Maternal-fetal Complications Research Articles

Prolonged pregnancy, incidence and morbidity

Abstract Background The classic term for a pregnancy is between 37 and 42 weeks of amenorrhea. In fact, the literature has shown that exceeding the term (LD, 42WG) is the cause of many maternal-fetal complications despite close monitoring and appropriate management. A new rigorous and adapted management is essential in view of the materno-fetal prognosis. Objectives To describe the complications and risks associated with exceeded pregnancies and to propose a new strategy indicating an appropriate course of action. Patients and Methods This is a retrospective study of 50 women who gave birth at 42 WG or more at the Maternity of the Farhat Hached University Hospital Center in Sousse. Results the average age of our patients was 30.56 years old, 70% of which were primiparous, 82% of our patients were monitored between 41 and 42 WG. Fetal complications demonstrated in our results were increased by macrosomia in 54% of cases, pathological FHR during labor in 48% of cases, fetal distress in 26% of cases. In addition, maternal complications were increased by cesarean delivery in 48% of cases, perineal tears in 40% of cases and forceps delivery in 20% of cases. Conclusions By comparing the expectation under supervision to induction of labour at 41WG, we concluded that induction of labour reduces maternal-fetal outcomes in a remarkable way. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis. Key messages Exceeding the classic term for a pregnancy may cause maternal and fetal complications. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis.

Validation of the CARPREG II risk stratification model and the WHOm scale in pregnant women with heart disease

Abstract The physiological changes of pregnancy imply a state of haemodynamic stress, which increases the risk of maternal-fetal complications in women with cardiac pathology. Risk stratification models allow clinical decisions to be guided and optimal diagnostic, follow-up and management strategies to be established according to each estimated category in order to reduce adverse outcomes. Objective To validate the CARPREG II and WHOm risk prediction models in a population of pregnant women with heart disease. Materials and methods Validation and comparison study of a risk prediction model in a prospective cohort of pregnant women with heart disease assessed between 2016 and 2019 by a cardiobstetric team in an average income country. The CARPREG II score was established and patients were classified according to the WHOm risk scale. We assessed cardiovascular and perinatal outcomes and determined the calibration and level of discrimination of these tools. Results In a cohort of 328 pregnant women (27±7 years), 33% (n=110) had congenital heart disease, followed by arrhythmias in 30% (n=98), valvular pathologies in 14% (n=46) and cardiomyopathies in 9% (n=29). In 56% of the pregnancies, the route of delivery was caesarean section, 84% of these by obstetric indication. A cardiac event occurred in 15%, with left heart failure (5.3%) and arrhythmias (2.3%) being the most frequent. The frequency of maternal death of cardiac origin during the study was 1.6%. Neonatal outcomes occurred in 37% of gestations (preterm delivery (16%) and low weight for gestational age (8.4%)) and obstetric events in 12.5%: pregnancy-induced hypertension (9%) and postpartum haemorrhage (2.3%). NYHA functional class III-IV or cyanosis (OR 12 95% CI 3.1 - 46.4) and left ventricular dysfunction (LVEF <55%) (OR 3 95% CI 1 - 10.9) were the most statistically significant risk predictors. Discrimination of both models was adequate (AUC-ROC of 0.74 95% CI 0.64 - 0.84) for the CARPREG II risk index and 0.77 for the WHOm scale (95% CI 0.69 - 0.86) (Figure 2). Calibration is also good in the study population (Hosmer- Lemeshow goodness-of-fit 0.6 and 0.1, respectively). By including in the CARPREG II model the variables ejection fraction and pulmonary artery systolic pressure in their numerical and not dichotomised form, a discrete improvement in the predictive ability of the scale is evident (AUC-ROC 0.81 95% CI 0.71–0.91). Conclusions The CARPREG II and WHOm risk stratification models have good ability to discriminate the risk of adverse cardiac outcomes in pregnant women with heart disease and fit our population. To improve the predictive power of CARPREG II, the variables pulmonary hypertension and left ventricular dysfunction could be used numerically and not dichotomised as in the original model. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): San Vicente Foundation University Hospital, Cardio-obstetric Center

Coping with Stress in Complicated Pregnancy and Gestational Weight Gain.

Maternal obesity is one of the leading health problems in the world. Excessive gestational weight gain (GWG) can lead to many complications during pregnancy, especially when it is accompanied by diabetes. Moreover, the risk of excessive GWG in pregnant women is significant, irrespective of prenatal counseling. Studies on this subject concerning coping with stress are lacking in the literature. The present work is aimed at evaluating the styles of coping with stress and their relation to GWG in pregnant women with gestational diabetes (GDM) for whom sudden adaptation to dietary management during this period can be challenging. It was indicated that women with GDM reported high stress related to potential maternal-fetal complications and worries about compliance with dietary management. The overall weight gain of participants in pregnancy was determined in connection to their prepregnancy body mass index (BMI) and classified based on the Institute of Medicine guidelines. A standardized psychological scale was used to assess coping styles. The results showed that almost half of the participants did not meet the Institute of Medicine recommendations for weight gain during pregnancy. There were significant correlations between the styles of coping with stress and the GWG. Additionally, low correlations were indicated between emotional, avoidant, task-oriented coping styles and the age of pregnant women with GDM. Regression analysis showed that the stress-coping style that focused on emotions was the most predictive of overall weight gain. There is a need for a better understanding of psychological barriers in achieving the recommended GWG and potential limitations in providers’ interventions, particularly for GDM.

Complicaciones obstétricas relacionadas con la terapia antirretroviral en gestantes infectadas por el VIH

IntroductionThe percentage of HIV-infected pregnant women seeking pregnancy has increased in developed countries due to the stability of the infection and the decrease in vertical transmission due to antiretroviral treatment (ART) and preventive measures. However, there is little information regarding the effect of ART on pregnancy. MethodsRetrospective study of HIV-infected pregnant women on ART monitored at Hospital La Paz between 2000-2017. Maternal-foetal complications were studied. ResultsOne hundred and forty-one gestations were collected in 112 HIV-infected women. The most commonly used ART was the combination of 2 nucleoside reverse transcriptase inhibitor analogues+1 protease inhibitor (58.1%), with significant differences between the different treatments in terms of plasma viral load being undetectable to a greater extent with 2 nucleoside reverse transcriptase inhibitor analogues+1 non-nucleoside reverse transcriptase inhibitor, the second most used regimen. The rates of low birth weight (<2,500g) term neonates (11.3%), preterm delivery (11.1%) and preterm premature rupture of membranes (5.6%) were higher than in the general population. Although there was no association, these complications were more frequent in pregnant women with a protease inhibitor/ritonavir. They were not related to plasma viral load. No increase in the rate of gestational terminations, malformations or gestational diabetes was found. ConclusionHIV-infected pregnant women on ART have an increased rate of low birth weight, prematurity, and preterm premature rupture of membranes at term compared to the general population, especially related to treatment with protease inhibitor, although without significant association.

PD14-03 THE ASSOCIATION OF PREGNANCY ON URETERAL DECOMPRESSION IN WOMEN WITH OBSTRUCTIVE PYELONEPHRITIS FROM NEPHROLITHIASIS: A POPULATION-BASED ANALYSIS

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (PD14)1 Sep 2021PD14-03 THE ASSOCIATION OF PREGNANCY ON URETERAL DECOMPRESSION IN WOMEN WITH OBSTRUCTIVE PYELONEPHRITIS FROM NEPHROLITHIASIS: A POPULATION-BASED ANALYSIS Albert Ha, Connie Wang, Christopher Haas, Caleb Miles, Matthew Katz, and Ojas Shah Albert HaAlbert Ha More articles by this author , Connie WangConnie Wang More articles by this author , Christopher HaasChristopher Haas More articles by this author , Caleb MilesCaleb Miles More articles by this author , Matthew KatzMatthew Katz More articles by this author , and Ojas ShahOjas Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001990.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obstructive pyelonephritis from nephrolithiasis (OPN) is a urologic emergency that requires prompt ureteral decompression. We explore the association of pregnancy on rates of decompression among those with OPN and whether such instances result in increased maternal and/or fetal morbidity. METHODS: Using the National Inpatient Sample from 2010 to 2015, women of reproductive age (15 to 44 years old) diagnosed with OPN were identified and stratified by pregnancy status. Survey-weighted regression models were used to assess the effect of pregnancy on ureteral decompression, delays in decompression, and hospital length of stay. Additional analyses using Rao-Scott Chi Square tests were performed to explore maternal and fetal complications from delayed decompression in pregnant women. RESULTS: A weighted total of 38,783 hospitalizations for obstructive pyelonephritis were identified, with 6.1% of admissions occurring in pregnant women. On multivariable regression, pregnant women with obstructive pyelonephritis had greater odds of no ureteral decompression (adjusted OR: 0.62; p <0.001) compared with women of reproductive age. If decompressed, pregnant women had greater odds of delayed decompression (adjusted OR: 2.27; p <0.001) and longer length of stay (adjusted IRR: 1.11; p=0.003). Delayed decompression among pregnant women was also associated with increased rates of C-section (7.7 vs. 1.1%; p=0.006), early or threatened labor (9.1 vs. 2.3%; p 0.016), fetal distress (2.6 vs. 0%; p=0.030), and umbilical cord complications (2.6 vs. 0%; p=0.030). CONCLUSIONS: Pregnant women had reduced odds of decompression, as well as increased odds of delayed decompression, when compared with non-pregnant women of reproductive age. Delays in ureteral decompression among pregnant women were also associated with increased maternal-fetal complications. Future studies are needed to delineate this association to inform clinical decision making for timely diagnosis and intervention for OPN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e216-e216 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert Ha More articles by this author Connie Wang More articles by this author Christopher Haas More articles by this author Caleb Miles More articles by this author Matthew Katz More articles by this author Ojas Shah More articles by this author Expand All Advertisement Loading ...

Hyperthyroidism in Pregnancy: The Delicate Balance between Too Much or Too Little Antithyroid Drug.

Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (<6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%); 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI < 10 mg/day (relapse in 14.2%), and in up to 55% in T3; (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively; FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3; (d) no fetal birth defects were recorded; one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy.

Effect of Adding Metformin to Insulin Therapy in Pregnant Women with Uncontrolled Type I Diabetes as Regard Pregnancy Outcome

Aim: This study aimed to examine if addition of metformin to insulin is an effective alternative to insulin alone for women with type I Diabetes Mellitus to lower insulin dose, hospital stay, maternal and neonatal complications, particularly in a resource-poor setting.Materials and Methods: Our randomized controlled trial included eighty patients, who were recruited into two equal groups; group A treated with metformin and insulin and group B treated with insulin alone, in Cairo and Beni-suef University Hospitals.Results: We found that metformin plus insulin group (Group A) showed significant outcomes regarding shorted hospital stay, lower insulin dose and lower maternal weight gain (p values 0.04, 0.02, 0.03, respectively). Most of maternal and neonatal complications were non-significantly lower in group A.Conclusion: Oral metformin therapy is an effective and safe additional treatment option for women with type I diabetes during pregnancy to lower the insulin requirements, hospital stay and most maternal-fetal complications in settings with limited economic resources.

Pregnancy in Women with Sickle Cell Disease

▪IntroductionSickle cell disease (SCD), characterized by recurrent crisis due to vaso-occlusion, results in acute morbid outcomes and cumulative organ damage. Acute hemolysis typically occurs in times of stress such as pregnancy. Although advances in the management of SCD complications have allowed most women with SCD to reach their reproductive age (Telfer et al. Haematologica.2007), pregnancies can be complicated; increased risks of preeclampsia, maternal death, stillbirths, preterm deliveries and small-for-gestational-age newborns have been reported (Oteng-Ntim et al. BJH.2014).The objective of our study is to assess maternal-fetal complications and vaso-occlusive crisis during pregnancy.MethodsThis is a retrospective chart review of twelve pregnancies in nine women (ages 22-34) with sickle cell disease over a 10 year period at a large urban hospital. All women had a documented history of sickle cell disease (HbSS, HbSC or HbSBthal), and met the inclusion criteria of consistent follow up with hematology for a 3 year span encompassing the year prior through the year after pregnancy. Women were excluded if they had a miscarriage, or were non-compliant with care. Number of crisis, method of delivery, fetal complications were collected.ResultsOf the twelve pregnancies, ten (83%) occurred in HbSS disease patients while two (17%) in HbSC patients. Ten out of twelve pregnancies had at least one crisis in the year prior pregnancy (baseline crisis); of these 60% had the same number of crisis during pregnancy. Interestingly, only 33% of the pregnancies had increase from their baseline crisis in the year after pregnancy.Three pregnancies received prophylaxis exchange after a crisis admission early in the pregnancy and were noted to not have any further crisis. Of nine remaining pregnancies, seven required urgent red cell exchange; two for crisis/preeclampsia, three for acute chest syndrome and two for vaso-occlusive crisis.Overall, 58% of pregnancies had c-section delivery; highest in women that did not receive exchange and lowest in women with prophylactic exchange (33%). Pregnancies that had crisis requiring urgent exchange had 50% rate of c-section. Three preterm deliveries and all fetal complications were noted in patients who had required urgent exchange. Fetal complications included intra-uterine growth retardation (17%), NICU admission (25%), and one fetal demise.ConclusionMedStar Washington Hospital Center is an urban hospital that cares for a large population of sickle cell patients however, due to sporadic follow up in our sickle cell population; data regarding maternal and fetal outcomes in pregnant patients is limited.All pregnancies with baseline crisis will have atleast the same number of crisis during pregnancy. Rates of C-section were noted to be much less (33%) in pregnancies receiving prophylaxis exchange, which is near national average (32.6%) in healthy women (CDC, 2013). Fetal complications were also more prevalent in pregnancies with crisis requiring urgent exchange. Therefore, we conclude that maternal complications such as acute crisis requiring hospitalizations and C-section as delivery modality, and fetal complications can be prevented with prophylactic exchange. DisclosuresNo relevant conflicts of interest to declare.

Evaluation of the proteinuria - Creatininuria ratio for the diagnostic confirmation of preeclampsia in congolese pregnant women

Context: Preeclampsia is a multisystem endothelial disease characterized by hypertension of pregnancy and glomeruloendotheliosis resulting in significant proteinuria. These days, the weight determination of urinary proteins by 24-hour proteinuria (P24) remains the reference method for biologically confirming this condition. However, the completion of the exam appears to be very burdensome with a long waiting period for results. Hence the need to use a simple alternative method such as the proteinuria / creatininuria ratio (PCR). Aims: Improve the diagnosis and management of preeclampsia by using a simple, less restrictive but reliable diagnostic method. Methodology: The study compared the results obtained from P24 versus PCR in confirming the diagnosis of preeclampsia in 149 Congolese women in whom the disease was suspected thanks to the urine dipstick. The cut-off values used for the diagnosis of preeclampsia were, for P24, a proteinuria&gt; 300 mg / 24 h and for PCR a value&gt; 30 mg / mmol. Results: Of the 149 pregnant women in whom the diagnosis of preeclampsia was suspected using the urine dipstick, only 85.9% had a P24&gt; 300 mg. This diagnostic confirmation rate was similar to that obtained with PCR (86.6%). A linear correlation was found between P24 and PCR in the quantification of proteinuria and in the diagnosis of preeclampsia (r² = 0.627, p &lt;0.004). Comparing the pathological values diagnosed by the two methods, the agreement was 89.1% (kappa = 0.767). The PCR showed an excellent predictive performance of maternal-fetal complications at the optimal threshold of 30.8 mg / mmol corresponding to a sensitivity of 96.6% and a specificity of 95% (Youden index 0.866). This threshold was 323 mg / 24h corresponding to a sensitivity of 84% and a specificity of 61.9% (Youden index 0.459) for P24. Conclusion: PCR seems to be a good alternative to P24 in confirming the diagnosis of preeclampsia in the settings most affected by this pathology

1280-PUB: The Impact of Proactive and Personalized Strategies in the Self-Monitoring of Blood Glucose in Women with Diabetes in Pregnancy: The Experience of the Cohort Cuido Mi Embarazo in Mexico

Women with Diabetes in Pregnancy (DP) have a higher risk of maternal-fetal complications, unfortunately in Mexico, its detection is only carried out in 1% of cases, and glucometers and glucose strips are not available for self-monitoring of blood glucose (SMBG). The cohort Cuido mi Embarazo (CME) ensures supplies for the Oral Glucose Tolerance Test (OGTT) and glucose screening through MIDO Embarazo®. Educational strategies have been implemented for health personnel focused on prevention, diagnosis and management. Patients with DP have been offered medical and nutritional counseling, and digital glucometers and glucose strips for SMBG. Up to now, 854 women are actively monitored and have performed the OGTT. 117 women have been found with diabetes, of which 96 (82.05%) are Gestational Diabetes (GDM) and 21 (17.95%) are pre-gestational diabetes, finding a prevalence of GDM of 11.2%. Regarding the SMBG in 84 women with diabetes that completed their pregnancy, 62 (73.8%) completed glucose measurements, representing a higher figure than the international literature. From those patients that completed their pregnancy with complete SMBG according to international standards, 39 (62.9%) women achieved control, 23 (37.1%) did not achieve control. No cases of children with macrosomia were detected. In the framework of the CME Cohort, it is demonstrated that: 1) Performing the OGTT and capillary glucose screening through MIDO Embarazo® allow the timely detection of DP. 2) Providing digital glucometers and glucose strips for SMBG, guarantees measurement, increases adherence and glucose control, and improves the health of the newborn and the mother. 3) The systematic approach that also includes the proactive participation of health professionals in the health center is a key element for success for the timely and adequate diagnosis of DP. These conclusions represent a significant public health lesson in Mexico. Disclosure L. Martinez-juarez: Research Support; Self; Lilly Global Health Partnership. R. Tapia-conyer: None. J. Lomelin-gascon: None. J. Ortega-montiel: Research Support; Self; Lilly Global Health Partnership. A. Benitez-herrera: None. D. Reyes-gómez: None. M. Carmona-ramos: None. L. Hernández-gonzález: None. E. Reyes-muñoz: Consultant; Self; Nestlé, Research Support; Self; Nestlé. H. Gallardo-rincón: None. Funding Eli Lilly and Company

Malaria in pregnancy complications in Southern Venezuela

BackgroundPregnant women are particularly vulnerable to malaria infections, increasing the risk of maternal–fetal complications, mainly in high-endemicity areas. However, few studies of malaria in pregnancy (MiP) have been carried out in Latin America, a region with low endemicity and transmission of both, Plasmodium falciparum and Plasmodium vivax. Despite the high malaria burden in Venezuela in the last years, no recent studies of MiP have been conducted. Hence, epidemiological and clinical characteristics of pregnant women with malaria in southern Venezuela are described herein.MethodsA retrospective study in pregnant women attending at the “Ruíz y Páez” University Hospital Complex, Bolivar state, Venezuela, was carried out between February and October, 2019. Epidemiological, clinical, and laboratory information was analysed.ResultsThirty-seven out of 52 pregnant women analysed were infected with P. vivax. Age ranged between 15 and 39 years, and adolescent pregnancies were common. Malaria infection was diagnosed mainly during the third trimester of pregnancy (63.4%). The distribution of symptoms and signs as well as clinical laboratory values was similar among Plasmodium spp. Although uncomplicated malaria was most frequent, 30% (13/52) had severe anaemia. A high proportion of studied women (44%) presented at least one complication during the pregnancy or delivery. Spontaneous abortion was recorded in four women, and three fetal deaths were observed. Six women had preterm delivery without any further complication.ConclusionsA high prevalence of maternal–fetal complications was found in the studied population, highlighting the requirement for a careful medical follow up during the prenatal check-ups, which should include routinary malaria tests. Preventive measures as distribution of insecticide-treated mosquito net for pregnant women at risk should also be implemented. Those measures can help to reduce the negative impact of malaria on the newborn and mother.

Maternal and fetal outcomes during pregnancy and puerperium in obese and overweight pregnant women. A cohort study.

compare incidences of maternal-fetal complications during pregnancy, labor, and early puerperium according to baseline BMI in a consecutive cohort of pregnant women. This retrospective cohort study compares pregnancy outcome indicators by body mass index (BMI) in 1236 pregnant women managed over the period January 2017 to May 2018. Data were collected regarding the personal history (smoking, diabetes and hypertension), obstetrics and BMI (kg/m2) (normoweight 18.5-24.9, overweight 25-29.9, obese ≥ 30). Of the 1236 women, 354 (28.6%) were overweight and 206 (16.7%) were obese at the start of pregnancy follow-up. Mean age at this time was 33years (SD 6). Risk factors for a cesarean-section delivery assessed through logistic regression were maternal age (OR 1.05 95% CI 2.06-6.15; p < 0.001) and previous C-section (OR 4.21 95% CI 2.89-6.14; p < 0.001) regardless of BMI. In a propensity score analysis, pregnancy weight gain was found lower in obese vs normoweight (- 2.73kg 95% CI - 3.74 to - 1.72 p < 0.001), and newborn weight higher in obese vs normoweight women (161.21g 95% CI 57.94-264.48 p = 0.002). Labor duration and weight gain were reduced in overweight vs normoweight subjects (- 0.72h 95% CI - 1.27 to - 0.17 p = 0.010 and 0.81kg 95% CI - 1.50 to - 0.12 p = 0.021, respectively). In this cohort, obese women showed higher rates of prenatal complications yet obesity and overweight were not related to worse puerperium outcomes.

Maternal-foetal complications in pregnancy: a retrospective comparison between type 1 and type 2 diabetes mellitus

BackgroundThe aim of the study was a retrospective comparison of the differences in maternal-foetal outcomes between women with type 1 and type 2 diabetes mellitus (T1DM and T2DM).MethodsA cohort of 135 patients with pregestational diabetes, 73 with T1DM (mean age 29 ± 5 years) and 62 with T2DM (mean age 33 ± 6 years), in intensive insulin treatment throughout pregnancy were evaluated. Clinical and metabolic parameters and the prevalence of maternal and foetal complications were assessed.ResultsWomen with T1DM showed lower pregestational BMI (p < 0.001), pregestational weight (p < 0.001), weight at delivery (p < 0.001), ∆_total_insulin requirement (IR) at the first, second and third trimesters (all p < 0.001) and higher weight gain during pregnancy (p < 0.001), pregestational HbA1c (p = 0.040), HbA1c in the first (p = 0.004), second (p = 0.020) and third (p = 0.010) trimesters compared to T2DM. Women with T1DM had a higher risk of macrosomia (p = 0.005) than T2DM, while women with T2DM showed higher prevalence of abortion (p = 0.037) than T1DM. At multivariate analysis, pregestational BMI and ∆_total_IR of the first trimester were independently associated with abortion in T2DM, while weight gain during pregnancy was independently associated with macrosomia in T1DM.ConclusionWomen with T1DM have a higher risk of macrosomia than T2DM due to weight gain throughout pregnancy. By contrast, women with T2DM have a higher risk of spontaneous abortion than T1DM, due to pregestational BMI and ∆_total_IR in the first trimester.

Manejo de neoplasias malignas raras durante el embarazo

El cáncer durante el embarazo ocurre en 0,07% a 0,1% de todos los embarazos. Debido al notable aumento en la edad materna al momento del parto, la incidencia de tumores malignos diagnosticados durante el embarazo ha aumentado. Aunque es una condición rara, debe ser identificada y tratada de inmediato, ya que el embarazo puede producir conflictos para el tratamiento materno y desarrollo fetal óptimo. Los casos de cáncer más frecuentes durante el embarazo son los de mama, cuello uterino, melanoma, leucemia y linfoma. Sin embargo, existen casos reportados en menor frecuencia de páncreas, riñón, glándulas suprarrenales, vejiga, pulmón, hepatobiliar, de vulva y sistema nervioso central. La falta de experiencia y conocimiento podría conducir a diagnóstico tardío, tratamiento impreciso y complicaciones materno-fetales. Las estrategias para el tratamiento del cáncer durante el embarazo no deberían diferir en forma significativa de los esquemas de tratamiento en mujeres no gestantes. La decisión sobre el inicio y la continuación del tratamiento debe ir precedida de análisis detallado de los posibles beneficios y riesgos. Por lo tanto, es necesario tener en cuenta las pautas diagnósticas y ponderar la seguridad fetal con un enfoque multidisciplinario para establecer las potenciales opciones terapéuticas.

STUDY OF CARDIOVASCULAR RISK FACTORS DURING GESTATIONAL DIABETES IN SENEGAL

The evolution of gestational diabetes is most often marked by preventable maternal-foetal complications. The objective of this study was to identify factors inuencing the development of pregnancy in women with gestational diabetes. This was a retrospective and analytical study including women with gestational diabetes and treated in gynaecological services in Dakar and its suburbs between 2018 and 2019. A total of 24 women with gestational diabetes were recruited. The mean age of the patients was 29.9 ± 6.45 years (18-45) with a predominance of women over 30 years old. Dyslipidaemias were frequent (91.2%) with a predominance of hypercholesterolemia (n = 13, 54.2%) followed by hyperLDLemia (n = 10, 41.7%). The atherogenic risk was high with the TG / HDL (12.5%) and Apo B / A (20.83%) ratios. A positive correlation was noted between homocysteine and total cholesterol (r = 0.457, p = 0.025), LDL (r = 0.449, p = 0.028), triglycerides (r = 0.540, p = 0.006), apolipoproteins A (r = 0.463, p = 0.023) and B (r = 0.480, p = 0.018), urea (r = 0.0671, p &lt;0.0001) and creatinine (r = 0.0673, p &lt;0, 0001). The development of the pregnancy was marked by caesarean deliveries (54.2%) and macrosomia (8.3%). The factors which were identied in relation to the caesarean section were delayed diagnosis of GD, history of personal abortion (RR (CI) = 2.04 (0.4 - 10.6)), multiparity (RR (CI)) = 2.3 (0.4 - 12.7)) and the advanced age of the woman (RR (CI) = 2.1 (0.5 - 14.4)). The biological monitoring of women with gestational diabetes must consider the dosage of lipid parameters extended to apolipoproteins and homocysteine for a favourable outcome of the pregnancy

Dyslipemias and pregnancy, an update

During pregnancy there is a physiological increase in total cholesterol (TC) and triglycerides (TG) plasma concentrations, due to increased insulin resistance, oestrogens, progesterone, and placental lactogen, although their reference values are not exactly known, TG levels can increase up to 300 mg/dL, and TC can go as high as 350 mg/dL. When the cholesterol concentration exceeds the 95th percentile (familial hypercholesterolaemia (FH) and transient maternal hypercholesterolaemia), there is a predisposition to oxidative stress in foetal vessels, exposing the newborn to a greater fatty streaks formation and a higher risk of atherosclerosis. However, the current treatment of pregnant women with hyperlipidaemia consists of a diet and suspension of lipid-lowering drugs.The most prevalent maternal hypertriglyceridaemia (HTG) is due to secondary causes, like diabetes, obesity, drugs, etc. The case of severe HTG due to genetic causes is less prevalent, and can be a higher risk of maternal-foetal complications, such as, acute pancreatitis (AP), preeclampsia, pre-eclampsia, preterm labour, and gestational diabetes. Severe HTG-AP is a rare but potentially lethal pregnancy complication, for the mother and the foetus, usually occurs during the third trimester or in the immediate postpartum period, and there are no specific protocols for its diagnosis and treatment.In conclusion, it is crucial that dyslipidaemia during pregnancy must be carefully evaluated, not just because of the acute complications, but also because of the future cardiovascular morbidity and mortality of the newborn child. That is why the establishment of consensus protocols or guidelines is essential for its management.

Maternal and Fetal Prognosis of Evacuated Parturients in N’Djamena Mother and Child Hospital (Chad)

Introduction: All pregnant women are at risk of obstetric complications leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients. Patient and Method: we conducted a prospective analytical survey for four months, from April 1st to July 31st, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software. Results: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1st delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric complications. Preruptive syndrome was the most common complication with 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The maternal mortality rate was 3%. Fetal complications were observed in 28.3% of cases and the neonatal mortality rate was 24.6%. Conclusion: The maternal and fetal complications of evacuated parturients are a real public health problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize obstetric emergencies will contribute to improve the maternal and fetal prognosis of evacuated parturients.

Expression of placental glucose transporter proteins in pregnancies complicated by fetal growth disorders.

During pregnancy fetal growth disorders, including fetal macrosomia and fetal growth restriction (FGR) are associated with numerous maternal-fetal complications, as well as due to the adverse effect of the intrauterine environment lead to an increased morbidity in adult life. Accumulating evidence suggests that occurrence of fetal macrosomia or FGR, may be associated with alterations in the transfer of nutrients across the placenta, in particular of glucose. The placental expression and activity of specific GLUT transporters are the main regulatory factors in the process of maternal-fetal glucose exchange. This review article summarizes the results of previous studies on the expression of GLUT transporters in the placenta, concentrating on human pregnancies complicated by intrauterine fetal growth disorders. Characteristics of each transporter protein found in the placenta is presented, alterations in the location and expression of GLUT isoforms observed in individual placental compartments are described, and the factors regulating the expression of selected GLUT proteins are examined. Based on the above data, the potential function of each GLUT isoform in the maternal-fetal glucose transfer is determined. Further on, a detailed analysis of changes in the expression of glucose transporters in pregnancies complicated by fetal growth disorders is given, and significance of these modifications for the pathogenesis of fetal macrosomia and FGR is discussed. In the final part novel interventional approaches that might reduce the risk associated with abnormalities of intrauterine fetal growth through modifications of placental GLUT-mediated glucose transfer are explored.

Assistência de enfermagem a paciente com diabetes mellitus gestacional: uma revisão de literatura

The aim was to analyze the evidence in the literature about nursing care in Primary Care for patients who had Gestational Diabetes Mellitus. This is an integrative literature review, the selected databases were: PubMed, SciELO and the VHL database platform. The following descriptors were used: Diabetes, Gestational; Nursing Care; Primary Health Care and Public Health. The research resulted in 325 works, after reading only 11 articles were selected, which were classified into four categories, namely: Understanding the potential of care; identifying the factors that affect the results; Capacity building/training/knowledge; Weaknesses of care. It is concluded that the management of patients with gestational diabetes mellitus in Primary Care becomes extremely relevant for reducing maternal-fetal complications as well as for decreasing the incidence of progression to type 2 diabetes.

Cortisol and estriol responses to awakening in the first pregnancy trimester: Associations with maternal stress and resilience factors

BackgroundLittle is known about the maternal cortisol awakening response (CAR) in the first pregnancy trimester. Similarly unknown is how the CAR in early gestation relates to other steroid hormones, such as estriol. Maternal estriol in blood and urine is used to monitor fetal well-being since it is produced by the fetoplacental unit from fetal precursors. Low levels have been associated with maternal-fetal complications. We were recently able to show that estriol is measurable in maternal saliva from 6 weeks’ gestation onwards. However, its pattern following morning awakening and potential links with salivary cortisol in early gestation is relatively unknown. In this prospective study, we explored the cortisol and estriol responses to morning awakening in first-trimester pregnant women, the potential association of these endocrine variables with maternal stress and resilience factors, and their predictive value for the further pregnancy course. MethodsFifty-one women with an uncomplicated, singleton pregnancy responded to questionnaires measuring chronic and pregnancy-specific stress, emotional support, and daily uplifts at 6 weeks’ gestation. At 8 and 10 weeks, the women collected saliva samples immediately, 30, and 60 min after morning awakening. After 12 weeks, 40 women reported on the further pregnancy course, of whom 6 had developed complications. ResultsIn response to morning awakening, cortisol levels increased significantly at 10 weeks (p = .04), while estriol levels decreased significantly at both 8 and 10 weeks (p < .001). A stronger cortisol increase was linked to a stronger estriol decrease at 8 (p = .03), but not at 10 weeks. Then, perceived emotional support at 6 weeks was negatively associated with cortisol baseline at 8 (p = .01) and positively with estriol baseline at 10 weeks (p = .03). Moreover, higher pregnancy-specific stress was related to a lower estriol baseline at 8 weeks (p = .047). Furthermore, compared to healthy women, those with complications at follow-up had already reported less emotional support (p = .03) and fewer daily uplifts (p = .03) at 6 weeks. These women also seemed to lack a significant estriol response to morning awakening at 8 weeks (p > .10). DiscussionThese findings advance our knowledge of cortisol and estriol secretion following morning awakening and encourage the investigation of E3 in addition to cortisol when researching prenatal stress and its consequences for maternal and fetal health.