Preconception Visit Research Articles

Single parenthood and depression: A thorough review of current understanding.

Single parenthood is becoming increasingly common in today's society for various reasons such as divorce, the death of a spouse, or the choice of parenthood. Regrettably, there seems to be no significant concern among world leaders regarding depression arising from single parenting. This article aimed to explore the prevalence of depression in single parents, the factors contributing to it, and its effects on their physical and emotional well-being. Additionally, it aims to investigate the long-lasting effects of depression in single parents, effective therapeutic approaches to tackle these issues and offer proactive suggestions for relevant global stakeholders. A selection of studies was identified through electronic databases such as PubMed, Embase, and PsycINFO databases. The search strategy encompassed terms related to single parenthood, depression, mental health, prevalence, risk factors, and treatment modalities. Included studies comprised of peer-reviewed research articles, systematic reviews, meta-analyses, and observational studies published in English. Today, there is a growing prevalence of single parenthood due to a range of factors, including divorce, the loss of a partner, and intentional decisions regarding single parenthood. However, this transition comes with challenges, including the risk of developing depression. Depression is a serious mental health condition affecting many individuals worldwide. Raising a child alone increases the likelihood of developing depression for the parent due to the increased burden and responsibilities. Such parents tend to have low self-esteem, suicide/suicide attempts, and so forth and children born by those parents are vulnerable to depression, physical abuse, infections, etc. Future research should focus on identifying effective interventions for treating depression among single parents and improving the availability of mental health facilities for this vulnerable population, especially in places with a high prevalence of depression. Mental health physicians in collaboration with obstetricians and gynecologists across the globe should offer counseling and mediation services during pre-conception care visits for both single and partnered parents.

Pregnancy planning, prevention, and risk evaluation clinics: rethinking the traditional preconception consult

The preconception consultation has traditionally centered pregnancy as desired and preordained. Separating preconception and contraceptive visits burdens patients and further fragments reproductive healthcare. We argue that the creation of a combined preconception and complex contraception clinic for individuals with significant medical and obstetric comorbidities is one approach to promoting reproductive autonomy. Pregnancy planning, prevention, and risk evaluation (PrePPARE) clinics are designed to review pregnancy related risks in the setting of patients’ medical and obstetric comorbidities, recommend strategies to reduce risks, and, if desired, provide contraceptive methods. Consultations for pregnancy risk evaluation and pregnancy prevention should not be considered mutually exclusive. Combining these visits is critical for obstetrically and/or medically complex patients. Rethinking the traditional preconception consultation is a change in healthcare delivery that centers comprehensive reproductive healthcare.

Not all Medicaid for pregnancy care is delivered equally.

Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period. This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months). Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid. In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.

A prospective preconception cohort study of the association between Mycoplasma genitalium and fecundability in Kenyan women trying to conceive.

Is Mycoplasma genitalium-infection associated with reduced fecundability? Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated. Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test. Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability. The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)). Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals. In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability. This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest. N/A.

Preconception maternal retinal arteriolar narrowing and fetal growth throughout pregnancy: A prospective cohort study.

To investigate the association between preconception maternal retinal arteriolar calibre and fetal growth. A hospital-based, prospective preconception cohort including 369 women with a singleton live birth. We collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit. We retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11-13, 18-21, 24-28, and 32-34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH-21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24-28 weeks and 32-34 weeks of gestation, after full adjustment. Maternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (-0.34; 95% CI -0.66 to -0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (-0.41; 95% CI -0.90 to -0.001) and fetal FL (-0.55; 95% CI -1.00 to -0.10) between 24-28 weeks and 32-34 weeks of gestation, respectively. Our findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy.

Sexual dysfunction, distress, and care-seeking among females during the preconception period

Despite the high prevalence of female sexual dysfunction in population-based studies and the importance of sexual functioning for mixed-sex couples attempting conception, little is known about female sexual function in the preconception period. This descriptive study aimed to assess the prevalence of female sexual dysfunction, distress, and pain with intercourse in a preconception population of pregnancy planners. The study also explored the extent to which participants discussed their sex lives with a healthcare provider during a preconception visit. We used data from Pregnancy Study Online, a web-based preconception cohort study (August 2020-October 2022). Eligible participants identified as female and were aged 21 to 45 years, residents of the United States or Canada, attempting pregnancy, and not using fertility treatments at cohort entry. At enrollment, participants completed a detailed baseline questionnaire. Thirty days after enrollment, participants were invited to complete an optional questionnaire about sexual function. Our study included 1120 participants who responded to the sexual function questionnaire within 1 year of completing their baseline questionnaire. We assessed sexual dysfunction using the 6-item Female Sexual Function Index, and sexual distress using the Female Sexual Distress Scale, which assess sexual function and distress in the previous 4 weeks, respectively. We also asked participants whether they had discussed their plans to conceive with a healthcare provider, and if so, whether they discussed their sex lives. If not, we collected information on perceived barriers. Twenty-five percent of the sample met criteria for female sexual dysfunction, whereas 12.2% met the criteria for sexual distress; 8% of our sample reported both sexual dysfunction and sexual distress. Thirty percent reported at least some pain with intercourse in the past 4 weeks. Although over 80% of the sample reported discussing their conception plans with a healthcare provider, 70% of these participants did not discuss their sex lives. The most commonly reported reasons for not discussing their sex life with a provider was not experiencing a sexual health issue, the provider not asking, feeling nervous/uncomfortable/ashamed, and feeling it was not relevant to becoming pregnant or inappropriate to discuss. The percentage of participants who reported discussing their sex lives varied across provider type, with those seeing midwives having the highest percentage (39%), followed by nurse practitioners (36%) and obstetrician-gynecologists (34%). Sexual dysfunction, distress, and painful intercourse are prevalent in the preconception period, but participants frequently did not discuss their sex lives when discussing plans to conceive. The provider not asking was a commonly reported barrier. Providers may consider raising the issue of sexual functioning at the time of a preconception visit to better support patients who may be dealing with a sexual function issue while attempting pregnancy. These findings may not generalize beyond a primarily non-Hispanic White, highly educated, and high-income population.

Myocardial oxygen consumption in pregnancies complicated by hypertensive disorders of pregnancy

Rate-Pressure Product (RPP) has been used as a surrogate for myocardial oxygen consumption (MOC), a dynamic non-invasive index of changes in cardiovascular (CV) demand. We sought to describe pre-conceptional (PC), antepartum (AP), and postpartum (PP) RPP among pregnancies complicated by hypertensive disorders of pregnancy (HDP). Retrospective longitudinal study of women aged 18-34 who became pregnant during the study period (2013-2022). We included pregnancies complicated by HDP, defined as gestational hypertension (HTN), pre-eclampsia with or without severe features, eclampsia, and/or HELLP. Individuals with chronic medical conditions including chronic HTN, multifetal gestation, and/or other complications were excluded. Authors searched the electronic medical record for demographic characteristics, as well as PC, AP, and PP heart rate (HR) and systolic blood pressure (SBP) values. RPP was defined as the product of HR and SBP (HR X SBP) at each visit. RPP % change from the PC (baseline) value at each visit was obtained using the following formula: [(RPP value– PP RPP)/PC RPP) x 100)]. Mean and standard deviation for absolute and % change from baseline were calculated for RPP at PC, by trimester, and PP. Mixed linear model was used to ascertain differences over time. A p-value < .05 was deemed statistically significant. 549 patients were included in our study. Data were normally distributed. Mean maternal age, BMI (kg/m2), and gestational age at delivery was 27, 33.3, and 37 weeks, respectively. 65% of the cohort was multiparous. Number of months at PC visit and weeks at PP visit was 6 and 2.5, respectively. The mean RPP value at baseline was 10178. Absolute RPP increased significantly from PC values at all time points (Figure 1). The RPP increased from PC to 2nd trimester by 9% (p< .001) and by 17% in the 3rd trimester (p < .001), while RPP PP values remained 9% higher than PC (p< . 001) (Figure 2). MOC as measured by RPP increases progressively with each trimester of pregnancy and remains higher than PC values following delivery among pregnancies complicated by HDP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Cultivable vaginal Lactobacillus is not associated with fecundability in Kenyan women attempting to conceive

To examine the association between cultivable vaginal Lactobacillus and fecundability in Kenyan women attempting nonmedically assisted conception. Prospective preconception cohort. Nairobi and Mombasa, Kenya. Women trying to conceive who reported ≤3 months of pre-enrollment conception attempt time. Cultivable Lactobacillus (primary), Lactobacillus morphotypes on Gram stain (secondary). Participants reported the first day of their last menstrual period and recent sexual behavior, underwent pregnancy testing, and provided vaginal specimen samples for Lactobacillus culture and Gram stain at ≤6 monthly preconception visits. The outcome was fecundability-the per-menstrual cycle probability of pregnancy. Associations between cultivable Lactobacillus and Lactobacillus morphotypes on Gram stain at the visit before each pregnancy test and fecundability were estimated using proportional probabilities models to generate fecundability ratios (FRs). A total of 458 women contributed 1,376 menstrual cycles. At enrollment, 65.3% (n = 299) of participants had cultivable Lactobacillus, 47.4% (n = 217) had cultivable hydrogen peroxide producing Lactobacillus, and 64.6% (n = 296) had Lactobacillus detected on Gram stain. In unadjusted analysis, there was no association between cultivable Lactobacillus at the prior visit and fecundability (FR, 0.92; 95% CI, 0.73-1.16); results were similar after adjustment for age, frequency of condomless sex, and study site (adjusted FR, 0.92; 95% CI, 0.72-1.18). Lactobacillus on Gram stain at the visit prior was associated with modestly higher fecundability (adjusted FR, 1.18; 95% CI, 0.92-1.51). Cultivable Lactobacillus was not associated with fecundability, although Lactobacillus morphotypes detected on Gram stain were somewhat associated with increased fecundability. The relationship between vaginal Lactobacillus and fecundity may be species-specific.

Ubiquitous Usage of Over the Counter Medications in Pregnancy: Perspectives of Maternal Apprehensiveness

The World Health Organization delineates self-medication as the utilization of medications by individuals in search of treating symptoms or self-diagnosed health state. During pregnancy, drug utilization is complicated because of incomplete data as clinical trials frequently don't enclose pregnant women, with reference to benefits and implicit undesirable outcomes on both the mother and the foetus. Bestowed limited data on the variety of over the counter medications applicable, physi­cians seek to counsel pregnant women about implicit pitfalls, and it is beneficial to give information on entire over the counter medications the patient is receiving at the preconception visit and entire distinctive ordinary visits. Antacid that containing sodium bicarbonate can cause fluid buildup in the tissues if used during pregnancy redundantly. Hypericum perforatum is ordinarily not recommended in preg­nancy because of a dearth of human data and it perhaps antecedent miscarriage and it also escalates the birth deformities of fetus. Early aspirinusage at the time of conception or in the 1st several weeks of pregnancy does not escalate the pitfall of spontaneous abortion.

POS0702 PREGNANCY IN SLE PATIENTS TREATED WITH BELIMUMAB: EXPERIENCE FROM 3 ITALIAN CENTERS

Background:Belimumab (BEL) is a monoclonal antibody approved for SLE treatment but few data are available about its use before or during pregnancy.Objectives:Our study aims to describe pregnancies in SLE patients who have discontinued BEL before conception, at positive pregnancy test or during pregnancy.Methods:Data from prospectively-followed pregnancies (2014-2020) in SLE patients treated with BEL in 3 Italian centers where retrospectively collected, focusing on maternal disease activity, obstetric and neonatal outcome. Continuous data are expressed as median [min-max].Results:Thirteen SLE pregnancies were analyzed (median age at conception 32 [24-41] years; 77% spontaneous, 69% primigravidae). All patients had positive ANA and anti-dsDNA antibodies; 4 had anti-Ro antibodies (31%); 4 had anti-phospholipid antibodies (aPL; 1 single, 2 double and 1 triple positivity). Seven patients (54%) had a history of lupus nephritis (LN); 2 patients (15%) had a concomitant diagnosis of antiphospholipid syndrome (1 thrombotic-APS and 1 thrombotic+obstetric-APS).Ten (77%) pregnancies were planned and the use of BEL with regard to pregnancy was agreed with the patient during preconception counseling. At preconception visit, 8 patients were in remission while 5 had active disease (median SLEDAI 3 [0-8]).BEL (11 intravenous, 2 subcutaneous) was stopped in 2 cases before conception, in 7 at positive pregnancy test and in 4 during pregnancy (2 at 11th week, 1 at 22nd, 1 at 24th); median duration of treatment at discontinuation was 29 [4-68] months. Other treatments during pregnancy were: oral prednisone in 12 cases (92%); intravenous methylprednisolone in 1 (8%); hydroxychloroquine in 10 (77%); chloroquine in 1 (8%); azathioprine in 5 (39%); calcineurin inhibitors in 5 (39%); low-dose acetylsalicylic acid in 10 (77%); low molecular weight heparin in 9 (69%).Three flares occurred during the 3rd trimester in patients who stopped BEL at positive pregnancy test.Live-births occurred in 92% of the pregnancies. A patient with thrombotic+obstetric-APS and LN, underwent assisted reproductive technology (embryo donation) and developed eclampsia (25thweek), an urgent cesarean section was performed and the newborn died after 3 days. One pre-eclampsia occurred in a patient with history of LN, double aPL positivity and active disease. One miscarriage at 11th week occurred; no early miscarriages (&lt;10th week) were recorded. Pregnancy complications and outcomes are reported in Table 1.Table 1.Pregnancy complications and outcomes according to the timing of discontinuation of BEL.BEL STOPPED PRECONCEPTIONALLY(2)BEL STOPPED AT POS PREGNANCY TEST(7)BEL STOPPED DURING PREGNANCY(4)Pre-eclampsia0/20/71/4 (25%)Eclampsia0/20/71/4* (25%)Gestational Diabetes0/21/7 (14%)0/4IUGR0/21/7 (14%)1/4* (25%)pPROM/PROM0/20/71/4 (25%)Live birth1/2 (50%)7/7 (100%)4/4 (100%)Severe pre-term birth(≤ 34thweek)0/20/71/4* (25%)Late pre-term birth(35th- 37thweek)0/23/7 (43%)0/4Small for Gestational age neonate0/24/7 (54%)1/4 (25%)Late miscarriage (&gt;10thweek)1/2 (50%)0/70/4Perinatal death0/20/71/4* (25%)IUGR: IntraUterine Growth Restriction; PROM: Premature Rupture of Membrane; pPROM: pretermPROM; *in the same patient (history of thrombotic and obstetric-APS and lupus nephritis) who underwent Assisted Reproductive Technologies (embryo donation).No malformations were recorded. Two newborns were transferred to the Intensive Care Unit (1 for milk protein intolerance and 1 for desaturation).Eight newborns received vaccinations according to national schedule (missing data for 3). Five newborns were breastfed, 1 received formula milk and 5 mixed-feeding. BEL was resumed in 7/13 patients after pregnancy (in 4 cases for flare), after a median period of 5 [4-22] months.Conclusion:While more data are needed, this small series suggests that BEL might be a therapeutic option for SLE patients during pregnancy planning, similarly to other biological drugs used in chronic forms of arthritis.Disclosure of Interests:None declared

Association between bacterial vaginosis and fecundability in Kenyan women planning pregnancies: a prospective preconception cohort study

AbstractSTUDY QUESTIONIs bacterial vaginosis (BV) associated with fecundability?SUMMARY ANSWERWomen with BV may be at increased risk for sub-fecundity.WHAT IS KNOWN ALREADYWhile BV has been associated with poor IVF outcomes, the association between vaginal microbiota disruption and non-medically assisted conception has not been thoroughly explored.STUDY DESIGN, SIZE, DURATIONKenyan women with fertility intent were enrolled in prospective cohort that included monthly preconception visits with vaginal fluid specimen collection and pregnancy testing. Four hundred fifty-eight women attempting pregnancy for ≤3 menstrual cycles at enrollment were eligible for this fecundability analysis.PARTICIPANTS/MATERIALS, SETTING, METHODSAt monthly preconception visits, participants reported the first day of last menstrual period and sexual behavior, underwent pregnancy testing and provided vaginal specimens. Discrete time proportional probabilities models were used to estimate fecundability ratios (FRs) and 95% CI in menstrual cycles with and without BV (Nugent score ≥ 7) at the visit prior to each pregnancy test. We also assessed the association between persistent BV (BV at two consecutive visits) and fecundability.MAIN RESULTS AND THE ROLE OF CHANCEParticipants contributed 1376 menstrual cycles; 18.5% (n = 255) resulted in pregnancy. After adjusting for age, frequency of condomless sex and study site, BV at the visit prior to pregnancy testing was associated with a 17% lower fecundability (adjusted FR (aFR) 0.83, 95% CI 0.6–1.1). Persistent BV was associated with a 43% reduction in fecundability compared to cycles characterized by optimal vaginal health (aFR 0.57, 95% CI 0.4–0.8).LIMITATIONS, REASONS FOR CAUTIONDetection of vaginal microbiota disruption using Gram stain and a point-of-care test for elevated sialidase identified a non-optimal vaginal environment, but these non-specific methods may miss important relationships that could be identified by characterizing individual vaginal bacteria and bacterial communities using molecular methods. In addition, results may be subject to residual confounding by condomless sex as this was reported for the prior month rather than for the fertile window during each cycle.WIDER IMPLICATIONS OF THE FINDINGSGiven the high global prevalence of BV and infertility, an association between BV and reduced fecundability could have important implications for a large number of women who wish to conceive. Multi-omics approaches to studying the vaginal microbiota may provide key insights into this association and identify potential targets for intervention.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-R.S.M.). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were made possible using REDCap electronic data capture tools hosted at the University of Washington’s Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for consulting from Lupin Pharmaceuticals. L.E.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for service on scientific advisory boards from Hologic and Nabriva Therapeutics.TRIAL REGISTRATION NUMBERN/A.

Nomograms for predicting adverse obstetric outcome in IVF pregnancy: A preliminary study.

In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to determine maternal prognosis factors that influence the IVF pregnancy outcome. We conducted an observational retrospective monocentric study between January 2014 and January 2018. Pregnancy over 22 gestational weeks (GW) obtained after IVF in our infertility clinic was included. Maternal characteristics and pregnancy outcome were collected. Data from 498 IVF pregnancies were analyzed. The most significant maternal prognosis factors for obstetric complications were maternal age above 40years (OR 3,0 [95% IC 1,30-7,09], P=0,010), twin pregnancies (3.8 [95% IC 1.49-9.99], P=.005), daily maternal smoking above 10 cigarettes (7.1 [95% IC 1.22-41.74], P=.029), maternal obesity (2.2 [95% IC 1.19-4.07], P=.012), endometriosis stages III and IV (6.4 [95% IC 1.52-27.04], P=.011), and history of ovarian hyperstimulation syndrome (OHSS) in early pregnancy (5.7 [95% IC 1.29-24.74], P=.021). Risk increase was independent of pregnancy type (singleton or twin) and allowed the elaboration of 2 nomograms. Our study showed a link between some maternal factors and increase in obstetric complications after IVF. Screening of these factors during preconceptional visit is essential to identify at high-risk pregnancies and adapt their monitoring.

SAT0368 PREGNANCY IN WOMEN WITH SPONDYLOARTHRITIS: WHO ARE THE PATIENTS AT RISK OF DISEASE FLARE?

Background:Patients with Spondyloarthritis (SpA) can experience flares during pregnancy and postpartum even though the available data are limited and not conclusive.Objectives:To assess disease activity and treatment modification during pregnancy and postpartum in patients with SpA and to identify risk factors for disease flare.Methods:Data on SpA pregnancies prospectively-followed in a pregnancy clinic from 2010 to 2019 were retrospectively analysed. Disease activity was assessed during each trimester and postpartum using ASDAS-CRP or DAS28-CRP. Flare was defined as an increase of disease activity leading to treatment modification (introduction or increase ≥5mg/day of prednisone, introduction of cDMARD or bDMARD)1.Results:Data on 50 pregnancies in 46 patients were collected (mean age at conception 33±4.7 years; median disease duration: 60 months (IQR 24-132); 33 psoriatic arthritis, 6 axialSpA, 2 reactive arthritis, 2 IBD-related SpA; 6 undifferentiated SpA, 1 juvenile idiopathic arthritis). Six pregnancies ended in miscarriage, so they weren’t considered for the analysis of flares during pregnancy (table 1). Fifteen out of 44 (34%) pregnancies had at least one flare during pregnancy (6, 7 and 4 during 1st, 2ndand 3rdtrimester respectively; 2 pregnancies had multiple flares). A higher rate of flare was observed in pregnancies of patients with axial involvement (p=0.01), on treatment with bDMARDs at preconceptional visit (p=0.03) and who stopped TNFi at positive pregnancy test (p=0.03). Peripheral involvement was associated with a lower rate of flares (p=0.02). Medications resumed during pregnancy were steroids (in 6 pregnancies), cDMARDs (2 sulfasalazine, 1 cyclosporine) and bDMARDs (4 certolizumab, 4 etanercept). During postpartum period flares were recorded in 46% of patients.Table 1.clinical features, medication and disease activity in pregnancies with flare vs without flareCLINICAL FEATURESFLARE (15)NO FLARE (29)pAxial involvement, n (%)11/15 (73)9/29 (31)0.01Peripheral arthritis, n (%)8/15 (53)26/29 (90)0.02Enthesitis, n (%)5/15 (33)14/29 (48)nsDactilitis, n (%)3/15 (20)8/29 (28)nsPsoriasis, n (%)6/15 (40)17/29 (59)nsIBD, n (%)2/15 (13)0nsUveitis, n(%)1/15 (7)3/29 (10)nsHLAB27 +7/11 (64)5/12 (42)nsMEDICATION HISTORYbDMARDs, n (%)11/15 (73)7/29 (24)0.003bDMARDs at preconception visit, n (%)8/15 (53)6/29 (21)0.04bDMARDs stopped at positive pregnancy test, n (%)7/15 (47)4/29 (14)0.03cDMARDs, n (%)12/15 (80)25/29 (86)nsDISEASE ACTIVITYACTIVE DISEASE* preconception visit, n(%)3/14 (21)4/23 (17)nsACTIVE DISEASE 1sttrimester, n(%)6/15 (40)1/29 (3)0.004ACTIVE DISEASE 2ndtrimester, n(%)8/15 (47)2/29 (7)0.001ACTIVE DISEASE 3rdtrimester, n(%)2/15 (13)1/29 (3)ns*DAS28-CRP&gt;3.2 or ASDAS-CRP≥2.1Conclusion:In our cohort of prospectively-followed SpA pregnancies, 34% experienced a flare during pregnancy and 46% during postpartum. Flares occurred especially in those patients who discontinued TNFi early in pregnancy and with axial involvement. When resumed during pregnancy, TNFi was able to control the disease. At preconception counselling, the continuation of TNFi during pregnancy should be considered to ensure a better control of disease.

Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the obstetrician’s view

This is the obstetrician's view on 3 different clinical scenarios involving bleeding and thrombotic disorders. In the first scenario, an 18 year old with a history of heavy menstrual bleeding since menarche presents with abdominal pain and ultrasound findings suggestive of a hemorrhagic ovarian cyst. The association with an underlying bleeding disorder is recognized. The goals of management, which are controlling hemorrhage and preserving fertility, are stated. Ovarian suppression, the most effective method to prevent recurrent hemorrhagic ovarian cysts, is outlined. Long-term management of heavy menstrual bleeding with hormonal contraception is described. In the second scenario, the same patient returns 5 years later for a preconception visit. The potential risks to an unborn baby with von Willebrand disease (VWD) are addressed. The natural rise in von Willebrand factor (VWF) during pregnancy is discussed, but the fact that women with VWD do not achieve the same VWF levels as women without VWD is emphasized and the implications are presented. In anticipation of pregnancy, the need for nonhormonal management of heavy menstrual bleeding and hemorrhagic ovarian cysts is mentioned. In the third and final scenario, the patient's cousin with factor V Leiden seeks consultation regarding the risks of thrombosis with in vitro fertilization. The steps of assisted reproductive technology are described. The strategies to prevent venous thromboembolism by preventing ovarian hyperstimulation and reducing the likelihood of multiple gestation are detailed.

Allergic Rhinitis during Pregnancy -an Update of Management

The concurrence of allergic rhinitis and pregnancy is common. The diagnosis of allergic rhinitis is easily and reliably made, by eliciting the characteristic symptoms on history. This diagnosis is easily confirmed by using the radioallergosorbent test (RAST) or enzyme-linked immunosorbent assay(ELISA) tests. Nasal symptoms, particularly obstruction, are often aggravated in pregnancy, through several possible mechanisms. The disease is often pre-existing and sometimes coincidental during pregnancy, and can worsen, improve, or stay the same during pregnancy. Besides ameliorating the detrimental effects of AR on the patient's quality of life, correct treatment is important for controlling concomitant asthma. If possible, it is important to highlight the risks of not taking such medications at a pre-conception visit. Although most medications for AR readily cross the placenta, there are several choices of treatment for controlling the symptoms during pregnancy. The choices may be varied depending on the disease course and symptoms, and inhaled corticosteroids are considered to be the first-line medical treatment. In addition, either a first-generation antihistamine, such as chlorpheniramine, or a secondgeneration antihistamine, such as cetirizine or loratadine, can be prescribed as the second-line medical treatment. As an alternative, intranasal cromolyn can be prescribed safely. Some of the leukotriene receptor antagonists and nasal decongestant sprays can only be prescribed when other methods are no longer valid and strict benefits can be expected. It is considered safe to continue immunotherapy during pregnancy.Medicine Today 2016 Vol.28(2): 83-88

Preconception care among low-risk mothers in a French perinatal network: Frequency of utilization and factors associated

ObjectiveDetermine the frequency of preconception care use in France and factors impacting preconception visit. Materials and methodsAn epidemiological study was conducted from September 2015 to October 2015 in 5 maternity hospitals within the “Alpes-Isère” perinatal network, comprising of French-speaking women, with uncomplicated pregnancies, who delivered a healthy term baby (≥37 weeks of gestational age). Two groups were compared: patients with and without preconception care. Descriptive, univariate and multivariate analyses were performed for the sociodemographic, the environmental characteristics and the gynecologic obstetric history. ResultsAmong the 392 patients included in this study, only 62 (15.8% [12.0–20.0]) had used preconception care before their pregnancy. Multivariate analysis showed that the primiparous women (adjusted OR 2.47 [1.37–4.46]) and the women with a high socio-professional category (adjusted OR 2.32 [1.13–4.77]) were more likely to used preconception care. ConclusionDespite the positive effects on mother and baby's health, preconception care is insufficiently used in France. Every effort must be made to improve awareness of preconception care among health workers and patients.

G2. Low pregestational fat mass and subsequent maternal cardiovascular maladaptation in early pregnancy. The missing link for preeclampsia

Introduction: Several studies have demonstrated the correlation between maternal obesity and pregnancy complications. Obese women seem to be at higher risk to develop late preeclampsia, which shows a more favorable perinatal outcome compared to the early form. The assessment of total vascular resistance (TVR) could play an additional role in the detection of these patients.Targets: To identify patients at higher risk of hypertensive complications through the assessment of pre-pregnancy maternal fat mass (FM) and TVR.Results: Patients were divided into two groups in the first trimester: group A with low TVR and group B with high TVR. Cardiac output, stroke volume and TVR were statistically different at preconceptional visit and during the first trimester. FM was the only bioimpedance parameter to be found significantly different, higher in group A (Table 1).In group A, it is possible to identify a subgroup with higher FM that could be at high risk of late preeclampsia difficultly recognizable throughout TVR and BMI (Figure 1).Figure 1. Correlation between FM/TVR.On the other side, a too low FM might negatively influence maternal adaptation to pregnancy.Conclusions: FM could represent a better marker of body composition and a target to monitor the effectiveness of dietary changes improving maternal and neonatal outcome.

Women's Knowledge of Ovulation, the Menstrual Cycle, and Its Associated Reproductive Changes.

The purpose of this study was to examine women's knowledge of female reproduction-anatomy, hormones and their functions, ovulation, the menstrual cycle and its associated reproductive changes, conception, and signs of pregnancy. A survey was completed by 125 women of childbearing age as part of a larger "Women's Health Promotion Program." Descriptive statistics, mainly univariate and bivariate analyses were conducted using STATA 13. The women in the study were ages 18-51 years, 52.0 percent were Hispanic, 36.0 percent African American, and 12.0 percent White. The majority, 70.4 percent, had a household income of less than $20,000, 58.4 percent were not married, 83.2 percent were not trying to get pregnant at the time, and 37.6 percent had sexual intercourse that may have put them at risk for pregnancy in the past month. Less than one-third knew about the reproductive hormones. Over 80.0 percent knew their reproductive anatomy, 68.8 percent were not keeping any log to track their menstrual flow, 53.6 percent did not know when their next menstruation would be, and 49.6 percent did not know the average number of days for a regular menstrual cycle. Many did not know what ovulation is (47.2%), the ovulation timing (67.2%), the number of eggs released from an ovary each month (79.2%), and how long an egg or sperm could live in a woman's body (62.4%). Reproductive knowledge should be assessed during preconception visits and women should be taught comprehensive reproductive education-not just selected topics-to be adequately equipped to make informed reproductive decisions.

Preconception Care of the Obese Woman.

One third of obese women report obtaining preconception care. Only one third of those women state that weight issues were discussed at their visit. Obese women should be educated about the risks of pregnancy so they can make informed choices as to whether and when to conceive. Women should be encouraged to mitigate risk by losing weight and exercising before conception and understand complications of pregnancy within specific pregravid body mass index strata. This manuscript describes the risks and provides guidance on topics to include in the preconception visit of an obese woman.

Pregnancy intention, receipt of pre-conception care, and pre-conception weight counseling reported by overweight and obese women in late pregnancy

We surveyed overweight or obese women receiving prenatal care for a singleton pregnancy at a large academic medical center in 2010. During late pregnancy, women reported pregnancy intentionality and pre-conception weight counseling. Participants (N = 82) had a mean age of 29.7 (SD: 6.3) years, 61% were non-Hispanic white, 47% were nulliparous. Before pregnancy, 45% were overweight and 55% were obese. Forty-eight percent reported that the current pregnancy was planned. Of these women, 36% reported a pre-conception visit. Of these, 29% reported pre-conception weight counseling (5% of sample). Unrealized opportunities exist in the clinical setting for promoting weight management during the childbearing years.