period 1983-2007 constituted a population at risk for congenital transmission. Increased migration from endemic areas of Bolivia might potentially increase the prevalence of Chagas disease among pregnant women. In addition, this study highlights the importance to analyze specific prevalence according to endemic areas to determine the profiles of potential hidden prevalence.

Сучасна діагностика захворювань піхви у вагітних

Сучасна діагностика захворювань піхви у вагітних

Study on the dynamic changes of D-dimer during pregnancy and early puerperium

Objective: To explore the dynamic changes of D-dimers during pregnancy and early puerperium(within 3 days postpartum). Methods: A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women's Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy(≤12 gestation weeks), middle pregnancy(12-28 gestation weeks), late pregnancy(>28 gestation weeks), 1 postpartum(within 48 hours postpartum)and 2 postpartum(48- 72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student's t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration ≤0.5 mg/L was used as the normal range. Results: (1)D-dimers concentrations during pregnancy were higher than the non-pregnant women(P<0.01), but there was no statistical difference between early pregnancy and late pregnancy(P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group(P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups.(2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48- 72 hours after vaginal delivery, ≤48 hours after cesarean section, 48- 72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89- 19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95% CI of the study population after cesarean section. Conclusions: D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

New Insights into the Management of Patients with Autoimmune Diseases or Inflammatory Disorders During Pregnancy.

The treatment of autoimmune diseases remains a serious problem. Current therapies can lead to adverse effects in patients. One of the most vulnerable patient groups is pregnant women. It has been reported that different autoimmune diseases have a certain trend during pregnancy and after delivery which could be explained by maternal immune responses. Better management of pregnant women with autoimmune diseases or inflammatory disorders could be achieved by linking such alterations in immune responses and governed immune responses in different autoimmune disorders while considering various reports of autoimmune conditions during pregnancy. This study considers changing the T helper cells (Th1) and Th2 balance and suggests some new approaches for the better management of autoimmune diseases in pregnant women based on immune responses. Additionally, the possible role of Th17, alterations in some selected autoimmune diseases including rheumatoid arthritis (RA), multiple sclerosis (MS), psoriasis, systemic lupus erythematosus (SLE), atopic dermatitis (AD), asthma and pemphigus during pregnancy, and possible associated mechanisms are discussed.

Relationship of Chronic Periodontitis and Plasma C-Reactive Protein during Pregnancy

Background: Maternal periodontal disease is a chronic oral infection with local and systemic inflammatory responses and may be associated with adverse pregnancy outcomes. Elevated levels of C-reactive protein has been linked to adverse pregnancy outcomes in maternal periodontal disease. Objectives: To assess plasma C-reactive protein levels in pregnant women with chronic periodontitis and in periodontal health and to compare the incidence of preterm delivery in pregnant women having chronic periodontitis and in periodontal health. Materials and Methods: A total of 122 pregnant women aged 18 years and above with gestational age < 26 weeks were recruited and divided into two equal groups (control group, study group) of 61 each. Blood samples were taken from both the groups to determine the serum C-reactive protein. Results: The mean value of C-reactive protein levels in subjects having chronic periodontitis was higher compared to control group i.e., 2.462 ± 0.318 compared to 1.307 ± 0.361 (P<0.001). The incidence of preterm delivery (<37 weeks) was 82% in the chronic periodontitis group (study group) compared to 3.3% in the control group (P<0.001). The incidence of low birth weight (<2500g) was 45.9% in chronic periodontitis (study group) compared to 14.8% in the control group (p<0.001). Conclusion: The findings from the study suggest that periodontal disease in pregnant women is associated with increased C-reactive protein levels in pregnancy. Incidence of preterm delivery and low birth weight infants is higher in pregnant women with chronic periodontitis compared to healthy controls.