Disorders In Pregnant Women Research Articles

P-993 - Prevalence and risk factors for antenatal depression in pregnant women attending national university hospital, singapore

Antenatal mental health problems are well recognised to impact negatively on a woman and her developing fetus, influencing both the pregnancy outcome and quality of life. There is limited information on prevalence and risk factors of antenatal depression in Singaporean women. To examine the prevalence of depressive disorders in pregnant women attending Singapore's National University Hospital (NUH) and the association between these conditions and socio-demographic factors. To improve our knowledge and understanding of the epidemiology of antenatal depressive disorders in Singapore. Pregnant women attending NUH (2009 to 2010) were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale. Patients who screened positive (scores > 13) were clinically assessed by trained clinicians using DSM IV criteria for diagnosis. The cases were then discussed with a core group of 3 psychiatrists to reduce interrater variability. From 530 screened women, the overall prevalence of antenatal depressive symptoms was 47.8% (EPDS > 13). 12.5% of patients were diagnosed with Major Depressive Disorder, 52.1% with Adjustment Disorder, 4.5% with Anxiety Spectrum illness (Panic Disorder, GAD, OCD, PTSD), 1.1% with Bipolar Disorder and 3.8% with Other diagnoses. After adjustment with socio-demographic variables, depressive symptoms were significantly associated with single, divorced or separated pregnant women (OR = 4.09, 95% CI = 1.39−12.09, p < 0.05) and those with three or more social relationship problems (OR = 1.68, 95% CI = 1.00–2.84, p < 0.05). Antenatal depressive symptoms are common in Singaporean women and they are associated with identifiable risk factors such as single status and limited social support.

Iodine and thyroid gland with or without nuclear catastrophe

Iodine, as a trace element, is a necessary and limiting substrate for thyroid gland hormone synthesis. It is an essential element that enables the thyroid gland to produce thyroid hormones thyroxine (T4) and triiodothyronine (T3). Synthesis of Thyroid Hormones and Iodine Metabolism. Three iodine molecules are added to make triiodothyronine, and four for thyroxine - the two key hormones produced by the thyroid gland. Iodine deficiency The proper daily amount of iodine is required for optimal thyroid function. Iodine deficiency can cause hypothyroidism, developmental brain disorders and goiter. Iodine deficiency is the single most common cause of preventable mental retardation and brain damage in the world. It also decreases child survival, causes goiters, and impairs growth and development. Iodine deficiency disorders in pregnant women cause miscarriages, stillbirths, and other complications. Children with iodine deficiency disorders can grow up stunted, apathetic, mentally retarded, and incapable of normal movements, speech or hearing. Excessive Iodine Intake. Excessive iodine intake, which can trigger a utoimmune thyroid disease and dysfunction. is on the other side. Iodine use in Case of Nuclear Catastrophe. In addition to other severe consuquences of radioactivity, high amount of radioactive iodine causes significant increase in incidence of thyroid gland carcinoma after some of the nuclear catastrophes (Hiroshima, Nagasaki, Chernobyl, Fukushima). The incidence of thyroid carcinoma was increased mostly in children. This paper was aimed at clarifying some of the possibilities of prevention according to the recommendations given by the World Health Organization.

Mood Disorders in Pregnant Women With Thyroid Dysfunction

Both mood disorders and thyroid dysfunction are common in pregnancy and the postpartum period and have significant short and long-term implications to the mothers and their infants. Thyroid hormones have a multitude of effects on the central nervous system, undergo significant changes during pregnancy, and it is now widely recognized that disturbances of mood and cognition often emerge in association with putative disturbance of thyroid metabolism in the brain. Several small studies have shown associations between clinical and subclinical thyroid dysfunction and depression during pregnancy or the postpartum period. Unfortunately, this relationship between maternal thyroid dysfunction and perinatal depression is not well studied.

P35. Hypertensive disorders in pregnant women affected by type 1 diabetes

Introduction Type I diabetes in pregnancy is associated with an increased incidence of hypertensive disorders. Objectives The aim of the present study was to evaluate the incidence of hypertensive disorders in pregnant women affected by type I diabetes and pregnancy outcome in women with and without hypertension. Methods One hundred seventy two pregnancies in 150 women affected by type I diabetes were assessed. Twelve pregnancies were excluded (8 because of spontaneous abortions, 1 for voluntary abortion and 3 twin pregnancies), and 160 pregnancies were considered for the study. Results Twenty-five pregnancies (15.6%) were complicated by hypertensive disorders: 4.4% by chronic hypertension (CH), 5% by gestational hypertension (GH), 4.4% by preeclampsia (PE) and 1.8% by preeclampsia superimposed on chronic hypertension (PE+CH); 32% of the women presented a vascular disease (renal or retinal disease). The diabetic women with hypertensive complications were compared with diabetic women without hypertension. The main results are shown in Table 1. Significant differences in mean birth weight and mean gestational age were found. The group affected by preeclampsia showed 14.7% of small for gestational age (SGA) neonates (birth weight percentile less than 10th pc), and 57.1% of large for gestational age (LGA) neonates (birth weight percentile greater than 90th pc), two of them were over 4000 g. Only one case of very preterm delivery ( Week at delivery (mean±SD)Peso (g) (mean±SD)pc° (mean±SD)Diabetic controls38.7±2.23272±662.357.9±28.5CH36.0±3.22640.0±875.251.0±30.5GH37.3±1.72936.3±566.751.2±31.2PE36.1±2.53092.9±1087.464.0±37.2PE on CH35.7±2.32453.0±525.434.0±8.5p-Valuep Conclusion As expected, the incidence of hypertensive disorders in population affected by type 1 diabetes is higher than in general population and a poor pregnancy outcome was observed in this group of women. However, the neonatal outcome of women affected by preeclampsia is not different from that observed in women without hypertensive complications (diabetic controls) in terms of mean birth weight despite a significantly lower mean week gestation at delivery.

Are major depression and generalized anxiety disorder associated with intrauterine growth restriction in pregnant women? A case-control study

Objective This study examined the prevalence of major depression and generalized anxiety disorder in pregnant women with and without a diagnosis of intrauterine growth restriction (IUGR). Method The study sample included 56 pregnant women with a diagnosis of IUGR and 92 control subjects. IUGR was determined by means of ultrasound assessment and was defined as estimated fetal weight, by ultrasound scan, which falls below the 10th percentile for the gestational age. Psychiatric evaluations were performed with depression and anxiety symptom scales and with structured clinical interviews. Results Pregnant women with IUGR had higher scores of depressive and anxiety symptom scores and had a higher prevalence rate of major depression and generalized anxiety disorder. Conclusions According to the results of the present study, both major depression and generalized anxiety disorder appear to be associated with IUGR in pregnant women.

Prevalencia de los trastornos hipertensivos del embarazo en mujeres embarazadas controladas en Assbasalud E.S.E, Manizales (Colombia), 2006 a 2008

Objetivo: Determinar la prevalencia de algún trastorno hipertensivo durante la gestación de mujeres embarazadas de todas las edades atendidas entre el 2006 y 2008 en ASSBASALUD E.S.E., Manizales (Caldas, Colombia, Sur América), que hayan asistido a uno o más controles y/o al parto.Materiales y métodos: Estudio de corte transversal. Se registraron las características sociodemográficas, clínicas y de tratamiento.Resultados: Se identificó0.8% de embarazadas con trastornos hipertensivos. Se encontró una relación significativa (p=0.014) entre presión arterial con edema. El 12.9% de los pacientes con hipertensión arterial estado 1 presentaron edema, en los pacientes prehipertensos y normales esta proporción baja a 3,8 % y 3%.Análogamente se encontró relación significativa (p=0.05) entre nivel de tensión arterial y educación, en ésta se observa que entre lapoblación con educación universitaria es más frecuente el estado de pre-hipertensión, 63,4%. No se encontró significancia entre proteinuria e hipertensión.

An effective analysis of screening strategies for thyroid disorders during early pregnancy

Objective To use the first trimester-specific reference intervals of thyroid-related hormones to explore the prevalence of thyroid dysfunction during early pregnancy and to analyze effectiveness of different screening strategies. Methods In this study 2 899 pregnant women were enrolled during the first trimester of gestation. TSH, FT4, FT3, and thyroid peroxidase antibody （TPOAb） were measured and thyroid disorders of pregnant women were diagnosed based on the first trimester-specific reference intervals. Results The prevalence of hypothyroidism was significantly higher in the high-risk group than in the non-high risk group （ 16.3% vs 5.3%,RR = 3.1,95% CI 2.4-4.0, P〈0.01 ）. TPOAb （ RR = 4.7, 95 % CI 3.6-6.0, P〈0.01 ）, and personal history of thyroid diseases （ RR=3.2, 95% CI 1.9-5.4, P〈0.01 ） increased the risk of hypothyroidism. The prevalence of hyperthyroidism was higher in the high-risk group （3.1% vs 1.4%, P = 0. 006, RR = 2.2, 95% CI 1.2-3.9, P=0.006）. TPOAb （RR=2.6, 95%CI 1.3-5.0, P=0.007）, and presence of personal history of thyroid diseases（ RR=4.7, 95% CI 1.7-12.5, P=0.006） also increased the risk of hyperthyroidism. 56.7% women with hypothyroidism and 64. 7% women with hyperthyroidism were in the non-high risk group. Conclusion We recommend that screening all pregnant women for thyroid disorders in the first trimester with TSH, FT4, and TPOAb is more effective than the case-finding approach. Key words: First trimester pregnancy ; Screening; Thyroid dysfunction ; Risk factors

An epidemiological study on the sleep disorders of pregnant women in Wenshou, Zhejiang province

睡眠障碍可对人体多系统产生影响,也是妊娠妇女常见的症状[1].睡眠障碍是先兆子痫的危险因素,可以造成胎儿宫内生长受限、产程延长、剖腹产概率增加、早产,甚至使胎儿窒息、死亡[2].为了解我国妊娠妇女睡眠障碍发生情况及相关因素,对温州地区2000名孕妇睡眠状况进行问卷调查。

The Impact of Mood Disorders and Their Treatment on the Pregnant Woman, the Fetus, and the Infant

Treatment of mood disorders in pregnant or nursing women can carry significant risks for the mother and the developing infant. For patients and physicians, it may be difficult to obtain current information to make the proper decisions regarding pharmacologic and alternative treatments. Thus, this paper discusses the risks and benefits of pharmacologic treatment and the risks of not treating depression and bipolar disorder in the pregnant woman. The safety of treatment options is reviewed. Alternative treatment options are also discussed.

Recurrent pregnancy-induced diabetes insipidus in a woman with hemochromatosis

Diabetes insipidus is a rare disorder in pregnant women, predating pregnancy or appearing for the first time during gestation. In pregnancy it usually affects women with HELLP syndrome or acute fatty liver of pregnancy and results from the reduced hepatic degradation of placental vasopressinase leading to its increased activity. Although infiltrative diseases have been found to cause diabetes insipidus in non-pregnant population, very few studies showed that these disorders may manifest for the first time during gestation. We describe here the case of transient diabetes insipidus in two subsequent pregnancies of a female with hemochromatosis. The first symptoms of this disease appeared for the first time at the beginning of the third trimester of her second pregnancy, and diagnosis was established on the basis of typical clinical presentation, confirmed by a water deprivation test. Diabetes insipidus resulted from the increased activity of vasopressinase, caused by hemochromatosis-induced liver dysfunction, the presence of which was confirmed between the pregnancies by liver biopsy and identification of the HFE gene mutation. Subsequent desferrioxamine treatment resulted in a less severe clinical course of diabetes insipidus in the last patient's pregnancy. In both pregnancies, the patient was successfully treated with oral desmopressin, which is resistant to degradation by placental vasopressinase. Although unrecognized pituitary disorders may pose a serious health problem to the mother and fetus, hemochromatosis-induced diabetes insipidus, as the case of our patient demonstrates, if effectively diagnosed and treated, cannot be regarded as a contraindication for pregnancy.

Prévention des désordres thyroïdiens au cours de la grossesse

Iodine is essential for biosynthesis of thyroid hormones and daily iodine intake needs are increased during pregnancy. Thyroid dysfunctions (hypothyroidism, hyperthyroidism) are due to autoimmune diseases (Hashimoto's disease, Graves' disease) in most women of childbearing age. During pregnancy they are associated with maternal and fetal complications: maternal hypothyroxinemia during the first trimester of gestation can be associated with abnormal cognitive development and intellectual outcomes in the newborn and the children. In patients with Graves' disease, TSH-receptor antibodies cross the placenta and can induce fetal and neonatal dysfunctions. In order to prevent maternal and fetal complications and ameliorate the pronostic of thyroid disorders in pregnant women, the prevention should be: a systematic prophylaxis of iodine deficiency in pregnant women; an adjustment of the preconception levothyroxine treatment in women with hypothyroidism diagnosed before the pregnancy; a targeted screening for maternal hypothyroidism in high-risk women; a rational measurement for TSH-receptor and anti-thyroperoxydase antibodies in some women with autoimmune thyroid diseases.

Calcium metabolism in pregnancy and lactation.

Homeostatic adaptation to maternal calcium metabolism is a prerequisite for optimal delivery of sufficient calcium to the fetus and neonate during pregnancy and lactation, respectively. This article outlines the major adaptations known to occur and the physiological regulators likely to be principally involved. Importantly, different adaptive responses are used in pregnancy and lactation. The rarity of calcium disorders in pregnancy underscores the successful implementation of these adaptations in most women. For those few women with either pre-existing or pregnancy-acquired disorders of calcium metabolism, a knowledge of normal physiology is essential to understand the implications for managing these disorders in pregnant women.

Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women

It has been suggested that women experience depression most commonly in the childbearing years and that reproductive events such as pregnancy and child birth may coincide with the onset of mood and anxiety disorders in women. Therefore, a brief screening tool, with good sensitivity/specificity for psychiatric diagnoses that could be administered to pregnant women would be a valuable and useful proxy measure. We assessed the validity of the K-10, using the SCID as the gold standard, in a sample of 129 healthy pregnant women who presented for care at midwife obstetric units in Cape Town, South Africa. A receiver-operating characteristic curve (ROC) analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the receiver-operating characteristic curve, 0.66), posttraumatic stress disorder (0.69), panic disorder (0.71), and social phobia (0.76). The K-10 may be a useful screening measure for mood and anxiety disorders in pregnant women.

Prevalence of post-traumatic stress disorder in pregnant women with prior pregnancy complications

Objective. To assess the prevalence of post-traumatic stress disorder (PTSD) in pregnant women with prior pregnancy complications.Methods. Seventy-six pregnant women at a maternal–fetal medicine referral clinic were asked to complete an anonymous questionnaire. Fifty-six women had a prior pregnancy complication (study group), and the remaining 20 had none (comparison group). Subjects were assessed with a questionnaire consisting of a modified patient-rated version of the Clinician Administered PTSD Scale (CAPS). The modified CAPS was used to approximate the prevalence of full or partial PTSD related to a prior pregnancy complication using two scoring rules, the rule-of-3 (original rule) and rule-of-4 (more stringent rule).Results. The prevalence of full PTSD among women with prior pregnancy complications was 12.5% and 8.9% based on the rule-of-3 and rule-of-4, respectively. For partial PTSD, the prevalence was 28.6% based on the rule-of-3 versus 17.9% based on the rule-of-4. The most common type of complication was miscarriage, accounting for 73.5% of the reported complications. None of the women in the comparison group met criteria for full or partial PTSD.Conclusions. The prevalence of PTSD in pregnant women with a prior pregnancy-related complication is considerable. These findings provide additional evidence that pregnancy complications can be experienced as traumatic, and as such lead to partial or full PTSD symptoms.

Pregnancy and the Kidney

Nephrologists are frequently called on to diagnose and treat renal disorders in pregnant women. In this review, we update recent literature pertinent to pregnancy and renal disease. We initially begin by describing the application of common clinical estimators of GFR and proteinuria in pregnancy and then summarize recent studies regarding pregnancy in women with chronic kidney disease and the latest information on the use of common renal medications in pregnancy. In the final section, we describe advances in our understanding of the pathophysiology of preeclampsia and the potential clinical implications of these discoveries for screening, prevention, and treatment of preeclampsia.

Alcohol Abuse Risk Factors and Psychiatric Disorders in Pregnant Women with a History of Infertility

To determine if a history of infertility is associated with alcohol abuse risk factors, depression, and other psychiatric disorders. Pregnant women awaiting their first prenatal visit completed a questionnaire and subsequently participated in an interview consisting of the Structured Clinical Interview for DSM-IIIR and the Family Alcohol and Drug Survey. The data obtained from women with a history of infertility were compared with the data from women without prior infertility. Eighty-nine pregnant women participated in the study, 27 with prior infertility and 62 without. Subjects were demographically similar, except that women with a history of infertility were slightly older than controls (34.7 vs. 31.1 years, p < 0.001). Pregnant women with a history of infertility reported needing significantly more drinks to get high, (3.3 vs. 2.7, p = 0.04) and were more likely to have clinically elevated tolerance, annoyance, cut-down, and eye-opener (T-ACE) alcohol tolerance scores (83.3% vs. 52.3%, p < 0.01) than women without such history. Major depression (lifetime) was diagnosed in 69.2% of infertility subjects compared with 30% of controls (p < 0.05). Lifetime simple phobia (23.1% vs. 10%, p < 0.01), generalized anxiety disorder (23.1% vs. 3%, p < 0.01), panic disorder (15.4% vs. 0%, p < 0.05), and bulimia (7.7% vs. 0%, p < 0.05) were also more common in women with a history of infertility compared with controls. Pregnant women with a history of infertility are at increased risk for alcohol abuse and are more likely to suffer from other psychiatric disorders than women without such history. Special attention to these issues is warranted when caring for pregnant women who were previously infertile.

Selective Serotonin Reuptake Inhibitors (SSRIs) in Pregnancy

Major affective disorders including depression and anxiety occur commonly in women of childbearing age and their incidence can increase during and after pregnancy. There is a critical clinical demand for treatment of these disorders, but the balance between treating affective disorders without harming the developing fetus is a difficult one. This has created concern both among women planning pregnancies, and those women who are pregnant already, as well as among families and healthcare providers. Currently, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice for the treatment of these disorders in pregnant women because of their documented efficacy and mild side effect profile. There is some research concerning SSRI use and pregnancy, which is the focus of this article.

Chorionic Villus Sampling and Risk for Hypertensive Disorders of Pregnancy

Adusumalli, J.; Han, C.S.; Beckham, S.; Bartholomew, M.L.; Williams, J. III Author Information

The role of thyroid autoimmunity in fertility and pregnancy

The thyroid gland and gonadal axes interact continuously before and during pregnancy. Hypothyroidism influences ovarian function by decreasing levels of sex-hormone-binding globulin and increasing the secretion of prolactin. In women of reproductive age, hypothyroidism can be reversed by thyroxine therapy to improve fertility and avoid the need for use of assisted reproduction technologies. For infertile women, preparation for medically assisted pregnancy comprises controlled ovarian hyperstimulation that substantially increase circulating estrogen concentrations, which in turn can severely impair thyroid function. In women without thyroid autoimmunity these changes are transient, but in those with thyroid autoimmunity estrogen stimulation might lead to abnormal thyroid function throughout the remaining pregnancy period. Prevalence of thyroid autoimmunity is significantly higher among infertile women than among fertile women, especially among those whose infertility is caused by endometriosis or ovarian dysfunction. Presence of thyroid autoimmunity does not interfere with normal embryo implantation, but the risk of early miscarriage is substantially raised. Subclinical and overt forms of hypothyroidism are associated with increased risk of pregnancy-related morbidity, for which thyroxine therapy can be beneficial. Systematic screening for thyroid disorders in pregnant women remains controversial but might be advantageous in women at high risk, particularly infertile women.

Migraine aura or transient ischemic attacks? A five-year follow-up case-control study of women with transient central nervous system disorders in pregnancy

BackgroundMigraine aura may be difficult to differentiate from transient ischemic attacks and other transient neurological disorders in pregnant women. The aims of the present study were to investigate and diagnose all pregnant women with transient neurological disorders of suspected central nervous system origin, and to compare this group with a control group of pregnant women with regard to vascular risk factors and prognosis.MethodsDuring a 28 month period, 41 patients were detected with transient neurological symptoms during pregnancy. These were studied in detail with thorough clinical and laboratory investigations in order to make a certain diagnosis and to evaluate whether the episodes might be of a vascular nature. For comparison, the same investigations were performed in 41 pregnant controls. To assess the prognosis, both patients and controls were followed with questionnaires every year for five years.ResultsMigraine with aura was the most common cause of symptoms during pregnancy, occurring in 34 patients, while 2 were diagnosed with stroke, 2 with carpal tunnel syndrome, 1 with partial epilepsy, 1 with multiple sclerosis and 1 with presyncope. Patients had more headache before pregnancy than controls, but the average levels of vascular risk factors were similar. None of the patients or the controls reported cerebrovascular episodes during the five-year follow-up.ConclusionThe diagnosis of migraine aura was difficult because for many patients it was their first ever attack and headache tended to be absent or of non-migraineous type. The aura features were more complex, with several aura symptoms and a higher prevalence of sensory and dysphasic aura than usual. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the International Classification of Headache Disorders, seem to be useful for differentiating aura from other transient disorders. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. The five-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events.