Prophylaxis In Pregnant Women Research Articles

PeRinatal, neOnatal, and Maternal OuTcomEs with azithromycin prophylaxis in pregnancy and labour (PROMOTE-PROPHYLAXIS): systematic review and meta-analysis

Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86-1.20, I 2 =0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65-2.42, I 2 =0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35-1.56, I 2 =43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67-3.91, I 2 =0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. None.

Safety and efficacy of dihydroartemisinin–piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs. For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109. From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups. In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria. European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture. For the Portuguese and French translations of the abstract see Supplementary Materials section.

Anticoagulant prophylaxis in pregnant women with a history of venous thromboembolism: A systematic review and meta-analysis

BackgroundVenous thromboembolism (VTE) remains one of the leading causes of morbidity and mortality during pregnancy and the postpartum period. Despite that, the prevention and management of VTEs in pregnant patients is an area of great debate. ObjectivesThe aim of this systematic review was to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk. MethodsMEDLINE and EMBASE were searched between January 2000 to December 2022. We included studies that evaluated pregnant patients with previous personal history of VTE and assessed VTE recurrence with or without thromboprophylaxis. A meta-analysis of proportions was done through a Freeman–Tukey transformation using random effect models. Results30 studies were included in this systematic review. The studies included 5075 pregnant patients with a previous history of DVT or PE. We found a wide variability in thromboprophylaxis strategies. The estimated pooled proportions of VTE recurrence were 2.5% (95% CI 1.8–3.3) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 4.7% (95% CI 1.8–8.8) in patients who received anticoagulation in the postpartum period only, and 13.6% (95% CI 6.5 to 22.8) in patients who were not on anticoagulation. ConclusionsIn patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were lower than for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown.

Cranberry Supplements for Urinary Tract Infection Prophylaxis in Pregnant Women: A Systematic Review of Clinical Trials and Observational Studies on Efficacy, Acceptability, Outcomes Measurement Methods, and Studies' Feasibility.

Cranberry supplements are commonly used to prevent urinary tract infections (UTIs).However, their usefulness is uncertain in pregnant women.We aimed to comprehensively summarize the current knowledge on cranberry supplements' efficacy and acceptability during pregnancy in addition to the outcomes measurementmethods and studies' feasibility. To achieve it, wesearched PubMed, PMC, and Europe PMC databases plus screened citations followed bycritical appraisal of included eligible English-written primary studies that(1) focused on pregnant women supplemented with any cranberry supplements; (2) provided data on cranberry supplements' efficacy, acceptability, outcomes measurementmethods, and studies' feasibility;(3) included human subjects; and (4) published worldwide.Two randomized clinical trials (RCTs) and one nested cohort study, including 1156 pregnant women in total, contributed to our analysis.A tendency toward UTI reduction was demonstrated, although the results' validity was impacted by significantjuice-induced gastrointestinal intolerance(23%; 44 of 188 subjects).Changing the form of supplementation from cranberry juice to capsules reduced the issue,causing side effects inone of 49subjects (2%). Nevertheless, both RCTs still experienced significant recruitment andretention problems, which wereat 33% and59% onaverage, respectively.Newly acquired safety data on 919 more subjects suggests no increased risks of all malformations, vaginal bleeding, and neonatal complications. Investigating cranberry capsules' efficacy as a non-antibacterial option for UTI prevention in pregnant women has become a feasible and important direction with the current advancement in understanding cranberry supplements' actions, recommended doses plus regimens, and their safety in the population. We reviewed the challenges and discovered knowledge gaps and the implementation strategies for future studies.

ЭФФЕКТИВНОСТЬ ЭКЗОГЕННОЙ ПРОФИЛАКТИКИ КАРИЕСА ПРИ ПОМОЩИ ТРЕХКОМПОНЕНТНОГО КАЛЬЦИЙ-ФТОР-ФОСФАТ-СОДЕРЖАЩЕГО ГЕЛЯ У БЕРЕМЕННЫХ ЖЕНЩИН С РАЗЛИЧНЫМ УРОВНЕМ РЕЗИСТЕНТНОСТИ ЗУБНОЙ ЭМАЛИ

Subject. Dental prophylaxis in pregnant women is frequently ineffective, and the indicators to characterize the dental caries intensity, and its growth rate during pregnancy have been persisted at a fairly high level. The tooth tissues resistance degree to aggressive factors of the oral cavity may be considered to be the significant. The teeth resistance to caries is determined by morphological structure of the enamel. A three-component calcium-phosphate-fluorine-containing gel improves the quality characteristics of tooth enamel, which is confirmed by the data of the KOSRE-test (clinical determination of enamel remineralization rate) and the electrical conductivity of tooth enamel. The dynamic assessment of using the three-component calcium-phosphate-fluorine-containing gel effectiveness as a mean of preventing caries in pregnant women with different levels of tooth enamel resistance to demineralization processes has been quoted.&#x0D; Objectives. Evaluation of the effectiveness of caries prevention using the three-component calcium-phosphate-fluorine-containing gel in pregnant women with different levels of resistance.&#x0D; Methodology. Clinical examining and observing 126 pregnant women with different levels of resistance have been performed. As a means of caries prevention, the three-component calcium-phosphate-fluorine-containing gel with the ratio Ca:F:P = 2:1:1 was used.&#x0D; Results. After applying a three-component calcium-phosphate-fluorine-containing gel the tooth enamel electrical conductivity of women with different levels of resistance has significantly decreased in comparison with the initial values. According to the KPUP Index data any statistically significant increasing in new carious cavities hasn’t been noticed after a year after using the three-component calcium-phosphate-fluorine-containing gel. By the way a low degree of tooth enamel compliance to the acid influencing, and the statistically significant rate of artificial demineralization focus recovering have been noted after using the gel.&#x0D; Conclusion. The caries-prophylactic measures have been determined to have to be administered for pregnant women with taking into account the tooth resistance level, because the teeth enamel at pregnant women with different levels of resistance has dissimilar resistance to demineralization processes. &#x0D; The three-component calcium-phosphate-fluorine-containing gel prescribed by using application is considered to be the versatile mean of caries prevention for pregnant women with different levels of resistance that has been confirmed by improving the electrical conductivity of tooth enamel to be the indicator of its mineralization, the data of the KOSRE-test, and the values of the DMFT Index (sum of all surfaces of permanent and milk teeth affected by caries, filled and removed) in observation dynamics.

Staphylococcal Resistance Patterns, blaZ and SCCmec Cassette Genes in the Nasopharyngeal Microbiota of Pregnant Women.

Antimicrobial resistance in Staphylococcus spp. colonising the nasopharynx can create risk factors of therapeutic treatment failure or prophylaxis in pregnant women. Resistance is mostly encoded on plasmids (e.g., blaZ gene for penicillinase synthesis) or chromosomes (e.g., mecA and mecC for methicillin resistance). The mecA gene is part of the chromosomal mec gene cassette (SCCmec), which is also located on the plasmid. The disc diffusion method for the selected drugs (beta-lactams, fluoroquinolones, streptogramins, aminoglicosides, macrolides, oxasolidinones, tetracyclines and other groups) was used. PCR for blaZ, mecA and mecC genes and SCCmec cassette detection and typing were performed. S. aureus (54.4%) and S. epidermidis (27.9%) were the most prevalent and showed the highest diversity of resistance profiles. The blaZ, mecA and mecC genes were reported in 95.6%, 20.6% and 1.5% of isolates, respectively. The highest resistance was found to beta-lactams, commonly used during pregnancy. Resistance to a variety of antimicrobials, including benzylpenicillin resistance in blaZ-positive isolates, and the existence of a very high diversity of SCCmec cassette structures in all staphylococci selected from the nasopharyngeal microbiota of pregnant women were observed for the first time. Knowledge of the prevalence of antimicrobial-resistant staphylococci in the nasopharynx of pregnant women may be important for the appropriate treatment or prophylaxis of this group of patients.

219. A Randomized, Double-Masked, Placebo-Controlled Phase IIB Trial of Azithromycin and Trimethoprim-Sulfamethoxazole as Bacterial STI Prophylaxis in Pregnant Women with HIV

Abstract Background This phase IIB randomized clinical trial was designed to test the efficacy of a novel regimen to prevent bacterial sexually transmitted infections and malaria in pregnant women with HIV in Cameroon, where HIV prevalence in pregnancy is 5.7%. Here we present the analysis of STI rates. Methods Pregnant women in prenatal care with confirmed HIV, gestational age &amp;lt; 28 weeks and singleton pregnancies were randomized to monthly azithromycin (AZ) 1 gram daily for 3 days and daily trimethoprim-sulfamethoxazole (TMPS) or the standard regimen of daily TMPS with monthly placebo AZ. The main outcome of interest was the proportion of women with a composite STI measure: chlamydia, gonorrhea and/or incident syphilis at delivery. Nucleic acid amplification testing (NAAT) for CT/NG was performed on provider-collected vaginal swabs. Incident syphilis was defined serologically as a newly positive treponemal test or 4 fold increase in RPR/VDRL titer since baseline. The proportion was compared by relative risk with 95% confidence intervals and a significant p value set at &amp;lt; 0.05. Results A total of 308 women were enrolled at three hospital facilities between March 2018 and August 2020. In all, 155 women were randomized to the AZ/TMPS arm and 153 women to the TMPS arm. A total of 260 women (84%) had delivery samples collected. Both groups were similar with median age 32 years, maternal education (71% secondary school or university), HIV diagnosis 3 years prior, and 94% reported excellent adherence to antiretroviral therapy (ART). Median CD4 count was 473 cells/mm3 (IQR 326-663). At baseline, prevalence of chlamydia was 1.4%, gonorrhea 1.0% and syphilis 1.9%. There was no difference in the proportion of women with the composite STI measure (3.2% in the AZ/TMPS arm and 3.3% in the TMPS arm; RR 0.78 (95% CI 0.21 – 2.84); p=0.70). Adverse birth outcomes were lower in the AZ/TMPS arm, but not significantly (preterm delivery 5% vs 10.3% [p=0.1], low birthweight 2.8% vs 5.1% [p=0.34], composite adverse birth outcome 8.4% vs 13.1% [p=0.19]. Table 1:Baseline Characteristics of Study Participants (n=308)Table 2:Efficacy Outcomes at Delivery by Arm - Intention to Treat Analysis (n= 278) Conclusion The addition of monthly azithromycin to standard daily TMPS prophylaxis in pregnant women living with HIV in Cameroon did not reduce the rate of bacterial STI at delivery. Women reported excellent ART adherence and rates of STI, malaria, and adverse birth outcome were low. Disclosures Katia J. Bruxvoort, PhD, MPH, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support.

Listeriosis outbreak caused by contaminated stuffed pork, Andalusia, Spain, July to October 2019.

Between 1 July and 26 October 2019 in Andalusia, Spain, a large outbreak with 207 confirmed cases of listeriosis was identified. Confirmed cases had a median age of 44 years (range: 0-94) and 114 were women (55.1%). Most cases (n = 154) had mild gastroenteritis, 141 (68.1%) required hospitalisation and three died; five of 34 pregnant women had a miscarriage. The median incubation period was 1 day (range: 0-30), and was significantly shorter in cases presenting with gastroenteritis compared to those presenting without gastroenteritis (1 day vs. 3 days, respectively, p value < 0.001). Stuffed pork, a ready-to-eat product consumed unheated, from a single producer contaminated with Listeria monocytogenes ST388 was identified as the source of infection. The outbreak strain was identified in 189 human samples and 87 non-human (82 food and 5 environmental) samples. Notification of new cases declined abruptly after control measures were implemented. These included contaminated food recall, protocols for clinical management of suspected cases and for post-exposure prophylaxis in pregnant women and communication campaigns with concise messages to the population through social media. Given that there were 3,059 probable cases, this was the largest L. monocytogenes outbreak ever reported in Europe.

Adherence to recommendations for preventing early neonatal sepsis associated with Streptococcus agalactiae colonization in a referral center in Bogotá, Colombia, 2019

To assess adherence to screening recommendations for the prevention of neonatal sepsis, and describe the prevalence of colonization by Group B streptococcus (GBS) as well as the perinatal outcomes associated with colonization by this bacterium. Retrospective cohort study that included pregnant women at term and their newborns, seen at a private high-complexity clinic in Bogota, between July 1 and December 31, 2019. Adherence to screening and intrapartum antibiotic prophylaxis in pregnant women colonized with group B streptococcus, as well as the prevalence of colonization and early adverse perinatal outcomes were assessed. Overall, 1928 women were included. Adherence to screening was 68.0 % (95 % CI: 66-70.1) and 87.9 % to intrapartum antibiotic administration (95 % CI: 87.8-88); non-indicated use of antibiotics occurred in 14.7 % of the women, for 86.3 % final adherence to antibiotic prophylaxis. The prevalence of GBS colonization was 12.5 % (95 % CI: 10.7-14.3); the incidence of neonatal hospitalization was 27.5 % (95 % CI: 16.3-33.7). There were no cases of mortality or early neonatal sepsis attributable to screening status, colonization or prophylactic antibiotics for GBS. Additional studies in other centers are required in order to determine adherence to this guideline, particularly in those that receive users affiliated to the subsidized regime which covers the most vulnerable population. Also, new population studies of GBS prevalence and cost-effectiveness of universal screening compared to risk factor-based antibiotic prophylaxis are needed.

Effectiveness of oral aciclovir in preventing maternal chickenpox: A comparison with VZIG

ObjectivesAlthough often presenting as a self-limiting childhood disease, chickenpox can have serious consequences if acquired in pregnancy. Until April 2022, the UK recommendations were that varicella immunoglobulin (VZIG) should be administered intramuscularly to susceptible pregnant women exposed to chickenpox prior to 20 weeks gestation. Oral aciclovir or VZIG was recommended if exposure occurred at 20+ weeks gestation. Our objective was to compare the effectiveness of oral aciclovir to VZIG in preventing maternal and neonatal chickenpox. MethodsWe identified and followed up 186 pregnant women who were exposed to chickenpox and compared their outcomes. Results: 171/186 (91.9%) of these women received either VZIG or oral aciclovir. Of the 145 women who received VZIG, 53/145 (36.6%) went on to develop chickenpox compared to 8 of the 26 (30.8%) women who received oral aciclovir (p = 0.32). No statistical difference was found between the oral aciclovir and VZIG groups even after controlling for maternal age, gestational stage, type of exposure and IgG titre (adjusted OR:0.83; 95%CI:0.26–2.65; p = 0.75). ConclusionsThese findings support the use of oral aciclovir as first-line prophylaxis in pregnant women exposed to varicella as they suggest its effectiveness at preventing maternal chickenpox is either better or equal to VZIG.

Improving Intrapartum Group B Streptococcus Prophylaxis in Patients with a Reported Penicillin or Cephalosporin Allergy: A Quality Improvement Project

ObjectiveTo evaluate the impact of a standardized allergy-guided approach to Group B Streptococcus (GBS) prophylaxis in pregnant women with reported penicillin or cephalosporin allergy. MethodsThis interrupted time-series analysis included obstetric patients requiring GBS prophylaxis who reported penicillin or cephalosporin allergies. Patients were divided into baseline (April 1, 2019 to July 21, 2020) and intervention (July 22, 2020 to July 31, 2021) groups. The primary outcome was prophylaxis appropriateness, based on antibiotic type, nature of reaction, and cross-reactivity risk. Secondary outcomes included type of prophylaxis received and antibiotic-related adverse events. ResultsThe study included 88 patients in the baseline period and 52 patients in the intervention period. Appropriate prophylaxis increased from 47% (41/88) to 85% (44/52), with the segmented regression model confirming a statistically significant increase over time (incidence rate ratio 1.57; 95% CI 1.02–2.43, P = 0.04, slope coefficient 1.06/month; 95% CI 1.01–1.10, P = 0.01). Penicillin and cefazolin use increased from 61% (54/88) to 87% (45/52) in the intervention period (P = 0.002), and no hypersensitivity reactions occurred during this period. ConclusionsImplementation of standardized allergy-guided prophylaxis safely improved appropriate β-lactam antibiotic use in obstetric patients requiring GBS prophylaxis who reported penicillin and cephalosporin allergies.

Iodine deficiency in pregnant women and newborns in the Saratov region: current state of the problem

Introduction. Iodine deficiency remains an urgent challenge for the Russian Federation. Pregnant women should receive prophylactic potassium iodide supplements at a dose of 200–250 mcg per day. To monitor the severity of iodine deficiency in the regions and the efficacy of prenatal iodine prophylaxis, it is prudent to use the neonatal hyperthyrotropinemia rate for newborns (thyroidstimulating hormone level is higher than 5 μIU/L) based on the results of congenital hypothyroidism screening.Objective. To assess the changes in the severity of iodine deficiency and the efficacy of iodine prophylaxis in pregnant women and newborns in the Saratov region based on the incidence of neonatal hyperthyrotropinemia over the past 25 years.Materials and methods. The incidence of neonatal hyperthyrotropinemia in newborns in the Saratov region for the period of 1996–2000 and 2015–2020 was analysed. In total, 229,625 children were examined.Results and discussion. In 1996–2000, neonatal hyperthyrotropinemia was detected in 37.4% of newborns, which was evidence of the presence of moderate iodine deficiency in the region. In 2015–2020, the incidence of neonatal hyperthyrotropinemia decreased by 5.42 times to 6.9% (p &lt; 0.0001) against the background of group iodine prophylaxis in pregnant women, but remained higher than the World Health Organization targets for iodine-rich regions (&lt;3%) suggesting the preservation of mild iodine deficiency in pregnant women and newborns in the Saratov region.Conclusions. Despite the obligatory doctor’s prescription of prenatal group iodine prophylaxis, there is still iodine insufficiency in pregnant women and newborns in the Saratov region, which requires further improvement of the regional iodine deficiency eradication action system in the risk groups. However, significant advances in the fight against iodine deficiency in the nutrition of the Russian population can only be achieved after the adoption of the federal law on universal salt iodization.

Iron profile of pregnant sickle cell anemia patients in Odisha, India

IntroductionDuring pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. MethodsTwenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer's protocol. The complete blood count was performed. The unpaired ‘t-test’ was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. Main ResultsThe studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. ConclusionThe current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy.

The importance of thrombo prophylaxis in pregnant women with Covid-19

The importance of thrombo prophylaxis in pregnant women with Covid-19

Avoidance of iodine deficiency/excess during pregnancy in Hashimoto's thyroiditis.

Hashimoto's thyroiditis is a common disease that also affects pregnant women. We analyzed to what extent the inflammatory process of Hashimoto's thyroiditis changes with iodine prophylaxis in pregnant women. The target for immunologic activity was levels of thyroid antibodies (TPO). The data were collected retrospectively from 20consecutive, pregnant patients who had been diagnosed with Hashimoto's thyroiditis between 01.12.2012 and 01.12.2014 and had received iodine supplementation with 100 µg (n = 1) or 150 µg (n = 19). At least two measurements of TPO antibody levels taken during pregnancy and one after pregnancy were evaluated for each patient in the study group. At the end of pregnancy, the average TPO antibody level for the 20 patients studied was 137 IU/ml (+/-214 IU/ml), the lowest being 16 IU/ml and the highest 1000 IU/ml. Despite iodine prophylaxis, levels of TPO antibodies decreased in 18 patients during pregnancy, falling below the reference value of 35 IU/ml in 5 cases. However, in one patient TPO antibodies increased from 60 IU/ml to 237 IU/ml during pregnancy while in another, levels remained constant at 1000 IU/ml. Iodine prophylaxis in pregnant women, taken at a dose of 100 or 150 μg daily was shown to have no negative systemic effects on Hashimoto's thyroiditis in a group of pregnant women with increased TPO levels, and can therefore be recommended for expectant mothers, including those with this disease.

CONDITION OF BONE TISSUE IN PREGNANT WOMEN WITH DISEASES OF THE CARDIOVASCULAR SYSTEM ON THE BACKGROUND OF ANTICOAGULANT PREVENTION

The article presents data on the development of side effects from anticoagulant prophylaxis in pregnant women with diseases of the cardiovascular system. In particular, the anticoagulant effects on the skeletal system. Were studied the features of sonographic examination in this category of patients. The level of the main biomarkers of osteosynthesis and osteoresorption during pregnancy was studied. Were analyzed the influence of anticoagulants on the level of biomarkers of bone metabolism. Has been studied the relationship between densitometry data and calcitonin levels in pregnant women. The main aspects of the formation of osteopenic syndrome and osteoporosis in pregnant women with heart disease are considered. Has been studied the relationship between the clinical manifestations of osteopenic syndrome and the level of biomarkers of bone metabolism. Proposed the drug correction of the development of side effects due to anticoagulant thromboprophylaxis.

LABORATORY CONTROL OF ANTICOAGULANT PROPHYLAXIS IN PREGNANT WOMEN WITH CARDIOVASCULAR DISEASES

This article examines the effect of anticoagulant prophylaxis on pregnancy, childbirth and the postpartum period in women with heart disease. Тhe main mechanisms of formation of side effects from anticoagulant prophylaxis in pregnant women with diseases of the cardiovascular system were studied by means of laboratory research methods,. Have been studied the effects and interaction of different types of anticoagulant prophylaxis and aspirin prophylaxis on primary hemostasis. An algorithm for diagnosing the negative effect of anticoagulants on platelets has been developed. The study examines the possibility of drug correction of the development of side effects from anticoagulant thromboprophylaxis for women with diseases of the cardiovascular system.

Is there Evidence for Vitamin K Prophylaxis in Pregnant Women taking Anticonvulsant Drugs?

Purpose: The objective of this study was to examine the need of vitamin K prophylaxis in women with epilepsy (WWE) taking anticonvulsant drugs (AED) during pregnancy to prevent neonatal bleeding. Patients and methods: The study population (n=1037) consisted of two study groups: i) the epilepsy group including all neonates of WWE (n=51) taking AED of the Innsbruck EURAP register. Twenty-four of the 51 were taking enzyme-inducing AED (EIAED). ii) the control group of 986 newborns not exposed to AED. Results: The two study groups did not differ regarding hemorrhagic complications in newborns. None of the newborns of WWE taking AED showed neonatal bleeding. Hemorrhagic complications were more prevalent in newborns with low birth weight (p<0.01) and in multiple birth (p=0.02). Conclusion: Neonates exposed to AED, enzyme-inducing and non-enzyme-inducing, were not at a higher risk for hemorrhagic complications compared to unexposed newborns. Birth-weight and multiple birth - not AED - should be considered as risk factors of neonatal bleeding.

COVID-19 and pregnancy: Narrative review on current status and clinical evidence for prophylaxis in pregnant women

COVID-19 and pregnancy: Narrative review on current status and clinical evidence for prophylaxis in pregnant women

Awareness of oral health prophylaxis in pregnant women.

I n t r o d u c t i o n: During pregnancy, changes in the oral cavity occur due to fluctuations in hormone levels and changes in eating habits and hygiene. O b j e c t i v e s: To evaluate pregnant women's awareness of oral health prophylaxis. Material and Methods: An anonymous questionnaire was completed by 341 pregnant women from Malopolskie Voivodeship. The statistical analysis was carried out in the R program (v. 3.4.3); a p-value <0.05 was considered significant. R e s u l t s: Over half of the respondents did not receive oral hygiene instruction and did not take part in any prophylactic program. The main sources of oral health knowledge were the internet (66.3%), dentist (43.1%) and gynaecologist (17.9%). Respondents willingly followed the advice of healthcare workers. Approximately 32% of the surveyed women were aware of the most appropriate period for dental treatment (second trimester). Over half of the women admitted that they would receive dental care more often if more procedures were reimbursed. Approximately 71% of the women were aware of the increased susceptibility to tooth decay during pregnancy. The relationship between the presence of caries in parents and that in children was known by 42.1% of respondents, but 45% admitted they did not know how to take care of their child's teeth properly. C o n c l u s i o n s: Women with a higher education level had better knowledge in the area of oral health. However, most of the respondents need to increase their knowledge in this area. Prophylactic programs should be broadly propagated, and healthcare workers should deliver essential information in daily practice.