Risk Of Subsequent Pregnancy Research Articles

Marine fish peptides (collagen peptides) compound intake promotes wound healing in rats after cesarean section.

BackgroundWound complications are a major source of morbidity after cesarean section (CS) and contribute to increased risks in subsequent pregnancies. In the present study, we aim to investigate the wound healing potential of a kind of oligopeptide compound, mainly derived from the marine fish peptides (MFPs), in rats after CS by biomechanical, biochemical, and histological methods.MethodsEighty-four pregnant Sprague–Dawleyrats were randomly assigned to four groups, namely the control group and 1.1, 2.2, and 4.4 mg/kg MFP groups, respectively. The MFPs or normal saline of the equal volume was intragastrically administered every morning on the second day after CS. On days 5, 10, and 15 after the surgery, seven rats from each group were randomly selected. The samples of skin wound and uterus were harvested and then used for the following experiments and analyses.ResultsUsing the CS rat model, this study demonstrated that in the MFP groups, the skin tensile strength, uterine bursting pressure, and hydroxyproline (Hyp) were significantly higher than those in the control group at all three time points (P < 0.05). The formation of collagen and smooth muscle fibers and the expression of CD34 and connective tissue growth factor at the incision site were increasingly observed in the MFP groups (P < 0.05).ConclusionsMFPs have a great potential to accelerate the process and quality of wound healing in rats after CS.

26-Year-Old Woman With Shortness of Breath and Chest Pain

26-Year-Old Woman With Shortness of Breath and Chest Pain

Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia.

Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.

Communicating with African-American Women Who Have Had a Preterm Birth About Risks for Future Preterm Births

PurposeAfrican-American women are at higher risk of preterm birth (PTB) compared with other racial/ethnic groups in the USA. The primary objective was to evaluate the level of understanding among a group of African-American women concerning risks of PTB in future pregnancies. Secondary objectives were to evaluate how some women obtain information about PTB and to identify ways to raise their awareness.MethodsSix focus groups were conducted in three locations in the USA during 2016 with women (N = 60) who had experienced ≥ 1 PTB (< 37 weeks of gestation) during the last 5 years. The population was geographically, economically, and educationally diverse.ResultsWe observed a tendency to normalize PTB. Knowledge about potential complications for the infant was lacking and birth weight was prioritized over gestational age as an indicator of PTB. Participants were largely unaware of factors associated with increased PTB risk, such as a previous PTB and race/ethnicity. The most trusted information source was the obstetrical care provider, although participants reported relying on mobile apps, websites, and chat rooms. The optimal time to receive information about PTB risk in subsequent pregnancies was identified as the postpartum visit in the provider’s office.ConclusionsAwareness of the risks of recurrent PTB was limited in this diverse population. Educational programs on the late-stage development of neonates may strengthen knowledge on the relationship between gestational age and PTB and associated health/developmental implications. For educational efforts to be successful, a strong nonjudgmental, positive, solutions-oriented message focused on PTB risk factors is crucial.

1071: Parental somato-gonadal mosaicism is a source of recurrence risk for de novo disorders: A meta-analysis

Mosaic genetic variations, mutations arising during cell divisions post fertilization, are not found uniformly throughout the body. When occurring in germ cell progenitors, these may pass to offspring in a non-mosaic state causing apparent de novo mutations. Gonadal mosaicism leads to recurrence risk in subsequent pregnancies and some parental health concerns associate with low-level mosaic pathogenic variants. We sought to determine the spectrum of parental somato-gonadal mosaic variants (PSGMVs) reported in the literature. A systematic literature search using Pubmed, Medline, Pubmed Central, and Scopus was performed to identify primary reports of germline transmission of PSGMVs. Manual review permitted tabulation of variant information. To date, we reviewed 243 articles reporting 303 distinct cases. PSGMVs has been reported in broad groups of disorders including connective tissue, cancer predisposition, metabolic, and neurologic disorders. Fathers (135/256; 53%) and mothers (121/256; 47%) have equivalently been reported as the parent of origin for PSGMVs. The percent mosaicism of PSGMVs spans from less than 1% to greater than 60% with 80 of 168 (43%) cases with PSGMVs identified in parents falling in the 10% to 30% range. PSGMVs were detected in parental blood in 263/285 (92%) cases, other somatic tissues (e.g. fibroblasts, hair roots, tumors) in 13/285 (4.5%), and solely in germ cells in 9/285 (3.1%). In 41/303 (13.5%) cases, transmitting parents had features attributable to the variant including intellectual differences, seizures, dysmorphisms, or cancer. In 24/303 (8%) cases, prenatal genetic testing was applied in subsequent pregnancies. While parents of a child with apparent de novo mutation should consider targeted testing prenatally in subsequent pregnancies, few cases have been reported. Clinical screening tests for PSGMVs could affect recurrence risk and genetic counseling. This is extremely valuable for couples considering future pregnancies when a prior child was affected by an apparent de novo mutation.

Sirenomelia: Study of Three Cases

AbstractSirenomelia is a rare congenital anomaly which is an extreme example of caudal regression syndrome characterized by lower limb fusion, sacral and pelvic bony anomalies with abnormalities in other organ systems, commonly affecting the gastrointestinal and the urogenital systems (Kanagagiri et al. JMSCR 5(7), 2017). It is a sporadic occurence with no increased risk in subsequent pregnancies. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation (Mirzapur et al. Glob J Reprod Med 3(5):555624, 2018). Prenatal sonographic findings of sirenomelia (or mermaid fetus) were retrospectively reviewed in three proven cases.

Sirenomelia, the Mermaid syndrome: a case report

Sirenomelia, also known as mermaid syndrome, is a rare congenital anomaly characterized by a single lower extremity which is associated with abnormalities in other organ systems, commonly affecting the gastrointestinal and the urogenital systems. It is sporadic with no increased risk in subsequent pregnancies. In almost all the cases of sirenomelia, a single umbilical artery (SUA) is present which arises from the abdominal aorta. The exact etiology of sirenomelia is unknown. Sirenomelia can be confidently diagnosed in the 1st trimester while the diagnosis in the 2nd and 3rd trimesters is difficult due to the lack of amniotic fluid in the later gestation. Antenatal diagnosis of this universally lethal condition is desirable so that possible termination of pregnancy can be offered at the earliest.

Effects of Women’s Weight Changes on Adverse Outcomes in a Second Pregnancy

ObjectiveTo estimate the effects of women’s weight changes in four sequential perinatal periods across first and second pregnancies (pregravid, first gestation, interpregnancy, second gestation) on adverse maternal and neonatal outcomes in the second pregnancy while accounting for interdependencies in weight across the four periods (Aim 1) and to test the influence of the sequential path of weight changes through the four perinatal periods of risk on maternal and neonatal outcomes in the second pregnancy (Aim 2). DesignSecondary data analysis. SettingThirty-one Wisconsin hospitals. SampleWomen with 24,795 linked records from first and second births from 2006 through 2013. MethodsWe used a fully recursive system of linear and logistic regression equations to examine the relationships among weight changes in the four perinatal periods with maternal (gestational diabetes mellitus, gestational hypertension, cesarean birth) and neonatal (macrosomia, small for gestational age, large for gestational age, low birth weight, congenital anomalies, and perinatal death) adverse outcomes in the second pregnancy. ResultsPregravid weight was weakly and inconsistently associated with weight changes in subsequent periods. Each 5-kg incremental weight change in the first pregnancy, interpregnancy, and second pregnancy contributed to a 0.75- to 5-kg weight change in subsequent periods, 9% to 25% change in risk for adverse maternal outcomes, and 8% to 47% change in risk for adverse neonatal outcomes in the second pregnancy. Fluctuations in weight across pregnancies and associations with outcomes were strongest among normal-weight and overweight women. ConclusionWeight changes across two pregnancies affected maternal and neonatal outcomes in the second pregnancy in all body mass index categories; the larger weight fluctuations observed in normal and overweight women were associated with greater risk of adverse outcomes. Attention to pregnancy weight during and between pregnancies is important for targeted weight counseling to reduce risks in subsequent pregnancies.

SAT-334 GENETIC TESTING OF FAMILIES WITH VERY EARLY ONSET POLYCYSTIC KIDNEY DISEASE REVEALS THE FUNCTIONAL SIGNIFICANCE OF HYPOMORPHIC VARIANTS

Autosomal dominant polycystic kidney disease (ADPKD) is generally an adult onset disorder; however rare very early onset (VEO) cases under the age of 2 years are reported and have a high recurrence risk in subsequent pregnancies. Elucidation of the underlying mechanism causing the early onset phenotype has significant benefits for genetic and reproductive counselling. We performed an audit of all ADPKD diagnostic referrals with age of onset less than 2 years referred for diagnostic genetic testing of PKD1 and PKD2 from 2010-2018. Testing was performed by long-range PCR with Sanger sequencing of all coding exons and/or next-generation sequencing (from 2016 onwards) and MLPA. A total of 28 cases with reported age of disease onset under 2 years were identified. 5 patients with a clinical history not suggestive of ADPKD and no mutation detected in PKD1 and PKD2 were subsequently excluded. Of the remaining 23 patients, 15 (65%) had at least 2 variants detected, including one likely hypomorphic variant; 4 (22%) had one pathogenic PKD1 mutation and 3 (13%) had no mutation detected in PKD1 or PKD2. Parental analysis from 12 families confirmed biallelic inheritance in 9 (75%) cases and 4 (33%) cases with a de novo mutation. Bilineal inheritance of PKD1 and PKD2 variants was found in 2 cases and biallelic PKD2 mutations in 1 case. Of the 15 patients with multiple variants, 13 had a likely or definitely pathogenic mutation as well as a likely hypomorphic variant; whilst 2 patients had 2 likely hypomorphic variants confirmed in trans. 10 (43%) cases had no previous family history of ADPKD. This study highlights a high incidence of hypomorphic variants inherited in trans with a pathogenic mutation or another hypomorphic variant in children with a VEO phenotype. The previously reported and experimentally validated p.(Arg3277Cys) hypomorphic PKD1 variant was detected in 3 families. The minor allele frequency of the hypomorphic variants detected ranged from 0-0.2% which is higher than expected for a disease-causing variant. These variants require careful consideration in the context of early onset disease and parental segregation analysis to determine phase. Our study also demonstrates a high incidence of de novo mutations and high incidence of cases with no previous family history. A model of reduced gene dosage during embryonic kidney maturation is the simplest molecular mechanism underlying the VEO phenotype.

Subsequent Reproductive Outcome Among Women With Peripartum Cardiomyopathy: A Nationwide Study

(BJOG. 2018;125:1018–1025) Peripartum cardiomyopathy (PPCM) is a condition characterized by idiopathic heart failure late in pregnancy or within 6 months postpartum. It is diagnosed when no other identifiable cause of heart failture is identified and left ventricular systolic function is impaired with left ventricular ejection fraction (LVEF) of 45% of lower. Women who have developed PPCM must receive counseling on potential risks in subsequent pregnancies, but there are not clear guidelines or literature on reproductive outcomes after PPCM. Previous studies reported increased relapse rates if LVEF was still impaired. This study used a Danish cohort of women to investigate perinatal outcomes in women with prior PPCM.

Subsequent pregnancy outcomes following second trimester miscarriage—A prospective cohort study

Objectives: Pregnancy after second-trimester miscarriage represents as clinical challenge. This study sought to determine the rates of recurrence, preterm birth and live births in a cohort of 185 women with previous second-trimester miscarriage. We hypothesized that there would be a higher rate of second-trimester miscarriage and preterm birth in subsequent pregnancy after second trimester miscarriage. The primary objectives of this study were to establish rates of second-trimester miscarriage, preterm birth and live births in this cohort. Secondary objectives were to examine medical and surgical interventions, in addition to other pregnancy outcomes and complications.Study design: This was a prospective cohort study carried out in a tertiary referral center in southern Ireland with over 8000 deliveries per year. 175 women were followed up. Inclusion criteria were an ultrasound confirmed second-trimester miscarriage between June 2009 and June 2013 and subsequently having a pregnancy between July 2009 and January 2016. Fifty-five women did not become pregnant during the study period and were excluded. Ten women were excluded for missing data.Results: Between July 2009 and January 2016, 110 women became pregnant following a previous second-trimester miscarriage. In total, 81 babies were born to 77 mothers. The recurrence rate of second-trimester miscarriage was 6.3% (7/110) and the preterm birth rate was also 6.3% (7/110). The cesarean section rate was 45%. Including those who experienced first or second trimester miscarriage, 47% (78/155) of those who were followed up did not go on to have a live infant.Conclusions: Women experiencing second-trimester miscarriage are at increased risk in subsequent pregnancies of recurrence. Second-trimester miscarriage needs to be highlighted as a risk factor for adverse pregnancy outcomes. Greater research into its pathophysiology is required to advance preventative measures.

Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele

Open maternal-fetal surgery for fetal myelomeningocele results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies. The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open maternal-fetal surgery for fetal myelomeningocele closure. An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal, and subsequent pregnancy outcomes following open maternal-fetal surgery for fetal myelomeningocele was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry. From 693 cases of open maternal-fetal surgery for fetal myelomeningocele closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2%, with 52 pregnancies delivering beyond 20 weeks gestational age and median gestational age at delivery of 37 (36.3-37.1) weeks. The uterine rupture rate was 9.6% (n= 5), resulting in 2 fetal deaths. Maternal transfusion was required in 4 patients (7.7%). The risk of uterine rupture or dehiscence in subsequent pregnancies with associated fetal morbidity after open maternal-fetal surgery is significant, but is similar to that reported for subsequent pregnancies after classical cesarean deliveries. Future pregnancy considerations should be included in initial counseling for women contemplating open maternal-fetal surgery.

1: Subsequent pregnancy outcomes after open maternal-fetal surgery for fetal myelomeningocele closure

Limited data is available regarding subsequent pregnancy outcomes after maternal-fetal surgery via hysterotomy. The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open fetal surgery (OFS) for myelomeningocele (MMC) closure. An international multicenter registry (North American Fetal Therapy Network/ fMMC Consortium Outcomes Registry) was created to track and report maternal, obstetric, fetal/neonatal and subsequent pregnancy outcomes following maternal-fetal surgery for MMC. Subsequent pregnancy outcome variables were collected via maternal questionnaire. Data are collected from each center and entered into a combined de-identified dataset using REDCap. Subsequent pregnancy outcomes data were analyzed using descriptive statistics. Centers participating in the registry obtained local IRB approval and executed data use agreements. A total of 52 subsequent pregnancies in 40 women were reported after OFS for MMC. Of these 40 women, 32 had 1 subsequent pregnancy, 5 women had 2, 2 women had 3, and 1 woman had 4 pregnancies after OFS, all singleton gestations. There are 10 that are ongoing or have missing outcome data. The live birth rate among those with complete data was 63%. Among the 52 subsequent pregnancies, 7 (13.5%) resulted in miscarriage < 20 weeks. Of the 35 pregnancies progressing > 20 weeks EGA, uterine rupture occurred in 11.4% (4/35) and OFS uterine incision thinning/dehiscence was described in 8.6% (3/35) at delivery. The mean GA at uterine rupture was 29 weeks (range 26-32); Two fetal deaths were reported as a result of uterine rupture. Placenta accreta was reported in a single case. Among live births, the mean GA at delivery was 36.2 weeks (range 26.4-38.4). Blood transfusion at delivery was required in 11.1%. All patients delivered via cesarean with 89.2 % via a low transverse uterine incision. Recurrence of fetal spina bifida was noted in 2 pregnancies. The risk of uterine rupture or dehiscence, with its associated risk of fetal morbidity and mortality, in subsequent pregnancies after open fetal surgery is significant. This risk should be included in the pre-operative counseling for patients who are candidates for maternal-fetal surgery. The risk for abnormal placentation requires additional investigation. Guidelines for management of pregnancies following OFS should be developed to address these risks.

High blood pressure in pregnancy // Hipertenzija u trudnoći

High blood pressure in pregnancy is a significant problem and has long been causing the attention of perinatologists. Hypertensive disorders in pregnancy are the leading cause of morbidity and mortality of mothers and fetuses. About 8% of pregnancies complicate high blood pressure. It is estimated that 192 women die daily due to hypertensive complications during pregnancy. Hypertension in pregnancy is not a single entity but it includes: pre-existing hypertension; gestational hypertension; pre-pregnancy existing hypertension complicated by gestational hypertension with proteinuria; prenatally unclassified hypertension. The aim of this paper is to point to the problem of hypertension in pregnancy and the importance of its early detection.It’s a literature review. The literature review period is from 2003-2013. The literature review was carried out in the Hinari, Pubmed and Google Scholar databases.A total of 50 scientific and professional papers in English and Serbian have been examined, of which work is included. 17. By reviewing the summary of each paper, all articles that did not report hypertension in pregnancy were excluded. Through research that was conducted, it was concluded that pregnancy is a significant problem in pregnancy and is therefore the leading cause of morbidity and mortality of both mothers and fetuses. However, the decision to introduce antihypertensive therapy and the choice of an adequate drug during pregnancy should be based on the assessment of the benefits and risks for each pregnant woman individually. Thus, the role of the health care nurse in gynecology and obstetrics has the primary goal and task to preserve and improve the health of women through a series of preventive-promotional activities, all of which are covered through primary, secondary, and tertiary prevention.A literature review lists the risk factors that can cause hypertension in pregnancy, including: age of the patient - under 20 and over 35 years, vascular and renal pathology, gestational diabetes, obesity or malnutrition, pheochromocytoma, systemic lupus, poor living conditions, there is and increased risk in first-born patients. Women who have been hypertensive during their first pregnancy have a higher risk of subsequent pregnancy.

Risk of subsequent pregnancy in previous peripartum cardiomyopathy – Clinical and echocardiograhic profile.

Risk of subsequent pregnancy in previous peripartum cardiomyopathy – Clinical and echocardiograhic profile.

“Slow” Cesarean Section by Inconsistent Corporal Scar (Clinical Case)

Introduction. Increasing the initial number of caesarean delivery operations involves certain risks when planning and carrying subsequent pregnancies. Despite the trend towards operative childbirth being gradually being replaced by natural, the frequency of recurrent caesarean is higher than the prevailing rate due to scar inconsistency and the presence of a “classic” (corporal) scar on the uterus. The use of corporal access to date is gradually being replaced by less traumatic access. The operation of “slow” caesarean section is considered as an alternative approach to surgical delivery.Purpose and objectives. To analyse the operation of “slow” caesarean section in the presence of corporal scars on the uterus.Materials and methods. The resulted clinical case of incomplete rupture of the uterus by corporal scar in the second pregnancy at a period of 38 weeks. Corporal scarring as a result of caesarean operations in the case of interruption of first pregnancy at a period of 22–23 weeks.Results. The patient was discharged in a satisfactory condition on the 5th day with the child. Postoperative period without complications; results of analyses performed prior to discharge within normal limits.Discussion. The conducted corporal incision at the first pregnancy was inexpedient due to presenting increased risks in subsequent pregnancies. For the termination of pregnancy in the second trimester, it was necessary to consider therapeutic methods, the operations of a minor caesarean section or a caesarean section in the lower segment of the uterus.Conclusion. Conducting “slow” caesarean section has the following advantages over classic caesarean section: soft adaptation of the foetus to environmental conditions, purification of the mucous oropharynx of the foetus, establishing a stronger bond between the mother and her future child. In future, we plan to conduct a clinical evaluation of children delivered through a “slow” caesarean section.

Outcomes of subsequent pregnancy following obstetric transfusion in a first birth.

BackgroundIncreasing rates of postpartum haemorrhage and obstetric transfusion mean that more women are entering subsequent pregnancies with a history of blood transfusion. This study investigates subsequent pregnancy outcomes of women with a prior obstetric red cell transfusion, compared to women without a transfusion.MethodsAll women with a first pregnancy resulting in a liveborn singleton infant of at least 20 weeks gestation delivering in hospitals in New South Wales, Australia, between 2003 and 2012 were included in the study, with followup for second births until June 2015. Linked hospital and births data were used to identify women with a transfusion and/or postpartum haemorrhage in their first birth, time to second pregnancy and adverse birth outcomes (including transfusion, postpartum haemorrhage and severe morbidity) in their subsequent birth.ResultsThere were 358,384 singleton births to primiparous women, with 1.4% receiving an obstetric blood transfusion. Sixty-three percent of women had at least one subsequent birth. The relative risk (RR) of requiring a transfusion in a second birth was 4.9 (95% CI 4.1,6.1) for women with a previous transfusion compared with women without. The risk (RR) of severe morbidity in a second birth was 4.1 times higher (95% CI 2.2,7.4) for those receiving a transfusion without haemorrhage in their first birth compared with women with neither haemorrhage nor transfusion.ConclusionIt is important to consider a woman’s history of transfusion and/or haemorrhage as part of her obstetric history to ensure management in a manner that minimises risk in subsequent pregnancies.

Massive Perivillous Fibrin Deposition of an Enterovirus A-Infected Placenta Associated With Stillbirth: A Case Report

Massive perivillous fibrin deposition (MFD) is a morphologically defined severe placental lesion associated with perinatal morbidity and mortality. The etiology is unknown, and recurrence risk in subsequent pregnancies is assumed to be high. In most cases, a pathologic immune reaction is supposed to be responsible for the lesion. We report a case of a pregnant woman's suffering from hand, foot, and mouth disease in the 20th gestational week. Subsequently, MFD developed in the placenta and was followed by intrauterine growth restriction and stillbirth in the 29th gestational week. Enterovirus A with high homology to Coxsackievirus A16 was detected in the placenta by means of immunohistochemisty and reverse transcription polymerase chain reaction. This infection could be a rare cause of MFD and should be taken into consideration in the differential diagnosis of the individual etiology. Recurrence risk of virus-related MFD is expected to be lower than in MFD without infectious association.

“It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, Canada

Young mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa, explore young mothers’ subsequent pregnancy experiences, and identify how services could be improved in Canada’s capital. In 2016, we conducted in-depth interviews with 10 young mothers and semi-structured interviews with 10 key informants working with pregnant and parenting youth. We analyzed interviews for content and themes using a multi-phased, iterative process. Four major themes emerged: (1) young mothers often plan their pregnancies actively or passively; (2) violence before, during, and after pregnancy is common; (3) mental health and substance abuse issues shape pregnancy risk; and (4) becoming pregnant often serves as a source of motivation for young mothers. Our results further indicate that young mothers have difficulty finding youth-friendly, non-judgmental support services and that integrated, multidisciplinary services offering individually tailored support and building on women’s strengths will likely be more successful in helping young mothers prevent subsequent pregnancies. Increasing awareness about existing services and supporting efforts that approach teen pregnancy comprehensively and holistically appear warranted.

Taking a wider view on fetal/neonatal alloimmune thrombocytopenia

In fetal/neonatal alloimmune thrombocytopenia (FNAIT), platelets are destroyed by maternal antibodies directed against fetal/neonate antigens. Thrombocytopenia can be severe and lead to intracranial hemorrhage (ICH) in about 10% of cases. Although three types of antigen groups, presented on platelets [ABO blood group antigens, human leukocyte antigens (HLA) and human platelet antigens (HPA)] are known to be implicated in immune platelet destruction, antibodies against HPA are most commonly involved in FNAIT and hence are the target of extensive research. Awareness of FNAIT by physicians as well as the availability of the most sensitive diagnostic methods capable of detecting a wide range of antibodies are crucial for the diagnosis of FNAIT and the prevention of severe thrombocytopenia and its bleeding risks in subsequent pregnancies.