Related Drug Treatments Research Articles

Metabolic stress and inflammatory response in high-yielding, periparturient dairy cows

Increased disease rates are commonly reported among high-yielding dairy cows in the transition period, extending from 3weeks before to 3weeks after calving, and characterized by the occurrence of an inflammatory response in terms of both positive and negative acute phase proteins (APP+ and APP−). To determine the above inflammatory response, the authors had developed the Liver Functionality Index (LFI), which defines the above condition on the basis of some APP− responses (albumin, cholesterol sensu stricto+bilirubin) during the first month of lactation. In this respect, low LFI values are associated to a high inflammatory response and vice versa. The relationship between LFI and inflammatory cytokine response was investigated from day −28 to day +28 with respect to calving in 12 periparturient dairy cows showing the six highest and six lowest LFI values within a cohort of 54 high-yielding dairy cows. The hypothesis being tested was that LFI and APP− on the whole could be used as readout of successful vs. non-successful adaptation to the transition period, with a strong association to disease occurrence. In fact, low LFI cows experienced many more disease cases (13 vs. 3 in high LFI Group) and related drug treatments till day +28. Interleukin-6 (IL-6) serum concentrations were always higher in low LFI cows (P<0.05 on day +28). The greater IL-6 levels were correlated with higher ceruloplasmin (APP+) and lower lysozyme serum concentrations (P<0.05 and <0.1, respectively). This latter finding was correlated with a clear role in vitro of lysozyme in a dose-dependent modulation of the inflammatory response of swine intestinal epithelial cells and bovine peripheral blood mononuclear cells. Hematological examinations showed no significant differences between the two groups under study. On the whole, our results indicate that LFI and LFI-related parameters could be used to identify cows at risk in the transition period toward an improved farm management. Also, our study indicates that disease cases in periparturient, high-yielding dairy cows are correlated with signs of accentuated IL-6 response and other markers of inflammatory phenomena. These likely start in the late lactation period or around dry-off, as suggested by our prepartal data, and proceed at much greater levels after calving.

Peptic ulcer disease with related drug treatment in pregnant women and congenital abnormalities in their offspring

Peptic ulcer disease (PUD) is a common disease which can also occur in pregnant women. However, the possible association of PUD and related drug treatments in pregnant women with the risk of structural birth defects (i.e. congenital abnormalities [CA]) in their offspring has not been estimated in controlled population-based epidemiological studies. Thus, the prevalence of PUD in pregnant women who later delivered babies (cases) with different CA and in pregnant women who delivered newborns without CA (controls) was compared in the Hungarian Case-Control Surveillance of Congenital Abnormalities. Controls were matched to cases. Of 22,843 cases with congenital abnormalities, 182 (0.80%) had mothers with reported/recorded PUD, while of 38,151 controls, 261 (0.68%) were born to mothers with reported/recorded PUD. However, PUD(?) based on maternal information and/or unspecified diagnostic criteria, and PUD(!) based on endoscopic diagnosis showed different variables of mothers and newborn infants. Thus, finally, 20 case mothers and 58 control mothers with PUD(!) and related drugs were evaluated in detail. There was no higher risk for total CA group in the offspring of mothers with PUD during pregnancy (adjusted OR with 95% CI: 0.6, 0.3-0.9). Specific CA groups in cases were also assessed versus controls, but specified CA had no higher risk in the offspring of pregnant women with PUD and related drug treatments. In conclusion, a higher rate of CA was not found in the offspring of mothers with PUD.

Chronic hypertension with related drug treatment of pregnant women and congenital abnormalities in their offspring: a population-based study

Chronic hypertension (CH) is a common chronic disease and occurs frequently in pregnant women. The teratogenic/fetotoxic effect of certain antihypertensive drugs has been shown. The objective of this study was to investigate the association between pregnant women with CH and the possible risk of congenital abnormalities (CAs) among their offspring. The prevalence of medically recorded CH in the prenatal maternity logbook was compared between 1030 pregnant women who later had offspring with CA (case group) and 1579 pregnant women with CH who later delivered newborn infants without CA (control group). Control newborn infants were matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities during 1980-1996. Of 23 different CA groups with informative offspring, esophageal atresia/stenosis was a greater risk in pregnant women with CH (adjusted odds ratios with 95% confidence intervals: 3.1, 1.4-6.8). In conclusion, a higher risk of esophageal atresia/stenosis was found in the offspring of pregnant women with severe CH, which could not be explained by related drug treatments. This finding requires confirmation or lack thereof by future studies.

No association between severe constipation with related drug treatment in pregnant women and congenital abnormalities in their offspring: A population‐based case‐control study

Constipation is a common pathological condition in pregnant women; nevertheless, its possible association with structural birth defects (i.e. congenital abnormalities [CA]) in their offspring has not been studied in controlled epidemiological studies. We evaluated the possible association between severe constipation with laxative treatment in pregnant women and congenital abnormalities in their offspring. The dataset of the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA) 1980-1996 contained 22 843 cases with CA and 38 151 matched controls without CA. Only pregnant women with prospectively and medically recorded constipation were included in the study and 13 CA groups were compared in cases and all their matched controls. A total of 78 (0.34%) cases had mothers with severe constipation and treatment during pregnancy compared to 144 (0.38%) controls (adjusted OR with 95% CI = 1.0, 0.7-1.3). Specified groups of CA were also assessed versus controls, but a higher occurrence of pregnant women with severe constipation and related treatment was not found in any CA group. Among laxative drugs, senna has no teratogenic potential; thus, if severe constipation requires laxative drug treatment in pregnant women, senna is not contraindicated. A higher rate of CA was not found in the offspring of pregnant women with severe constipation and related senna treatment.

The efficacy of antihypertensive treatment in pregnant women with chronic and gestational hypertension: a population-based study

The efficacy of antihypertensive treatment was investigated in pregnant women with chronic hypertension (CH) or gestational hypertension (GH) on the basis of the occurrence of pregnancy complications and adverse birth outcomes. Medically recorded pregnancy complications and birth outcomes of 1579 pregnant women with CH and 1098 pregnant women with GH were compared to 34,633 pregnant women without CH, GH, preeclampsia-eclampsia or any secondary hypertension who delivered newborn infants without defects in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 1579 (4.1%) pregnant women with CH, 1522 (96.4%) were treated with antihypertensive drugs. Of 1098 (2.9%) pregnant women with GH, 657 (59.8%) were treated. Pregnant women with treated CH had a higher risk of threatened abortion, preterm delivery, and placental disorders, in addition to low-birthweight newborns. However, pregnant women with untreated CH and GH had no higher risk of pregnancy complications or adverse pregnancy outcomes. Antihypertensive treatments were not able to neutralize the harm of severe CH in pregnant women, the antihypertensive treatments were not appropriate and/or effective, or related drug treatments may contribute to these adverse effects.

A possible association between maternal dyspepsia and congenital rectal/anal atresia/stenosis in their children: a population‐based case–control study

To study the possible association of common dyspepsia including heartburn and gastro-esophageal reflux disease and its related drug treatments in pregnant women with congenital anomalies (CAs) in their offspring. Comparison of cases affected with different CAs and matched controls without defects in a ratio of 1:2 born to mothers affected with severe chronic dyspepsia in early pregnancy. Hungarian Case-Control Surveillance System of Congenital Abnormalities. CAs were evaluated in informative offspring: live-born infants, stillborn fetuses, and malformed fetuses after prenatal diagnosis followed by elective termination of pregnancy in the population-based Hungarian material. Prospectively and medically recorded severe chronic dyspepsia recorded in the prenatal maternity logbook was compared among women who later delivered babies with different CAs (cases) and matched women who delivered newborns without any defect (controls). Different CAs, gestational age and birthweight, rates of preterm birth, and low birthweight newborns. Of 22,843 cases with CAs, 148 (0.65%) had mothers with severe chronic dyspepsia, compared to 214 (0.56%) of 38,151 controls (adjusted OR with 95% CI = 1.2, 0.9-1.4). Specific groups of CAs assessed vs. controls showed that only isolated rectal/anal atresia/stenosis was associated with a higher risk of severe maternal dyspepsia in early pregnancy (adjusted OR with 95% CI: 4.3, 1.7-10.5). Severe chronic dyspepsia in early pregnancy and drug treatment for this was not associated with a higher risk of CAs, except possibly isolated rectal/anal atresia/stenosis.

No association between vulvovaginitis-bacterial vaginosis, related drug treatments of pregnant women, and congenital abnormalities in their offspring — A population-based case-control study

Abstract The possible association between prospectively and medically recorded vulvovaginitis-bacterial vaginosis (VV-BV) and different congenital abnormalities (CA) has not been studied. The data set of the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996 were evaluated, i.e. 22,843 pregnant women who had newborns or fetuses with congenital abnormality (cases) and 38,151 pregnant women who delivered newborn babies without any congenital abnormality (controls). The main outcome measures were different congenital abnormalities. Of 22,843 cases with CA, 1,536 (6.7%) had mothers with VV-BV, while of 38,151 matched controls without CA, 2,698 (7.1%) had mothers with VV-BV in the second and/or third gestational month of pregnancy. Nearly all pregnant women with VV-BV were treated during pregnancy, but a higher risk for the total group of CAs (adjusted POR with 95% CI: 0.95, 0.89–1.02) or any CA group was not found. In addition, the risk for total CAs was significantly lower in cases born to mothers with VV-BV and appropriate treatment than born to mothers with VV-BV but without treatment. Thus maternal VV-BV needs treatment during pregnancy as well, because it helps reduce the rate of preterm birth without a risk for CAs.

Prevalence of Risk Determinants for Metformin-associated Lactic Acidosis and Metformin Utilization in the Study of Health in Pomerania

Risk determinants for the life threatening complication of metformin-associated lactic acidosis are frequently disregarded. Our first aim was to investigate the prevalence of risk determinants in subjects with type 2 diabetes mellitus (DM2) taking metformin compared to subjects with nonmetformin treatment. Our second aim was to estimate the proportion of subjects with alternative drug-treatment, and no risk determinants, which would probably benefit from metformin. The Study of Health in Pomerania is a population-based health survey including 322 DM2 subjects. Risk determinants were assessed by personal interview, ultrasound, and laboratory analysis. Among the subjects with DM2 n=92 (28.6%) were treated with metformin, n=162 (50.3%) with alternative medication, and n=68 (21.1%) with diet. The prevalence of at least one risk determinant was 65% [corrected] for metformin-users. There was no difference in number and type of risk determinants. Heart failure, angina pectoris, and liver disorders presented the most frequent risk determinants. Current risk determinants for metformin-associated lactic acidosis are largely disregarded. Improved selection of patients can result in safe metformin utilization in one quarter of subjects on DM2 related drug treatment. Risk determinants need to be revised. A more practical definition of risk determinants would improve prescription adherence.

Maternal Urinary Tract Infection and Related Drug Treatments during Pregnancy and Risk of Congenital Abnormalities in the Offspring

Obstetric Anesthesia Digest: September 2007 - Volume 27 - Issue 3 - p 143-144 doi: 10.1097/01.aoa.0000288276.36048.03

Pregnancy complications and birth outcomes of pregnant women with urinary tract infections and related drug treatments

Maternal urinary tract infections in pregnancy showed an association with a higher rate of preterm birth in previous studies. The aim of this study was to check this relationship, and in addition to evaluate the efficacy of recent medical treatments. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was evaluated. Of 38,151 newborn infants, 2188 (5.7%) had mothers with urinary tract infections during pregnancy, and 90% of these maternal diseases were prospectively and medically recorded. The prevalence of pre-eclampsia and polyhydramnios showed an association with urinary tract infections during pregnancy. Pregnant women with urinary tract infections in pregnancy had a somewhat shorter gestational age (0.1 week) and a higher proportion of preterm births (10.4% vs 9.1%). These differences were correlated with the severity of urinary tract infections. However, the preterm-inducing effect of maternal urinary tract infections is preventable by some antimicrobial drugs such as ampicillin, cefalexin and cotrimoxazole. In conclusion, maternal urinary tract infections during pregnancy increase pre-eclampsia and polyhydramnios, and in addition the rate of preterm birth; however, the latter is preventable by appropriate drug treatments.

Maternal urinary tract infection and related drug treatments during pregnancy and risk of congenital abnormalities in the offspring

The association between urinary tract infection (UTI) of pregnant women and preterm birth/low birthweight is known, but the possible association between UTI and congenital abnormalities (CAs) was evaluated rarely. Only one study showed an association with atrial septal defect, thus we decided to check this possible association. The population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA); most maternal UTIs were based on medically recorded data. SETTING The HCCSCA, 1980-1996, contained 22 843 newborns or fetuses with CAs and 38 151 matched controls, i.e. newborn infants without any HCAs. Hungarian informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Case-control pair analysis. Twenty-five CA groups. A total of 1542 (6.75%) mothers in the case group had UTI during entire pregnancy compared with 2188 (5.74%) mothers in the control group (adjusted prevalence odds ratios [POR] with 95% CI: 1.15, 1.06-1.24). We did not find a higher prevalence of UTI during the second and/or third months of pregnancy in total case group (adjusted POR with 95% CI: 1.1, 0.9-1.2) and in any group of CAs including atrial septal defect type II. No evidence for the teratogenic effect of maternal UTI and related drug treatments during early pregnancy.

Maternal kidney stones during pregnancy and adverse birth outcomes, particularly congenital abnormalities in the offspring

The possible adverse birth outcomes, particularly congenital abnormalities (CAs) in pregnant women with kidney stones (KS) previously have not been evaluated; therefore, we decided to study this possible association. The population-based data set of the Hungarian Case-Control Surveillance of CAs, 1980-1996, was used for this analysis. Of 22,843 newborns or fetuses with CAs, 69 (0.30%) had mothers with KS during pregnancy. Of 38,151 matched control newborns without any abnormalities, 147 (0.39%) had KS during pregnancy. KS were associated with an adjusted prevalence odds ratio (POR) with 95% CI of 0.8, 0.6-1.0 for CAs. A higher prevalence of maternal KS during the first trimester of pregnancy was not found in any CA group. There was no higher rate of preterm birth and low birthweight in the newborns of pregnant women with KS. There is no higher risk for adverse birth outcomes particularly CAs in the offspring of mothers with KS and related drug treatments during pregnancy.

Pregnancy complications and delivery outcomes in pregnant women with severe migraine

Objective The objective was to study the possible association among maternal migraine during pregnancy, pregnancy complications, and the delivery outcomes: sex ratio, gestational age/birth weight and preterm birth/low birth weight. Study design The population-based large data set of newborn infants without any defects of the Hungarian Case–Control Surveillance System of Congenital Abnormalities, 1980–1996 was analyzed. Results Out of 38,151 newborn infants, 713 (1.9%) had mothers who had severe migraine during pregnancy; 68% were medically recorded. Pregnant women with severe migraine had a higher prevalence of preeclampsia and severe nausea/vomiting, but a lower occurrence of threatened abortion and preterm delivery. However, mean gestational age and birth weight, as well as the proportion of low birth weight and preterm births, were similar in newborn infants born to mothers with or without migraine. Conclusion Severe maternal migraine and its related drug treatment may increase the occurrence of preeclampsia and severe nausea/vomiting during pregnancy, but is not associated with unfavorable delivery outcomes.

Acute respiratory infections during pregnancy and congenital abnormalities: a population‐based case‐control study

Diseases of respiratory system caused by acute infections are among the most common maternal diseases during pregnancy. The objective of the study was to estimate the association between congenital abnormalities and acute respiratory infections during the first trimester of pregnancy. The data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities including 22 843 cases with congenital abnormalities, 38 151 population controls without congenital abnormalities and 834 malformed controls with Down syndrome between 1980 and 1996 was evaluated. 2118 cases with congenital abnormalities (9.3%), 3455 population controls (9.1%) and 92 malformed controls with Down syndrome (11.0%) had mothers with acute respiratory infections. Of 25 different congenital abnormality groups, esophageal atresia/stenosis showed a high adjusted prevalence odds ratios (POR) with 95% confidence interval (CI) for acute respiratory infections during the first trimester of pregnancy in case mothers compared with population controls (3.6, 1.4-9.1) and malformed controls (1.9, 1.0-3.5), respectively. In addition there was an association between medically recorded acute respiratory infections during the first trimester of pregnancy and a higher risk for some other congenital abnormalities, such as posterior cleft palate and multiple congenital abnormalities. In conclusion a possible association between some congenital abnormalities, particularly esophageal atresia/stenosis and maternal acute respiratory infections cannot be excluded due to the interactions of the microbial agents, related drug treatments and last but not least the indirect effect of maternal diseases, such as fever-hyperthermia, hypoxia and dietary deficiency. However, periconceptional multivitamin/folic acid supplementation during the early pregnancy was able to reduce the acute respiratory infection related risk for congenital abnormalities.

Use of a cross-sectional survey to estimate outcome of health care: The example of anxiety and depression

Our study proposes that a population-based cross-sectional survey can be used to estimate the outcome of health care by linking general practice morbidity records to the survey. Using the example of anxiety and depression to test this idea, we conducted a survey of an adult population registered with one general practice in the UK. The Hospital Anxiety and Depression (HAD) questionnaire was used to identify cases and controls. After mailing to a randomly selected adult population of 4002, there was an adjusted response rate of 66% ( n = 2,606), with 416 (16%) high-score cases, 506 (19%) medium-score cases, and 1684 (65%) low-score controls. All cases were compared with a sample of controls ( n = 450). In the 12 months before the survey, the high-score case group had experienced significantly higher GP contacts ( n = 377 [91%] versus 354 [79%]), diagnoses for anxiety or depression (119 [29%] versus 21 [5%]), and related drug treatments (111 [27%] versus 22 [5%]) compared with the control sample. Most of the diagnoses and drug treatments had been initiated at least 9 months before the survey. The linkage between the survey and the clinical records suggested that the health outcome of previously identified anxious and depressed patients was poor, with an estimated two-thirds who will not have fully recovered within an average of 9 months. This study demonstrates the potential for using cross-sectional population surveys to estimate not only the need for health care but also the outcome of health care.