Number Of Pregnancies In Women Research Articles

Pregnancy in women diagnosed with Antineutrophil cytoplasmic antibody–associated vasculitis: Outcome for the mother and the child

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is infrequently seen in women of childbearing age. Only a limited number of pregnancies in women with AAV have been reported, and often they were associated with complications. This was a single-center retrospective observational study. All pregnancies in women with granulomatosis with polyangiitis (Wegener's) (n = 13) and microscopic polyangiitis (n = 1) were included. Women of childbearing age were counseled to abstain from pregnancy during or shortly after disease activity or <1 year after cyclophosphamide treatment. We described 22 pregnancies in 14 women with AAV (median age at diagnosis was 25 years [range 19-36 years]) diagnosed between 1982-2008. The ear, nose, and throat region (71%) and kidneys (50%) were predominantly involved. All women were in remission at conception and cyclophosphamide had been administered to 9 women (15 pregnancies). The median gestational age was 39+4 weeks, including 2 preterm deliveries. The median birth weight was 3,400 gm (1,860-3,890 gm). Hypothyroidism occurred in 1 newborn and a cleft palate in 1 newborn of a twin pregnancy. Otherwise, the fetal outcome was excellent. Preeclampsia was diagnosed in 2 pregnancies. A caesarean section was performed in 2 patients. The median followup after the last conception was 98 months (range 11-307 months). Eight women experienced a relapse 21 months (range 7-62 months) after conception, 1 during pregnancy, and 7 after delivery. In this study, the pregnancy outcome in patients with AAV in remission was excellent. Pregnancy in women with AAV in remission does not seem to be associated with increased risk of relapse. Counseling, careful management, and close followup are essential in pregnant women with AAV.

Type 2 diabetes in pregnancy: more to come?

AbstractThe objective of this study was to determine the rate of increase in pregnancies complicated by type 2 diabetes in the former UK Northern health region between 1996 and 2006.Since 1993, all data for women with pregnancies complicated by pre‐existing type 1 and type 2 diabetes have been prospectively collected by the Northern Diabetes Pregnancy Survey. The annual incidence of women with type 2 diabetes was collected and further analysed for associations with age, body mass index and ethnicity, perinatal mortality and stillbirth rates.There was an approximate four‐fold increase in type 2 diabetes in pregnancy (r2 = 0.85) during the 11 years. The majority (80.8%) of the women were white, although ethnic minorities were over‐represented; 88.2% women were overweight or obese. Stillbirth and perinatal mortality rates were four to five times higher than the national average.The number of pregnancies in women with type 2 diabetes is increasing. This has important implications for primary care and maternity service provision as these pregnancies are high risk. Women with type 2 diabetes will need targeted preconception care and maternity units may need to expand their diabetes service provision if a rise in perinatal mortality is to be prevented. Copyright © 2008 John Wiley &amp; Sons.

Pre-existing T-cell immunity against mucin-1 in breast cancer patients and healthy volunteers

There is evidence that some tumor patients are able to generate tumor-associated antigen (TAA)-specific T-cell immunity spontaneously. However, little is understood about the existence and nature of self-reactive T-cells that recognize TAA in healthy donors (HD). Human mucin (MUC-1), a highly glycosylated transmembrane protein, is a well characterized TAA expressed by epithelial tumors. We compared endogenous MUC-1-specific T-cell immunity of breast cancer patients (BCP) and healthy volunteers using two MUC-1-derived HLA-A*0201-restricted peptides (MUC-1(950-958), MUC-1(12-20)). Antigen-dependent interferon (IFN)-gamma and Granzyme B expression of T-cells were analysed by a reverse transcription-polymerase chain reaction (qRT-PCR)-based assay. A 32% of BCP and 43% of healthy volunteers revealed pre-existent CD8+ T-cells specific for MUC-1(950-958) but not for MUC-1(12-20). In patients, MUC-1-specific T-cells have been detected mainly in early stage disease prior adjuvant therapy. Those T-cells showed MUC-1-dependent IFN-gamma production after short-term stimulation but no clear Granzyme B expression. However, after repetitive in vitro stimulations using peptide-pulsed CD40-stimulated B-cell lines as autologous antigen presenting cells (APC) T-cell lines exhibited lytic capacity against HLA-A*0201+/MUC-1+ tumor cells. MUC-1(950-958) is a dominant tumor antigen against which CD8+ T-cells were found frequently in BCP as well as in HD. Until now, this was only known for MelanA/MART-1. In contrast to previous reports, MUC-1-specific immunity was not linked to gender or number of pregnancies in women. Whether MUC-1(950-958)-related immunity highlights a yet unknown cross-reactivity in HD remains unclear. The presence of MUC-1-specific T-cells in some BCP may reflect a balance between immune tolerance and immune defence during aetiopathology.

Current concepts of Down syndrome screening tests in assisted reproduction twin pregnancies: another double trouble

Assisted reproductive technologies (ART) have increased both the number of pregnancies in women beyond the age of 35 and the incidence of multiple pregnancies. Various methods of screening for Down syndrome (DS) were introduced in clinical practice during the last two decades, and specific problems were encountered when they were applied for twin pregnancies. The current review aims to explore the problematic issue of prenatal DS screening in ART twins. Overall, more women with twin pregnancies (mainly those who conceived via assisted reproduction) are found to be false positive for DS. This is because mid-trimester maternal serum screening is associated with a higher false-positive rate secondary to changes in the feto-placental endocrinologic metabolism, reflected mainly in high human chorionic gonadotrophin (hCG) levels in the ART pregnancies. First-trimester nuchal translucency (NT) measurement in twin pregnancies is not affected by the problems encountered in serum screening. This sonographic screening approach enables a fetus-specific identification of those fetuses at high risk of DS and is associated with a lower false-positive rate than mid-trimester serum screening. DS screening in ART twins presents several challenges in determining the most appropriate screening test modality. Whether there is any significant benefit of adding first-trimester biochemistry or nasal bone scanning in screening ART-conceived twins awaits further investigation.

PRL-secreting pituitary adenomas in pregnancy.

Dopamine-agonists have significantly increased the number of pregnancies in women with micro- and macro-prolactinomas, as ovulation can be restored in the great majority of these patients. Thus, the main questions regard the possible consequences of high estrogen levels on tumor volume and the possible effects of D2-agonists on fetal development. While the risk of tumor increase is low in patients with prolactin secreting micro-adenoma (MIP), in PRL secreting macro-adenoma (MAP) patients the possibility of tumor growth is enhanced and influenced by previous treatment. Moreover, while it is well known that the exposition for only the first 4 weeks to bromocriptine (BRC) therapy does not affect the outcome of pregnancy, data on the use of BRC during the whole gestation are limited to just over 100 cases. Female pregnant patients with MIP, therefore, must be reassured and medical therapy suspended, with successive clinical follow-up. In the case of pregnant MAP subjects, the best approach from pre-pregnancy debulking, dopamine-agonist therapy interruption and BRC therapy continuation must be agreed on with the patient, and a careful follow-up instituted.

PREGNANCY DURING CHRONIC HEMODIALYSIS: A SINGLE DIALYSIS-UNIT EXPERIENCE WITH FIVE CASES

Background: Pregnancy is uncommon in women with end-stage renal disease (ESRD) requiring chronic dialysis. An increasing number of successful pregnancies in women in hemodialytic treatment have been recently reported but few institutions experienced more than one or two cases of pregnancy. Methods: Between 1988–1998 five pregnancies in patients receiving hemodialysis were observed in our center. Medical records of these patients were reviewed. Results: At the conception the mean age was 27 years. One patient started dialysis after conception. All patients received bicarbonate dialysis. Three patients were dialyzed six times per week, the other two patients three-four times per week. The dry weight was increased progressively; on average of 1.2 ± 0.5 kg in the first trimester and of 0.5 kg per week since the second trimester. The predialysis BUN was maintained between 50–100 mg/dL (17.85–35,70 mmol/L) during the pregnancy. Four patients were treated with erythropoietin to maintain hematocrit between 30–35%. Erythropoietin related—complications were not observed. Polyhydramnios was observed in all cases. All deliveries occurred before term. The mean gestational age of infants was 28.6 ± 4 weeks. Four out of five pregnancies resulted in liveborn infants. Two infants had an Apgar score of zero. All neonates were of low birth weight (1431 ± 738 g) with percentile of birth weight in the normal range. No one was small for date. Conclusion: A successful pregnancy is possible in women on chronic dialysis. Prematurity occurs frequently as well as low weight birth leading to increased perinatal morbidity and mortality.

Perinatal Mortality in Type 2 Diabetes Mellitus

Summary Aims In many parts of the world the number of pregnancies in women with Type 2 diabetes mellitus (DM) now exceeds that in women with Type 1 DM, but there are few data published on perinatal mortality in Type 2 DM. This study reports observational data on perinatal mortality in Type 2 DM from a population with a high background rate of this disorder. Methods Over a 12-year period (1985–1997) at the Diabetes Clinic at National Women’s Hospital, Auckland, there were 434 pregnancies in women with Type 2 DM (256 known and 178 diagnosed with gestational diabetes mellitus (GDM), but confirmed to have Type 2 DM early post-partum), 160 pregnancies in women with Type 1 DM and 932 in women with GDM. Perinatal mortality was classified as either intermediate fetal death (20–28 weeks’ gestation), late fetal death (28 weeks’ gestation to term) or early neonatal death (up to 1 month post-partum). Results The perinatal mortality in Type 2 DM was 46.1/1000, significantly higher than the rates for the general population (12.5), Type 1 DM (12.5) and GDM (8.9) (P < 0.0001). Congenital malformations accounted for only 10% of the perinatal mortality. There was a seven-fold increase in the rate of late fetal death and 2.5-fold increase in the rates of intermediate fetal and late neonatal death. Subjects with Type 2 DM were significantly older and more obese than subjects with Type 1 DM, and presented later to the diabetes service. Conclusions Perinatal mortality in Type 2 DM is significantly increased, mainly owing to an excess of late fetal death. Maternal factors such as obesity may be important contributors to the high perinatal mortality. Women diagnosed with GDM who have unrecognized Type 2 DM are also at high risk, but perinatal mortality is low in women with milder degrees of glucose intolerance in pregnancy.

Perinatal mortality in Type 2 diabetes mellitus.

In many parts of the world the number of pregnancies in women with Type 2 diabetes mellitus (DM) now exceeds that in women with Type 1 DM, but there are few data published on perinatal mortality in Type 2 DM. This study reports observational data on perinatal mortality in Type 2 DM from a population with a high background rate of this disorder. Over a 12-year period (1985-1997) at the Diabetes Clinic at National Women's Hospital, Auckland, there were 434 pregnancies in women with Type 2 DM (256 known and 178 diagnosed with gestational diabetes mellitus (GDM), but confirmed to have Type 2 DM early post-partum), 160 pregnancies in women with Type 1 DM and 932 in women with GDM. Perinatal mortality was classified as either intermediate fetal death (20-28 weeks' gestation), late fetal death (28 weeks' gestation to term) or early neonatal death (up to 1 month post-partum). The perinatal mortality in Type 2DM was 46.1/1,000, significantly higher than the rates for the general population (12.5), Type 1 DM (12.5) and GDM (8.9) (P < 0.0001). Congenital malformations accounted for only 10% of the perinatal mortality. There was a seven-fold increase in the rate of late fetal death and 2.5-fold increase in the rates of intermediate fetal and late neonatal death. Subjects with Type 2 DM were significantly older and more obese than subjects with Type 1 DM, and presented later to the diabetes service. Perinatal mortality in Type 2 DM is significantly increased, mainly owing to an excess of late fetal death. Maternal factors such as obesity may be important contributors to the high perinatal mortality. Women diagnosed with GDM who have unrecognized Type 2 DM are also at high risk, but perinatal mortality is low in women with milder degrees of glucose intolerance in pregnancy.

Screening for fragile X syndrome.

BACKGROUND AND AIM OF REVIEW. In 1991, the gene responsible for fragile X syndrome, a common cause of learning disability, was discovered. As a result, diagnosis of the disorder has improved and its molecular genetics are now understood. This report seems to provide the information needed to decide whether to use DNA testing to screen for the disorder. HOW THE RESEARCH WAS CONDUCTED. A literature search of electronic reference databases of published and 'grey' literature was undertaken together with hand searching of the most recent publications. RESEARCH FINDINGS. NATURAL HISTORY. Physical characteristics of fragile X syndrome include facial atypia, joint laxity and, in boys, macro-orchidism. Most affected males have moderate-to-severe learning disabilities with IQs under 50 whereas most females have borderline IQs of 70-85. Behavioural problems are similar to those seen with autism and attention-deficit disorders. Although fragile X syndrome is not curable there are a number of medical, educational, psychological and social interventions that can improve the symptoms. About 6% of those with learning disabilities tested in institutions have fragile X syndrome. Population prevalence figures are 1 in 4000 in males and 1 in 8000 in females. GENETICS. The disorder is caused by a mutation in a gene on the X chromosome which includes a trinucleotide repeat sequence. The mutation is characterized by hyper-expansion of the repeat sequence leading to down-regulation of the gene. In males an allele with repeat size in excess of 200, termed a full mutation (FM), is always associated with the affected phenotype, whereas in females only half are affected. Individuals with alleles having repeat size in the range 55-199 are unaffected but in females the sequence is heritably unstable so that it is at high risk of expansion to an FM in her offspring. This allele is known as a pre-mutation (PM) to contrast it with the FM found in the affected individual. No spontaneous expansions directly from a normal allele to an FM have been observed. SCREENING STRATEGIES. The principal aims of screenng for fragile X syndrome is to reduce the birth prevalence of the disorder, by prenatal diagnosis and selective termination of pregnancy, or by reducing the number of pregnancies in women who have the FM or PM alleles. Possible screening strategies are: routine antenatal testing of apparently low risk pregnancies, preconceptual testing of young women, and systematic testing in affected families ('cascade' screening). A secondary aim is to bring forward the diagnosis of affected individuals so that they might benefit from early treatment. Active paediatric screening and neonatal screening could achieve this but there is no direct evidence of any great benefit from early diagnosis. SCREENING TESTS. Cytogenetic methods are unsuitable for screening purposes. Southern blotting of genomic DNA can be used but is inaccurate in measuring the size of small PMs, there is a long laboratory turnaround time, and it is relatively expensive. The best protocol is to amplify the DNA using polymerase chain reaction on all samples, and when there is a possible failure to amplify, a Southern blot.(ABSTRACT TRUNCATED)

Anaesthesia for the parturient with cystic fibrosis

Cystic fibrosis is an inherited disorder that primarily affects the exocrine glands of the gastrointestinal and respiratory systems. It is commonly diagnosed at birth or shortly thereater, and until recently few of these patients lived to reproductive age. However, as a result of improved medical care, there are now an increasing number of pregnancies in women with cystic fibrosis. We present the histories of two parturients with cystic fibrosis and discuss the anaesthetic and perinatal implications of thes complex disease to their management.

Women and Health in Choco, Colombia

Part of a larger project designed to study and promote primary health care (PHC) in the Colombian province of Choco this article reports on the health status of women in the area. One of Colombias poorest provinces Choco has 300000 mostly rural inhabitants 90% of them black and 65 Indian. The PHC project ran from 1979-1988 and one of its components involved the training of rural health workers selected by their communities in the delivery of primary health that ranged from curative and preventive medicine to family planning. Relying on a village-based monitoring system the project collected data on morbidity mortality and the coverage of health activities. In 1982 the project carried out a survey on socioeconomic conditions and morbidity. Data shows that single women lead 22% of the households in the region and that 50% percent of the people are living in free unions instead of marriages. Since women have a reduced access to land female headed households face increased economic risks. Although literacy levels were the same for men and women infant mortality was significantly higher among children of illiterate women. Morbidity levels were often higher among women including a 435 prevalence rate of vaginal discharge. The rate of cervical cancer was also very high. Furthermore fertility rates reflect the low prevalence of family planning. The average completed family size was 7.5 children/women and the average number of pregnancies in women over 45 was 9. This study indicate that besides increased primary health services education and socio-economic improvement are needed.

Preventing rhesus isoimmunization: Antepartum Rh immune globulin prophylaxis versus a sensitive test for risk identification

The controversial proposal to use Rho (D) immune globulin (human) prophylactically in pregnancy should not detract from the most expedient approach to further reduction of Rh disease; that is, to ensure that every eligible woman is given Rho (D) immune globulin (human) after delivery, abortion, or ectopic pregnancy. Family planning by Rh-negative women at risk and limiting the number of pregnancies in women already immunized will be additional effective ways to reduce the current incidence of hemolytic disease in most communities. Present evidence shows that blanket antepartum Rho (D) immune globulin (human) prophylactic treatment will be very costly and will place many subjects at potential risk while offering benefit to only a few. Sensitive and practical laboratory testing for fetomaternal hemorrhage is presently only a research tool but will soon be clinically available to provide new data on fetomaternal hemorrhage. In the near future, pregnant women truly at risk for Rh isoimmunization may be identified by analysis of their blood, and this will be a rational basis for antepartum Rho (D) immune globulin (human) treatment. There are compelling advantages in cost, risks, and benefits for an approach of selective antepartum Rho (D) immune globulin (human) therapy as opposed to routine prophylaxis for all Rh-negative gravid women.