Frequency Of Congenital Anomalies Research Articles

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

Spectrum of Congenital Malformations in Neonates at a Rural Teaching Hospital — A Cross Sectional Observational Study

Introduction: The global estimates of congenital anomalies in neonates are 6% and few of them are severe enough to cause death. According to World Health Organization (WHO), congenital anomalies attribute to 17-42% of the infant mortality. Apart from causing death, they also contribute to preterm births, childhood and adult mortality, with significant repercussions in families. With the advancement of technology, there has been a decrease in the number of deaths due to other causes and there has been an increasing concern about congenital anomalies. This calls for an inquiry into the recent burden of congenital anomalies and their associated risk factors. Hence, the study was carried out. Objectives: 1. To assess the frequency and pattern of congenital anomalies. 2. To determine the factors associated with congenital anomalies. Materials & methods: This is an observational study which included all live born neonates with congenital anomaly/ies admitted to R L Jalappa Hospital (RLJH) and still born neonates or aborti with congenital anomaly/ies delivered in RLJH during the study period. A detailed history of the study participants was taken, and all the anomalies were coded as per the ICD coding system. For still born babies, aborti and neonatal deaths, infantogram, gross autopsy and histopathological examination findings were noted. Statistical analysis: Data was analysed using “Microsoft excel sheet” and the analysis was done using Statistical Package for Social Sciences (SPSS-16) software. Significance was defined as p<0.05. Results: Our hospital had 2,400 deliveries during the study period, out of which the frequency of congenital anomalies was 1.3%. As per the associated risk factors, 66.6% of the babies had no associated risk factors while the remaining 33.4% of the babies had an associated risk factor. Most commonly seen risk factor in the study was 3rd degree consanguinity (11.1%). As per the system involved, Musculoskeletal system involvement was seen in the majority (63.9%) of the neonates, followed by Cardiovascular system in 11.1%, Central Nervous System (CNS) in 8.3%, Genital system in 8.3%, Lymphatic system in 5.6%, Gastrointestinal system in 2.8%, Cutaneous in 2.8%, Oral cavity in 2.8% and syndromic anomaly in 2.8%. Conclusion: The prevalence of congenital anomalies is considerably high and increasing the awareness to prevent them is the need of the hour. Appropriate consideration should be given to reducing the risk factors and genetic counseling should be provided to parents with high risk. Keywords: Congenital malformations, Neonates, Congenital anomalies

Influence of Atmospheric Air Pollution on Frequency of Congenital Anomalies (on an example of a region)

INTRODUCTION: Atmospheric air pollution is the underlying factor of a great number of human diseases in both industrialized and developing countries. Studies show that exposure to atmospheric pollutions in pregnancy can be associated with an increased risk of congenital anomalies (CAs).
 AIM: To analyze the impact of atmospheric air pollutants in Ryazan city on the incidence of CAs in newborns.
 MATERIALS AND METHODS: The data of monitoring of CAs by Ryazan Regional Perinatal Center; information on atmospheric air pollution of the Federal Service for Hydrometeorology and Environmental Monitoring, of Ryazan Center for Hydrometeorology and Environmental Monitoring, of Rospotrebnadzor of the Ryazan region are presented. The statistical analysis was conducted using free R computing environment (ver. 4.1.2).
 RESULTS: In 2019, the prevalence of CAs in Ryazan was 24.09 per 1,000 newborns; in the period 20102021, the absolute number of recorded CAs grew by 244.57%. The most common congenital anomalies were Q21.0 Ventricular septal defects (28.5%, 95% CI: 20.836.2%) and Q62.0 Congenital hydronephrosis (7.3%, 95% CI: 2.911.7%). Correlation was recorded with such air pollutant as sulfur dioxide (SO2) in the second month of pregnancy (AOR 1.39; 95%; CI 1.051.83, p 0.05) and the third month of pregnancy (AOR 1.59; 95% CI 1.172.16, p 0.05). No statistically significant relationship was established between CAs and carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3, p 0.05).
 CONCLUSION: The study confirms the association between atmospheric air pollution and frequency of CAs. In particular, SO2 has a negative effect in the second and third months of pregnancy. In this context, it is important that the authority bodies of the region and governmental regulatory agencies direct their efforts to reduction of the pollution of the environment which should help reduce the frequency of CAs in children.

Применение селективного ингибитора фосфодиэстеразы–5 силденафила при беременности с учетом его возможного влияния на плод

Objective of the Review: To evaluate the possibilities and effectiveness of the use of sildenafil in obstetric practice, its effect on both the fetus and the mother's body. Key points. Sildenafil is a potent vasodilator drug used to treat pulmonary hypertension in adults and children. In addition to the vasodilating effect, sildenafil has a proliferative effect on the vascular network, reduces the muscle mass of the vascular wall. The vasodilating effect of sildenafil also appears on the uterus and myometrial vessels, which leads to increased uterine circulation and thickening of the endometrium. Its use during pregnancy is mainly limited to a few specific indications. In particular, high pulmonary hypertension – is sufficient reason to prescribe this drug off–label even at the stage of pregnancy planning. To date, antenatal therapy with sildenafil for conditions such as preeclampsia, preterm labor, oligohydramnios, congenital diaphragmatic hernia, intranatal fetal distress, and intrauterine growth restriction are being actively studied in many countries. More than 130 in vivo and ex vivo animal studies, pharmacological and toxicokinetic studies have demonstrated the safety of sildenafil. It has been proven that there is no teratogenic effect, as well as an increase in the frequency of congenital anomalies in the fetus. Conclusion. The use of sildenafil during pregnancy is of interest to researchers around the world. Based on preliminary data, it can be assumed that serious side effects in pregnant women, negative effects on the fetus, an increase in the frequency of stillbirths, neonatal deaths and congenital anomalies associated with taking sildenafil were not observed. However, additional fundamental studies are needed, including using experimental animal models, in order to finally evaluate the ability of sildenafil to overcome the transplacental barrier, as well as the possibility and effectiveness of its use in various groups of patients. Keywords: sildenafil, transplacental transfer, safety during pregnancy, pharmacology, hemodynamics.

Prenatal diagnosis of 21 fetuses with balanced chromosomal abnormalities (BCAs) using whole-genome sequencing.

Balanced chromosomal abnormalities (BCAs) are the most common chromosomal abnormalities and the frequency of congenital abnormalities is approximately twice as high in newborns with a de novo BCA, but a prenatal diagnosis based on BCAs is subject to evaluation. To detect translocation breakpoints and conduct a prenatal diagnosis, we performed whole-genome sequencing (WGS) in 21 subjects who were found BCAs, 19 balanced chromosome translocations and two inversions, in prenatal screening. In 16 BCAs on non-N-masked regions (non-NMRs), WGS detected 13 (81.2%, 13/16) BCAs, including all the inversions. All the breakpoints of 12 (12/14) cases of sufficient DNA were confirmed by Sanger sequencing. In 13 interrupted genes, CACNA1E (in case 12) and STARD7 (in case 17) are known causative and PDCL was found in subject (case 11) with situs inversus for the first time. Case 12 with abnormal ultrasound reached a definitive genetic diagnosis of CACNA1E-disease, while STARD7 exon deletion has never been found causative in patients. WGS provides the possibility of prenatal diagnosis in fetuses with BCAs, and its clinical significance also lies in providing data for postnatal diagnosis.

O-085 School-Age Outcomes Among IVF-Conceived Children: A Causal Inference Analysis Using Linked Population-Wide Data

Abstract Study question To determine the causal effect of in-vitro fertilisation (IVF) on primary school-age childhood developmental and educational outcomes, compared with outcomes following spontaneous conception. Summary answer The school-age developmental and educational outcomes for children conceived by IVF are equivalent to those of spontaneously conceived peers. What is known already More than 8 million children have been conceived globally with the assistance of in-vitro fertilization (IVF). Large cohort studies have suggested an increase in the frequency of congenital abnormalities, autism spectrum disorder, developmental-delay and intellectual disability in children conceived via IVF. Educational and cognitive outcomes following IVF conception have not yet been adequately established. Two large Scandinavian studies (Norrman et al 2018 and Wienecke et al 2020) found poorer educational outcomes in children born after IVF-conception. Study design, size, duration Causal inference methods (based on the potential outcomes approach) were used to analyse observation data in a way that emulates the results of a target randomised clinical trial. The study cohort comprised state-wide linked maternal and childhood administrative data from Victoria, Australia. Participants/materials, setting, methods The study included singleton infants conceived spontaneously or via IVF and born between 2005-2014. The exposure of interest was conception via IVF, with those born after spontaneous conception as the control group. Two separate measures of childhood outcome were examined: The Australian Early Developmental Consensus (AEDC), (age 4-6); and the National Assessment Program – Literacy and Numeracy (NAPLAN) at age 7-9. We combined inverse probability weighting with regression adjustment to estimate population average causal effects. Main results and the role of chance The final cohort included 412,713 children across the two outcome cohorts. Linked records were available for 4,697 IVF-conceived cases and 168,503 controls for AEDC outcome data, and 8,976 cases and 333,335 controls for NAPLAN data. The mothers of IVF-conceived children were older, more highly educated mothers, who lived in more socio-economic advantaged areas and were less likely to be from non-English speaking backgrounds. There was no causal effect of IVF-conception on the on the risk of developmental vulnerability at school-entry compared to spontaneously conceived children, as defined by AEDC metrics; with an adjusted risk difference of -0.3% (95% CI -3.7% to 3.1%) and an adjusted risk ratio of 0.97 (95% CI 0.77 to 1.25). At age 7-9 years, there was no causal effect of IVF-conception on the NAPLAN overall z-score, adjusted mean difference of 0.030 (95% CI -0.018 to 0.077) between IVF-conceived and spontaneously conceived children. Given the use of observational data, there were missing data and inherent differences in the covariate profile of the exposure cohorts. Multiple imputation and doubly robust inverse probability weighting regression adjustment modelling was utilised to allow a causal interpretation of results. Limitations, reasons for caution Children who did not attend school due to severe disability were not included, possibly leading to selection bias. It is possible that unmeasured common cause confounders could have led to bias in estimating the average treatment effects. Wider implications of the findings This study, in contrast to previous evidence, suggests that conception via IVF does not affect early childhood developmental and educational outcomes. These findings provide important reassurance for current and prospective parents, and clinicians alike. Trial registration number Not applicable

Frequency Risk Factors and Pattern of Congenital Anomalies in Neonates in Nawabshah Pakistan

Objectives: The objectives of this study were to determine the frequency, risk factors and pattern of congenital anomalies in neonates admitted at a tertiary care hospital.
 Methodology: It was a descriptive cross-sectional study. Research was conducted at NICU Pediatric ward, PMCH Nawabshah. Duration of study was 6 months after the approval of synopsis from January 2020 to July 2020. This study involved 300 neonates in NICU which were screened for congenital anomalies. Age, gender and birth weight of the neonate was recorded. Mothers were also enquired about consanguinity and use of folic acid and smoking and diabetic status during pregnancy. Frequency and type of birth defect were noted and were compared across various subgroups based on various neonatal and maternal factors.
 Results: The mean age of the neonates was 10.5±7.4 days while the mean birth weight was 2.89±0.74 Kg. There were 174 (58.0%) male and 126 (42.0%) female neonates with a male to female ratio of 1.4:1. 77 (25.7%) neonates were low birth weight. Birth defect was noted in 35 (11.7%) neonates. 3 neonates had multiple anomalies. The frequency of birth defects was significantly higher in women with no use of folic acid during pregnancy (14.8% vs. 5.2%; p-value=0.015) and cousin marriage (16.6% vs. 2.8%; p-value<0.001).
 Conclusion: In the present study, 11.7% of neonates had birth defects comprising of congenital hydrocele, spina bifida, cleft lip/palate and club foot that were associated with lack of folic acid use during pregnancy and cousin marriages. Public awareness against cousin marriages and antenatal counseling of mothers for routine folic acid use during pregnancy should be assured for this.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010-2018.

Objective:To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010–2018.Methods:An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance.Results:The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period.Conclusions:The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.

Safety of topical ophthalmic antibiotics in pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis: propensity score analyses.

To investigate the association between exposure to topical ophthalmic antibiotics during pregnancy and adverse neonatal outcomes. In this retrospective cohort study, we identified pregnant women with hordeola, chalazia, blepharitis, or bacterial conjunctivitis from 2005 to 2018 using the Japanese Medical Data Centre Claims Database. From the eligible women, we extracted women who were dispensed no topical antibiotics during the first trimester (non-antibiotic group), women who were dispensed topical fluoroquinolones alone at least once (fluoroquinolone alone group), and women who were dispensed any single type of antibiotic (single-antibiotic group). We compared the frequency of congenital anomalies (CA), preterm birth (PB), low birth weight (LBW), and the composite outcome of these three between the fluoroquinolone and non-antibiotic groups and between the single-antibiotic and non-antibiotic groups, using propensity score adjustment. A total of 891 eligible women were identified. In the fluoroquinolone (n = 409) and non-antibiotic (n = 309) groups, CA occurred in 6.8% and 6.8%, PB in 2.4% and 3.2%, LBW in 2.9% and 3.2%, and the composite outcome in 10.5% and 11.3%, respectively. Analysis using propensity score adjustment showed no significant difference between the groups in the frequency of CA (adjusted odds ratio, 1.15; 95% confidence interval, 0.61-2.18), PB (0.80; 0.30-2.17), LBW (1.08; 0.45-2.63), or the composite outcome (1.12; 0.67-1.87). Comparison of the single-antibiotic and non-antibiotic groups showed similar results. Topical ophthalmic antibiotics for hordeola, chalazia, blepharitis, or bacterial conjunctivitis during the first trimester were not associated with increased adverse neonatal outcomes.

The Frequency, Types and Risk Factors of Congenital Anomalies in a Tertiary Neonatal Intensive Care Unit (A hospital based study)

Background: Congenital anomalies (CA) are common causes of infant’s and childhood deaths and disability. Objectives: The aim of the study is to determine the frequency, describe the types and risk factors of congenital anomalies among newborns admitted to Neonatal Intensive Care Unit (NICU) of Assiut University Children's Hospital. Study design: It is a prospective observational study (analytic cross sectional study) was performed and screening of the newborns admitted at NICU of Assiut University Children's Hospital (for 6 months) during the period from 1st December 2017 to 31st May 2018. The sample included 346 newborns, 173 cases and 173 controls. We collected data using a record checklist and an interviewing questionnaire.Results: There were significant differences between cases and controls concerning gestational age (P=0.001), single or multiple babies (P=0.002), residence (P=0.001), consanguineous marriage (P=0.01) and family history of unfavorable outcome (P=0.001). We also found that the most common type of congenital anomalies was gastrointestinal anomalies 63 cases (36.4%) with tracheoesophageal fistula 17 cases (27%) being the most common GIT anomalies. Then the musculoskeletal anomalies being the second common anomalies 14.5% with diaphragmatic hernia 10 cases being the most common in musculoskeletal anomalies followed by other anomalies (22 multiple and 1Conjoined Twins) 23 cases (13.3%) followed by cardiovascular anomalies 22 cases (12.7%), followed by CNS anomalies 18 cases (10%). Conclusions: The frequency of congenital anomalies was 22.97%. The most common anomalies were gastrointestinal anomalies (GIT), musculoskeletal anomalies, multiple anomalies and cardiovascular system anomalies. The risk factors were consanguineous marriage, positive family history, urban areas, full-term and singleton pregnancies.

Child health after preimplantation genetic testing

Research questionDespite the increasing use of preimplantation genetic testing (PGT) for aneuploidy and monogenic diseases, for children conceived using PGT there is limited follow-up beyond 2 years of age. This study examined the health, well-being and development of school-aged children (5–8 years old) conceived following PGT. DesignRetrospective cohort study of children conceived after IVF with PGT (exposed cohort) and children conceived after IVF without PGT (unexposed cohort) at two IVF clinics in Melbourne, born between 2000 and 2008, recruited with a 1:2 ratio. Mothers of the children completed a questionnaire asking child-specific questions regarding health and well-being, mental health, development, educational achievement and family-specific questions regarding family functioning and parent–child attachment. ResultsA total of 155 participants were recruited to the PGT cohort and 303 participants to the IVF-only cohort. There were no differences between the two cohorts with regards to maternal characteristics, birth defect frequency and pregnancy characteristics, apart from delivery by Caesarean section, which was more frequent in PGT singletons (55%) compared with IVF-only singletons (36%). While no significant differences between the PGT and IVF-only cohorts were found for the majority of general health and psychological scales, there were differences when compared with population data. Children in the exposed cohort appeared to have more positive outcomes in many of the measures. ConclusionThe data from this study suggest that PGT does not cause adverse outcomes in children. However, the nature (self-report) and small sample size of the study must be taken into consideration when interpreting the data.

Abstract 12526: The Risk of Critical Congenital Heart Disease in Children Born After Assisted Reproductive Technology

Introduction: Assisted reproductive technology (ART), which began 40 years ago, has spread all over the world. And 1 in 18 Japanese infants is conceived through ART. But it is known that infants conceived through ART have a high frequency of congenital anomalies and a high birth rate of congenital heart disease (CHD). Because of the high elderly birth rate and advanced medical system in Japan, Japan has the highest number of ART implementations in the world. However, there are no reports on the frequency of CHD in infants conceived through ART in Japan, so we performed this study. Methods: Four hundred eighteen infants diagnosed with critical CHD (lesions requiring catheter treatment or surgery within 28 days of life, or ductal-dependent lesions; CCHD) at the two pediatric heart centers from January 2014 to December 2019, were reviewed retrospectively. Results: In total, 229 males and 189 females were included in this study. The gestational age was 38± 2weeks. Maternal age was 32±5 years and paternal age was 34±6 years. Seventy-eight patients (19%) had chromosome abnormalities, gene abnormalities or syndrome. Sixty-one patients (15%) were conceived through fertility treatment and 46 patients (11%) were conceived through ART. One hundred eleven patients (27%) had univentricular heart defect (UVH). Compared with the proportion of ART (6%) in all births in Japan, the proportion of ART (11%) in CCHD was high. In addition, the proportion of ART in UVH was 20/111 (18%), while the proportion of ART in biventricular heart defect was 30/307 (10%) (p=0.0218). Among them, the highest proportion of ART in hypoplastic left heart syndrome and pulmonary atresia with intact ventricular septum was 7/23 (30%) and 5/19 (26%), respectively. Conclusions: The number of ART implementations in Japan is expected to increase in the future. At present, there are many cases in which infants conceived through ART cannot be diagnosed with CCHD before birth. Because infants conceived through ART might have a high incidence of complex CHD and UVH, they need more careful fetal follow-up than infants conceived naturally.

Frequency of Birth Defects in a Tertiary Care Hospital in Bangladesh

Background: Birth defects usually present at birth and may cause morbidity and mortality in the newborn. These defects may involve any organ system of the body. Gradually the incidence is rising due to various etiologies. The objective of the study was to find out the frequency, types and etiology of birth defects.
 Materials & Methods: This cross-sectional study was done in a tertiary care hospital in Bangladesh. In this study, 100 neonates with birth defects were enrolled, thoroughly examined, investigated and evaluated. Then collected data were analyzed.
 Results: The frequency of birth defects in this study was 1.54%. The most frequent birth defect was club foot deformity i.e. 11% and the most frequently involved organ system was cardiovascular system i.e. 28%. Among the birth defects 78% were major and only 22% were minor. Among those children with birth defect mortality was 17%; 41% were referred to advanced center and 42% were improved and discharged. In some of the cases with birth defect chromosomal anomaly, congenital infection (TORCH), maternal diabetes was found as causing factor.
 Conclusion: The frequency of birth defects was found 1.54% and most of the birth defects were major defect. Club foot deformity was found as the most common birth defect.
 Bangladesh J Child Health 2020; VOL 44 (1) :8-12

Frequency of congenital birth defects in newborn babies born at Hyderabad, Sindh.

Objectives: This study has been conducted in a tertiary care hospital to observe the frequency of congenital birth defects in newborn babies born at, Hyderabad, Sindh. Study Design: Prospective observation study. Setting: The Departments of Obstetrics and Pediatrics, Isra University Hospital, Hyderabad. Period: Two years from 2016 to 2018. Material & Methods: All the pregnant women irrespective of their parity and were included in the study after getting informed and written consent from their family heads and after the approval from Hospital’s ethical committee. We have used SPSS version 21.0 software for both data entering and analysis. All the continuous variables were analyzed using student t test and categorical variables were analyzed using chi-square test. P-value of ≤0.05 was taken as statistically significant. Results: A total of 150 pregnant women were included in our study with their mean age and SD was 26.72 ± 7.07 years and the mean years of marriage were 5.95±6 years. Most of the women were multiparous (47%), as compared to nulliparous and grandmultiparous, 33% and 20%, respectively. The prevalence of congenital birth defect was 11.3%, of these 30% had CNS malformations followed by 30% with gastrointestinal, 24% musculoskeletal, 12% genitourinary and 4% had ear malformations. Conclusion: The interfamily marriages (consanguineous marriages) are more common than outside family in study population. The frequency of birth defects was more than i-e: twice higher in interfamily marriages than outside family marriages.

Frequency of Congenital Anomalies in the Brazilian Midwest and the Association with Maternal Risk Factors: Case-control Study.

To evaluate the frequency of structural congenital anomalies (CAs) in the midwest of Brazil and its association with maternal risk factors. This was a prospective, observational, case-control study based on a hospital population. Pregnant women attended at a fetal medicine service in Brazil were analyzed in the period from October 2014 to February 2016.A total of 357 pregnant women were included, 223 of whom had fetuses with structural anomalies (group case), and 134 of whom had structurally normal fetuses (control group). The clinical history was made previous to prenatal consultation, and the diagnosis of the structural CA was performed through ultrasound. A frequency of 64.27% (n = 223) of pregnant women with fetuses with structural anomalies was observed. The most frequent structural CAs were those of the central nervous system (30.94%), followed by anomalies of the genitourinary system (23.80%), and, finally, by multiple CAs (16.60%). The background of previous children with CAs (odds ratio [OR]: 3.85; p = 0.022), family history (OR: 6.03; p = < 0.001), and consanguinity between the progenitors (OR: 4.43; p = 0.034) influenced the occurrence of structural CA. The most frequent CAs are those of the central nervous system, followed by those of the genitourinary system, and then multiple anomalies. The maternal risk factors that may have influenced the occurrence of structural CA were previous children with CA, family history, and consanguinity among the parents.

Peripartum issues in the inflammatory arthritis patient: A survey of the RAPPORT registry

Childbearing women with rheumatoid (RA) and psoriatic arthritis (PsA) have significant peripartum issues. A retrospective anonymous RedCAP survey of peripartum period in females with RA/PsA in the RAPPORT registry was performed. Completed analyses included descriptive statistics, Chi-square and Fisher’s exact test. 162 patients (133 RA/29 PsA) completed the survey (103 women having 234 pregnancies), 164 pregnancies occurring before and 70 pregnancies occurring after diagnosis. Pregnancy outcomes from 103 patients included: 96% live births, 1.9% stillbirths, 23% miscarriages, and 15% therapeutic abortions. A third of patients had fewer children than desired due to disease activity, medications and other reasons. For 63 pregnancies after diagnosis: (1) 49% of pregnancies received pre-conception counseling; (2) 65% described good disease control during pregnancy but 74% flared in the first 3 months postpartum; (3) 79% of pregnancies discontinued IA medications; (4) 35% of pregnancies occurred on biologic therapy at or prior to conception. Gestational age at time of delivery was 37–40 weeks in 58% (33/57) post-arthritis vs 66% (83/126) pre-arthritis pregnancies. No statistically significant differences occurred between pregnancies before or after RA/PsA diagnosis for: pregnancy planning, fertility treatment, pregnancy and labour/delivery complications, birth defect frequency or neonatal complications. Neonatal ICU admissions were significantly lower in pre- compared to post-arthritis pregnancies (3.2% vs 14.5%). No pregnancy complications were noted in 24/54 pregnancies on medications compared to 6/9 pregnancies not on medications. The impact of RA/PsA before, during and after pregnancy varied considerably in this cohort emphasizing the importance of informed-decision making at all stages.

Characteristics and morbidity of prematurely born newborns conceived with assisted reproductive technologies

Introduction/Objective. The percentage of live-born infants conceived with assisted reproductive technologies (ART) in some European countries reaches 6% and in Serbia over 1%. The aim of this study was to analyze characteristics and morbidity of prematurely born newborns conceived with ART. Methods. The study included 154 prematurely born newborns from pregnancies conceived with ART and 154 prematurely born newborns conceived naturally, hospitalized at the Institute of Health Care of Children and Adolescents of Vojvodina. Participants from both groups were matched according to gestational age and date of birth. Results. Statistically significantly more newborns with very low birth weight have been in the group of newborns conceived by ART in comparison to newborns conceived naturally (?2 test, p = 0.0001). Morbidity of newborns conceived with ART is not higher in comparison to newborns of the same gestational age conceived naturally. Bronchopulmonary dysplasia, occurred more frequently in children from ART (?2 test, p = 0.006) and retinopathy of prematurity occurred more frequently in children conceived spontaneously (?2 test, p = 0.047). There was no difference in the frequency of birth defects, genetic syndromes, and inborn errors of metabolism between the two groups. Conclusion. Lower birth weight and intrauterine growth restriction are potential risk factors for worse postnatal outcome in newborns from pregnancies conceived with ART.

Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study.

Women with inflammatory bowel diseases (IBD) often receive biologicals during pregnancy to maintain disease remission. Data on outcome of vedolizumab-exposed pregnancies (VDZE) are sparse. To assess pregnancy and child outcomes of VDZE pregnancies and to compare these results to anti-TNF exposed (TNFE) or both immunomodulatory and biologic unexposed (CON IBD) pregnancies. A retrospective multicentre case-control observational study was performed. VDZE group included 79 pregnancies in 73 IBD women. The TNFE and CON IBD group included 186 pregnancies (162 live births) in 164 IBD women and 184 pregnancies (163 live births) in 155 IBD women, respectively. At conception, cases more often had active disease ([VDZE: 36% vs TNFE: 17%, P=.002] and [VDZE: 36% vs CON IBD: 24%, P=.063]). No significant difference in miscarriage rates were found between groups (VDZE and TNFE: 16% vs 13%, P=.567; VDZE and CON IBD: 16% vs 10%, P=.216). In live-born infants, median gestational age and birthweight were similar between groups. Median Apgar score at birth was numerically equal. Prematurity was similar in the VDZE group compared to the control groups, even when correcting for disease activity during pregnancy. The frequency of congenital anomalies was comparable between groups as were the percentages of breastfed babies. During the first year of life, no malignancies were reported and infants' infection risk did not significantly differ between groups. No new safety signal was detected in VDZE pregnancies although larger, prospective studies are required for confirmation.

Exposure to Infliximab During Pregnancy: Post-Marketing Experience.

BackgroundWomen of childbearing potential are often treated with monoclonal antibodies to control chronic and debilitating inflammatory diseases. Remicade® (innovator infliximab [IFX]) may cross the placenta after the first trimester of pregnancy. Hence, evidence is needed to optimize treatment while carefully weighing benefits and risks to the mother and child. Here, we report on birth and infant outcomes (up to 2 years) following gestational exposure to IFX based on a summary of cumulative pregnancy reports in women exposed to IFX during pregnancy from the Janssen global safety database.MethodsProspective and medically confirmed safety data on IFX-exposed pregnancies from Janssen’s global safety surveillance database since authorization in 1998 are summarized. Descriptive statistics were used to summarize pregnancy and infant outcomes overall, by disease and timing of exposure.ResultsAs of 23 August 2018, 1850 maternally IFX-exposed pregnancies with known outcomes were identified from the safety database. Of the 1850 pregnancies (mean age 29.7 years), 1526 (82.5%) resulted in live births. When reported, most women had Crohn’s disease (67.7%) or ulcerative colitis (18.4%), and 82.8% of live births were exposed to IFX in the first trimester. Spontaneous abortion/intrauterine death/ectopic pregnancy/molar pregnancy (12.1%), preterm births (9.2%), low birth weight infants (3.6%), congenital anomalies (2.0%), and infant infections (1.2%) were documented. The type of congenital anomalies and frequency of serious infant infections observed were consistent with the general population. Frequencies of congenital anomalies and other adverse outcomes were similar in women exposed to IFX in the first trimester and those exposed in the third trimester. More preterm births (13–18.8%) and infant complications (8.7–12.5%) were reported with concomitant immunosuppressant use.ConclusionsThe observed prevalence of adverse pregnancy and infant outcomes including congenital anomalies following exposure to IFX did not exceed estimates reported for the general population and no unexpected patterns were observed.

The importance of progesteron for the safety of pregnancy at early and late terms

Progesterone is a key hormone to support pregnancy and pregnancy onset. Problem of low fertility, infertility is becoming increasingly important, which in turn further exacerbates miscarriage. The aim of this systematic review is to elucidate new information based on current scientific evidence, evidence-based medicine and world clinical protocols, summarize actual knowledge of the importance of sequential use of one type of gestagen for pre-conceptual preparation, treatment, and prevention of the risk of pregnancy termination in different clinical settings. Analysed data indicate that it is natural micronized progesterone to be the drug of choice in the treatment of habitual miscarriage associated with luteal phase deficiency, and it is important to use one type of gestagen at the pre-conception stage. Currently, vaginal drugs of micronized progesterone used to support the luteal phase during IVF cycles due to the relative ease of use and efficiency equivalence to intramuscular progesterone. Vaginal progesterone has advantages due to the effect of primary passage through the uterus, it concentration in endometrial tissues is usually much higher than in serum. An independent, randomized, double-blind, placebo-controlled trial PRISM showed the efficacy of vaginal micronized progesterone in women with genital bleeding early in pregnancy (clinic of abortion). In group of micronized progesterone the rate of live birth was higher by 3% compared to placebo, which in absolute numbers was greater for 54 live births. The best results were achieved in patients with a history of 3 or more miscarriages, where the odds of live birth due to micronized progesterone (Utrogestan®) increased by 28%. Also it is important that Utrogestan® at a dose of 800 mg/day for up to 16 weeks of gestation is safe for the fetus (the frequency of congenital abnormalities did not differ in the vaginal progesterone and placebo group) and did not prevent the rejection of the genetically defective embryo.