Course Of Pregnancy In Patients Research Articles

Dilemmas concerning the course of pregnancy in patients with anorexia nervosa considering hormonal and somatic parameters.

Mental anorexia nervosa is a rare, potentially severe, chronic, and recurrent mental disorder that occurs more often in women than in men, especially during the childbearing years. The disorder is associated with an increased risk of mortality, mainly related to the physical consequences of severe malnutrition and suicide. Malnutrition of the body can cause serious hormonal and somatic problems. Despite significant hormonal disturbances that reduce fertility, a woman with anorexia can become pregnant. A new phenomenon now seen with increasing frequency is pregorexia, an eating disorder associated with pregnancy. It involves the use of dietary restrictions to avoid excessive weight gain during pregnancy. Pregnancy changes the hormonal economy mainly due to the development of the placenta, which secretes many hormones, not just sex hormones. Mental anorexia poses a significant risk to both mother and child if not diagnosed and treated properly. Treatment of anorexia involves simultaneous somatic and psychological treatment. During pregnancy, additional care should be taken to create an optimal environment for the developing foetus. Unfortunately, there is still a lack of research providing guidance in this area. Available studies are mainly case reports or reports focusing on specific clinical situations. It is worth noting that no study to date has attempted a comprehensive assessment of endocrine disruption in pregnant women with anorexia. Recognising the existing knowledge gap on endocrine disorders in pregnant women with anorexia nervosa, a systematic review of the literature was conducted.

Features of pregnancy course in patients with thrombophilia and abnormal placenta location

Aim: to identify inherited and acquired thrombophilia as well as features of pregnancy course in women with abnormal placenta location.Materials and Methods. Within the framework of a prospective controlled cohort non-randomized, interventional study there was analyzed pregnancy course in 135 women with abnormal placenta location: group I – 42 patients with abnormal placenta location in history; group II – 61 women with placenta previa detected during ongoing pregnancy; group III – 32 patients with placenta previa detected both in ongoing and previous pregnancy. The control group consisted of 120 pregnant women with normal placenta location without a previous complicated obstetric history. All patients underwent clinical examination of pregnancy course assessing fetus intrauterine growth retardation (IUGR) and fetal biophysical profile; inherited and acquired thrombophilia were identified – analyzing circulating antiphospholipid antibodies (APAs) by ELISA, inherited thrombophilia by polymerase chain reaction to identify mutations in genes encoding 5,10methylenetetrahydrofolate reductase (MTHFR), G20210A mutations in prothrombin gene, V Leiden mutation, polymorphismin fibrinogen and plasminogen activator inhibitor 1 (PAI-1) genes.Results. Inherited thrombophilia was detected in 101 (74.81 %) pregnant woman with abnormal placenta location: group I – in 31 (73.8 %) patients, group II and group III – in 44 (72.1 %) and 26 (81.3 %) patients, respectively. Inherited forms of thrombophilia were detected in 29 (24.2 %) women from control group. Multigenic forms of thrombophilia peaked in group III (14/43.8 %), followed by group I (16/38.1 %) and group II (23/37.7 %). In the control group, multigenic thrombophilia was detected in 16 (13.3 %) women. Selective inherited thrombophilia and АРАs circulation were detected in 30 (22.22 %) women with abnormal placenta location: group I – in 8 (19.0 %) patients, group II – in 13 (21.3 %), and group III – in 9 (28.1 %) cases. In the control group, there were only 8 (6.7 %) such patients. Patients with IUGR signs were identified in all study groups: 4 (9.52 %) in group I, 6 (9.84 %) in group II, 6 (18.75 %) in group III as well as in control group in 6 (6.67 %) women.Conclusion. Pregnancy management in patients with thrombophilia and placental abnormalities should be accompanied by an proper fetal assessment (biophysical profile) and, in some cases, anticoagulant or antiplatelet therapy. However, insufficient number of cases requires to conduct further investigations to assess a relation between thrombophilia, placenta previa and a risk of obstetric complications particularly IUGR.

Analysis of the impact of uterine fibroids of different locations and sizes on the perfusion and metabolic characteristics of the endometrium

BACKGROUND:Uterine fibroids are the most common benign tumor of the female reproductive system. A number of factors affect endometrial receptivity in patients with uterine fibroids such as transcription factorsHOXA10andHOXA11, cytokines (growth factors and inflammatory markers), etc. The negative effect of myomatous nodes, which deform the uterine cavity, on endometrial receptivity has been well studied and is beyond doubt, while the influence of intramural and intramural-subserosal fibroids on the endometrium is debatable. An important point is to define clear criteria that justify myomectomy in patients without clinical symptoms of the disease who are planning pregnancy, in particular, with the help of assisted reproductive technology. This article presents the results of studies on the impact of uterine fibroids of different locations on the endometrium. The data were obtained from foreign literature sources and such electronic databases as PubMed, CyberLeninka, and Google Scholar in the period from 2000 to 2022. This survey also reflects the main aspects of federal clinical recommendations and demonstrates the results of our own research.
 AIM:The aim of this study was to determine the effect of intramural and intramural-submucosal myomatous nodes nodes on the perfusion and metabolic characteristics of the endometrium.
 MATERIALS AND METHODS:We conducted a comprehensive examination of 20 patients of reproductive age with uterine fibroids who underwent surgical treatment in Gynecological Department One with Operating Unit of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (Saint Petersburg, Russia) and the Gynecological Department of N.A. Semashko City Hospital No. 38 (Saint Petersburg, Russia). Two groups were formed: group I consisted of 10 patients with multiple uterine fibroids (FIGO types 2 and 3); group II included 10 patients with intramural and intramural-subserosal myomatous nodes (FIGO types 4 to 6). Studies of endometrial perfusion and metabolism were carried out using a fiber optic system that implements fluorescence spectroscopy and laser Doppler flowmetry, including the LAKK-M diagnostic complex (Lazma Ltd., Russia) and a laparoscopic fiber optic probe, followed by registration of optical signals.
 RESULTS:In the group of patients with uterine fibroids that deform the uterine cavity, we revealed a statistically significant decrease in the microcirculation index in endometrial tissues and an increase in fluorescence signals at a wavelength of 365 nm. This may indicate hypoxic phenomena in endometrial tissues of patients with FIGO types 2 and 3 fibroids. These findings are some of the significant pathogenetic causes of implantation disorders and abnormalities in the physiological course of pregnancy in patients of this study group.
 CONCLUSIONS:The data obtainedsubstantiate the need to continue research in this direction in order to develop perfusion-metabolic criteria that allow for optimizing the choice of treatment strategies in patients with uterine fibroids.

Дебют системной красной волчанки во время беременности

For a long time, systemic lupus erythematosus remains an insufficiently studied problem of rheumatology, the factors influencing the development and progression of the disease are not clear. The hormonal factor remains one of the possible triggers in the development of the disease in predisposed individuals. The course of pregnancy in patients with systemic lupus erythematosus is always associated with multiple risks. The onset of the disease during pregnancy often leads to the death of the fetus and the threat to the life of the mother. At the present stage, thanks to the possibilities of modern diagnostics and treatment, the prognosis for the life and health of both mother and fetus has improved. A case of the development of systemic lupus erythematosus during pregnancy and successful therapy with corticosteroids and belimumab is presented.

А rare clinical case of pregnancy and childbirth in a patient with an implanted neurostimulator for Оppenheim torsion dystonia (DYT-1)

The problems of planning, follow-up of pregnancy and childbirth in women with inherited extrapyramidal neurological disorders, including torsion dystonia, are represented by isolated cases and receive little literature coverage. Dystonia is a rare disease, the incidence of its various types is 300–400 patients per million (0.03%). Idiopathic torsion dystonia is a group of genetically determined hyperkinetic disorders, which refers to an extrapyramidal pathology of the central nervous system with a progressive course of the disease. This article presents the case follow-up of pregnancy and childbirth in a patient with torsion dystonia and chronic neurostimulation 1.5 years after implantation of the ActivaRC neurostimulation system without drug therapy. The patient has given birth via elective caesarean section while receiving neurostimulation via the ActivaRC system. This clinical observation shows that the physiological course of pregnancy in patients with this diagnosis is possible in case of its advance planning and correction of the DBS programming. A multidisciplinary approach to the management of a patient with generalized torsion dystonia and chronic neurostimulation made it possible to achieve a favourable pregnancy outcome for both mother and fetus. Follow-up of pregnancy in such patients requires a correction of the DBS programming and choosing the optimal timing and method for delivery. The routine follow-up clinical examination by a neurologist should be carried out both in the planning stage and throughout the entire period of pregnancy (end of the first trimester, weeks 21–23, 32–34), as well as in the postpartum period.

Pregnancy in patients with complete atrioventricular block: management and perinatal outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Although bradyarrhythmias may occur in pregnant patients, there are few data on their management, pregnancy course and perinatal outcomes. Purpose To evaluate the effects of bradyarrhythmias on the course and outcomes of pregnancy. Methods This single-center, prospective study included 8 cases of complete atrioventricular block in pregnant patients (Mean age of pregnant was 25.4±3.6 years, mean gestation age 17.6 ±2.4 weeks). All patients were without structural heart disease. Pregnancy course, clinical outcomes and bradyarrhythmias management were evaluated. Results Complete atrioventricular block was registered in three women prior to pregnancy (37.5%). In 5 cases (62.5%) atrioventricular block diagnosed for the first time during this gestation. All included patients had symptoms of dizziness and syncope during pregnancy. Due to hemodynamic instability pacemakers were implanted in all cases of complete atrioventricular block. Procedure-related complications were not documented. Implantation was performed with the help of echocardiographic guidance and electroanatomical mapping (Ensite Precision system) with minimal fluoroscopy. Pregnancy course in patients with bradyarrhythmias characterized by increased incidence of uterine contractile activity (n=3, 37.5%), uterine blood flow violation was in one case (12.5%). Perinatal outcomes: spontaneous vaginal delivery was in the majority of cases (n=7; 87.5%). One pregnant (12.5%) was delivered by cesarean section. One women had placental abruption and preeclampsia (12.5%). Maternal adverse cardiac events and adverse fetal outcomes were none declared. There were 8 live births (in all cases, 100%). Fetal birth weight was 3158.07±458.2 grams, 5 minute Apgar was 8.87±0.6. There were no maternal and fetal mortality. Conclusions Complete atrioventricular block, observed in patients, did not require termination of gestation. Implantation of pacemaker in cases of complete atrioventricular block can be safety performed in pregnancy and associated with benign pregnancy course and outcomes in the majority of cases.

Assessment of the vitamin d levels effect on the course of the first trimester of pregnancy

Introduction. The course of physiological pregnancy is provided by many complementary factors. Thus, a deficiency in one of the links of the metabolic network contributes to the development of an imbalance in the work of the whole organism, which ensures the growth and development of the embryo from the first days of gestation. It has been proven that vitamin D can act as an immune regulator during implantation, providing a protective effect in whole period of pregnancy.Aim. The aim of this study is assessed the features of the course of pregnancy in patients with different levels of vitamin D in the blood in the first trimester.Materials and methods. A prospective multicenter randomized study was conducted in the North-West region of the Russian Federation among 88 pregnant women in the first trimester of gestation (up to 13 weeks). All patients were divided into 3 groups depending on the initial level of vitamin D (group 1–14 women with a 25(OH)D < 10 ng/ml, group 2–62 pregnant women from 10 to 30ng/ml, group 3–12 pregnant women with a vitamin D content > 30 ng/ml).Results. In group 1.86% of patients with severe vitamin D deficiency were diagnosed with threatened miscarriage, which is significantly higher than in group 3 (85.7% and 33.3%, χ2 = 7.490, p = 0.007). At the same time, retrochorial hematoma in group 1 occurred 3.5 times more often than in group 3 (57.1% and 16.67%, respectively, χ2 = 4.473, p = 0.035). Subsequently, every 4th woman from the group with vitamin D deficiency gave birth earlier than expected, which was not observed among patients from group 3 (25%, 0%, χ2 = 1.231, p = 0.268).Conclusion. Prescribing cholecalciferol vitamin replacement therapy as part of complex preserving therapy for threatening miscarriage, followed by monitoring its blood level and deviating from normal parameters, contributing to a favorable course of pregnancy and improving perinatal outcomes.

Features of the 1st trimester of pregnancy course with severe deficiency of 25(OH)D

Introduction The course of physiological pregnancy is provided by many complementary factors. Thus, a deficiency in one of the links of the metabolic network contributes to the development of an imbalance in the work of the whole organism, which ensures the growth and development of the embryo from the first days of gestation. It has been demonstrated that vitamin D can act as an immune regulator during implantation, providing a protective effect in the entire period of pregnancy. Objective The aim of this study is to assess the features of the course of pregnancy in patients with different levels of vitamin D in the blood in the first trimester. Materials and methods A prospective multicenter randomized study was conducted in the North-West region of the Russian Federation among 88 pregnant women in the first trimester of gestation (up to 13 weeks). All patients were divided into 3 groups depending on the initial level of vitamin D (group 1–14 women with a 25(OH)D < 10 ng/ml, group 2–62 pregnant women from 10 to 30 ng/ml, group 3–12 pregnant women with a vitamin D content >30 ng/ml). Interventions Criteria of inclusion: pregnant women from 20 to 44 years of the first trimester of gestation (up to 13 weeks) with the studied level of vitamin D in the blood serum; singleton pregnancy; BMI ≤30 kg/m2; signing by the patient of informed consent for inclusion in the study group. Main outcome measures and results In group 1, 86% of patients with severe vitamin D deficiency were diagnosed with threatened miscarriage, which is significantly higher than in group 3 (85.7% and 33.3%, χ 2 = 7.490, p = .007). At the same time, retrochorial hematoma in group 1 occurred 3.5 times more often than in group 3 (57.1% and 16.67%, respectively, χ 2 = 4.473, p = .035). Subsequently, every 4th woman from the group with vitamin D deficiency gave birth earlier than expected, which was not observed among patients from group 3 (25%, 0%, χ 2 = 1.231, p = .268). Conclusion Prescribing cholecalciferol vitamin replacement therapy as part of complex preserving therapy for threatening miscarriage, followed by monitoring its blood level and deviating from normal parameters, contributing to a favorable course of pregnancy and improving perinatal outcomes.

Rare and acute complications of endometriosis in pregnant women

Here we analysed rare and acute complications of endometriosis in pregnant women by searching Cochrane, HINARY, and PubMed databases. Keywords were “rare”, “causes”, “acute”, “complications”, “endometriosis”, and “pregnancy”. The search depth was 10 years (2011−2021). In total, we found 126 publications, 41 of which met the selection criteria. The course of pregnancy and childbirth in patients with endometriosis is insufficiently studied. Yet, it is characterised by a higher risk of complications including those rarely occurring: haemoperitoneum, intestinal perforation, appendicitis, torsion and rupture of the endometrioid cyst, and thoracic endometriosis. Because of major hormonal changes occurring during the pregnancy, endometriosis undergoes a significant progression or decidualisation. As endometrioid tissue is characterised by a resistance to progesterone, its defciency during the pregnancy can lead to necrosis, perforation of decidualised foci, and severe bleeding. Progesterone deficiency provokes hypervascularisation of the endometrioid tissue, which is the most common cause of spontaneous haemoperitoneum and most frequently occurs in the third trimester of pregnancy and after in vitro fertilisation. Pregnancy increases the risk of endometriosis-related intestinal perforation of different localisation: small intestine, caecum, appendix, and rectosigmoid colon. Limited information about the pregnancy-related complications of endometriosis leads to their underestimation, albeit they can be life-threatening and significantly impact the health of the mother and fetus. The results of this review indicate the need for the further studies of the pregnancy course in patients with endometriosis, especially after the use of assisted reproductive technology. Development of specific clinical guidelines would contribute to the efficient prevention of obstetric and perinatal complications in patients with endometriosis.

РЕВМАТИЧЕСКИЕ ЗАБОЛЕВАНИЯ И БЕРЕМЕННОСТЬ

. The problem of pregnancy in rheumatic diseases does not lose its relevance. The most studied is the course of pregnancy in patients with rheumatoid arthritis, systemic lupus erythematosus and axial spondyloarthritis. Observations in other systemic connective tissue diseases are episodic and do not allow us to draw reliable conclusions. The course of the disease itself, as well as the therapy received by patients, can affect pregnancy, starting with the possibility of conception and ending with unfavorable pregnancy outcomes for the mother and fetus. The onset of pregnancy should be planned at the time of remission or minimal activity of the disease. Of particular interest is drug therapy in patients with rheumatic diseases during gestation. This issue has been and remains complex and has not been fully studied due to the fact that any conclusions about the effect of drugs on the fetus are made retrospectively and cannot be the result of a deliberately initiated study. Currently allowed, though with some reservations, during pregnancy drugs are glucocorticoids, non-steroidal anti-inflammatory drugs, hydroxychloroquine and sulfasalazine. The development of genetic engineering has raised the question of the possibility of using genetic engineering basic therapy during gestation. Currently, the largest number of observations is available for TNF-α inhibitors, the use of which is recognized as possible during pregnancy. The presence of rheumatic disease in itself is not an absolute indication for a caesarean section. The question of the method of delivery is decided individually. Pregnant patients with rheumatic diseases should be under regular joint supervision of an obstetrician-gynecologist, rheumatologist and neonatologist

POSSIBILITIES OF CORRECTION OF PSYCHOVEGETATIVE DISORDERS IN PREVENTION OF FETAL DISTRESS WITH WEIGHTENED OBSTETRIC ANAMNESIS

The purpose – to evaluate the effectiveness of the correction of psychovegetative disorders in the prevention of fetal distress in pregnant women with complicated obstetric history (perinatal losses).Materials and methods. Pregnant women with complicated obstetric history were divided into 2 clinical groups: the main (group I) and the comparison group (group II). Patients of the main group (n = 60) were prescribed the proposed treatment complex, which includes a combination of psychotherapy and autonomic stabilizing drugs. The comparison group consisted of 60 pregnant women with a history of perinatal losses that did not differ in age, sex, body mass index and received only standard drug therapy. Cardiointervalography indicators were used to assess the dynamics of autonomic imbalance before and after treatment. The level of psycho-emotional state and psychosomatic disorders was determined by the Spielberg-Khanin scale.Results. Under the influence of the therapy, the severity of clinical manifestations of autonomic disorders was significantly reduced, and the frequency of sympathotonia was significantly reduced according to cardiointervalography. After treatment in the main group there was a significant increase in the percentage of pregnant women with normoadaptive state of regulatory systems from 48.3% to 86.7%, a marked decrease in anxiety and restoration of normal psycho-emotional state. The use of the proposed treatment complex helped to improve the course of pregnancy in patients with a history of perinatal losses, in particular, reduced the incidence of hemodynamic disorders from 34.1% to 10% and fetal distress - from 10.8% to 3.3%.Conclusions. The increase in the incidence of obstetric complications, in particular, fetal distress, in pregnant women with a history of perinatal losses is associated with the development of autonomic disorders, as evidenced by cardiointervalography. Analysis of heart rate variability can be used for early diagnosis of autonomic disorders and prevention of gestational complications. The proposed treatment complex, which included psychoemotional regulation and symptomatic therapy of autonomic dysfunction, helps to optimize the fetus perinatal protection, to prevent the hemodynamic disorders and fetal distress.

ТЕЧЕНИЕ БЕРЕМЕННОСТИ И ИСХОДЫ РОДОВ У ЖЕНЩИН С ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ

Background. The problem of genital endometriosis is relevant both in medical and in social aspects.Aim of the research. To analyze the course of pregnancy, childbirth and their outcomes in genital endometriosis to justify the critical terms of the complicated course of pregnancy and determine approaches for the development of therapeutic and preventive measures.Material and methods. The main group – 160 pregnant women, previously treated for genital endometriosis. The control group was 50 healthy women with a normal pregnancy. The generally accepted clinical laboratory and instrumental methods of the research were used. Statistical analysis of the data was carried out using the software package Statistica 10.0. Results. Gestational periods of 6-12 weeks, 18-22 weeks, 30-34 weeks of pregnancy are critical for women of the main group. The course of pregnancy is complicated by the threat of an early miscarriage (50%), placental disorders (65%), chronic hypoxia (35%) and fetal growth retardation (20%), anomalies of labor (60%).Conclusions. The complicated course of pregnancy in patients with genital endometriosis justifies the need to develop a comprehensive program for the prevention of gestational and perinatal complications.

A clinical case of a patient with liver cirrhosis in non-alcoholic fatty liver disease and pregnancy

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a significant health problem in society and it affects around a billion people on a global scale. NAFLD is the most common reason for liver damage worldwide and is considered the hepatic manifestation of the metabolic syndrome. NAFLD could be classified into two categories: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), which can progress to liver cirrhosis. There is limited literature on the occurrence of NAFLD in pregnant women and its effect on pregnancy. It is presumed that there is an increase in the frequency of gestational diabetes, premature birth, low birth weight, preeclampsia, more frequent delivery with Caesarean section, and more frequent occurrence of intrahepatic cholestasis. There is no data on the course of pregnancy in patients with NAFLD and cirrhosis, which is already formed. Clinical case: We present the clinical case of a 30-year-old woman, who is pregnant in the VIII lunar month and was brought to the hospital due to heaviness, feeling of bloating, and swelling in the legs. Laboratory examination conducted a month before hospitalization revealed that: AST - 460 U/L, ALT - 980 U/L, GGT - 28.3 U/L, total bilirubin – 20.2, Hb - 138 g/L. The patient informed that she had had two miscarriages in the past. After the second miscarriage three years ago, she was hospitalized for the first time due to icterus and fever. For the first time, she was diagnosed with: liver cirrhosis caused by non-alcoholic steatohepatitis, active, decompensated, child stage B; portal hypertension; metabolic syndrome; hypertension; obesity class III. Autoimmune and viral etiology of cirrhosis was excluded. Hepatoprotective treatment was conducted. Following the first hospitalization at the Endocrinology Clinic, the patient was diagnosed with: impaired fasting glycemia; decreased glucose tolerance; metabolic syndrome; hypertensive disease stage II, moderate degree; obesity class III; dyslipidemia; Hashimoto's thyroiditis. Glucobay therapy, diet, and hypocaloric and exercise regimen were prescribed. The last hospitalization at the Endocrinology Clinic was during the VI lunar month of the current pregnancy. Insulin treatment was started. The results of the laboratory tests conducted during the last hospitalization in the Clinic are shown in Table 1. Ultrasound examination showed cirrhotic transformation of the liver, moderate ascites, splenomegaly, and pregnancy with coexisting live fetus. The presence of acute infection with hepatotropic and non-hepatotropic viruses was excluded. After consulting with a cardiologist and an echocardiography, the presence of heart failure was rejected. Hepatoprotective treatment and diuretics were carried out, which resulted in normalization of liver parameters and a slight reduction of ascites. The patient was discharged and referred for planned delivery by Caesarean section when the fetus reaches maturity. Conclusion: The clinical case presents a patient with underlying hepatic cirrhosis in NAFLD and pregnancy, who developed transient hepatocytolysis and decompensation of cirrhosis with ascites during pregnancy, as well as diabetes mellitus on the background of previous impaired glucose tolerance. NAFLD is a disease, which could affect young patients in childbearing age. The presence of an advanced stage of NAFLD is associated with many complications during pregnancy, which requires follow-up by a gastroenterologist.

Do lifestyle factors influence the rate of complications after amniocentesis?

The impact of lifestyle factors including health-promoting physical activity on complication rate following amniocentesis is unclear. To examine the further course of pregnancy in patients undergoing amniocentesis in relation to selected risk factors including the level of health-promoting activity and occupational work on the complication rate after genetic amniocentesis. Medical records from 317 diagnostic amniocenteses were analyzed and 230 procedures carried out on 219 pregnant women were included in the study. The mean maternal age was 34.50 ±5 years (range: 22-47 years). In the patients studied, amniocentesis was performed at 12-24 gestational weeks with a median at 16 gestational weeks (mean: 16.13 ±2.02 weeks). Overall, 174 amniocenteses (75.6%) did not reveal any genetic disorder while 56 (24.4%) confirmed a genetic disorder. One hundred procedures (43.5%) were followed by at least 1 complication, while 130 procedures (56.5%) were uneventful. The following complications were observed: general pain - 37 (16%), fever - 5 (2.2%), dizziness - 7 (3%), amniotic fluid leakage - 5 (2.2%), vaginal bleeding - 3 (1.3%), and fetal death - 11 (4.8%). The following lifestyle factors were reported: use of stimulants - 12 (5.2%), occupational work - 158 (68.7%), commuting - 137 (59.6%), and physical activity - 62 (27%). Abdominal pain/uterine contractions were significantly more frequent with generalized pain, fever, vaginal bleeding, and physical activity. The presence of dizziness correlated with generalized pain in women who were working and commuting. Working occupationally when pregnant correlated positively with practicing sport. Better newborn condition was significantly correlated with older gestational age and longer sick leave. Physical activity performed by pregnant women after amniocentesis increases the risk of post-procedural complications such as abdominal pain, uterine contractions, dizziness, and syncope. Reducing physical effort 2 weeks after the procedure is recommended. Further studies are warranted.

Paliperidone and pregnancy-an evaluation of the German Embryotox database.

Schizophrenic or schizoaffective disorders often occur in early adulthood and thus affect women of childbearing age. For paliperidone information about reproductive safety is wanting. Therefore, we evaluated data from the German Embryotox pharmacovigilance institute regarding paliperidone therapy during pregnancy. The German Embryotox pharmacovigilance institute offers risk assessment on drug use in pregnancy and documents the outcome of more than 3500 drug-exposed pregnancies per year. In our study, we analyze the outcome of all pregnancies with paliperidone exposure, which have been assessed by our institute between January 2007 and June 2016. Of the 17 prospectively assessed pregnancies, 14 resulted in 15 live-born children (including one pair of twins). None of the infants presented with major congenital malformations. There were two spontaneous abortions at gestational weeks 6 and 11, respectively, and one elective termination due to personal reasons. Sixty-five percent of the pregnant women smoked cigarettes throughout pregnancy, 17% consumed alcohol. Five children were born prematurely (< 37 gestational weeks) and four were small for gestational age, each group including the twins. The results of our study suggest that paliperidone may be administered during pregnancy. The increased rate of prematurity and small for gestational age children can at least partially be explained by other risk factors. Psychiatric and obstetric close monitoring as well as additional medical and social support are recommended to ensure a healthy pregnancy course in patients with a severe mental illness.

Pregnancy course in patients with intrahepatic cholestasis of pregnancy treated with very low doses of ursodeoxycholic acid

Objective. Ursodeoxycholic acid (UDCA) has been proposed as the optimal pharmacological treatment for intrahepatic cholestasis of pregnancy (ICP). The lowest effective dosage of UDCA in women with ICP has not been established. The objective is to determine the risk of adverse pregnancy outcomes resulting from ICP and to measure changes in liver function parameters and pruritus severity in ICP patients treated with low doses of UDCA. Material and methods. ICP was diagnosed in 203 patients on the basis of pruritus and elevated liver biochemical parameters. Patients with total bile acids (TBA) ≥10 μmol/l (n = 157) received UDCA (300–450 mg/day; 4–6 mg/kg/day) until delivery. Maternal and fetal outcomes of women with ICP were compared with 100 patients without cholestasis. Patients with ICP were hospitalized for treatment and fetal surveillance. Results. There was no correlation between fetal and neonatal complication rates in ICP patients and biochemical markers of cholestasis. Significant declines in serum TBA (p = 0.003), bilirubin concentration (p = 0.026) and aminotransferase activity (p < 0.001) were observed during treatment with low doses of UDCA. Moreover, severity of pruritus was ameliorated during the 2 weeks of therapy (p = 0.037). A total of 17 patients (10.9%) did not respond to treatment. Conclusions. UDCA at low doses improved biochemical markers and clinical symptoms in almost 90% of ICP patients.

SAT0025 Pregnancy Outcomes in A Cohort of Women with Sle. Long Term 20 Years Observation

BackgroundThe issue of pregnancy in systemic lupus erythematosus (SLE) is very complex. The risk of relapse of the underlying condition and the involvement of fetus of a mother with SLE...

Tu1834 The Course of Pregnancy in Wilson's Disease-One Center, 20 Years' Experience

Introduction: Under treatment or not, the course of pregnancy in patients with Wilson's disease and drug safety in lactation are issues not well understood. Materyal and Methods : In this study, 194 patients (156 index cases) in Istanbul Faculty of Medicine with a follow-up of median 51 months (13-105 months) and 1069 patient-years were evaluated retrospectively for pregnancy. All patients met EASL 2012 Wilson's disease guideline's criteria. Results: 20 (16 index cases) out of 84 women had a total of 49 pregnancies. On presentation, 7 patients had decompensated cirrhosis, 4 had compensated cirrhosis, 6 had neurological signs (dysarthria, tremor etc.) and 9 were in precirrhotic stage. Out of 16 pre diagnosis pregnancies, 9 resulted in spontaneous abortion. Out of 33 post diagnosis pregnancies, 5 resulted in spontaneous abortion and 5 underwent termination (one due to fetal anomaly and 4 on patients' request). Out of 23 live births, one was born premature and died in three weeks. No anomalies were reported in the other 22 and they are still alive and healthy. One patient was diagnosed with antiphospholipid syndrome and Wilson's disease after 7 abortions. Under treatment, she had a live birth following two miscarriages. One of the patients who discontinued her medication during pregnancy died in the second month postpartum due to liver failure. The other patient developed tremor in the third trimester and her treatment was started again. Drug doses were reduced during pregnancy; one patient was treated with zinc (100mg/d), one was treated with 600 mg of trientine plus 100 mg of zinc and others were treated with D-penicillamine 600 mg/d and zinc 100 mg/ d. Copper deficiency did not develop in any of the pregnancies. The patients breastfed their babies. After lactation, drug doses were increased when needed. No wound healing problems occurred after the c-section of 10 patients who were under D-penicillamine (600 mg/d) treatment. Conclusion : Wilson's patients can get pregnant under combination therapy (chelator and zinc) even if they present with decompansated cirrhosis. During pregnancy, drugs should be administered twice daily (D-penicillamine 600 mg/d, trientine 600 mg/d, zinc 100 mg/d) and treatments should never be discontinued. At given doses, D-penicillamine does not impair wound healing after c-section. No complications occurred when treatment was continued during lactation as long as the mother was thoroughly informed, but further studies are needed to better understand the subject.

Specific features of pregnancy in patients with type 1 diabetes in the prepubertal period. Results of a 15-year long clinical observation

Aim. To evaluate effect of different factors on pregnancy course in patients with type 1 diabetes mellitus developing in the prepubertal period. Materials and methods. The study based at Endocrinological Research Centre included 77 women with prepubertal diabetes 18 of whom developedpregnancy that ended in delivery. Results. As per 2009, the age of the patients is 26,6?4,6 years. They became pregnant at 23,2?3,3 years and had had diabetes since the age of9,6?4,8 years. Their HbA1c level before and after pregnancy was 8,6?1,4 and 6,8?1,6% respectively, the difference being insignificant (p=0,3).Significant difference was documented between these HbA1c levels and that during pregnancy (p=0,0004 and 0.003 respectively). Nine (56,2%) patientsused ultrashort-acting insulin analogs and the remaining 7 (43,7%) recombinant human insulins. The mean insulin dose was 43,7?11 U/din the 1st trimester, 51,8?13,7 U/d in the 2bd trimester, and 45,3?10,8 U/d after delivery. 16 (88%) of the patients reported frequent hypoglycemia,five (27,8%) of them had episodes of severe daytime and nocturnal hypoglycemia. 11 (61%) developed microvascular diabetic complications beforepregnancy, with 9 (50%) having DR and 4 (22,2%) DN (microalbuminuria). The delivery occurred on weeks 36-37 in 7 (38,9%) women. Naturaland cesarean section deliveries took place in one and 17 (94,4%) patients respectively. Conclusion. Long-term follow-up of patients wit DM1 in accordance with algorithms of specialized medical aid to DM1 patients in Russia at a multidisciplinaryendocrinological centre decreases the risk of pregnancy and delivery complications and that of microvascular diabetic complications

Autoimmune Hepatitis and Pregnancy: A Rheumatologist's Dilemma

To review the course, predisposing risk factors, treatment employed, and complications of autoimmune hepatitis (AIH) during pregnancy. Maternal and fetal outcomes will be discussed. We reviewed the literature from February 1966 to January 2004 using MEDLINE and the key words autoimmune hepatitis, chronic active hepatitis, lupoid hepatitis, and pregnancy. An additional case of ours was included as she had AIH since childhood with worsening of liver disease during pregnancy. Including the present case, 58 pregnant women with AIH were reported in 17 case reports and series. In the 101 pregnancies documented in these cases, there were 47 flare-ups, 5 clinical improvements, 45 stabilizations of the disease during pregnancy, and 4 cases in which the disease course was not reported. Two maternal deaths occurred. A perinatal mortality of 4% and 19 fetal deaths were described. Most women were treated with prednisone alone; however azathioprine was used in a number of patients. Pregnancy course in patients with AIH is unpredictable. AIH exacerbates in some patients and is associated with a high rate of fetal complications including prematurity and death. Low-dose prednisone seems to be the preferred treatment. The use of azathioprine must be individualized and further studies are needed to better define its role and safety during pregnancy in patients with AIH. A better understanding of the course of pregnancy in patients with AIH should help design appropriate therapeutic schemes to improve pregnancy outcomes for both mother and fetus.