Pregnancy Events Research Articles

Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for Mild Chronic Hypertension During Pregnancy

(N Engl J Med. 2022;386:1781–1792. doi: 10.1056/NEJMoa2201295) More than 2% of pregnancies are impacted by chronic hypertension (HTN), specifically among black women. Chronic HTN has been correlated with risk for preeclampsia, placental abruption, preterm birth, small-for-gestational-age birth weight, perinatal death, maternal death, heart failure, stroke, pulmonary edema, and acute kidney injury. International organizations recommend extending antihypertensive treatment to patients with severe HTN, but they differ in their recommendations for treating mild HTN because of increased risk of small birth weight neonates. This study identifies the impact of mild hypertensive treatment on adverse pregnancy events up to 2 weeks after birth, placental abruption, and negative perinatal outcomes including birth weight through a randomized assignment to either the mild HTN treatment group or the nontreatment group.

Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment.

To compare the pregnancy outcomes in women with gestational diabetes (GDM) based on the timing of diagnosis. This retrospective cohort study was conducted between January 2011 and September 2017 amongst 2638 Asian Indian pregnant women. The inclusion criteria included; singleton pregnancies having HbA1c <48 mmols/mol (6.5%) in the first trimester, GDM screening by 75 g OGTT using IADPSG criteria and delivery at our centre. The cohort was divided into 3 groups: Early GDM (E-GDM)-diagnosis <24 gestational weeks (Gw), Standard GDM (S-GDM)-diagnosis ≥24Gw, Non-GDM- No GDM ≥24 Gw. Multivariable logistic regression models compared the pregnancy outcomes between Non-GDM, S-GDM and E-GDM groups. A sub-group multivariable analysis was done amongst GDM women using gestational age at diagnosis both as a categorical and continuous variable. Compared to Non-GDM women, the odds were higher for premature birth, large for gestational age (LGA) babies, macrosomia, Neonatal ICU(NICU) admission and lower for normal vaginal delivery in the E-GDM group, but for the S-GDM group, the risk was higher for premature birth, LGA babies, NICU admission and induction of labour. Compared to GDM women in the 24-28 Gw category significantly higher odds for premature birth and LGA babies were observed in the <14 Gw category. A continuous increase of 19% odds for premature birth with every 4 weeks decrease in gestational age at GDM diagnosis was observed. Asian Indian women having a GDM diagnosis before 24Gw are at higher risk for adverse pregnancy events than those having diagnosis ≥24Gw or not having GDM.

Visualization of preimplantation uterine fluid absorption in mice using Alexa Fluor™ 488 Hydrazide†.

Uterine fluid plays important roles in supporting early pregnancy events and its timely absorption is critical for embryo implantation. In mice, its volume is maximum on day 0.5 post-coitum (D0.5) and approaches minimum upon embryo attachment ~D4.0. Its secretion and absorption in ovariectomized rodents were shown to be promoted by estrogen and progesterone (P4), respectively. The temporal mechanisms in preimplantation uterine fluid absorption remain to be elucidated. We have established an approach using intraluminally injected Alexa Fluor™ 488 Hydrazide (AH) in preimplantation control (RhoAf/f) and P4-deficient RhoAf/fPgrCre/+ mice. In control mice, bulk entry (seen as smeared cellular staining) via uterine luminal epithelium (LE) decreases from D0.5 to D3.5. In P4-deficient RhoAf/fPgrCre/+ mice, bulk entry on D0.5 and D3.5 is impaired. Exogenous P4 treatment on D1.5 and D2.5 increases bulk entry in D3.5 P4-deficient RhoAf/fPgrCre/+ LE, while progesterone receptor (PR) antagonist RU486 treatment on D1.5 and D2.5 diminishes bulk entry in D3.5 control LE. The abundance of autofluorescent apical fine dots, presumptively endocytic vesicles to reflect endocytosis, in the LE cells is generally increased from D0.5 to D3.5 but its regulation by exogenous P4 or RU486 is not obvious under our experimental setting. In the glandular epithelium (GE), bulk entry is rarely observed and green cellular dots do not show any consistent differences among all the investigated conditions. This study demonstrates the dominant role of LE but not GE, the temporal mechanisms of bulk entry and endocytosis in the LE, and the inhibitory effects of P4-deficiency and RU486 on bulk entry in the LE in preimplantation uterine fluid absorption.

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

ObjectiveTo examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services.DesignPragmatic, multicentre, single blinded, phase 3,...

Romiplostim use in pregnant women with immune thrombocytopenia.

Treatment for immune thrombocytopenia (ITP) in pregnancy is hampered by the lack of fetal safety evidence of maternally-administered medications. The Pregnancy Surveillance Program (PSP) collected patient information from 2017-2020 for pregnancy, birth outcomes, and adverse events (AEs) for 186 women exposed to romiplostim from 20 days before pregnancy to the end of pregnancy. Timing of exposure was available in 128 women. Seventy-one mothers (38%) had prepregnancy exposure to romiplostim; intrapartum exposure was known for the first (for many mothers when they discovered their pregnancy), second, and third trimesters for 74 (40%), 22 (12%), and 44 (24%) mothers, respectively, with 15 mothers exposed during >1 trimester. Among the 86 mothers with known pregnancy outcomes, 46 (53%) had at least one pregnancy-related serious AE (SAE); approximately 2/3 of SAEs were due to underlying ITP. Of 92 mothers with known birth outcomes, 60 (65%) had a normal pregnancy and 16 (17%) had complications, with both categories including term and preterm births; there were 12 (14%) spontaneous miscarriages/stillbirths, 3 (3%) ectopic pregnancies, and 1 (1%) molar pregnancy. Most abnormal births resulted from abnormal pregnancies. There were five neonatal/postnatal AEs of note: inguinal hernia, cytomegalovirus infection, trisomy 8 (third trimester single-dose romiplostim exposure), single umbilical artery without known anomalies, and development of autism at age 2 years. Seven of 12 infants with neonatal thrombocytopenia had resolution of thrombocytopenia before discharge; all 12 were discharged. Review of pregnancies in women exposed to romiplostim did not reveal any specific safety concerns for mothers, fetuses, or infants.

Machine Learning to Predict Pre-Eclampsia and Intrauterine Growth Restriction in Pregnant Women

The use of artificial intelligence in healthcare in general and in obstetrics and gynecology in particular has great potential. Specifically, machine learning methods could help improve the health and well-being of pregnant women, closely monitoring their health parameters during pregnancy, or reducing maternal and perinatal morbidity and mortality with early detection of pathologies. In this work, we propose a machine learning model to predict risk events in pregnancy, in particular the prediction of pre-eclampsia and intrauterine growth restriction, using Doppler measures of the uterine artery, sFlt-1, and PlGF values. For this purpose, we used a public dataset from a study carried out by the University Medical Center of Ljubljana, in which data were collected from 95 pregnant women with pre-eclampsia and intrauterine growth restriction. We adopted a multi-label approach to accomplish the prediction task. Different classifiers were evaluated and compared. The performance of each model was tested in terms of accuracy, precision, recall, F1 score, Hamming loss, and AUC-ROC. On the basis of these parameters, a variation of the decision tree classifier was found to be the best performing model. Our model had a robust recall metric (0.89) and an AUC ROC metric (0.87), taking into account the size of the data and the unbalance of the class.

Early pregnancy vitamin D status and risk of select congenital anomalies in the National Birth Defects Prevention Study.

Vitamin D deficiency is associated with adverse pregnancy events. However, its role in the etiology of congenital anomalies remains unclear. We examined the association between vitamin D status, measured through prepregnancy diet, UV exposure, season of conception, and congenital anomalies. We used data from the National Birth Defects Prevention Study, a U.S. population-based case-control study (1997-2011). Prepregnancy dietary vitamin D was calculated from food frequency questionnaires and evaluated using tertiles, based on the distribution in controls. We used the National Oceanic and Atmospheric Administration Weather Service to assign UV indices based on location and estimated date of conception, then dichotomized UV exposure (low vs. high). Seasons of conception was categorized as fall/winter spring/summer. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Lower prepregnancy dietary vitamin D intake (<65.21 IU/d vs. >107.55 IU/d) was associated with increased odds of anencephaly (aOR=1.28, 95% CI 1.01, 1.63), hypospadias (aOR=1.21, 95% CI 1.04, 1.40), septal defects (aOR=1.16, 95% CI 1.05, 1.30), diaphragmatic hernia (aOR=1.42, 95% CI 1.13, 1.79), and gastroschisis (aOR=1.27, 95% CI 1.07, 1.52). Findings were consistent when we stratified by UV exposure and season of conception. Our findings suggest lower dietary intake of vitamin D may be associated with increased risk of select congenital anomalies. Further investigations are warranted to evaluate the effects of other nutrients and appropriate thresholds and sources of vitamin D using serum.

A nationwide cohort study on the impact of gestational diabetes on future cardiovascular events

Abstract Background The link between hypertensive disease in pregnancy and future cardiovascular events is well established, as is the increased risk of developing type 2 diabetes mellitus after gestational diabetes (GDM). What is less well understood is the impact of GDM on future cardiovascular events. The literature is conflicting although suggestive that the risk of cardiovascular events with a history of GDM is 2 fold higher. Purpose Using the largest cohort to date and utilising robust data acquisition procedures and follow up we assessed the prognostic value of GDM for future cardiovascular events. Methods All female patients discharged from French hospitals in 2013 with at least 5 years of subsequent follow-up were identified. Those with a previous major adverse cardiovascular event, history of hypertensive disease, pre-existing diabetes or under the age of 18 years old were excluded. They were grouped depending on their history of GDM. After propensity score matching, patients with GDM were matched 1:1 with patients with no GDM. Hazard ratios for cardiovascular events during follow-up were adjusted by age at baseline. Results A total of, 1,738,101 women were included in the analysis, leaving 1,141,743 women (mean age 52.2, SD 19.7) once exclusion criteria were applied: 6998 (0.6%) had a history of GDM and the mean follow-up was 5.1 years (SD 1.3 years). Those with a history of GDM had a lower risk of new onset heart failure (HF) (hazard ratio [HR] 0.66, 95% confidence interval [CI]: 0.45–0.98) and all-cause death (HR 0.61, 95% CI 0.47–0.79). There was no significant difference in risk for myocardial infarction (HR 0.88, 95% CI 0.38–2.03), ischaemic stroke (HR 0.94, 95% CI 0.55–1.63), new onset atrial fibrillation (AF) (HR 0.61, 95% CI 0.33–1.11), cardiovascular death (HR 1.25, 95% CI 0.47–3.36) and major cardiovascular events (i.e. in-hospital cardiovascular death, myocardial infarction, ischaemic stroke or new-onset HF (MACE-HF)) (HR 0.75, 95% CI 0.56–1.01). Conclusions In a large contemporary analysis of female patient seen in French hospitals and utilising a robust data set we present the largest population analysis of the association between GDM and future cardiovascular events. Those with a history of GDM do not have a higher risk of myocardial infarction, ischaemic stroke, new onset AF, cardiovascular death or MACE-HF. Contrary to what is widely thought, a history of GDM confers a lower risk of new onset HF and all-cause death when compared to those women with no history of GDM. Funding Acknowledgement Type of funding sources: None.

S977 Ectopic Pregnancy in Women With IBD: Experience at a Tertiary Care IBD Center

Introduction: Women with IBD often have risk factors for ectopic pregnancy (EP) including previous abdominal or pelvic surgery, pelvic sepsis or intra-abdominal adhesions. The prevalence of an ectopic pregnancy among healthy women who present to an emergency department with first trimester bleeding, pain, or both ranges from 6% to 16%. To date, the single large population-based cohort study for EP in IBD was not able to account for medication use, disease activity or severity, and was published prior to wide-spread use of anti-TNF agents in the preconception and pregnancy states. We were interested in assessing EP in our population from a tertiary care IBD center, in particular taking into account disease activity and use of biologics prior to conception. Methods: The electronic medical record was queried for legal sex females with a diagnosis of ulcerative colitis (UC), Crohn's disease (CD) or inflammatory bowel disease (IBD) and a history of a pregnancy event receiving all of their care at our tertiary care center. From this cohort the term “ectopic pregnancy” using ICD-10 code and SNOMED concepts between 1/1/13 and 2/28/2022 were used to identify our population of interest. Chart review including diagnosis, surgical history, current and previous medications, and disease activity at the time of conception was then performed. Pregnancy specific variables include age at time of conception, parity, history of previous pregnancy loss, history of Caesarean section, or endometriosis. Results: 20,624 legal sex females with CD, UC or IBD were identified and 335 patients were diagnosed with a pregnancy event with all of their care at our center. 6 patients were diagnosed with an EP. Of interest, only 4 had their EP after an established diagnosis of UC or CD. Of these 4 patients, 3 had UC and 1 had CD. Duration of disease prior to EP ranged from 6 months to 4 years. Of the 3 patients with UC, all were in remission on either aminosalicylate or anti TNF therapy. The patient with CD had mild activity, was status post one resection and on no medication at the time of the EP. None had other common risk factors for EP. Conclusion: EP in our practice was uncommon, with an incidence of only 2%. Whether this is because of improved control of disease activity or preconception counseling has yet to be determined. Larger population-based studies are needed to assess the impact of newer medical therapies and disease management on the risk of this pregnancy outcome.

Do adversities experienced over the early life course predict mental illness and substance use behaviour in adulthood: A birth cohort study

A range of adult health outcomes have been linked to early childhood adversities. These early adversities include parental marital breakdown and family economic disadvantage. Childhood experiences of maltreatment have also been linked to a variety of adult health outcomes. As both childhood adversities and child maltreatment often co-occur, we examine whether childhood adversities at 3 stages of the child's early life course predict any of nine adult mental health outcomes controlling for past experiences of child trauma (maltreatment).Data are from a long running birth cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We use bivariate and multinomial logistic regression with adjustment for confounding, to predict adult outcomes.Experiences of recent life events in pregnancy appear to be unrelated to adult mental health. Recent life events experienced at the 5-year follow-up independently predicts lifetime ever depression and cannabis use disorder. Experiences of recent life events at 14-years of age predict lifetime ever depression, cannabis and amphetamine use in adulthood.Our findings support early childhood interventions which should be supplemented with a focus on later childhood and the adolescent period of development. Interventions should also focus on the broader social and demographic context within which children are born. Efforts to reduce the occurrence and consequences of childhood maltreatment should be given primary attention in order to reduce the childhood factors contributing to adult mental illness.

Pregnancy and childbirth outcomes in women with myeloproliferative neoplasms—a nationwide population-based study of 342 pregnancies in Sweden

Pregnancy and childbirth in women with myeloproliferative neoplasms (MPN) are reported to be associated with maternal thrombosis, hemorrhage, and placental dysfunction. To assess the risks of adverse events in pregnancy in women with MPN, we performed a large population-based study using Swedish health care registers, and included all pregnancies that had reached gestational week 22 (prior to 2008, week 28) during the years 1973–2017 in women with MPN. Control pregnancies were matched 1:1 for age, calendar year, and parity. We identified 342 pregnancies in 229 women with MPN. Preterm birth was significantly increased in pregnancies in MPN, 14% compared to 4% of pregnancies in controls (p < 0.001). Correspondingly, low birth weight (<2500 g) was also significantly increased in MPN pregnancies (p = 0.042). Stillbirth was rare, with two events (0.6%) in MPN, none in controls. Maternal thrombotic complications occurred in three (1%) of the pregnancies in MPN patients, compared to none in controls. Pregnancy-related bleeding affected 14% of pregnancies in MPN and 9% in controls (p < 0.110). Cesarean section was significantly more common in pregnancies in MPN. Incidence was 12.2 per 100.000 pregnancies. In summary, preterm birth was an important complication in MPN pregnancies, while maternal complications were less common than previously reported.

Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis

BackgroundA significant proportion of women with preeclampsia (PE) exhibit persistent postpartum hypertension (PHTN) at 3 months postpartum associated with cardiovascular morbidity. This study aimed to screen patients with PE to identify the high-risk population with persistent PHTN.MethodsThis retrospective cohort study enrolled 1,000 PE patients with complete parturient and postpartum blood pressure (BP) profiles at 3 months postpartum. The enrolled patients exhibited new-onset hypertension after 20 weeks of pregnancy, while those with PE superimposed upon chronic hypertension were excluded. Latent class cluster analysis (LCCA), a method of unsupervised learning in machine learning, was performed to ascertain maternal exposure clusters from eight variables and 35 subordinate risk factors. Logistic regression was applied to calculate odds ratios (OR) indicating the association between clusters and PHTN.ResultsThe 1,000 participants were classified into three exposure clusters (subpopulations with similar characteristics) according to persistent PHTN development: high-risk cluster (31.2%), medium-risk cluster (36.8%), and low-risk cluster (32.0%). Among the 1,000 PE patients, a total of 134 (13.4%) were diagnosed with persistent PHTN, while the percentages of persistent PHTN were24.68%, 10.05%, and 6.25% in the high-, medium-, and low-risk clusters, respectively. Persistent PHTN in the high-risk cluster was nearly five times higher (OR, 4.915; 95% confidence interval (CI), 2.92–8.27) and three times (OR, 2.931; 95% CI, 1.91–4.49) than in the low- and medium-risk clusters, respectively. Persistent PHTN did not differ between the medium- and low-risk clusters. Subjects in the high-risk cluster were older and showed higher BP, poorer prenatal organ function, more adverse pregnancy events, and greater medication requirement than the other two groups.ConclusionPatients with PE can be classified into high-, medium-, and low-risk clusters according to persistent PHTN severity; each cluster has cognizable clinical features. This study’s findings stress the importance of controlling persistent PHTN to prevent future cardiovascular disease.

Clinical Assessment of Fetal Well-Being and Fetal Safety Indicators.

Delivering safe clinical trials of novel therapeutics is central to enable pregnant women and their babies to access medicines for better outcomes. This review describes clinical monitoring of fetal well‐being and safety. Current pregnancy surveillance includes regular antenatal checks of blood pressure and urine for signs of gestational hypertension. Fetal and placental development is assessed routinely using the first‐trimester “dating” and mid‐trimester “anomaly” ultrasound scans, but the detection of fetal anomalies can continue throughout pregnancy using targeted sonography or magnetic resonance imaging (MRI). Serial sonography can be used to assess fetal size, well‐being, and placental function. Carefully defined reproducible imaging parameters, such as the head circumference (HC), abdominal circumference (AC), and femur length (FL), are combined to calculate an estimate of the fetal weight. Doppler analysis of maternal uterine blood flow predicts placental insufficiency, which is associated with poor fetal growth. Fetal doppler analysis can indicate circulatory decompensation and fetal hypoxia, requiring delivery to be expedited. Novel ways to assess fetal well‐being and placental function using MRI, computerized cardiotocography (CTG), serum circulating fetoplacental proteins, and mRNA may improve the assessment of the safety and efficacy of maternal and fetal interventions. Progress has been made in how to define and grade clinical trial safety in pregnant women, the fetus, and neonate. A new system for improved safety monitoring for clinical trials in pregnancy, Maternal and Fetal Adverse Event Terminology (MFAET), describes 12 maternal and 18 fetal adverse event (AE) definitions and severity grading criteria developed through an international modified Delphi consensus process. This fills a vital gap in maternal and fetal translational medicine research.

Hubungan Kehamilan Tidak Diinginkan dengan Kejadian Berat Bayi Lahir Rendah di Pedesaan Pulau Jawa (Analisis Data SDKI 2017)

Background: There was an increase in the proportion of birth weight less than 2500 grams from 5.7 in 2013 to 6.2 in 2018. Several provinces in Java Island also still have the proportion of LBW above the average proportion of LBW in Indonesia (&gt; 6.2 %) such as Banten, West Java, Yogyakarta Special Region, and East Java. Maternal characteristics such as rural residence and unwanted pregnancy status are related to low birth weight. This study aims to determine the relationship between unwanted pregnancy and LBW events in rural areas in Java Island.Methods: This study was conducted by analysing secondary data from the results of the 2017 Indonesian Demographic and Health Survey (IDHS). The sample in this study consists of all live births in the last 5 years prior to the survey with reports of birth weight less than 2500 grams born to women aged 15- 49 years in rural Java Island when the survey took place and was successfully interviewed, and has a complete answer (no answer missing).Result: After weighting, 1821 samples were obtained. The result found that the proportion of LBW events in rural areas in Java Island is 6.3%. Meanwhile, of all pregnancies during the study period, 13.5% were unwanted pregnancies. The results of the multivariate analysis showed that there was no significant relationship between unwanted pregnancy status and LBW in rural areas in Java Island after adjusted by maternal age, mother's education level, maternal employment status, economic level, problems in getting health care/treatment, ANC, and parity (POR = 1.31, 95% CI = 0.72-2.38).Conclusion: It is necessary to measure variables more accurately in the questionnaire and carry out further research by including other risk factors.

Lifetime adverse pregnancy outcomes and associated factors among antenatal care booked women in Central Gondar zone and Gondar city administration, Northwest Ethiopia.

BackgroundIn developing countries, adverse pregnancy outcomes are major public health issues. It is one of the leading causes of neonatal morbidity and mortality worldwide. Despite the fact that ending prenatal mortality and morbidity is one of the third Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of lifetime adverse pregnancy outcomes among antenatal care (ANC) booked women in Northwest Ethiopia.MethodsAn institutional-based cross-sectional study design was conducted in Northwest Ethiopia, between March 2021 and June 2021. A multi-stage stratified random sampling technique was employed to recruit participants. An interviewer-administered and checklist questionnaire were used to collect the data. The data were entered into Epi-data version 4.6 software and exported to Stata version 16 for analysis. The binary logistic regression model was fitted to identify an association between associated factors and the outcome variable. Variables with a p-value of < 0.05 in the multivariable logistic regression model were declared as statistically significant.ResultsIn this study, the lifetime prevalence of adverse pregnancy outcome among study participants was 14.53% (95%CI: 11.61, 18.04). Road access to the health facilities (AOR = 2.62; 95% CI: 1.14, 6.02) and husband-supported pregnancy (AOR = 2.63; 95 CI: 1.46, 4.72) were significantly associated with adverse pregnancy outcomes.ConclusionsMore than one in 10 reproductive age women had adverse pregnancy outcome throughout their life. Road access to health facilities and husband-supported pregnancy were statistically significant factors for adverse events in pregnancy. Therefore, it is better to give more attention to expanding infrastructure like road accessibility and increasing husband-supported pregnancy to reduce adverse pregnancy outcomes.

Racial discrimination and adverse pregnancy outcomes: a systematic review and meta-analysis

IntroductionRacial discrimination has been consistently linked to various health outcomes and health disparities, including studies associating racial discrimination with patterns of racial disparities in adverse pregnancy outcomes. To expand our...

A comparison of adverse pregnancy events between ureteral stents and percutaneous nephrostomy tubes in the treatment of nephrolithiasis during pregnancy: A propensity score-matched analysis of a large multi-institutional research network.

To investigate rates of adverse pregnancy events associated with the use of percutaneous nephrostomy tubes (PCN) versus ureteral stents in the treatment of nephrolithiasis during pregnancy. We queried the TriNetX Diamond Network database to evaluate pregnant women (ICD-10 Z34, O09) with a history of nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement up to 6months before delivery (O80-82). We controlled for the following potentially confounding variables through propensity score matching: age, race, ethnicity, acute pyelonephritis (N10), infections of the genitourinary tract in pregnancy (O23.0), and other sepsis (A41) at the time of stent or PCN placement. We identified 2,999 pregnant women who underwent ureteral stent placement and 321 who underwent PCN. Following propensity score matching, we found there to be no significant difference in the rate of premature labor or delivery (aOR 1.08, 95% CI 0.735-1.588), premature rupture of membranes (0.889, 0.453-1.743), intrauterine infection (0.906, 0.379-2.165), or c-Sect.(0.825, 0.408-1.667). Within 6months of their initial procedure, women with a ureteral stent experienced a significantly decreased rate of subsequent urinary tract infection (UTI) or pyelonephritis (0.52, 0.38-0.71), inpatient hospital stay (0.40, 0.26-0.64), emergency department visit (0.65, 0.48-0.89), and repeat exchange procedure (0.70, 0.51-0.96). In the treatment of nephrolithiasis during pregnancy, PCN versus ureteral stent placement does not confer a significant difference in rates of adverse pregnancy events. However, ureteral stent placement was associated with a lower incidence of hospital admissions, emergency department visits, exchange procedures, and new UTIs or pyelonephritis.

Effects of different sensitization events on HLA alloimmunization in renal transplant cases; a retrospective observation in 1066 cases

BackgroundPatients awaiting solid organ transplantation may develop anti-HLA antibodies after sensitization events such as transfusions, pregnancies, or previous transplantations. However, the effects of a particular sensitization event on HLA alloimmunization have not been well studied in parallel using cell-based assays and solid-phase assays. In this study, we evaluated and compare how different sensitization events affect the HLA antibody screening (HLA-Ab) and donor specific antibody (DSA) status in solid renal organ transplantation patients. MethodsHLA antibody (HLA-Ab) screening tests like complement-dependent cytotoxicity crossmatch (CDC-XM), flow cytometry crossmatch (FC-XM) and Luminex panel-reactive antibody (L-PRA) were performed in all 1066 patients (635 males and 431 females). If any of these tests turned out to be positive, a Luminex single antigen bead (L-SAB) assay was performed for DSA identification. Test positive rates and antibody strengths were analyzed according to the different sensitization events and gender. ResultsIn this study, HLA-Ab screening tests positive rates (L-PRA, FC-XM and CDC-XM) were significantly higher in patients with previous transplantation (73.91%, 100% and 56.52% p < 0.001), previous pregnancy (57.46%, 70.14% and 18.85% p < 0.001) or blood transfusion (27.33%, 35.55% and 7.33% p < 0.001) compared with patients without a sensitizing event (6.17%, 13.58% and 1.09). In this study, re-transplantation group showed significantly stronger antibody strength (DSA) than non sensitized group (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 2659, 3329; P < 0.001) and those with single sensitization events of transfusion (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 5790.26, 6004.16; P < 0.001) or pregnancy (class I & II MFI 11418, 17,837 vs class I and II MFI 8631.71, 7253.29; P < 0.001). ConclusionsPregnancy and blood transfused had high allo-immunization rate for class I HLA antigens. While re-transplantation patients had high allo-immunization rate for both the HLA classes (HLA- class I and HLA- class II). Re-transplantation group showed significantly stronger antibody strength, followed by pregnancy and then transfusion.

Prevalence of exposure to benzodiazepines among pregnant women in Taiwan: A nationwide longitudinal study.

Although more than one hundred studies have examined the prevalence of the use of benzodiazepines and benzodiazepine-like Z-hypnotics (BZDs) among pregnancy events, further analysis of the effects of dosage or type of BZDs is needed. The aim of this study was to examine the prevalence rate of BZDs use in pregnancy events, stratified by trimester over time, with characteristics of the dosage and type of BZDs. This is a retrospective population study based on linking three national databases. We examined the prevalence rates from 2004 to 2017, and contrasted the results based on >0 defined daily dose (DDD) and ≥0.5 DDD. We identified 2,630,944 pregnancy events with live births; 89,897 (3.4%) of the associated pregnancy events had used some form of BZD during pregnancy. The prevalence of BZDs use, as defined by >0 DDD, decreased from 4.1% in 2004 to 2.9% in 2017, indicating a decrease in sporadic use and an increase in stable use within therapeutic doses. Meanwhile, BZDs use defined by ≥0.5 DDD increased from 0.1% in 2004 to 0.4% in 2017. Zolpidem was the most frequently prescribed BZDs, as defined by >0 DDD or ≥0.5 DDD. This national cohort study demonstrates the importance of average dosage in the definition of BZDs use in pregnancy events, and it found opposite trends in the prevalence of use between different dosages.

Periodontitis y enfermedad cardiovascular: Una actualización

Periodontitis is an inflammatory disorder, initiated by the presence of bacterial plaque, which affects both the periodontal ligament and the bone that surrounds the teeth. These ailments include cardiovascular disease, gastrointestinal and colorectal cancer, diabetes and insulin and Alzheimer's disease, as well as respiratory tract disease and adverse events of pregnancy. In recent decades, several lines of evidence have supported the existence of a relationship between periodontitis and systemic health. Periodontitis acts within the same chronic inflammatory model seen in cardiovascular disease, it is now evident that cardiac disorders are worsened by periodontitis, both experimentally and in humans. For all these reasons, it is highly plausible that the prevention of periodontal lamina alteration has an impact on the progression of cardiovascular alterations. In this review, we have provided an updated account of the current understanding of periodontitis and cardiovascular disease.